Objective: To investigate the expression and significance of Shh, Ptch1, Smo and Gli1 of Hedgehog signaling pathway in rat endometrium after mechanical injury. Methods: 24 eight weeks old wistar rats were randomly divided into normal group (6 rats) and experimental group (18 rats).The rat endometrium injury models in experimental group were established by mechanical curettage. 24 hours ,72 hours and 7 days after curettage respectively, the uterine specimens of six rats were taken from experimental group and were examined by hematoxylin eosin staining, Masson staining, immunohistochemistry and real time quantitative polymerase chain reaction at different time points. Results: 24 hours after endometrial mechanical injury, the endometrial structure of rats was destroyed, the endometrial epithelium was missing and the glands were reduced. 72 hours after the mechanical damage of rat uterus, the uterus cavity was covered by thin layer epithelium.7 days after the endometrial mechanical injury, the rat endometrium was slightly thicker than that at 72 hours, glands were decreased significantly, uterine cavity form was poor, endometrium was still thinner than the normal endometrium. The results of Masson staining showed that 7 days after the mechanical injury of the endometrium, the collagen fibers was significantly increased in the endometrium of rats than that of the normal rats. The results of Masson staining showed that collagen fibers were significantly increased in the endometrium, which were more wounded than those of the normal rats’ endometrium at7 days after the mechanical injury. The immunohistochemical results showed that Shh, Smo, Ptch1 and Gli1 staining were mainly located in the endometrium and the uterine gland. No expression of Shh was found in all rats in each group. After curettage, the expression of Smo was very weak, and it was increased gradually in 72 hours after curettage. The expression of Ptch1 was weakly expressed at 24 hours after curettage and increased significantly at 72 hours after curettage. The expression of Gli1 was significantly increased at 72 hours and 7 days after curettage. The results of real time quantitative PCR showed that Shh mRNA had no expression in the uterus of each time point of each group. Compared with the normal group, the expression of Smo mRNA was 0.7 times (P<0.05) at 24 hours after curettage, the expression of Ptch1 mRNA was 1.2 times (P>005), and the expression of Gli1 mRNA was 1.6 times (P<0.05). At 72 hours after curettage, the expression of Smo mRNA was 1.4 times (P<0.05), the expression of Ptch1 mRNA was 3.3 times (P<0.01), and the expression of Gli1 mRNA was 9.3 times (P<0.01). At 7 days after curettage, the expression of Smo mRNA was 1.5 times (P<005), the expression of Ptch1 mRNA was 2.5 times (P<0.05), and the expression of Gli1 mRNA was 5.7 times (P<0.01). Conclusion: Ptch1, Smo and Gli1 are all expressed in rats’ endometrium after mechanical injury. The expression of Ptch1 mRNA, Smo mRNA and Gli1 mRNA are related to the rat endometrium fibrosis. Hedgehog (Hh) signaling pathway may be involved in the endometrium fibrosis repair after mechanical injury.  

2018 Vol. 26　(5):　343- [Abstract]（ 573 ） HTML (0 KB)  PDF  (0 KB)  ( 66 )

Objective: To analyze the current situation and needs of prepregnancy health check service from the perspectives of people who accepted service based on qualitative and quantitative research, and to put forward suggestions to improve service quality. Methods: Six group interviews and 15 personal interviews in participants were conducted and 229 families by randomly selected were given return visiting by telephone in 45 counties. Results: 44.5% people known related examination information from family planning advocate, 76.9% people accepted free service before eugenics health inspection service at the country level, 92.6% people had received the test results and informed notice, but 37.7% among them were told by telephone only. 74.7% people were satisfied or very satisfied with the project of free prepregnancy health examination. There was statistically significant different in satisfaction of people who had received informed notice or not. And there was also significant different in satisfaction between the people who received paper informed notice and informed by telephone (P < 0.001). Conclusion: In Yunnan province, people who had accepted free pregnancy eugenics health examination have perfect satisfactions for the project. The feedback of childbearing age people can reflect the quality of service directly. Improving assessment of the informed notice and strengthening consulting guidance are the keys to increase the acquisition and satisfaction of people.

2018 Vol. 26　(5):　353- [Abstract]（ 459 ） HTML (0 KB)  PDF  (0 KB)  ( 45 )

Objective: To investigate the effect of ethinyl estradiol cyproterone combined with pioglitazone for treating infertility patients with polycystic ovary syndrome (PCOS) and type 2 diabetes (T2DM). Methods: 88 infertility women with PCOS and T2DM were randomly divided into two groups.The women in research group (n=44) were treated by ethinyl estradiol cyproterone and pioglitazone for 3 months, the women in control group (n=44) were treated by ethinyl estradiol cyproterone and metformin for 3 months. The indexes of glucose and lipid metabolism, sex hormone before and after treatment were compared between the two groups. And the situation of menstrual cycle and ovulation, and rate of spontaneous conception were observed. Results: After treatment, the levels of BMI, WHR, LDLC, TC, TG, FBG, 2hPG, FINS, HbAlc and HOMAIR of women in research group were significantly lower than those of women in control group, while the levels of HDLC and HOMAβ were significantly higher (P<0.05).After treatment, the levels of E2, LH, FSH, LH / FSH, T, FAI and A2 of women in research group were significantly lower than those of women in control group, while SHBG were significantly higher (P<0.05).The follicles diameter of women in research group was significantly bigger than that of women in control group, while ovarian capsule thickness, ovarian volume and number of follicles were significantly lower (P<0.05). There was no significant difference in the incidence of ovarian hyper stimulation syndrome (OHSS) between the two groups (P>0.05), while the menstrual cycle normal rate, normal ovulation rate and pregnancy rate of women in research group were significantly higher than those of women in control group (P<0.05). Conclusion: Ethinyl estradiol cyprprovone combined with pioglitazone has exact effect for infertility women with PCOS and T2DM, which can decrease insulin resistance and androgen, and improve endocrine disorders, and can enhance the rate of natural conception.

2018 Vol. 26　(5):　362- [Abstract]（ 456 ） HTML (0 KB)  PDF  (0 KB)  ( 52 )

Objective: To explore the effect of Neiyi recipe combined with gonadotropinreleasing hormone agonist (GnRha) for treating women with ovarian endometriosis cysts after surgery and its influence on ovarian function. Methods: 100 women with ovarian endometriosis cysts who had undergoing surgical treatment were randomly divided into control group and observation group by random number table (50 cases in each group). All women in both groups were treated by CnRHa diphereline, while the women in observation group were additionally treated by Neiyi recipe. The curative effect was compared between the two groups. Serum follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2) of women in both groups were determined before treatment and 3 months after treatment. Changes of the diameter of ovarian cysts, antral follicle count (AFC) and blood flow resistance index (RI) of ovarian stroma were monitored by ultrasound. Results: The total effective rate of women in observation group was higher than that of women in control group (P< 0.05). Before treatment, there was no statistically significant difference in each parameter between the two groups (P > 0.05). After treatment, the decrease of score of traditional Chinese medicine syndrome of women in the observation group was more than that of women in control group (P< 0.05). The levels of FSH, LH and E2 of women in observation group were lower than those of women in control group (P< 0.05). The diameter of cysts and value of RI by ultrasound of women in observation group were lower than those of women in control group, while AFC of women in observation group was higher than that of women in control group (P< 0.05). Conclusion: Neiyi recipe combined with GnRha can improve the function and enhance the ovarian blood supply when used for treating ovarian endometriosis cysts.

2018 Vol. 26　(5):　371- [Abstract]（ 427 ） HTML (0 KB)  PDF  (0 KB)  ( 80 )

Objective: To explore the association between the mode of delivery and perinatal outcome in dichorionic diamniotic (DCDA) twin pregnancy. Methods: 162 patients of DCDA from January 2012 to January 2017 in the first affiliated hospital of Kunming medical university were enrolled and divided into two groups according to the mode of delivery, which included vaginal delivery group (50 cases) and cesarean delivery group (112 cases). The perinatal outcome was compared between the two groups. Results:  (1)The incidence of pregnant week less than 37 weeks and birth weight less than 2500g in vaginal delivery group was significantly higher than that in cesarean delivery group (P﹤005). The incidence of pregnant week more than or equal to 37 weeks and birth weight more than or equal to 2500g in cesarean delivery group were significantly higher than those in vaginal delivery group (P﹤0.05). (2) The incidence of preeclampsia in cesarean delivery group was significantly higher than that in vaginal delivery group (P﹤0.05). (3) There was no significantly difference in postpartum hemorrhage and neonatal mortality rate between the two groups (P＞0.05).(4) There was no significantly difference in neonatal asphyxia rate of the first fetus between the two groups (P＞0.05), whereas the neonatal asphyxia rate of the second fetus was significantly higher in vaginal delivery group than that in cesarean delivery group (P﹤0.05). There was no significantly difference in neonatal asphyxia rate of the second fetus when delivery interval less than or equal to 15 minutes between the two groups (P＞0.05), whereas the neonatal asphyxia rate of the second fetus when delivery interval over 15 minutes was significantly higher in vaginal delivery group than that in cesarean delivery group (P﹤0.05). The pH and base excess (BE) of the second fetus when delivery interval over 15 minutes was significantly higher in vaginal delivery group than that in delivery interval less than or equal to 15 minutes group (P﹤0.05). Conclusion: To achieve the optimal perinatal outcome, the mode of delivery of DCDA pregnancy with the cephalic presentation of the first fetus should be analyzed according to pregnant weeks, estimated fetal weight and pregnant complications. Meanwhile, the management of the second fetus in the second should be emphasized and the delivery interval should be less than or equal to 15 minutes.

2018 Vol. 26　(5):　379- [Abstract]（ 452 ） HTML (0 KB)  PDF  (0 KB)  ( 84 )

Objective: To explore the relationship between level of serum antimullerian hormone(AMH) and age or level of sex hormones of childbearing age women. Methods: In the retrospective study, dates of 719 childbearing age women from Guigang city people’s hospital were collected, which included level of serum AMH, follicle stimulating hormone(FSH), luteinising hormone(LH), testosterone(T), estradiol (E), and progesterone(P). All recruited women were divided into two groups based on their age (from 38 to 45 years old in elder group, and from 23 to 37 years old in control group). The level of serum parameters of included women by the mannwhitney test were compared between the two groups. The relationship was analyzed by spearman rank correlation coefficient method between serum AMH and age or level of sex hormones of women in the two groups. Results: The level of serum FSH of women in elder group were significant higher than that of women in control group (P<0.01), the level of AMH, E, P and T of women in elder group were significant lower than those of women in control group (P<0.01), but there were no significant different in the level of LH between the two groups（P>0.05）. The levels of serum AMH was negatively correlated with age and FSH（P<0.01）, and was positively associated with P（P<0.05）in both groups. The level of serum AMH was positively associated with LH and T（P<0.01）, but was no significant correlation with E（P>0.05）in control group. The level of serum AMH was negatively correlated with LH（P<0.01）, and was positively correlated with E（P<0.01）, but was no significant correlation with T（P>0.05）in elder group. Conclusion: The level of serum AMH of women is gradually declined with age. The level of serum AMH decreasing (begins from 30 years old) can reflect the decline of female fertility early when compared to that the level of serum FSH (begins from 38 years old). The correlation between serum AMH and FSH, LH or E2 of women at 3845 years old is more close than that of women in 2337 years old.

2018 Vol. 26　(5):　386- [Abstract]（ 432 ） HTML (0 KB)  PDF  (0 KB)  ( 89 )

Objective: To explore the effect of balloon occlusion of abdominal aorta and bilateral internal iliac artery in women with perilous placenta previa combined with placenta implantation and its influence on the pregnant outcomes. Methods: A retrospective analysis was conducted. 43 patients with placenta previa and placenta accreta from April 2015 to September 2016 were in internal iliac artery group, who had experienced bilateral iliac artery balloon occlusion. 50 patients with placenta previa and placenta accreta from October 2016 to December 2017 were in abdominal aorta group, who had experienced abdominal aorta balloon occlusion. The type of placenta implantation, volume of operative blood lost, blood transfusion volume, operative time, the incidence of hysterectomy, lower extremity thrombosis and disseminated intravascular coagulation (DIC) were observed in both groups. The pregnant outcomes were also recorded. Results: There was no significant different in the type of placenta implantation and the incidence of DIC and lower limb thrombosis between the two groups (P>0.05). The volume of blood lost, volume of blood transfusion, operation time and rate of hysterectomy of patients in the abdominal aorta group were significant lower than those of patients in the internal iliac artery group (P<0.05). There were no significant different in neonatal malformation, newborn weight, neonatal Apgar score, and neonatal asphyxia between the two groups of (P>0.05). Conclusion: Abdominal aortic balloon occlusion can reduce the hysterectomy rate, can reduce operative time, and can improve pregnant outcomes of patients with placenta previa and placenta accreta.

2018 Vol. 26　(5):　393- [Abstract]（ 415 ） HTML (0 KB)  PDF  (0 KB)  ( 83 )

Objective: To identify the genetic mutations and its mutation site of a Chinese family with Joubert syndrome. Methods: Target exome sequencing was applied to examine the DNA sample of a male patient in the Chinese family with Joubert syndrome. Candidate variants were selected by bioinformatics analysis. Polymerase chain reaction followed by Sanger sequencing was used to verify the candidate variant. Results: The chromosome 9 INPP5E had two hybrid mutation site, which were c.1524C>G, p.Asp508Glu and c.1688G>A, p.Arg563His. The two mutation sites of the family members were conform to the genetic cosegregated rule. Compound heterozygous variants were identified in INPP5E. Conclusion: Target exome sequencing combined with Sanger sequencing find site of c.1524C>G and c.1688G>A of INPP5E gene cause Joubert syndrome. This is the first report that the case of Chinese Joubert syndrome caused by INPP5E gene mutation, c.1524C>G is a novel mutation site for disease.

2018 Vol. 26　(5):　400- [Abstract]（ 422 ） HTML (0 KB)  PDF  (0 KB)  ( 53 )

Objective: Explore the effect of post abortion care (PAC) services on use of highly effective contraception immdiatly after abortion.  Methods：The women in study group were given the intervention of PAC service, and women in control group were treated as normal. The clinical effect of women in study group was observed compared to women in control group. Results：11 women (1.5%) in study group had unwanted pregnancy again in half a year after abortion, which had was significantly lower than that of women (57 cases, 17.0%) in control group (P< 0.05). 96.2% women in study group used contraception immediately after abortion, which was significantly higher than that of women (18.4%) in control group (P< 0.05). The rate of awareness of contraception knowledge of women in the study group was 98.8%, which was significantly higher than that of women (30.3%) in control group (P< 0.05). The rate of efficient contraception used of women in the study group was 75.0%, which was significantly higher than that of women (29.8%) in control group (P< 0.05). Conclusion：PAC service can increase the awareness of contraceptive knowledge of women, and can improve the contraception used.

2018 Vol. 26　(5):　420- [Abstract]（ 670 ） HTML (0 KB)  PDF  (0 KB)  ( 56 )