2015年 · 第50卷第01期

Magazine is a platform for professional academic exchange, a garden for technical team construction, and should also be a strong thrust for academic development. Particularly in the following aspects:

premature rupture of membrane (PROM) refers to the spontaneous rupture of fetal membranes before delivery, which is divided into term PROM and preterm premature rupture of membrane (PPROM) according to the gestational age at which it occurs. The incidence of term singleton PROM was 8%; The incidence of PPROM in single pregnancy is 2% ~4%, and that in twin pregnancy is 7% ~20%. PPROM is one of the main causes of premature birth^[1,2,3,4]。 The diagnosis and treatment of PROM, especially the management strategy of PPROM, has always been a difficult problem in obstetric clinical work. At present, there is a lack of consensus on the treatment principles of PPROM at different gestational weeks in China; There are still controversies about whether or not to induce labor and the method of inducing labor in full-term PROM without labor in a short period of time; There are no uniform guidelines or norms for the management of expected treatment of PPROM, the duration of fetal preservation, how to prevent infection, and how to terminate pregnancy.

shoulder dystocia occurs after the fetal head is delivered, the fetal shoulder cannot be delivered, and the situation is urgent. Although the incidence rate of shoulder dystocia is not high, once it occurs, it is very harmful to mother and child. If it is not handled properly, it will cause serious mother-child complications, such as birth canal laceration, neonatal brachial plexus injury, neonatal fracture, neonatal asphyxia, neonatal intracranial hemorrhage, etc. At the same time, it is also a critical illness that is most prone to medical disputes in obstetrics. Therefore, early prediction, recognition and correct management of shoulder dystocia are particularly important.

combined oral contraceptives (COC) are combined steroidal hormone preparations containing estrogen and progestin to control fertility. The first COC preparation was successfully developed and approved for marketing in 1960. After more than 50 years of development, COC has become one of the commonly used contraceptive methods in the world. When used correctly, the pregnancy rate is only 0.3/100 women-years. However, in China, many clinical medical staff often have some confusion when applying COC, especially in the aspects of long-term use, the impact on reproductive function and offspring safety, and the risk of gynecological malignant tumors, which leads to the probability of recommending COC contraception. Low. This paper explains several common and concentrated clinical cognitive problems of COC.

intrauterine adhesion refers to a series of syndromes caused by damage to the basal layer of the endometrium caused by any factor, resulting in partial or total occlusion of the uterine cavity. Its main clinical manifestations are decreased menstrual flow, repeated miscarriage, infertility, etc. Studies have shown that pregnancy-related curettage and curettage surgery is the main cause of intrauterine adhesions despite numerous causes^[1]。 In recent years, the number of patients with intrauterine adhesions, especially severe adhesions, is on the rise. Although the clinical manifestations of intrauterine adhesions are different, infertility is the main reason for the vast majority of patients to see a doctor, especially patients with severe adhesions often face the problems of long treatment cycle, high cost and poor prognosis, which have a great impact on their physical and mental health and family happiness. It is necessary to study the risk factors of severe intrauterine adhesions. This study investigated the risk factors of severe intrauterine adhesions, and provided reference for clinical treatment and prevention.

Cervical cancer is a high incidence of gynecological malignant tumor in the world, which seriously threatens women's health. It is urgent to study the molecular mechanism and treatment of cervical cancer evolution, and HPV infection is the most important risk factor of cervical cancer^[1]。 In recent years, phosphatidylinositol 3 kinase (PI3K) /protein kinase B (Akt) /rapamycin target protein (mTOR) has been considered as an important signaling pathway for protein synthesis, involved in regulating cell proliferation, differentiation, migration, etc^[2]。 Studies have found that HPV can promote the progression of malignant tumors through the PI3K/Akt pathway^[3]。 Pharmacological studies have confirmed that shikonin has anti-tumor, anti-inflammatory, anti-viral and anti-fungal effects^[4]However, due to its high toxicity and poor specificity, it has not been applied clinically. Beta-hydroxyisovaleryl shikonin (beta-HIVs) is one of the naturally occurring shikonin derivatives. Therefore, in this study, the cervical cancer cell line HeLa cells were selected to establish a nude mouse transplanted tumor model, to study the inhibitory effect of β-HIVS on the growth of transplanted tumors, and to explore its mechanism and the relationship with PI3K/Akt/mTOR pathway, so as to provide experimental basis for the clinical diagnosis and treatment of cervical cancer.

Cervical cancer is a malignant tumor second only to breast cancer among women in the world. According to the data released by the National Cancer Center and the National Health and Family Planning Commission, in 2008, the proportion of new cases of cervical cancer in China was 12.19/100,000, and the proportion of deaths was 3.90/100,000^[1]。 At present, it has been confirmed that persistent HPV infection is the primary cause of cervical cancer, and the progression of persistent HPV infection to cervical cancer is a long process. Therefore, cervical cancer is a preventable and curable malignant tumor. Only a small number of people with persistent HPV infection develop into cervical cancer, which suggests that the carcinogenic-related genomic changes caused by persistent HPV infection are an important step in the evolution of malignant tumors. Therefore, it is particularly important to study HPV-related oncogenes. The triple-domain family protein (TRIM) family plays an important role in antiviral innate immunity, and the TRIM22 gene is one of the TRIM family members, which was initially studied from its antiviral function^[2]With the deepening of research, it is found that TRIM22 also plays a role in the occurrence and development of some malignant tumors as the target gene of p53 gene. In this study, the expression of TRIM22 mRNA and protein in normal cervix, chronic cervicitis, high-grade cervical lesions (i.e. cervical intraepithelial neoplasia (CIN) Ⅱ, Ⅲ) and cervical cancer tissues were detected, and the role of TRIM22 gene in the development and development of cervical cancer was investigated.

The 28-year-old patient went to Hebei Institute of Family Planning Science and Technology in July 2013 because she was not pregnant for one and a half years after spontaneous abortion and uterine curettage. The menstrual cycle is regular, the menstrual flow is normal, and there is no pain in menstruation. This time, on the 6th day of clean menstruation, all preoperative examinations were improved. There were no contraindications for acute or chronic reproductive system infection and transvaginal water injection laparoscopic (THL) surgery, and THL combined with hysteroscopy was voluntarily undergone. When the posterior uterine wall, bilateral ovaries and fallopian tubes were observed sequentially during THL after perfusion of expansion medium and expansion of the pelvic cavity, it was found that the germinal epithelium and albuginea of the right ovary were torn apart, forming an ovulatory foramen with neat edges, such as the opening after volcanic eruption. The tissue around the ovulatory foramen was congested and the blood vessels were dilated (seeFigure 1）； Transparent follicular fluid containing fine clots and granulosa cells flows slowly from the ovulatory orifice and forms fasciculated mucous bands floating in the expanded liquid medium (seeFigure 2）。 Subsequently, it was observed that the egg-crown-colliculus complex was adhered to the lateral pelvic wall adjacent to the ovulatory foramen by fibrin filament-like structure, and it was difficult for the complex to fall off from the adhered lateral pelvic wall by gently shaking the lens. The inner wall of the follicular cavity was observed by the mirror from the ovulatory foramen, which resembled a fold of the gastric mucosa (seeFigure 3）。 Continuing observation, it can be seen that the fimbrial end of the oviduct on the ovulatory side is located at the lateral edge of the ipsilateral ovary. Compared with the morphology of the fimbrial end of the contralateral oviduct, it only shows mild congestion and swelling, but there is no obvious pulse rate-like oscillation. After continuous observation for 13 min, the expansion medium was released, and after another observation for 6 min, no follicular fluid, mucus and other substances flowed out of the ovulatory orifice; The whole real-time observation process of ovulatory foramen and egg-crown-columulus complex was about 19 min.

Shoulder dystocia is an obstetric emergency that can lead to serious adverse pregnancy outcomes. It can cause cervical tear, uterine rupture, neonatal brachial plexus injury, fetal asphyxia, neonatal intracranial hemorrhage, etc. due to sudden occurrence and incarceration of the fetal shoulder. The incidence of shoulder dystocia varies according to different diagnostic definitions and different regions, generally ranging from 0.2% to 3.0%^[1,2]Although the incidence rate is not high, because the current medical technology is difficult to predict, it is particularly important to strengthen standardized diagnosis and treatment. Therefore, this article gives a lecture on the diagnosis and treatment of shoulder dystocia.

deep infiltrating endometriosis (DIE) refers to the appearance of endometrial implantation, fibrosis and myometrial hyperplasia under the peritoneum, with a lesion infiltration depth ≥5 mm^[1]。 DIE most commonly involves the uterosacral ligament, followed by the rectovaginal septum, recto-uterine depression, ureter, the junction of rectum and sigmoid colon, and bladder^[2]。 Pain and infertility are the main manifestations of DIE, among which pain includes dysmenorrhea, chronic pelvic pain, painful intercourse, painful defecation, painful urination and back pain, etc. Surgery is the main treatment for DIE. Correct diagnosis and evaluation of the lesion range of DIE before surgery are crucial for the choice of surgical methods.

The endometrium is divided into functional layer and basal layer, which are rich in blood vessels and glands. The powerful regenerative ability of basal layer makes the functional layer peel and repair again and again^[1]。 This remarkable regenerative ability of the endometrium suggests the presence of stem or progenitor cells. To date, endometrial cell clone formation^[2]side population^[3]And the expression of the surface marker W5C5^[4]It is clear that there are endometrial stem cells or progenitor cells in the endometrium that can continuously proliferate and differentiate. Endometrial stem cells provide the basis for the regeneration of various cells in the endometrium, however, the origin of endometrial stem cells is currently unknown. In 2004, Taylor^[5]Endometrial cells derived from donor bone marrow cells have been found in the endometrium of patients receiving bone marrow transplantation. Since then, studies have continuously proved that bone marrow derived stem cells (BMDSC) are extrauterine sources of endometrial cells and participate in the regeneration and functional reconstruction of the endometrium after injury. In addition, it has been reported that the damaged endometrium has been successfully repaired by BMDSC intrauterine transplantation^[6]。 This article reviews the research progress of BMDSC in endometrial repair.

Endometrial cancer is the second largest malignant tumor in gynecology, and its incidence is increasing year by year, accompanied by the tendency of younger onset, which seriously threatens women's health. It is a popular hypothesis that "non-antagonistic estrogen action" leads to the occurrence and development of endometrial carcinogenesis. However, with the further research on its etiology, more mechanisms are gradually confirmed. In recent years, more and more research evidence shows that insulin resistance is a risk factor for the development of endometrial cancer. This article will review the relationship between insulin resistance and endometrial cancer from three aspects: evidence-based medicine, pathogenesis and clinical early intervention strategies.

Primary retroperitoneal tumors are those that occur in the retroperitoneal space, except for those of retroperitoneal organ origin or metastasis to the retroperitoneum. Retroperitoneal boundary, anterior boundary is peritoneum, ipsilateral colon, mesocolon, pancreas, liver and stomach, posterior boundary is psoas, quadratus lumbis, transversus abdominis and iliac muscle, middle is spine, paraspinal muscles, inferior vena cava, aorta, bilateral boundary is ipsilateral abdominal muscle tissue, upper boundary is transverse diaphragm, right lobe of liver, duodenum, pancreas or spleen, and lower boundary is iliopsoas muscle, femoral nerve, iliac vessel or pelvic wall. Because of the special position of retroperitoneal anatomy, it brings certain difficulties to clinical diagnosis and treatment. This article will summarize it from the aspects of epidemiology, clinical manifestations, auxiliary examination, diagnosis and differential diagnosis, treatment and prognosis.