女性生育力评估

随着人口老龄化和生育力的下降,我国放开了三孩政策,对有生育要求的夫妇进行生育力评估显得非常必要。女性生育力与年龄关系密切,还依赖于卵巢、输卵管、子宫等生殖器官。本文就影响女性生育力的因素进行介绍。     

卵巢硬化性间质瘤的研究进展

卵巢硬化性间质瘤是一种临床罕见的卵巢良性肿瘤，其发病率低，病因不明确，以年轻女性多见，多为单侧肿块，常因月经不规则出血或体检发现腹部包块而就诊。影像学检查可见“湖岛征”、“快进慢出”和“向心性强化”等改变。病理组织学见单侧类圆形囊实性肿块，“假小叶”为特征性病变。免疫组织化学可见抑制素、波形蛋白和肌动蛋白等阳性表达。确诊主要通过病理组织学诊断，影像学检查具有重要参考价值。术前诊断困难，容易与卵巢纤维瘤、卵泡膜细胞瘤、卵巢库肯勃瘤和颗粒细胞瘤等相混淆。手术治疗为主要治疗手段，多采用患侧肿瘤切除术或附件切除术，术后预后较好，卵巢功能可恢复正常。对于肿瘤细胞出现核分裂象和坏死较多时，需警惕复发风险，建议长期跟踪随访。     

Turner Syndrome and Fertility

Turner syndrome (TS) is tightly associated with hypergonadotropic hypogonadism and ovarian dysgenesis, typically resulting in infertility in the great majority of patients. Therefore females with TS are usually treated with female sex steroids from 11–12 years of age until the normal age of natural menopause of around 53–54 years of age. Infertility is rated among females with TS as a distressing concern and a detractor from a good quality of life. Options for motherhood for females with TS has expanded during recent years. Originally, only adoption was an option, unless of course for the small minority of TS females that still has ovarian function and are capable of achieving pregnancy through normal means. Oocyte donation has become the mainstream option in many countries and seems to work well, especially if patients have been treated with optimal estrogen and gestagen for a prolonged time before the intervention. It comes with an increased risk of cardiovascular complications and TS oocyte donation pregnancies are viewed as high risk pregnancies necessitating increased vigilance. Oocyte cryopreservation of own oocytes is also becoming an option in a select group of TS and has special challenges. Ovarian tissue cryopreservation is a promising new techniques that has been applied successfully in children with cancer. Currently, several trials are running around the world evaluating this techniques in TS. The genetics and genomics behind the ovarian dysgenesis seen in TS is not understood, but new studies have elucidated global changes in DNA methylation and RNA expression in blood from persons with TS and it is likely that similar changes are present in the ovaries. We still, however, need more thorough research to fully uncover the genetic background of ovarian failure in TS. Gene expression studies and methylation analysis from ovarian TS tissues still needs to be performed.     

免疫治疗在卵巢癌中的应用研究进展

卵巢癌的临床早期症状不明显，筛查手段有限，就诊时常处于晚期阶段，5年生存率仅30%~45%，严重威胁着女性健康。免疫治疗尤其是免疫检查点抑制剂治疗因其持久的抗肿瘤效应已被批准用于晚期或复发性的多种类型癌症的治疗。目前免疫治疗的一些研究进展为卵巢癌患者的临床管理提供了新的机遇与挑战。     

New evidence supporting lung cancer screening with low dose CT & surgical implications

IntroductionLung cancer is the leading cause of cancer-death worldwide. The U.S. Preventative Services Task Force (USPTSF) approved screening for current or former smokers aged 55–80 based on the results of the National Lung Screening trial (NLST). Following the NLST, new evidence has emerged from clinical trials and updates to previous trials prior to the anticipated update to the USPSTF guideline. We review the new evidence on lung cancer screening with low dose computed tomography (LDCT) and the surgical implications.MethodsA review of new literature was performed pertaining to lung cancer screening since implementation of UPSTF guidelines. Articles for inclusion were identified by both authors’, then search of the Pubmed and Cochrane database was performed from January 1st, 2013 through February 4th, 2020 using the MeSH search terms: “lung cancer”; “screening”; “low dose CT”. The results of these studies are summarized.ResultsWe identified multiple prospective randomized control trials and meta-analysis since the NLST supporting lung cancer-specific mortality with screening. We identified new nodule classification systems and the development of risk-models which may reduce false positive rates and identify high risk patients not currently eligible for screening. Finally, we discussed the surgical implications of screening.ConclusionNew data supports NLST findings and show ongoing benefit to LDCT for lung cancer screening. Standardized LDCT screening classification has been shown to reduce harm and lower false positive rates. Further study is needed regarding use of risk-modeling. Screening will require an increase in the thoracic workforce to accommodate the amount of surgically operable cancers.     

多囊卵巢综合征患者血清外泌体中miR-184的表达水平及其对卵巢颗粒细胞增殖的影响

目的研究多囊卵巢综合征(PCOS)患者血清外泌体中miR-184的表达水平及其对卵巢细胞颗粒增殖的影响。方法回顾性选取2018年2月至2020年4月期间盘锦辽油宝石花医院收治的60例PCOS患者作为PCOS组,另纳入同期30名健康成年女性作为对照组,提取2组受试者血清外泌体。应用实时荧光定量聚合酶链式反应(qRT-PCR)法检测2组受试者血清外泌体中及人卵巢颗粒细胞KGN和人正常卵巢上皮细胞IOSE80中的miR-184的相对表达。转染miR-184抑制剂的KGN细胞设为miR-184抑制剂组,转染抑制剂对照物的KGN细胞设为对照组,不做任何处理的KGN细胞设为空白组。应用MTT法检测各组KGN细胞的增殖情况,应用平板克隆实验检测各组KGN细胞的克隆形成率。结果PCOS患者血清外泌体中和KGN细胞中的miR-184的相对表达量为4.23±0.49、5.81±0.73,显著高于对照组(1.32±0.21)和IOSE80组细胞(1.19±0.15),差异有统计学意义(P<0.05)。miR-184抑制剂组KGN细胞在24、48、72、96 h的吸光度值分别为0.20±0.05、0.22±0.07、0.26±0.08、0.29±0.07,均显著低于阴性对照组(0.31±0.09、0.52±0.11、0.78±0.12、0.96±0.18)和空白对照组(0.31±0.08、0.53±0.10、0.77±0.14、0.94±0.18),克隆形成率(26.78±5.98)%显著低于阴性对照组[(45.98±4.12)%]和空白对照组[(43.56±4.34)%],差异有统计学意义(P<0.05)。结论PCOS患者血清外泌体和人卵巢颗粒细胞KGN中miR-184呈现高表达,PCOS的发病可能与miR-184促进卵巢颗粒细胞增殖有关。