超声造影联合血清CEA、CA72-4对卵巢良恶性肿瘤鉴别诊断的价值

目的:探讨超声造影联合血清癌胚抗原（CEA）、糖类抗原72-4（CA72-4）对卵巢良恶性肿瘤鉴别诊断的价值。方法:选取2017年1月至2018年6月本院肿瘤科收治的128例卵巢肿瘤患者进行研究，进行超声造影和血清CEA、CA72-4水平检测，观察超声造影、CEA、CA72-4及联合检测对卵巢良恶性肿瘤鉴别诊断的价值。结果:在良性肿瘤组中超声造影符合率为72.92%，恶性肿瘤组中超声造影符合率为75.00%，两组比较差异无统计学意义（P>0.05）；恶性肿瘤组患者血清CEA、CA72-4水平高于良性肿瘤组，两组比较差异有统计学意义（P<0.05）；恶性肿瘤组超声造影、CA72-4检测阳性率均高于良性肿瘤组（P<0.05），两组血清CEA检测阳性率比较差异无统计学意义（P>0.05），三者联合检测阳性率高于单项指标检测（P<0.05）；通过ROC曲线分析显示，CEA的AUC为0.644，诊断灵敏度为31.25%，特异性为82.29%，CA72-4的AUC为0.702，诊断灵敏度为40.63%，特异性为79.17%，二者联合检测的AUC为0.785，诊断敏感性为56.25%，特异性为73.96%；三项指标单独检测，超声造影检测的灵敏度、阳性预测率、阴性预测率、诊断准确度及误诊率最高，CEA检测的特异性、漏诊率最高，三者联合检测的灵敏度、特异性、阳性预测率、阴性预测率、诊断准确度最高，漏诊率、误诊率最低。结论:超声造影联合血清CEA、CA72-4检测较单独检测诊断效能高，对卵巢良恶性肿瘤鉴别诊断有较高参考价值。     

The potential role of assisted oocyte activation in the management of a POSEIDON group 3 patient with fertilization failure: A case report and literature review

ObjectiveAssisted oocyte activation combined with ICSI (ICSI-AOA) has been reported to improve fertilization outcomes of couples with oocyte activation deficiency (OAD). Although there's no sufficient evidence to support ICSI-AOA as routine use, it might be beneficial for POSEIDON group 3 patients with suspected oocyte-related OAD.Case reportA 29-year-old female presented with a history of primary infertility for two years. She was classified as a POSEIDON group 3 patient and had a total fertilization failure history. With the help of ICSI-AOA, six oocytes were successfully fertilized. Pregnancy was later confirmed after embryo transfer. A living infant was born after 34 weeks of pregnancy.ConclusionOAD should be taken into consideration for POSEIDON group 3 patients since low Antimüllerian hormone is associated decreased quality. Further research needs to be done to understand the mechanism underlying oocyte-related OAD and the potential role of ICSI-AOA in young patients with suboptimal ovarian response.     

CircKIF4A靶向调控miR-384表达对卵巢癌SKOV3细胞增殖和凋亡的影响

Objective?To explore the effect of circKIF4A on the proliferation and apoptosis of ovarian cancer SKOV3 cells and its regulatory mechanism on miR-384. Methods?The qRT-PCR method was used to detect the expression of circKIF4A and miR-384 in ovarian cancer tissues and adjacent tissues. si-NC, si-circKIF4A, miR-NC, miR-384 mimics, si-circKIF4A and anti-miR-NC, si-circKIF4A and anti-miR-384 were transfected into SKOV3 cells respectively. The qRT-PCR method was used to detect the expression of circKIF4A and miR-384 in SKOV3 cells. MTT experiment and flow cytometry experiment were used to detect cell proliferation and apoptosis respectively. The dual luciferase reporter experiment was used to detect the targeting relationship between circKIF4A and miR-384. Results?Compared with adjacent tissues, the expression level of circKIF4A in ovarian cancer tissues was increased [(1.00±0.06), (4.28±0.32)] (t=62.915, P＜0.05), and the expression level of miR-384 was decreased [(1.00± 0.05), (0.43±0.03)] (t=61.047, P<0.05). After transfection with si-circKIF4A, the OD value of SKOV3 cells was decreased [(0.75±0.05), (0.41±0.03)] (t=17.493, P＜0.05), and the apoptosis rate was increased [(6.36±0.53)%, (23.19± 2.21)%] (t=22.216, P<0.05). After transfection of miR-384 mimics, the OD value of SKOV3 cells was decreased [(0.73±0.05), (0.47±0.04)] (t=12.182, P＜0.05), and the apoptosis rate was increased [(7.53±0.41)%, (19.11)±1.06)%] (t=30.567, P<0.05). The dual luciferase report experiment confirmed that circKIF4A could adsorb miR-384 and can act as a sponge molecule for miR-384. After co-transfection with si-circKIF4A and anti-miR-384, the OD value of SKOV3 cells was increased [(0.40±0.04), (0.65±0.03)] (t=15.000, P＜0.05), and the apoptosis rate was decreased [(25.20± 2.21)%, (10.37±0.86)%] (t=18.761, P＜0.05). Conclusion?Inhibition of circKIF4A expression could negatively regulate the expression of miR-384, thereby inhibiting the proliferation of ovarian cancer cells and inducing apoptosis.     

获卵数低多囊卵巢综合征患者再次促排卵的妊娠结局及影响因素分析#br#

Objective?To investigate the impact of different ovulation induction protocols on the clinical outcomes and analyze related factors when polycystic ovarian syndrome(PCOS) patients whose number of eggs obtained last time equal to or less than five received the ovarian hyperstimulation treatment again. Methods?The retrospective analysis was made on the clinical data of 242 PCOS patients whose number of eggs obtained last time was equal to or less than five in in vitro fertilization and embryo transfer(IVF/ICSI) in the Reproductive Center of Peking University Third Hospital from January 2011 to December 2018 who received the ovulation induction treatment again. The amount of Gn used, the number of eggs obtained, and the pregnancy outcome of different ovulation induction protocols was compared. At the same time, the multi-factor linear regression analysis model was used to analyze the related factors affecting the accumulative live birth rate. Results?242 patients used the ultra-long protocol, long protocol, short protocol, and antagonist protocol for ovarian hyperstimulation. The number of eggs obtained was 12.46±2.66, 12.28±86, 10.64±1.77, 13.25±0.97, respectively. There was no statistical difference among different groups (P=0.780). The amount of Gn used and the number of days of use in the antagonist protocol group was significantly smaller than those of the ultra-long protocol and long protocol groups (P＜0.05). The amount of Gn used in the ultra-long protocol group was significantly bigger than that of the long protocol, short protocol, and antagonist protocol groups (P＜0.05). In 115 transplant cycles, the rate of embryo implantation, clinical pregnancy rate, and accumulative live birth rate of different ovulation induction protocols had no statistical difference (P＞0.05). The multi-factor regression analysis showed that the treatment method was the important affecting factor of the accumulative live birth rate (P＜0.05) and the number of eggs obtained was a mediating variable. Conclusion?For PCOS patients whose number of eggs obtained last time was not big, after another time of ovulation induction, the average number of eggs obtained maybe bigger than ten and an ideal reproduction assistance outcome could be achieved.     

中国卵巢上皮性癌维持治疗指南（2021年版）

        卵巢恶性肿瘤是女性生殖系统常见的恶性肿瘤之一，中国人群卵巢癌新发病例为52 100例/年，死亡达22 500例/年［1］。由于缺乏有效的早期筛查手段，患者就诊时多为晚期，中国卵巢癌患者5年生存率约为40%［2］。近年来，随着抗血管生成药物、聚腺苷二磷酸核糖聚合酶（poly ADP-ribose polymerase，PARP）抑制剂等靶向治疗药物的出现及相关维持治疗研究结果的公布，有效地延长了晚期患者的生存期，改变了卵巢癌的治疗策略。 浏览更多请关注本刊微信公众号及当期杂志。