2016年 · 第51卷第03期

In 1971, Friesen successfully isolated and purified human pituitary prolactin (PRL), and established a method for determining human serum PRL concentration, which was applied to basic and clinical research, thus revealing the physiology of human pituitary PRL and the pathophysiological mechanism of ovarian dysfunction caused by hyperPRLemia and pituitary PRL adenoma^[1]。 In 1974, the first report of dopamine agonist bromocriptine in the treatment of hyperPRLemia was published^[1]。 Subsequently, the widespread application of MRI examination in the sellar region changed the diagnosis and treatment of menstrual disorders, and became an important progress in the field of female reproductive endocrine since 1980s. In 2009, the Neurosurgery Branch of Chinese Medical Association, together with experts in the fields of Endocrinology Group, Endocrinology Department and Radiotherapy Department of Obstetrics and Gynecology Branch of Chinese Medical Association, compiled and published the first edition of "Consensus on Diagnosis and Treatment of Hyperprolactinemia"^[2]。 Because female hyperPRLemia first involves ovarian function, it is a common disease in gynecological reproductive endocrinology, and the diagnosis and treatment of female hyperPRLemia patients has its own characteristics. Therefore, the Endocrinology Group of Obstetrics and Gynecology Branch of Chinese Medical Association updated the consensus in 2009 and formed this "Consensus on Diagnosis and Treatment of Female Hyperprolactinemia" to provide reference for clinicians.

Primary tumors of broad ligament originate from the remains of the mesonephric duct during embryonic development, or the components of the ligament itself, such as smooth muscle or vascular smooth muscle tissue, fibrous tissue, lymphatic vessels, nerves, etc. Each mesenchymal component can develop corresponding malignant tumors. Among them, malignant tumors that occur within the broad ligament, are completely independent and are not connected in any way to the uterus or ovaries, and are characterized by smooth muscle in morphological and immunological markers are called primary leiomyosarcoma of broad ligament (LBL). LBL is rare and highly malignant in clinical practice. There are no more than 30 cases reported in domestic and foreign literatures. At present, there is no corresponding clinical management standard to follow^{[1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25]}。 In recent years, two such patients have been treated in Drum Tower Hospital affiliated to Nanjing University School of Medicine, which are reported as follows in combination with literature review.

Cervical cancer is one of the common malignant tumors in women, and its incidence is second only to breast cancer. Previously, it has been reported that framework protein 1 (RACK1) is increasingly expressed in a variety of malignant tumors, such as colon cancer, small cell lung carcinoma and melanoma^[1,2], expression is also upregulated during angiogenesis^[1]。 Angiogenesis is a necessary condition for the growth of solid tumors, which can provide nutrition needed for the rapid proliferation of malignant tumor cells and promote the growth of tumors. Therefore, western blot and immunohistochemical SP were used to detect the expression of RACK1 protein in cervical cancer and its adjacent tissues, so as to explore its role and significance in the development and development of cervical cancer.

Endometriosis (endometriosis) is one of the high incidence of women of childbearing age, with an incidence rate of 5% ~10%. According to statistics from the World Endometriosis Society (WES) in 2014, the number of Endometriosis cases worldwide exceeded 200 million, and the number of cases in Asia exceeded the number of other continents combined. China lacks definite statistics, but the number is certainly huge based on its large population base. The pain and infertility caused by endometriosis seriously impair the quality of life of patients, and bring great economic burden to the family and society of patients, but there is no radical cure for it at present. As early as 2008, the American Society for Reproductive Medicine pointed out that endometriosis should be regarded as a chronic disease, and a long-term management plan needs to be developed, with the goal of maximizing drug treatment and avoiding repeated surgical procedures. There are many clinical drugs for the treatment of endometriosis, but there are certain limitations in controlling symptoms and disease progression, eliminating lesions, preventing recurrence and side effects, which are far from achieving the clinical desired therapeutic effect. Therefore, developing new drugs and changing treatment models are the direction for endometriosis treatment to get out of the predicament.

hormone replacement therapy (HRT) can improve female perimenopausal symptoms and prevent and treat osteoporosis caused by estrogen deficiency. However, long-term use of HRT therapy can cause breast tenderness, abnormal vaginal bleeding, mood swings and thrombosis. Side effects, such as formation of blood, reduce patient compliance and increase the risk of breast cancer in postmenopausal women^[1]。 The US Food and Drug Administration (FDA) has approved the combination of conjugated estrogens (CE) + bazedoxifene (bazedoxifene) for the treatment of moderate and severe menopausal-related vasomotor symptoms (hot flashes) and the prevention and treatment of postmenopausal osteoporosis in postmenopausal women without hysterectomy. The selective ER modulator-Bazedoxifene can effectively inhibit the pro-proliferative effect of estrogen on the endometrium. Due to the absence of progesterone involvement, the incidence of abnormal uterine bleeding and breast pain is reduced, and at the same time, it can effectively reduce the effect of estrogen on the thymus^[2,3]； CE + bardoxifene can effectively prevent osteoporosis in postmenopausal women, and bardoxifene alone without CE combination can also effectively reduce the risk of fracture in postmenopausal women^[4,5]。 In recent years, the research on badoxifen, CE + badoxifen is no longer limited to the prevention and treatment of osteoporosis in postmenopausal women, but has gradually expanded to the fields of blood lipid, cardiovascular, breast gland, female reproductive system and so on. In recent years, there have been many studies on badoxifene and its therapeutic effects at home and abroad. The research progress of badoxifene on the therapeutic effects and tissue selection effects of different tissues and organs in menopausal women is summarized as follows.

Endometrial cancer is a common malignant tumor in gynecology. It is estimated that 60 050 women in the United States will suffer from endometrial cancer in 2016, ranking the first among malignant tumors of the female reproductive system^[1]。 Endometrial cancer accounts for 7% of malignant tumors in women, and 2% ~3% of them are Lynch syndrome-related endometrial cancer^[2,3]。 Lynch's syndrome is characterized by familial clustering, early onset, with synchronous or metachronous extraintestinal malignancies. As early as 1913, Professor Warthin first reported a family of Lynch syndrome characterized by familial multiple non-polypoid colon cancers, accompanied by high incidence of gastric and endometrial cancers, called the G family^[4]。 In 1966, Professor Lynch of Creighton University in the United States reported two families of Lynch syndrome, and systematically explained their clinical characteristics for the first time, and named them "Cancer Family Syndrome". In honor of Professor Lynch's contribution, it was also called Lynch syndrome^[5]。 In 1991, it was named as hereditary nonpolyposis colorectal cancer (HNPCC) at the Amsterdam Conference in the Netherlands, emphasizing its hereditary nature and characteristics that are different from familial polyposis. In 2004, the Bethesda guidelines in the United States proposed to use the nomenclature of Lynch syndrome to be more precise, because the nomenclature of HNPCC ignored the high incidence of extraintestinal malignancies. At present, most studies on Lynch syndrome focus on colorectal cancer, but little is known about Lynch syndrome-associated endometrial cancer. Therefore, this article reviews the pathogenesis of Lynch syndrome and the diagnosis, clinicopathological characteristics and clinical prevention and treatment strategies of Lynch syndrome-associated endometrial cancer.

essential thrombocythemia (ET) is a clonal disease of hematopoietic stem cells, which is manifested by a significant increase in peripheral blood platelet count and vigorous proliferation of megakaryocytes in bone marrow; 50% ~70% of ET patients have V617F mutation in JAK2 gene^[1]。 In 2006, the epidemiological survey of ET was conducted in five countries in Europe and America, and the prevalence of ET was reported to be 0.59/100,000~2.53/100,000^[2]Middle-aged and elderly people are more likely to have hair, with a male-female ratio of 2:1. At present, there are few reports on pregnancy complicated by ET at home and abroad, but studies show that the risk of complications such as abortion and thrombosis in pregnant women with ET is higher than that in normal pregnant women, and giving necessary treatment to pregnant women with ET can improve the prognosis of mother and child^[3,4,5,6]。 Based on the lack of understanding of disease monitoring and treatment in pregnancy health care of pregnant women with ET in China, this article summarizes from the following aspects to provide reference for clinical diagnosis and treatment.

intrauterine fetal resuscitation refers to a series of measures used to improve fetal oxygen supply during delivery, including: change of body position, oxygen inhalation, intravenous fluid rehydration, and use of uterine contraction inhibitors. The assessment of fetal health during delivery mainly comes from fetal heart monitoring. At present, the relevant guidelines for fetal heart monitoring abroad^[1]Fetal heart monitoring patterns are divided into three categories. For Class II and Class III patterns, intrauterine resuscitation measures can be used to re-evaluate them. These measures may correct or improve abnormal fetal heart monitoring patterns by improving fetal oxygen supply, provide a basis for continuing vaginal trial delivery, and also buy time for vaginal assisted delivery or cesarean section. The graphic judgment of fetal heart rate monitoring and the implementation of intrauterine resuscitation measures during delivery are based on the full understanding of the physiological mechanism of oxygen transport between mother and fetus. The physiological mechanism of fetal oxygen delivery and intrauterine resuscitation measures are explained as follows.