2017年 · 第52卷第04期

The adjustment of fertility policy in China is implemented steadily in accordance with the rhythm of "two children alone", "two children alone" and "two children in an all-round way". The adjustment of population policy is consistent with the needs of the country, society and families, which is of great significance to the stable development of social economy in China^[1,2]。

unexplained recurrent spontaneous abortion (URSA) refers to the occurrence of more than two consecutive spontaneous abortions of unknown etiology, and its etiology is very complex^[1,2]。 transforming growth factor-β 1 (TGF-β 1) exert biological effects through TGF-β receptor (TGF-β R) signaling. It is an important negative immune balance regulator of trophoblast cells, which is closely related to embryo implantation and placenta formation in early pregnancy^[3]。 Recent studies suggest that the single nucleotide polymorphism (SNP) of TGF-β 1 and TGF-β R genes has regional, ethnic and ethnic differences, and the results of the research on the relationship between the gene polymorphism and URSA susceptibility are inconsistent^[4,5]。 Matrix-assisted laser desorption ionization time-of-flight mass spectrometry was used in this study (matrix-assisted laser desorption/ionization time of flight mass spectrometry, MALDI-TOF-MS) Technical analysis of polymorphisms of TGF-β 1 gene C-509T, TGF-β R1 gene Int7 G24A and TGF-β R2 gene G-875A in patients with URSA, through case-control study, from the perspective of genetics and reproductive immunology to explore the mechanism of URSA.

Endometriosis (endometriosis) is a common benign disease in gynecology, and pain is a characteristic clinical symptom of endometriosis, but the mechanism of endometriosis-related pain is still unclear. Recent studies have found that sensory nerve fibers exist in endometriosis lesions, and their nerve fiber density is closely related to the pain severity of patients; The afferent nerve fibers present in endometriosis lesions are mainly sensory C and A δ nerve fibers^[1,2,3,4]。 Animal experiments found that vaginal hyperalgesia occurred only when nerve fibers were distributed in endometriosis lesions in model rats^[5]。 This indicates that endometriosis-related pain is a kind of nociceptive pain, and the abnormal distribution of sensory afferent nerve fibers in endometriosis lesions may be the key factor of pain in endometriosis patients. purinergic receptor P2X3 is a subtype of the ligand-gated ion channel P2X, a member of the purine receptor family; P2X is a family of adenine nucleotide receptors (P2), including P2X receptor subtypes 1 to 7^[6]。 P2X3 is widely distributed in central and peripheral nervous system, not only expressed in dorsal root ganglion neurons, spinal dorsal horn neurons, but also highly selectively expressed in small diameter sensory neurons containing C or A δ fibers. Therefore, P2X3 receptor is currently considered to be the most relevant purine receptor in pain production, and it plays a key role in transmitting pain signals^[7]。 It was found that endometriosis model rats can activate endothelial cells to release endothelin-1 after mechanical stimulation. Endothelin-1 can release adenosine triphosphate (ATP) from active cells, and ATP can sensitize P2X3 receptors on nociceptors, thus triggering peripheral nerve sensitization to produce pain^[8,9,10]。 Endometriosis is a chronic inflammatory disease. The presence of small-diameter C and A δ sensory nerve fibers in the lesion indicates that the inflammatory mediators and ATP present in the endometriosis lesion may activate P2X3 receptors on nociceptors, thus triggering endometriosis-related pain. In this study, the expression of P2X3 in ectopic endometrium and eutopic endometrium of patients with endometriosis was detected, and the correlation between P2X3 and pain was compared. At the same time, the expression of P2X3 on nerve fibers in endometriosis lesions was detected to explore the role of P2X3 in molecular signaling of endometriosis-related pain, and to provide laboratory data for exploring the mechanism of endometriosis-related pain.

Uterine fibroids are common benign tumors of female reproductive system, and nearly 20% of patients are women of childbearing age^[1]。 In its surgical treatment, laparoscopic myomectomy is widely used. If the specimen is large, it is necessary to use a rotary myomectomy to gradually cut the specimen into small pieces and remove it. According to the National Institutes of Health (NIH), fibroid rotators are used in more than 50,000 surgeries each year in the United States^[2]。 However, the use of uterine fibroid rotating device during operation can increase the possibility of unprotected fibroid tissue debris remaining and spreading in the pelvic and abdominal cavities, resulting in iatrogenic parasitic fibroids. At present, there are still few research reports on iatrogenic parasitic fibroids. Combined with literature review, two cases of iatrogenic parasitic fibroids admitted to Peking University People's Hospital are reported as follows.

electronic fetal monitoring (EFM) can evaluate the intrauterine condition of the fetus by monitoring the changes of fetal heart rate, and is the most commonly used fetal monitoring method at present. maternal-fetal Holter monitoring (maternal-fetal Holter monitoring) is an emerging method of fetal monitoring. It uses fetal electrocardiograph (FECG) technology to obtain parameters for evaluating fetal heart rate, and FECG can obtain real instantaneous heart rate variation^[1], superior to Doppler ultrasound technology; Through the monitoring, acquisition and data conversion of fetal ECG signals, the intrauterine condition of the fetus can be analyzed. In recent years, research on FECG by foreign scholars believes that FECG can accurately and effectively monitor the intrauterine condition of the fetus^[2,3]Chinese scholars have also carried out relevant preliminary research in the field of obstetrics.

chronic kidney disease (CKD) is a global health problem. In 2002, the Kidney Disease Outcomes Quality Initiative (K-DOQI) working group of the National Kidney Foundation issued guidelines to update the definition of CKD^[1]； 2012, Kidney Disease-Improving Global Outcome (KDIGO) organization guidelines for K-DOQI 2002^[1]The refined guidelines^[2]Expands the diagnostic criteria for CKD, emphasizing the management and treatment of patients with CKD with normal renal function. This Guide^[2]After the release, the diagnosis rate of CKD increased year by year, and by 2016, about 3% of women of childbearing age were diagnosed with co-CKD^[3]Some women with CKD have a strong desire to pregnant, but there are still many problems that are not clear about the management of pregnancy, pregnancy outcome and the influence of pregnancy on the progression of kidney disease in pregnant women with CKD. In order to better provide perinatal care for pregnant women with CKD and improve their prognosis, the pregnancy-related problems of pregnant women with CKD are summarized as follows.

The successful implantation of the embryo depends on the receptivity of the endometrium and the invasion ability of the embryo. The receptivity of the endometrium is the key factor of embryo implantation, which means that the endometrium is in a special state of receiving embryo implantation, allowing the embryo to adhere and penetrate to induce a series of cellular and molecular level changes in the uterine interstitium. The embryo is implanted in the endometrium through "mother-fetus dialogue"; This period is called "implantation window period", that is, the 20th to 24th day of normal women's menstrual cycle. The endometrium shows the greatest tolerance at this time. If it is advanced or beyond this period, embryo implantation will fail, which is both temporal and spatial, but the mechanism is unknown so far. Clinically, patients with endometriosis (endometriosis) often have different degrees of decreased endometrial receptivity, as well as implantation failure or pregnancy abortion. How to improve the endometrial receptivity of patients with endometriosis has become one of the difficult problems in the field of assisted reproduction.

sentinal lymph node biopsy (SLNB) has been deeply studied in cervical cancer and vulvar cancer, and may gradually replace pelvic and para-abdominal aortic lymphadenectomy to assess lymph node metastasis. However, the research of SLNB in endometrial cancer started late. In 1996, Burke et al^[1]First introduction of SLNB into surgery for endometrial cancer. Until recent years, the research of sentinel lymph node (SLN) in endometrial cancer has gradually increased and made great progress. In 2008, domestic Li Bin et al^[2]The feasibility of SLN in endometrial cancer was also studied, and it is considered that it is feasible to use blue dye to identify SLN in endometrial cancer surgery. However, there is no consensus on which patients with endometrial cancer can be evaluated by SLNB for pelvic and abdominal lymph node metastasis, and a large sample size prospective study still needs to be explored. This paper introduces the latest progress from two aspects: the influencing factors of SLNB success and the predictive value of SLNB on pelvic and para-abdominal aortic lymph node metastasis.

endometrial stromal sarcoma (ESS) is a malignant tumor derived from endometrial stromal cells. Its incidence is low, accounting for about 1% of all uterine malignancies, but it is the second most common uterine sarcoma^[1,2]。 Traditionally, ESS can be classified into low-grade ESS and high-grade ESS based on the number of nuclear divisions. However, further studies found no significant correlation between mitotic activity and prognosis in ESS patients^[3]。 Because high-grade ESS lacks specific differentiation and is histologically different from endometrial cancer, the 2003 WHO classification changed ESS to two types: low-grade ESS and undifferentiated endometrial sarcoma (UES) [or undifferentiated uterine sarcoma (UUS)]. In recent years, more and more studies have shown that the scope of UES is too wide, including two types of tumors with obvious differences in morphology, genetics, clinical manifestations and prognosis, but their naming is not unified. Until 2014, the 4th edition of WHO classification classified ESS into three types: low-grade ESS, high-grade ESS and UUS based on its clinical and pathological characteristics and combined with molecular genetics research progress^[1]。 High-grade ESS has a low incidence and unique biological behavior. In recent years, as a research hotspot of gynecological tumors, a series of new discoveries have been made and consensus has been reached. In 2014, it was re-proposed as an independent tumor type in the WHO classification. The related research progress is summarized as follows.