Objective: To explore the expression of HAS gene dominant subtypes and CD44 in cultured adenomyosis (ADS) eutopic endometrial cells in vitro, and to analyze the effect of estrogen on the expression of HAS-2 and CD44. Methods: From October 2017 to September 2018, 21 patients with ADS (ADS group) who underwent surgical treatment, and 19 patients without endometrial lesions were selected in control group. RT-qPCR was used to detect the expressions of HAS subtypes (HAS1, HAS2, HAS3) and standard CD44 of cultured endometrial cells, and also measured the responsiveness of HAS subtypes and standard CD44its by estrogen with different concentrations. Results: The expression levels of HAS2 and CD44 in endometrial cells of ADS group (0.302±0.063, 0.254±0.067, respectively) was significant higher than that (0.168±0.025, 0.128±0.018, respectively) of control group (P<0.0001), and there was a positive correlation between the expression of HAS2 and CD44 in endometrial cells of ADS group (r= 0.797, P<0.0001). There was no significant difference in the expression of HAS3 and HAS1 (P>0.05). 17 beta-estradiol in 0.1, 1.0, or 10.0 nmol/L could up-regulate the expression of HAS2 mRNA of cells in ADS group, which was significant different from that of cells without treated by 17 beta-estradiol (P<0.05), while only 17 beta-estradiol in 1.0 nmol/L could up-regulate significantly the expression of HAS2 mRNA in control group (P<0.05). 17 beta-estradiol in 1.0 and 10.0 nmol/L significantly increased the expression of CD44 mRNA in ADS group compared with that of control
group (P<0.05), while only 17 beta-estradiol in 10 nmol/L significantly increased the expression of CD44 mRNA of control group (P<0.05). Conclusion: The expression of HAS2 and CD44 in ADS endometrial cells is abnormally increased, which is regulated by high concentration of estrogen.

2019 Vol. 27　(5):　556- [Abstract]（ 360 ） HTML (0 KB)  PDF  (0 KB)  ( 40 )

Objective: To observe the clinical curative effect of tubal sterilization operation between by signal hole laparoscopic tubal electrocoagulation and by tubal ligation. Methods: 400 women who wanted tube sterilization were as the research objects from March 2010 to March 2016, and all the women were divided into control group and research group according to the random number table method (200 cases in each group). The women in control group were accepted tube sterilization by tubal ligation, and the women in study group were accepted signal hole laparoscopic bipolar tubal electrocoagulation. The situation of women in the two groups were recorded, the serum levels of E2, LH and FSH of women before and after operation were measured, and the rate of unwanted pregnancy and the satisfactory 12 months after the operation were followed up. Results: The operations of women in the two groups were all successful. The volume of bleeding, the time of operation and stay in hospital of women in study group were significant lower than those of women in control group (P<0.05). The overall incidence of postoperative adverse reactions of women in study group (12.0%) was significant lower than that of women (21.5%) in control group (P<0.05). There were no significant different in serum E2, LH, FSH and FSH/ LH levels before and after surgery (P>0.05). However, the proportion of women with serum FSH>10 U/L or FSH/LH>2 (9.0% or 26.5%) in study group was significant lower than that of women (17.5% or 37.0%) in control group (P<0.05). In the 12 months after operation, the rate of unwanted pregnancy of women in study group (0.0%) had no statistically different from that (1.0%) of women in control group (P>0.05). The satisfaction rate of women in study group (97.5%) was significant higher than that (92.5%) of women in control group (P<0.05) within 1 months after the operation, and the satisfaction rate of women in both groups increased after 3 months, 6 months and 12 months of operation. Conclusion: The tubal sterilization operation by both laparoscopic electrocoagulation and tubal ligation has high success rate and has high effectiveness of contraception. Compared to that by tubal ligation, the tubal sterilization operation by laparoscopic electrocoagulation has more convenient, less iatrogenic trauma and adverse effect on ovarian function, and postoperative adverse reaction, which can shorter recovery time and improve satisfaction of women.

2019 Vol. 27　(5):　565- [Abstract]（ 346 ） HTML (0 KB)  PDF  (0 KB)  ( 38 )

Objective: To observe the clinical effect of intrauterine device (IUD) inserted immediately after artificial abortion by manual negative pressure aspiration. Methods: 460 women with unwanted pregnancy who voluntarily asked for contraception after abortion were included as research subject form May 2013 to May 2016. All the included women were divided into study group and control group (230 cases in each group) randomly based on table of random numbers. Women in study group were inserted IUD immediately after artificial abortion by manual negative pressure aspiration, while women in control group were inserted IUD immediately after artificial abortion by electric negative pressure aspiration. The situation of all women during abortion were evaluated. The rates of adverse reaction, unexpected pregnancy, and IUD removed due to symptoms of women were recorded in 2 years after IUD used. Results: The intraoperative bleeding volume, intraoperative VAS score, operative time, and postoperative stay hospital time of women in study group were significant less than those of women in control group (P<0.05). The incidences of menstrual disorders, abnormal menstrual flow, intrauterine adhesions, and effective rate of contraceptive of women in study group (3.9%, 2.6%, 0.9%, and, 100.0%) had no significant different from those (5.2%, 4.4%, 2.8%, and 99.6%) of women in control group (P>0.05). The incidences of vaginal irregular bleeding, low back and abdominal pain, acute pelvic inflammatory disease, IUD removal rate, and IUD removed due to symptoms of women in study group (3.0%, 2.8%, 0.4%,0.9%, and 3.0%) were significant lower than those (7.4%, 6.1% 3.0%, 3.1%, and 7.8%) of women in control group (P<0.05). Conclusion: Compared to those of IUD inserted immediately after electric negative pressure aspiration, IUD inserted immediately after manual negative pressure aspiration is more convenient, has less iatrogenic trauma, fewer adverse reaction, and less removal rate due to symptoms.

2019 Vol. 27　(5):　573- [Abstract]（ 346 ） HTML (0 KB)  PDF  (0 KB)  ( 33 )

Objective: To explore the influences of multimodal analgesia by parecoxib sodium combined with sufentanil on pain and stress response of patients after cervical cancer radical operation. Methods: 89 patients after radical hysterectomy for cervical cancer were selected and divided into control group (47 cases) and observation group (42 cases) according to different anesthesia methods. All patients received sufentanil controlled analgesia after operation, and patients in observation group were given parecoxib sodium intravenously 30min before the after operation, while the patients in control group were given normal saline. Before anesthesia, 2h, 6h, 12h and 24h after operation, the levels of serum Cortisol (Cor), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP) of all patients were detected by enzyme-linked immunosorbent assay (ELISA), and the levels of serum norepinephrine (NE) and epinephrine (E) were measured by radioimmunoassay. Visual analogue scale (VAS) was used to assess the degree of pain, Ramsay score was used to assess sedation degree. The incidences of adverse reactions of patients in the two groups were analyzed. Results: The number of patient-controlled press of analgesic and sufentanil dosage of patients in observation group were3.1±1.6 times and 0.059±0.005mg, which were significant less than those (0.065±0.007mg and 11.0±0.9 times) of patients in control group (P< 0.05). Postoperative 2h, 6h, 12h, and 24h, the VAS scores of the patients in observation group were significant lower than those of the patients in control group (P<0.05).The analgesic satisfaction rate of patients (92.9%) in observation group was significant higher than that (17.8%) of the patients in control group (P< 0.05). Compared with before anesthesia, the levels of serum NE, E, Cor, TNF-α, and CRP at postoperative 2h, 6h, 12h of all patients were significantly increased (P<0.05), and those of the patients in observation group increased more than those of patients in control group (P<0.05). The total incidence of postoperative analgesic adverse reaction of patients (2.4%) in observation group was significant lower than that (14.9%) of patients in control group (P<0.05). Conclusion: Multimodal analgesia by parecoxib sodium combined with sufentanil can significantly reduce the pain degree of patients after cervical cancer radical operation, can reduce body stress response and inflammatory reaction, and can decrease adverse reactions, which is better than that of patient-controlled analgesia by sufentanil used only.

2019 Vol. 27　(5):　580- [Abstract]（ 303 ） HTML (0 KB)  PDF  (0 KB)  ( 39 )

Objective: To investigate the effect of dexmedetomidine used in spinal anesthesia for preventing chill and traction response of women during cesarean section. Methods: 68 women with cesarean section were divided into two groups (34 cases in each group) by random number table. The women in both groups underwent cesarean section under spinal anesthesia. After anesthesia, the women in control group were given intrathecal normal saline, and the women in observation group were given intrathecal dexmedetomidine hydrochloride. The hemodynamic changes at different time, the intraoperative sedation levels, and rates of chills and traction reactions of women were compared between the two groups. Results: There were no significant different in the sensory block time, the highest level of sensory block, the time of surgery preparation, the time from skin incision to delivery, and the time from uterine incision to delivery between the two groups (P>0.05). The recovery time of exercise block of women in observation group was significant shorter than that of women in control group (P<0.05). There were no significant different in values of SBP, DBP and HR of women at T0, T1, T2 and T3 time between the two groups (P>0.05). The incidence of chills, the proportion of chills 2-3 class, the incidences traction reaction, and the total rate of adverse reaction of women in observation group were significant lower than those of women in control group (P<0.05). The sedation level of women in observation group was better than that of women in control group (P<0.05). Conclusion: The using of dexmedetomidine after intrauterine spinal anesthesia during cesarean has good sedative effect, which can prevent chills and traction response during anesthesia, improve the recovery of motor block, and doesn’t affect hemodynamics.

2019 Vol. 27　(5):　589- [Abstract]（ 320 ） HTML (0 KB)  PDF  (0 KB)  ( 43 )

Objective: To observe the influence of dipeptidyl peptidase 4 (DPP-4) inhibitor on serum levels of betatrophin and lipidmetabolism of women with polycystic ovary syndrome (PCOS) initial diagnosed. Methods: 225 women with PCOS initial diagnosed were randomly divided into group A, B and C (75 cases in each group). The women in group A were treated by sitagliptin (DPP-4 inhibitor), the women in group B were treated by sitagliptin combined with diane-35, and the women in group C were treated by metformin combined withdiane-35. All the women were treated for 3 months. Body mass index (BMI), waist-to-hip ratio (WHR), glycolipid metabolism indexes, sex hormones levels and serum betatrophin levels were compared before and after treatment. Results: After treatment, the menstrual improvement of women in group A and B was better than that of women in group C, the improvement of acne or hirsutism of women in group B and C was better than that of women in group A (P<0.05). The values of BMI and WHR of women in group A and B were significant lower than those of women in group C(P<0.05).The levels of HbAlc, PPGE, MAGE, HOMA-IR, TC, TG, LDL-C and betatrophin of women in group A and B were significant lower than those of women in group C, and the level of HOMA-βwas significant higher (P<0.05), while there were no significant different in the levels of WHR, FPG, 2hPG, MBG, FINS, and HDL-C among the three groups (P>0.05). The levels of FSH, LH, T and A of women in group A and B were significant lower than those of women in group C (P<0.05), while the E2 and P levels had no significant different among the three groups (P>0.05). There was no any woman with adverse reaction in group A and B, which was significant lower than that (16.0%) of women in group C (P<0.05). Conclusion: DPP-4 inhibitor is safe and effective for treating women with PCOS initial diagnosed, which can alleviate IR, hyperandrogenemia, and glycolipid metabolism disorder of women.

2019 Vol. 27　(5):　599- [Abstract]（ 363 ） HTML (0 KB)  PDF  (0 KB)  ( 38 )

Objective: To observe the curative effect of interferon gel combined with Baofukang suppository for treating women with CIN Ⅲ after Loop electrosurgical excisional procedure (LEEP), and to analyze its influence on the level of inflammatory factors of women. Methods: 176 women with CIN Ⅲ who had experienced LEEP were as the research objects from May 2017 to September 2015. All the women were divided into control group (n=88) and study group (n=88) according to random number table. The women in control group were treated by Baofukang suppository, and the women in study group were treated by Baofukang suppository combined interferon gel. The serum levels of TNF-α and hs-CRP of all women were detected at 1 month after LEEP operation. The wound healing time of all women was counted. The curative effect, the rate of high risk HPV turned to negative, postoperative complication rate, and the recurrence rate of CIN within 1 years after treatment were compared between the two groups. Results: The healing time of the cervical wound of women (17.5±3.6d) in study group was significant shorter than that (25.2±4.2 d) of women in control group (P=0.000). 1 month after LEEP, the serum levels of TNF-α and hs-CRP were significantly decreased, and the serum levels of TNF-α and hs-CRP of women in study group were significant lower than those of women in control group (P<0.05). There was no significant different in the effecti-e rate (94.3% VS. 95.5%) between the two groups (P=0.732>0.05). The rate of high risk HPV turned to negative of women in study group (92.9%) was significant higher than that(66.2%) of women in control group (P=0.000). The incidence of postoperative complications (8.0%) and CIN recurrence rate during 1 year (2.41%) of women in study group were significant lower than those (19.3% and 11.9%) of women in control group (P=0.028, 0.018). Conclusion: Interferon gel combined with Baofukang suppository for treating women with CIN Ⅲ after LEEP can significantly decrease the inflammation reaction degree, shorten wound healing time, promote the high-risk HPV turned to negative, and reduce the risk of complications and recurrence of CIN, so it is worthy of gynecology clinical application.

2019 Vol. 27　(5):　608- [Abstract]（ 348 ） HTML (0 KB)  PDF  (0 KB)  ( 39 )

Objective: To explore the effect of Xinshenghua granules combined with tablets of mifepristone and misoprostol for treating women with missed abortion (MA), and to analyze its influence on serum levels of hypoxia-inducible factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF). Methods: 82 women with MA were enrolled, and were randomly divided into observation group and control group (41 cases in each group) from January 2017 to January 2018. The women in control group were treated by mifepristone and misoprostol tablets, and the women in observation group were treated by Xinshenghua granules combined with tablets of mifepristone and misoprostol. The efficacy rate and serum levels of HIF-1α and VEGF of women were compared between the two groups. Results: The complete abortion rate of women in observation group was 92.7%, which had no significant different from that (82.9%) of women in control group (P>0.05), but the time of embryo discharge and vaginal bleeding, and the volume of blood loss of women in observation group were significant less than those of women in control group (P<0.05). 1 and 2 weeks after treatment, the serum levels of HIF-1α and VEGF of all women were significant lower than those before treatment, and the serum levels of HIF-1α and VEGF of women in observation group were significant lower than those of women in control group (P<0.05). On the 7 day of treatment, the serum levels of HIF-1α and VEGF of women with vaginal bleeding stopped were significant lower than those of women with vaginal bleeding continually (P<0.05). In women with vaginal bleeding continually,  the serum levels of HIF-1α and VEGF of women in observation group were significant lower than those of women in control group  (P<0.05). There was no significant different in adverse reaction rate between the two groups (P>0.05). Conclusion: Xinshenghua granules combined with tablets of mifepristone and misoprostol for treating women with MA has the exact effect, which can promote embryo discharge, shorten the time of vaginal bleeding, and reduce the volume of vaginal bleeding. The mechanism may be related to the down regulation of serum HIF-1α and VEGF levels.

2019 Vol. 27　(5):　616- [Abstract]（ 322 ） HTML (0 KB)  PDF  (0 KB)  ( 55 )

Objective: To investigate the clinical efficacy of laparoscopy combined with GnRH-a for treating infertility women with endometriosis (EMT). Methods: 104 infertility women with EMT were selected and divided into two groups according to the different treatment methods (52 cases in each group). All included women were treated by laparoscopic surgery, and then the women in study group were given GnRH-a, and the women in control group were given oral contraceptives. The subjective symptoms, sex hormone levels, and antral follicles number of women was observed before and after treatment, the pregnancy rate, and the relapse rate of women were followed up. Results: The scores of pelvic symptoms, signs and subjective symptoms, and the levels of LH, FSH and E2 of women in study group were significant lower than those of women in control group in the 6th month after operation (P<0.05). There was no significant difference in AMH level between the two groups before and after operation (P>0.05). The total effective rate of study group was 92.3%, which was significant higher than that (76.9%) of control group (P<0.05). The number of AFC of women in both groups had decreased significantly in the 6th month after operation, but the number of AFC of women in study group was significant lower than that of women in control group. In 2 years after operation, the rate of natural pregnancy and fullterm delivery of women in study group were significant higher than those of women in control group, but the recurrence rate was significant lower than that of women in control group (P<0.05). The total incidence of adverse reaction of women in study group was significant higher than that of women in control group (P<0.05). Conclusion: Laparoscopy combined with GnRH-a for treating infertility women with EMT can effectively alleviate subjective symptoms, reduce estrogen and progesterone levels, protect ovarian function, prevent disease recurrence, and improve pregnancy rates.

2019 Vol. 27　(5):　624- [Abstract]（ 328 ） HTML (0 KB)  PDF  (0 KB)  ( 40 )

Objective: To explore the diagnosis and treatment of tubal pregnancy women with intraperitoneal hemorrhage. Methods：A retrospective analysis was conducted on 27 tubal pregnancy women with intraperitoneal hemorrhage and low serum HCG level（<1000mIU/ml）who experienced surgery in Beijing Haidian hospital. Results：The median value of serum HCG level of included women was 460.2mIU/ml. Surgery was the first choice for 74.1% (20/27) women, while 25.9%（7/27）women were transferred to surgery due to failure of MTX therapy. The feature of transvaginal sonography was the heterogeneous echopattern near to ovary. The median volume of bleeding in abdominal cavity was 800 ml. 70.4% tubal abortion and 25.9% tubal rupture was found during operation. The pain situation and the serum HCG level were related with volume of intraperitoneal bleeding. Literature review suggests that intraperitoneal bleeding of women with tubal pregnancy had complex clinical phenotype, there was no any single predictive factor could be used for predicting intraperitoneal bleeding occurred in women with tubal pregnancy. Conclusion: The tubal pregnancy women with Intraperitoneal hemorrhage may be have different clinical characteristic. The view of transvaginal sonography only used for predicting intraperitoneal bleeding because of tubal pregnancy rupture should be change, it is necessary to seek for clinical parameters which can be used for predicting intraperitoneal hemorrhage of women with tubal pregnancy.

2019 Vol. 27　(5):　632- [Abstract]（ 414 ） HTML (0 KB)  PDF  (0 KB)  ( 39 )

Objective: To explore the influences of different heart disease types and cardiac function status of pregnant women with heart disease on the maternal and infant prognosis. Methods: The data of 128 pregnant women with heart disease were retrospectively analyzed, and all included women were divided into group A (women with NYHAIII-IV class) and group B (women with NYHA I-II class) according to the type of heart disease and cardiac function. The maternal and child prognosis were compared between the two groups. Results: The cesarean section rate of women in group A was 94.3%, which was significantly higher than that (79.6%) of women in group B. The gestational weeks when delivery of women, the weight of the newborns in group A were significant higher than those of women in group B (P<0.05), but the incidences of maternal heart failure, premature delivery, low birth weight infants of full-term delivery, perinatal death, and neonatal asphyxia of women in group A were significant higher than those of women in group B (P<0.05). There were no significant different in cesarean section rate among the women with congenital heart disease, the women with rheumatic heart disease, the women with hypertensive heart disease, and the women with cardiomyopathy (P>0.05). The gestational weeks when delivery and weight of the newborn of women with arrhythmia were significant higher than those of women with other types of heart disease, but the rates of maternal heart failure, premature delivery, full-term low birth weight, perinatal death, neonatal asphyxia were significant lower (P<0.05). Conclusion: The pregnant women with NYHA III~IV class have higher rates of heart failure, premature delivery, full-term low birth weight, perinatal death, neonatal asphyxia, and they has worse maternal and child prognosis. As for pregnant women with different type of heart disease, the maternal and infant prognosis of women with arrhythmia is relatively better, and the maternal and infant prognosis of women with congenital heart disease, rheumatic heart disease, hypertensive heart disease, and cardiomyopathy are almost the same.

2019 Vol. 27　(5):　640- [Abstract]（ 307 ） HTML (0 KB)  PDF  (0 KB)  ( 31 )

Objective: To investigate clinical characteristics and pregnancy outcomes of elderly pregnant women. Methods: The data of 3624 pregnant women with single fetus and over 28 gestational weeks were retrospectively analyzed, and were divided into group A (2536 women with less 34 years old), aged group B (950 women with 34-40 years old), and group C (138 women with over 40 years old) according to the different maternal ages from March 2015 to February 2017. The situation of general conditions, prenatal examination, delivery mode, and the rate of pregnant complication, and the neonatal outcomes of pregnant women were compared among the three groups. Results: The incidence rate of postpartum hemorrhage, gestational hypertension, gestational diabetes mellitus, premature rupture of membranes, abruption of membranes, oligohydramnios, placenta previa, and placenta implantation of women in group B and C were significant higher than those of women in group A (P<0.017), but there were no significant different between group B and group C (P>0.017). The incidences of uterine fibroids, anemia, sexually transmitted diseases, and thyroid dysfunction ranking of women in group C were highest, but those in group A were lowest (P<0.017). The vaginal delivery rate of women in group A was highest, but that in group C were lowest (P<0.017). The incidences of fetal distress, macrosomia, fetal growth damage, and preterm birth of women in group B and group C were significant higher than those of women in group A, and rate of macrosomia in group C was significant higher than that of women in group B (P<0.017). There was no significant different in the rate of the neonatal asphyxia among three groups (P>0.017). Conclusion: Elderly pregnant women have higher incidence of gestational complications and poorer pregnancy outcomes, so the maternal examination and health education should be paid more attention to, and diagnosis and treatment of pregnant complications early can improve the pregnancy outcomes.

2019 Vol. 27　(5):　647- [Abstract]（ 303 ） HTML (0 KB)  PDF  (0 KB)  ( 43 )

Objective: To study the possibility of serum estrogen and progesterone levels of pregnant women in the first trimester for predicting their pregnancy outcomes. Methods: The data of 184 pregnant women were retrospective analyzed. The serum levels of estrogen and progesterone of all included pregnant women at the 5th gestational week (35-41 days) were measured and the pregnant situations of women before 14 gestational weeks were observed. ROC curve was drawn through estrogen level, progesterone level, and estrogen level combined with progesterone level. Results: The serum E2 level of normal pregnant women at the 5th gestational week was 1923.4±747.9pmol/L, which was significant higher than that of women with abortion (1476.8±621.0pmol/L), and the cut off value, the sensitivity, and the specificity of E2 level was 1666.2pmol/L, 0.837, and 0.825, respectively. The serum P level of normal pregnant women at the 5th gestational week was 99.2±27.0nmol/L, which was significant higher than that of women with abortion (71.2±24.2nmol/L), and the cut off value, the sensitivity, and the specificity of P level was 77.9nmol/L, 0.809, and 0.839, respectively. The area under of the ROC of E2 level combined with P level was 0.901, the sensitivity was 0.851, and the specificity was 0.825. Conclusion: The levels of estrogen and progesterone of pregnant women in the first trimester is both good prognostic indicator for pregnancy outcomes, but combination of levels of estrogen and progesterone for predicting pregnancy outcomes is better.

2019 Vol. 27　(5):　658- [Abstract]（ 337 ） HTML (0 KB)  PDF  (0 KB)  ( 38 )