2017年 · 第52卷第06期

pelvic organ prolapse (POP) is the prolapse of pelvic organs inside or outside the vagina caused by defects, injuries or dysfunctions of pelvic floor supporting structures. The accurate anatomical definition of POP is mostly the definition proposed by the National Institutes of Health (NIH) in 2001: POP refers to the anterior edge of any vaginal segment reaching or exceeding the limbus of the hymen by more than 1 cm^[1]。 Literature reports, age<The incidence of POP requiring hospitalization is 2/1 000 among adult women aged 60 years; The probability of a woman's lifetime undergoing pelvic floor repair surgery is about 20% by age 80^[2]。 Although the diagnosis of POP is defined, in clinical practice, the definition criteria of diagnosis are often different. Population-based epidemiological survey literature reports that the prevalence of POP fluctuates from 3% to 50%, while the prevalence of POP determined by physical examination fluctuates from 41% to 50%, because most mild POP is asymptomatic, but can be found by physical examination^[3,4]。 It can be seen that there are still problems that need unified standardization in the diagnosis of POP.

Pseudohypertrophic muscular dystrophy is the most common X-linked recessive inherited muscular disease, including Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD), with only male infants, and the incidence of DMD and BMD is 1/3 500 and 1/30 000 of live male infants, respectively^[1]。 Pseudohypertrophic muscular dystrophy is a myogenic injury caused by mutations in dystrophin gene, which affect the expression of dystrophin in striated muscle^[2], manifested as slow, progressive aggravation of symmetric muscle weakness, muscle atrophy, and pseudohypertrophy of gastrocnemius muscle. Although the pathogenic genes of DMD and BMD are the same, the clinical symptoms of BMD are milder than those of DMD, and they are generally differentiated by whether they can walk at the age of 12. The prognosis of children with pseudohypertrophic muscular dystrophy is poor, and there is no effective treatment at present. Therefore, detecting the mutation of its pathogenic gene and providing prenatal diagnosis is the only way to prevent the birth of children with pseudohypertrophic muscular dystrophy. The risk of recurrence of pseudohypertrophic muscular dystrophy in the offspring is high when the proband mother has germline mosaicism or gonadal mosaicism. In this study, genetic testing and prenatal diagnosis were performed in a family with a proband mother suspected of gonadal mosaicism with DMD and a history of pregnancy and delivery of children with multiple DMD. The results are reported below.

in the treatment of in vitro fertilization-embryo transfer (IVF-ET), with the development of vitrification technology, more and more studies have shown that the pregnancy outcome of frozen embryo transfer (FET) is better than that of fresh cycle^[1]This provides strong theoretical support for whole embryo freezing in patients with high risk tendency of ovarian hyperstimulation syndrome (OHSS) who are not suitable for fresh embryo transfer. For patients with whole embryo frozen, the Reproductive Medicine Center of Henan Provincial People's Hospital recommended on the third day after egg retrieval that patients with ≥6 embryos could be used to select two embryos at cleavage stage with the best morphological performance (that is, embryos with the highest rating, the most uniform blastomere, the nearest number of blastomeres to 8 and the fewest fragments in morphological performance) for frozen, and the remaining embryos were cultured for blastocyst, and the available blastocysts were frozen, and then FET was performed at an elective time. During the FET cycle, choosing an appropriate embryo transfer strategy is particularly important. In early IVF-ET treatment, in order to improve the success rate of pregnancy, two or even more embryos are often transferred, followed by a significant increase in the rate of multiple pregnancy and the incidence of pregnancy complications. Therefore, in order to explore the most suitable embryo transfer strategy during the FET cycle, so as to control the occurrence of multiple pregnancy and related complications to the greatest extent on the premise of ensuring the pregnancy rate and live birth rate, this study discussed the embryo transfer mode of the first FET in patients with two cleavage embryos and at least two blastocysts at the same time. The report is now as follows.

Epithelial ovarian carcinoma (ovarian cancer) is the most common gynecological malignant tumor, its mortality rate is the highest among gynecological tumors, and its 5-year survival rate is only 45%^[1]。 The characteristics of high metastasis and high invasion of ovarian cancer are the main reasons for its poor clinical efficacy^[2]。 Recent studies have found that histone demethylase (KDM5B) can remove the methylation modification of histone 3 lysine (H3K4) at position 4^[3]Has the functions of regulating stem cell differentiation, promoting cell proliferation, inhibiting gene transcription, maintaining genome stability and the like^[4]。 The KDM5B gene is expressed at low levels in differentiated normal adult tissues except testis and bone marrow; The expression level is elevated in malignant tumors such as prostate cancer, breast cancer, gastric cancer^[5,6]But expression levels are reduced in melanoma^[7]。 It indicated that KDM5B gene plays an important role in the differentiation and development of normal cells and tumorigenesis, and can play a role as a tumor-promoting or tumor-suppressing factor in different tumors. However, the role of KDM5B gene in ovarian cancer has been rarely reported. In this study, the expression of KDM5B in ovarian cancer tissues and its effect on cell proliferation and metastasis were investigated.

Epithelial ovarian cancer (ovarian cancer) is one of the common malignant tumors of female reproductive system. Its mortality rate ranks first among gynecological malignant tumors and ranks fifth among female death causes in developed countries, which seriously threatens the life and health of women^[1]。 The ovary is located deep in the pelvic cavity, and ovarian cancer often has no obvious clinical symptoms in the early stage, which is difficult to detect; Late detection is often accompanied by metastasis, and the 5-year survival rate is low, only 25% ~30%^[2]。 In recent years, with the progress of diagnosis and treatment technology of ovarian cancer, its clinical treatment has made some progress, but its mortality rate has not been significantly reduced. This is closely related to the high metastatic and hyperplastic capacity of ovarian cancer. Epidermal fatty acid binding protein 5 (FABP-5) is located in epidermal cells. It is an intracellular lipid binding protein, which can bind hydrophobic ligands such as long chain fatty acids in cells, and its relative molecular mass is 15 kb. Studies have shown that the FABP-5 gene is important in prostate cancer^[3]Oral squamous cell carcinoma^[4]Triple-negative breast cancer (i.e. breast cancer in which ER, PR, and epidermal growth factor type 2 receptor are all negative)^[5]It is highly expressed in various tumor cells, and can promote the migration and invasion of tumor cells. Therefore, FABP-5 gene may be closely related to tumor progression and is expected to be the target of tumor therapy. The effects of FABP-5 gene on the proliferation, migration and apoptosis of ovarian cancer cells were observed by using small interfering RNA (siRNA) technique to silence the expression of FABP-5 gene in ovarian cancer cell line SKOV3.

The 41-year-old patient was seen in the gynecological clinic of our hospital on March 5, 2012 due to the increase of vaginal watery discharge for more than half a month. Gynecological examination: No skin and mucous membrane ulcers were seen in vulva; The vagina is smooth, the mucosa is intact, and the secretion is slightly excessive, which is purulent; An ulcer can be seen from 8 to 11 o'clock in the cervix and vagina, which is irregular in shape, with a size of 2.0 cm ×1.0 cm ×0.5 cm. There is no protrusion on the edge of the ulcer, soft in texture, and no bleeding when touched. There were no obvious abnormalities in the uterus and bilateral adnexal areas. Pelvic ultrasonography: posterior uterine position 5.3 cm ×5.1 cm ×4.5 cm; The thickness of the endometrium was 0.9 cm, and the thickness of the isthmus was 0.2 cm; There were no abnormalities in bilateral attachments. Past history: recurrent oral ulcers within two years; One vulvar ulcer attack, positive acupuncture test, previous diagnosis of Behcet's syndrome, oral prednisone and Chinese herbal medicine treatment. Diagnosis and treatment in our hospital: No cervical intraepithelial neoplasia was found in liquid-based cytology. Cervical and vaginal discharge HPV-DNA test was negative. Serum syphilis test was negative. Blood herpes simplex virus (HSV-2) IgM negative, vaginal discharge HSV-2 DNA negative, fungus negative. In order to further exclude cervical cancer, a colposcopic biopsy was performed on April 3. The cervical ulcer was slightly reduced compared with the previous gynecological examination, and a small amount of purulent secretion was still visible on the surface, seeFigure 1。 Pathological return of biopsy: chronic inflammation of the mucosa with squamous epithelial hyperplasia. Combined with the patient's medical history and diagnosis and treatment, it is considered that cervical ulcer caused by Behcet's syndrome. Because the patient refused vaginal medication, only oral treatment. An outpatient review after 4 months showed a smooth cervical surface and complete disappearance of the ulcer, seeFigure 2。

With the adjustment of China's population policy (the full implementation of the policy that one couple can have two children), the obviously increased cesarean section rate 5~10 years ago made obstetricians face the problem of re-pregnancy and delivery of women with scar uterus caused by a large number of cesarean sections. Pregnant women with scar uterus, whether they undergo elective repeat cesarean delivery (ERCD) or trial of labor after cesarean section (TOLAC), may have serious complications, including bleeding, damage to soft birth canal and adjacent organs, infection, hysterectomy and even death, etc. Obstetricians must pay attention to the great challenges brought by pregnancy and delivery of women with scar uterus to obstetric clinical practice.

Epithelial ovarian cancer (ovarian cancer) is one of the three common malignant tumors of female reproductive system. The incidence of ovarian cancer ranks 7th among female malignant tumors worldwide^[1]； In China, the incidence of ovarian cancer ranks 9th among female malignant tumors and 3rd among female reproductive system malignant tumors^[2]。 Because the lesions of ovarian cancer are located deep in the pelvic cavity and the early symptoms are atypical, only about 25% of patients are found in stage I, about 70% of patients are advanced at the time of diagnosis, and up to 70% of patients still relapse after treatment^[3]。 Therefore, it is particularly important to evaluate the therapeutic effect and prognosis of ovarian cancer patients. A large number of detection serum CA has been used at home and abroad₁₂₅And human epididymal protein 4 (HE4) in the diagnosis of ovarian cancer, the U.S. Food and Drug Administration (FDA) has approved HE4 and CA₁₂₅As a monitoring index for the follow-up of ovarian cancer patients^[4]But for the use of serum CA₁₂₅and HE4 to judge the prognosis of ovarian cancer patients, there are few literatures, and now the serum CA₁₂₅This paper reviews the effects of HE4 in predicting the treatment effect and prognosis of ovarian cancer.