2016年 · 第51卷第10期

Female vaginal micro-ecosystem is one of the components of human micro-ecosystem, which consists of microbial flora in vagina, endocrine regulatory system, vaginal anatomy and local immune system. There are many kinds of vaginal microbial flora, which are symbiotic and antagonistic to each other. They are influenced by various factors in vivo and outside the body, and participate in the formation of complex microecosystems. The normal vaginal microbial flora is dominated by Lactobacillus, which can be accompanied by a small number of other miscellaneous bacteria. The vaginal pH was between 3.8 and 4.5. When vaginal micro-ecological balance is imbalanced, changes characterized by abnormal vaginal flora and abnormal vaginal pH value can occur, which is a tendency change, which can lead to decreased vaginal resistance to pathogenic microorganisms and secondary infection^[1]。

Since the development of surgery, it has entered the era of minimally invasive surgery, which achieves the maximum therapeutic effect with the least trauma. Since the development of gynecological laparoscopic surgery, the technology is becoming more and more perfect, but it is also faced with the problem of how to pursue the minimally invasive concept and bring more humanistic care to patients. laparoendoscopic single site surgery (LESS) is based on the basic concept of natural orifice transluminal endoscopic surgery (NOTES), which has emerged in recent years, that is, to reduce or hide surgical scars, reduce postoperative pain and promote postoperative rehabilitation. transumbilical laparoendoscopic single site surgery (TU-LESS), which hides the surgical incision in the umbilical foramen or around the umbilical cord, makes use of the natural scar remaining in human congenital to make the operation almost scar-free, has outstanding cosmetic advantages, and is also a beneficial supplement to the development of traditional laparoscopic technology^[1]。 Based on the development situation at home and abroad, LESS has a broad application prospect in the field of gynecology, and it is necessary to make an objective understanding at this stage.

sexually transmitted infections (STIs) are a general term for a class of diseases whose main route of transmission is sexual contact or similar sexual contact. STI is one of the ancient human diseases and the most widespread infectious disease in the world. According to WHO estimates in 2005, there are nearly 448 million new cases of STI (syphilis, gonorrhea, and chlamydia infection) that can be cured in adults aged 15 to 49 years worldwide every year. In developing countries, STI and its complications rank among the top 5 disease types for adults to seek health care, significantly draining national health resources and household income^[1]。

In recent years, the research on paclitaxel resistance and its mechanism in ovarian epithelial cancer (ovarian cancer) has been deepened, but whatever mechanism is, it is related to paclitaxel-related target molecules and signaling pathways in the treatment of ovarian cancer. Since paclitaxel was approved by the U.S. Food and Drug Administration (FDA) for the treatment of ovarian cancer in 1992, the benefits obtained have reached a rising plateau or encountered a bottleneck. The discovery of a new mechanism of paclitaxel resistance in ovarian cancer presents challenges and rethinking of existing chemotherapy modalities. Although ovarian cancer has a high response rate to paclitaxel-based combination chemotherapy, its risk of recurrence remains high, and approximately 80% of patients will eventually develop chemoresistance, resulting in failure of chemotherapy again^[1]。 This makes clinicians feel helpless or discouraged, and it is also a very serious challenge for drug developers. Needless to say, there is an urgent need in clinical work to understand which patients will benefit from paclitaxel chemotherapy and which will develop resistance? Only by solving this problem can the individualization of chemotherapy for ovarian cancer be achieved. Therefore, revealing what exactly is the "culprit" of paclitaxel resistance in ovarian cancer is particularly important to promote the innovation of clinical treatment strategies.

gestational diabetes mellitus (GDM) is a common metabolic disease during pregnancy^[1]Its onset is closely related to the significantly enhanced insulin resistance (IR) in the second and third trimester of pregnancy^[2]However, the exact pathogenesis is unclear. Due to the significant genetic similarity between GDM and type 2 diabetes mellitus (T2DM^[3]Therefore, at present, in the focus area of GDM genetics research, the disease-related genes of T2DM, especially the genes related to glucose metabolism and signaling links, are often used as candidate genes for GDM disease gene research.

epithelioid trophoblastic tumor (ETT) is a rare gestational trophoblastic tumor (GTN) developed by Shih and Kurman in 1998^[1]First reported and named, it is listed as a separate type of GTN in the WHO Classification of Pathology and Genetics of Breast and Female Genital Tumors (2003)^[2]。 So far, there are less than 100 cases of ETT reported in domestic and foreign literatures, and ETT combined with cervical adenocarcinoma is rare. Sichuan Cancer Hospital admitted a patient with cervical adenocarcinoma complicated with ETT in 2015, which is now reported in combination with the literature review as follows.

Amniotic fluid specimens with different traits will be encountered in prenatal diagnosis, such as amniotic fluid mixed with a large amount of fetal fat, meconium, a large amount of fresh blood or old intrauterine hemorrhage. Amniotic fluid can be green, red or brown and other different colors. At this time, cell culture is difficult. It has been reported in domestic literature that the success rate of cell culture of unqualified amniotic fluid (such as bloody amniotic fluid, mixed with fetal fat or meconium, and too little precipitate after centrifugation) is only 78%^[1]Foreign studies also suggest that maternal cell contamination is more likely to occur in bloody amniotic fluid (that is, maternal cells and fetal cells grow simultaneously in culture medium)^[2]。 The following retrospective analysis was carried out in Shaoxing Maternal and Child Health Hospital of Zhejiang Province on the success rate of cell culture and maternal cell contamination of different traits of amniotic fluid.

Vaginal bleeding in infants and young children is usually caused by trauma, foreign bodies, precocious puberty and malignant tumors, while those caused by benign Müllerian papilloma are extremely rare. Mullerian papilloma occurs in the upper vagina and cervix of infants and young children. It has a polypoid appearance and is almost all benign tumors. Non-invasive hysteroscopy is a hysteroscopic examination, but no speculum is placed, and the cervix is not clamped, but the intravaginal lesions can still be clearly observed. In recent years, Fuxing Hospital affiliated to Capital Medical University has treated 3 children with vaginal cervical Müllerian papilloma treated by non-invasive hysteroscopy. The clinical symptoms are vaginal bleeding, which is rare, but should still be paid attention to. This article summarizes its clinicopathological characteristics, diagnosis and treatment in combination with literature review, and is reported as follows.

Pregnant woman 26 years old, pregnant 1 delivery 0, due to menopause 16 weeks⁺⁵He was admitted to Zhejiang Xiaoshan Hospital on June 26, 2015. In 1996, multiple blue-purple subcutaneous cystic masses in both feet were discovered. They were considered "hemangioma" in a local hospital and surgically removed. After that, the masses recurred and increased, mainly in the limbs, concentrated on the inner left thigh, around the left knee joint, both feet and both upper arms. In December 2011, he underwent intravenous sclerosing agent injection for both feet malformation + vasculectomy for right hand malformation + local chondroma resection + bone grafting in a foreign hospital. Postoperative pathology confirmed that he was Maffucci syndrome. Auxiliary examination in an external hospital from February 2014 to March 2015 (before pregnancy): X-ray examination showed deformation of both feet, multiple phlebites in the soft tissue around both feet (suggesting hemangioma), and multiple phlebites in the soft tissue around the right elbow joint; CT examination of the chest revealed multiple distensive bone destruction of the left rib, mixed density, and multiple calcifications inside, seeFigure 1； magnetic resonance angiography (MRA) of lower limbs showed that there were widely distributed nodular abnormal signals (multiple hemangiomas) in the subcutaneous and intermuscular spaces of bilateral lower limbs, and the left side was more common. Abdominal MRA and enhanced CT examination showed no hemangioma lesions in the viscera and lower abdominal wall. Since my visit to our hospital in June 2015, many B-ultrasound examinations in our hospital during pregnancy showed that the fetus developed normally, and there was no obvious increase and enlargement of subcutaneous mass. 38 weeks gestation⁺⁵Physical examination: normal intelligence, height 145 cm, multiple blue-purple subcutaneous masses in limbs, distributed in both feet, bilateral lower limbs, left iliac, left upper limbs, hands, and left labia majora. There was no touch pain, itching, ulceration and bleeding in the masses. Laboratory and auxiliary tests: Serum calcium, phosphorus and magnesium levels were normal, and blood routine and tumor markers were normal. 30-Nov-2015 39 weeks pregnant⁺¹Cesarean section of the lower uterus was performed in our hospital, and a live baby was delivered successfully.

achondroplasia (ACH) is common in adult hereditary short stature, and it is also one of the common types of fetal non-fatal skeletal malformations, with an incidence of (1.3~6.0) /100 000^[1,2,3]。 The affected individuals showed short root shape of the limbs, that is, the proximal ends of the limbs were obviously shortened, and the trunk was relatively narrow and slender. The average height of adult male patients was (131.0±5.6) cm, and the average height of adult female patients was (124.0±5.9) cm, which may be accompanied by abnormalities such as giant cranium, protrusion of the forehead, dysplasia of the middle of the face, "tripronged hand", hyperextension of joints, and excessive protrusion of lumbar vertebra^[4]It has a serious impact on the physiology and psychology of patients. ACH fetuses mostly develop long bone growth lag after 25 weeks of gestation^[5]Most cases have entered the third trimester of pregnancy when diagnosed, which brings many problems to clinical management. Therefore, the early diagnosis of ACH has been a hot spot in the field of prenatal diagnosis. At present, some progress has been made in prenatal diagnosis and postnatal treatment of ACH in the first and second trimester of pregnancy, which are summarized as follows.

HPV is a common pathogenic microorganism in female lower reproductive tract. Sexually active women have at least one HPV infection in their lifetime, but the vast majority of them will clear themselves, and only a few of them have persistent infection. Persistent high-risk HPV (HR-HPV) infection is an essential factor in the pathogenesis of cervical intraepithelial neoplasia (CIN) and cervical cancer^[1]。 Reviewing the natural history of HPV infection and CIN, it was found that both HPV infection and CIN had a high reversal rate^[2]Only a few develop persistent HPV infection, CIN or even cancer. Because the detection rate of vaginal infection in HPV infected and CIN population is very high, it is speculated that vaginal infection may promote the occurrence and development of CIN by changing the local microenvironment of the cervix. The correlation between vaginal infection and HPV infection and CIN in women was reviewed.

aerobic vaginitis (AV) is mainly caused by aerobic bacterial infection, which was first named "chronic exudative vaginitis"^[1], subsequently known as "desquamative vaginitis (desquamative inflammatory vaginitis, DIV) "^[2]。 Previously diagnosed "intermediate bacterial vaginosis" (Nugent score 4-6) has been associated with most cases of aerobic infection^[3]。 Sobel^[4]In 1994, it was found that the vaginal lactobacillus was significantly reduced or deleted in patients with this disease, that is, the normal native bacteria were replaced by aerobic bacteria, which aroused people's attention. In 2002, Donders et al.^[5]AV was defined as a new type of vaginitis, and the diagnosis of "AV" was clearly proposed, and DIV was considered as a severe AV. AV is often co-infected or co-infected with bacterial vaginosis (BV), vulvovaginal candidiasis (VVC) and trichomonas vaginitis (TV). Therefore, the treatment of AV is more complicated and it is more difficult to select an effective treatment plan based on diagnosis.

mycoplasma (mycoplasma) is the smallest prokaryotic cell type microorganism of class I that has no cell wall, is morphologically polymorphic, and can grow and reproduce on inanimate medium through commonly used sterilizing filters. The family Mycoplasma contains two genera: Mycoplasma and Ureaplasma. Ureaplasma mainly includes Ureaplasma urealyticum and Ureaplasma parvum, and mycoplasma pneumoniae, mycoplasma hominis and mycoplasma genitalium are mainly pathogenic to humans. Mycoplasma infection can lead to the occurrence of infectious diseases of female reproductive tract; Mycoplasma hominis and Ureaplasma urealyticum are closely related to female reproductive health^[1]。 As a newly discovered pathogen of sexually transmitted diseases (STD) in recent years, Mycoplasma genitalium has few related studies at home and abroad due to limited detection methods. In this paper, the pathogenicity of Mycoplasma genitalium in reproductive health and the relationship between Mycoplasma genitalium and reproductive health are discussed.

Uterine sarcoma is a relatively rare gynecological malignant tumor, accounting for 1% ~3% of all gynecological malignant tumors and 8% of all uterine malignant tumors^[1]。 The pathological types of uterine sarcomas are diverse. The more common uterine sarcomas in the 2014 edition of WHO's new classification of gynecological tumors include uterine leiomyosarcoma, low-grade endometrial stromal sarcoma, high-grade endometrial stromal sarcoma, and undifferentiated uterine sarcoma. Due to the low incidence and diverse pathological types of uterine sarcoma, there is no unified standard treatment plan at present. The treatment of uterine sarcoma is mainly total hysterectomy. In the 2016 edition of the guidelines of the National Comprehensive Cancer Network (NCCN), low-grade endometrial stromal sarcoma is distinguished from high-grade endometrial stromal sarcoma, undifferentiated uterine sarcoma, and uterine leiomyosarcoma. However, the surgical method is total hysterectomy ± bilateral adnexectomy. There is no recommendation on whether to perform retroperitoneal lymphadenectomy and whether young patients can preserve their ovaries. There is no unified view on this issue in the current literature reports. This article reviews the clinical studies related to uterine sarcoma surgery, aiming to analyze the lymph node metastasis regularity of different types of uterine sarcoma and the influence of lymph node and ovary preservation on the prognosis of patients, and explore the appropriate surgical methods.