2015年 · 第50卷第02期

combined oral contraceptives (COC) are one of the highly effective contraceptive methods widely used worldwide at present. They are compound steroid hormone preparations containing low doses of estrogen and progestin (similar to the natural estrogen and progestin in women). Its application began in the early 1960s, mainly by inhibiting ovulation and exerting contraceptive effects. COCs with ethinyl estradiol ≤35 µg are low-dose COCs recommended by the WHO. At present, a large number of basic and clinical studies have confirmed that in addition to the significant contraceptive effect of COC, the health benefits also far outweigh its possible risks.

Because monochorionic double amniotic sac twins share a placenta, there is vascular communication anastomosis in the placenta, which causes one fetus to transfuse blood to another fetus, resulting in unbalanced blood flow distribution, which leads to various complications in the twin fetuses, among which twin-twin transfusion syndrome (TTTS) is the most common. TTTS is a chronic form of blood transfusion between twins, with an incidence of 10% to 15% in monochorionic twins^[1]The main manifestation is that one of the two fetuses has polyhydramnios and the other has oligohydramnios, so it is also called twin oligopolyhydramnios sequence (TOPS). twin anemia-polycythemia sequence (TAPS) is another chronic form of blood transfusion between twins. Unlike TTTS, TAPS has no significant difference in amniotic fluid volume, and is mainly manifested by the difference in hemoglobin content between the two fetuses. TAPS can be divided into primary and iatrogenic (secondary to TTTS laser therapy). The incidence of primary TAPS in monochorionic twins is 3% ~5%^[2,3]Iatrogenic TAPS occur in 2% to 13% of TTTS^[4,5]。 The clinical data of two patients with primary TAPS admitted to the Third Hospital of Peking University are reported as follows in combination with literature review.

Amenorrhea is a common disease in obstetrics and gynecology clinics, which can be divided into primary and secondary. The possible causes of the former include anatomical abnormalities, gonadal dysplasia or enzyme defects. Congenital adrenocortical hyperplasia is a type of disease with abnormal steroid hormone synthesis caused by enzyme deficiency and may be accompanied by amenorrhea, among which 17 α-hydroxylase/17,20-lyase deficiency (17 α-hydroxylase/17,20 lyase deficiency, 17-OHD) is a rare but not uncommon type, and its causal gene is the CYP17A1 gene located on chromosome 10q24.3. Cytochrome P450c17 protein encoded by CYP17A1 gene is a mitochondrial cytochrome P450 enzyme expressed in ovary, testis and adrenal gland. It has the activity of 17 α-hydroxylase and 17,20-lyase, and is a key enzyme in the synthesis of adrenal steroid hormone^[1]It plays an important role in maintaining normal physiological processes such as the onset of adrenal gland function, sex hormone synthesis and pubertal development^[2]。 CYP17A1 gene mutation can lead to changes in the expression, structure and function of P450c17 protein^[3]It affects the activity of enzymes, ultimately reduces the synthesis of cortisol and sex hormones, and promotes the increase of adrenocorticotropic hormone (ACTH) and gonadotropin levels and the synthesis of mineralocorticoids. The clinical manifestations of 17-OHD patients were primary amenorrhea, sexual dysplasia, hyporenic hypertension, hypokalemia and bilateral adrenal hyperplasia, while all patients were of female phenotype. In this study, a young female phenotype with primary amenorrhea with sexual dysplasia and hypertension was examined for CYP17A1 gene mutation and clinical follow-up, and the occurrence, development and clinical diagnosis and treatment strategies of 17-OHD were further explored in combination with literature.

Matrix metalloproteinase (MMP) 9 is a zinc-dependent proteolytic enzyme. Its function of degrading extracellular matrix and destroying basement membrane is the basic condition of tumor invasion, metastasis and vascularization. Studies have shown that MMP-9 is overexpressed in a variety of tumor tissues and is closely related to tumor cell invasion and metastasis^[1]。 It has also been reported that MMP-9 can induce epithelial-mesenchymal transition of tumor cells, enabling cells to obtain functional changes with enhanced migration or invasiveness^[2]。 Therefore, as a key factor of tumor invasion and metastasis, MMP-9 has become a hot spot in the field of tumor research. Although some studies have confirmed the relationship between MMP-9 and some cytokines, the whole regulatory network centered on MMP-9 is still unclear. Studies have shown that homeobox gene (HOX) A10 and nuclear factor κ B (NF-κ B) are two transcription factors closely related to tumorigenesis and development, which affect or participate in tumor invasion and metastasis^[3]However, whether HOXA10 and NF-κ B have regulatory effects on MMP-9 gene has not been discussed in detail. In this study, cervical cancer HeLa cells were selected to investigate this regulatory effect.

The patient, 24 years old, was pregnant 1 and gave birth 0. Due to menopause for more than 7 months, paroxysmal right lower abdominal pain worsened for 1 day after 1 week, and was transferred from the local hospital to Gansu Provincial People's Hospital on April 8, 2013. Regular menstruation in the past, last menstruation on September 12, 2012, no obvious early pregnancy reaction, no history of radiation exposure and viral infection in the early stage of menopause. Prenatal examination at the local hospital at 3 months of pregnancy showed no abnormalities. One week before admission, there was no obvious trigger for right lower abdominal pain and paroxysmal attack. I went to a local hospital. Color ultrasound examination showed intrauterine singleton, more than 31 weeks of pregnancy; Cystic mass in right abdomen (torsion of ovarian cyst pedicle possible); Amniotic fluid is on the low side. The emergency department was transferred to our hospital. Admission examination: body temperature 36.6℃, pulse 86 beats, blood pressure 120/80 mmHg (1 mmHg =0.133 kPa). Painful and sick. No abnormalities were heard in cardiopulmonary auscultation, abdominal swelling, four fingers above the fundus umbilicus, irregular contractions, cystic mass in the upper right lower abdomen, obvious tenderness and no rebound pain; Fetal heart rate 144 beats; Mobile voiced negative; No bleeding and fluid from the vagina. Internal examination: 80% of the cervical canal disappeared, the uterine mouth was not opened, the head was outcropped first, the fetal membrane was not broken, and the pelvis was normal. Laboratory test: white blood cell count 15.7×10⁹/L, neutrophils 0.84, hemoglobin 110 g/L, total plasma protein 60.8 g/L, albumin 33.3 g/L, coagulation index was normal. Color ultrasound examination showed: intrauterine single live fetus, gestational age 29 weeks; Cystic structure of the right lower abdomen, approximately 9 cm ×10 cm in size, considered ovarian origin; No obvious abnormalities in liver, gallbladder, pancreas, spleen and kidney were Because of the refusal of pregnant women and family members, pelvic and abdominal CT examination was not performed. Preliminary diagnosis: 29 weeks gestation⁺⁵, threatened premature birth; Right lower abdominal mass (nature to be determined).

adenomyosis refers to the disease caused by the invasion of the endometrium (including glands and interstitium) into the myometrium layer. The clinical manifestations are progressive aggravation of dysmenorrhea, increased menstrual flow, prolonged menstrual period, uniform enlargement of the uterus (spherical shape) or localized nodular bulge. According to the results of pathological examination after hysterectomy, the incidence rate is 8% ~27%^[1]。 The main incidence population is women aged 30-50 years. With the delay of women's childbirth age, the number of patients with adenomyosis combined with infertility in clinic increases significantly. Scholars disagree on the effects of adenomyosis on fertility. Some scholars believe that adenomyosis is uncommon in women with low fertility, while others believe that adenomyosis plays a key role in infertility^[2]。 With the rapid development of imaging technology, especially the application of high-resolution ultrasound and MRI, the accuracy of adenomyosis diagnosis has been enhanced. More and more patients with unexplained infertility are diagnosed with adenomyosis. At the same time, a series of pathogenic hypotheses have been put forward to explain the relationship between adenomyosis and infertility, and people are constantly exploring new treatment methods. In the past 20 years, a variety of drugs, surgery and other methods have been tried for the treatment of adenomyosis complicated with infertility, and certain curative effects have been achieved. However, so far, there has been no global consensus on the treatment plan of this disease. In this paper, the clinical and experimental studies of adenomyosis complicated with infertility in recent years were reviewed, and the possible pathogenic mechanisms and treatment options were reviewed.

Thromboembolic diseases include arterial thromboembolic diseases and venous thromboembolic diseases, the former mainly includes acute coronary syndrome, arterial ischemic attack, stroke, etc. The latter mainly refers to venous thromboembolism (VTE), including pulmonary thromboemblism (PTE) and deep venous thrombosis (DVT). Patients with malignant tumors are a high risk group of VTE, and VTE related to malignant tumors has a high recurrence rate and poor prognosis, which seriously affects the quality of life of patients, even threatens the life safety of patients, and delays the standardized treatment of malignant tumors. Patients with gynecological malignant tumors have increased their risk of VTE due to their unique anatomical structure and the influence of chemotherapy, radiotherapy, hormone therapy and other factors. Prevention, early detection, early diagnosis and early treatment are the key to reduce the occurrence of VTE, improve the quality of life of patients and improve their prognosis. There is still no unified view on the best strategy for the prevention and treatment of VTE in clinic. New safe, effective and simple prevention and treatment measures have become the hot topic of discussion and research among clinicians.

In 1990, the human genome project (HGP) was launched, with the participation of many countries. The project aims to measure more than 3 billion base pairs of human chromosomes, clarify genes and their positions on chromosomes, map the genome, and achieve the ultimate goal of cracking human genetic information. By 2005, the sequencing of the human genome had been completed.

A systematic analysis of 277 studies indicated that the incidence of primary and secondary infertility in women was as high as 1.5% and 3.0%, respectively^[1]。 Fallopian tubal lesions are an important cause of infertility. According to the American Society of Reproductive Medicine (ASRM), 25% to 35% of women who see a doctor for infertility have structural or functional abnormalities in the fallopian tubes^[2]。 The main cause of fallopian tube damage is pelvic inflammatory disease (PID), and the other causes include non-specific inflammation of fallopian tube, endometriosis, fallopian tube surgery, peritubal lesions, dysplasia, etc. The patency of fallopian tubes directly affects female fertility. Therefore, the evaluation of tubal patency is a routine procedure in the diagnosis and treatment of infertility. This article will introduce the application of four-dimensional hysterosalpingo-contrast sonography (4D-HyCoSy) in the diagnosis and treatment of tubal infertility.