2018年 · 第53卷第07期

Unintended pregnancies are a global problem, with approximately 85 million unintended pregnancies each year, i.e. 40 percent of pregnancies are unintended pregnancies, and 50 percent of unintended pregnancies end in abortion^[1]That is, there are 40 to 60 million induced abortions every year. The rate of high-efficiency contraception among women in China is low, the awareness of high-efficiency contraceptive methods is poor, and the rate of induced abortion remains high^[2]。 Data from the Statistical Yearbook of Health and Family Planning indicate that the number of induced abortions reached about 9.62 million in 2014^[3]。 Induced abortion, whether negative pressure suction or medical abortion, will destroy the woman's own protective barrier, damage the endometrium, and cause potential harm to the reproductive system and its function^[4]。 Therefore, attaching importance to contraception is the first step to protect female reproductive health. WHO Medical Standards for the Selection of Contraceptive Methods^[5]It is the "cornerstone" technical guide of family planning, and authoritatively evaluates the effectiveness of various existing contraceptive methods. Intrauterine device (IUD), various hormonal contraceptive methods, correct use of condoms, etc. are all highly effective contraceptive methods. However, women have different choices of contraceptive methods in different physiological stages and combined with different diseases, and they need to be selected after evaluating different physiological stages and different disease states on the basis of considering safety and effectiveness.

Approximately 1 in 78 women is at risk of developing epithelial ovarian cancer (ovarian cancer) in their lifetime, with a probability of 1.3%, and is characterized by advanced diagnosis and poor prognosis, with a 5-year survival rate of only 45%^[1]。 The standard treatment of cytoreductive tumor surgery combined with platinum + paclitaxel regimen chemotherapy can achieve clinical remission in up to 80% of ovarian cancer patients, but most of these patients will experience tumor recurrence and chemoresistance, leading to death. Ovarian cancer has previously been thought to be insensitive to immunotherapy, but there is increasing evidence that ovarian cancer is in fact an immunogenic tumor^[2]Therefore, immunotherapy may become a new method for the treatment of ovarian cancer^[3]。 However, before the advent of immune checkpoint blockers, the focus of immunotherapy was often on dendritic cell (DC) and exogenous T lymphocyte therapy with defined antigens, the latter including tumor infiltrating lymphocyte (TIL), T lymphocyte receptor (TCR) transgenic T lymphocyte therapy and chimeric antigen receptor (CAR) -T lymphocyte, i.e. adoptive T lymphocyte therapy. At present, there are limited options for immune intervention in clinic, mainly including anti-cytotoxic T lymphocyte antigen 4 (CTLA-4) and programmed cell death protein 1 (PD-1) /PD-1 ligand (PD-L1) signaling pathway blockers, indoleamine 2,3-dioxygenase 1 (IDO1) signaling pathway blockers. Therefore, a better understanding of the molecular events that regulate the immune response after chemotherapy becomes an urgent issue. In this paper, the immunosuppressive signaling pathway centered on myeloid differentiation factor 88 (MyD88), IDO1 and aromatic hydrocarbon receptor (AHR) in ovarian cancer and its potential molecular targets were discussed, which provided new ideas for the immunotherapy strategy of ovarian cancer.

Free DNA in blood refers to the extracellular DNA fragments in peripheral blood, which are mainly produced by active release of living cells or passive release of apoptosis and dead cells^[1]。 1997, Lo et al.^[2,3]cell-free fetal DNA (cffDNA) was found in the peripheral blood of pregnant women, and cffDNA was widely used in noninvasive prenatal screening for fetal chromosome abnormalities, detection of single gene diseases and identification of genetic relationships^{[4,5,6,7,8,9,10]}。 Among them, the concentration of cffDNA is the key factor affecting the accuracy of non-invasive prenatal diagnosis. At present, the non-invasive prenatal screening of fetal chromosomal abnormalities generally requires the concentration of cffDNA ≥4%^[11,12]。 There are three main indicators for evaluating cffDNA concentration: (1) Specific fragments on Y chromosome of male fetus. (2) fetal-specific single nucleotide polymorphism (SNP) sites; (3) Fetal-specific DNA methylation region^{[3,4,5,6,7,8,9,10,11,12,13,14,15,16]}。 At present, there are relatively few research reports on cffDNA concentration in the first trimester of pregnancy. This study evaluated the plasma cffDNA concentration of pregnant women by analyzing SNP-based targeted deep sequencing method, and explored the change law of cffDNA concentration in the first trimester of pregnancy, which provided more theoretical basis for the application of high-throughput sequencing in non-invasive prenatal diagnosis.

Endometrioid adenocarcinoma is a common malignant tumor of female reproductive system, and its incidence is increasing in recent years. Retroperitoneal lymph node metastasis is an important factor affecting the prognosis of patients with endometrioid adenocarcinoma. At present, there is no consensus on whether routine lymphadenectomy is required in patients with endometrioid adenocarcinoma with clinical stage I (i.e., preoperative stage). Convery et al.^[1]The criteria of low-risk endometrioid adenocarcinoma were reported by Mayo Clinic in the United States. The following conditions should be met at the same time: (1) Pathological grade is G₁or G₂； (2) Muscle infiltration<1/2； (3) Tumor diameter ≤2 cm; (4) No other metastatic lesions were found macroscopically during the operation. The authors believe that total hysterectomy + bilateral adnexectomy is sufficient for patients with low-risk endometrioid adenocarcinoma who meet the above criteria, and lymph node resection is not beneficial to the patient. But for patients with major risk factors, such as pathological grade of G₃And/or deep muscle infiltration, etc., it remains unclear whether it can benefit from lymphadenectomy. Therefore, this study collected clinicopathological data and follow-up information of patients with clinical stage I endometrioid adenocarcinoma who underwent standard staged surgery in the Hospital of Obstetrics and Gynecology affiliated to Zhejiang University School of Medicine from January 2002 to December 2015, and retrospectively analyzed the preoperative or intraoperative risk factors related to postoperative lymph node metastasis in patients, so as to provide assistance in clinical decision-making of surgical scope.

Pregnant woman 31 years old, 1 pregnancy and 1 delivery, due to "18 weeks of menopause⁺²In 2012, a baby boy was delivered naturally. One month after birth, the baby boy (proband) was diagnosed with "congenital adrenal hyperplasia (CAH)" in another hospital. Then, the peripheral venous blood of the proband and his parents was collected, and the microdeletion and microduplication of 21-hydroxylase gene (CYP21A2) were detected by multiplex ligation dependent probe amplification (MLPA). The sequencing analysis of CYP21A2 gene showed that the proband's CYP21A2 gene had a known pathogenic mutation c.1451_1452delGGinsC (p.Arg484Profs*58), and at the same time, the CYP21A2 gene also had a single copy deletion of exons 1 to 7, which confirmed the diagnosis of the proband as a child with 21-hydroxylase deficiency (21-hydroxylase deficiency, 21-OHD); However, the CYP21A2 gene of the proband's father has a single copy deletion of exons 1~7, and the CYP21A2 gene of the proband's mother has a heterozygous mutation of c.1451_1452delGGinsC and a triple copy duplication of exons 1~7, that is, their parents are both carriers of CYP21A2 gene pathogenic mutation. The results showed that two copies of CYP21A2 gene were present in the mixed sample after mixing the genomic DNA of the parents of the proband in equal amounts and performing MLPA detection. The pregnant woman underwent amniocentesis and prenatal diagnosis in July 2016. The results suggest that the CYP21A2 gene of the fetus in this pregnancy has the same pathogenic mutation as the proband. Considering the fetus is a child with 21-OHD, the pregnant woman and her family requested to terminate the pregnancy.

Amniotic fluid is a fluid filled in the amniotic cavity. The amount and nature of amniotic fluid are closely related to the prognosis of the fetus. In prenatal ultrasonography, amniotic fluid is generally anechoic, but enhanced amniotic fluid echo is often found before labor in the third trimester. At present, due to the relationship between amniotic fluid echo enhancement and amniotic fluid turbidity and meconium contamination, there are different views and opinions. The confusion of clinical management of amniotic fluid echo enhancement found by prenatal ultrasound can lead to premature intervention or artificial premature termination of pregnancy, which can lead to premature delivery of many fetuses that could have developed normally to term. This article gives a lecture on the significance and treatment of amniotic fluid echo enhancement.

intrahepatic cholestasis of pregnancy (ICP) is a disease unique to pregnancy, which occurs in the middle and third trimester of pregnancy^[1]。 The incidence of ICP in the world ranged from 0.1% to 15.6%, higher in South America and lower in Europe^[2,3]； In China, the incidence of ICP is 2.3% ~6.0%^[4]Among them, the incidence rate of the Yangtze River Basin is 1.0% ~4.0%, which is the highest incidence area in Asia^[5]。

Endometriosis (endometriosis) is a chronic inflammatory disease, but the pathogenesis has not been clarified so far. In recent years, the relationship between gastrointestinal microorganisms and diseases has been gradually paid attention to. Many studies have shown that the implantation rate and infection rate of gastrointestinal microorganisms in the eutopic endometrium of patients with endometriosis are significantly increased, which promotes the occurrence of endometriosis. Gastrointestinal microorganisms can participate in host metabolic pathways and activate inflammatory signaling pathways through their metabolites and molecular structures, thus leading to metabolic abnormalities and inflammatory responses. At present, the field of microorganisms has become the basis for predicting the occurrence and development of diseases. This article mainly reviews the research status, mechanism and clinical significance of gastrointestinal microorganisms involved in the occurrence and development of endometriosis, so as to provide reference for future clinical diagnosis and treatment.

real-world study (RWS), as the name implies, refers to clinical research derived from real-world samples. In recent years, it has been paid more and more attention worldwide. RWS is different from randomized controlled trials (RCTs) in that it can provide research evidence consistent with clinical practice (i.e., real-world environment) so that clinicians can make better clinical decisions. In addition to therapeutic studies, RWS can also be used for studies of etiology, diagnosis and prognosis, and it covers a broader scope than RCT. Because the external authenticity of RWS is better than that of RCT, its research results have better generalization in clinical practice, and are increasingly being applied to clinical research. In the research of gynecological malignant tumors, although there was no shortage of high-quality RCT in the past, due to its poor external authenticity, the research results are often inconsistent with clinical practice, which affects the making of medical decisions to a certain extent. RWS can obtain more evidence in line with clinical practice, and its research results are easier to translate into clinical practice, which better compensates for the shortcomings of RCT. The application of RWS is expected to provide a new direction for the extensive and in-depth clinical research of gynecological malignant tumors.