艾灸合暖宫贴干预寒湿凝滞型痛经的临床观察

目的探讨艾灸合暖宫贴对寒湿凝滞型痛经女大学生痛经症状、疼痛程度和睡眠质量的影响。方法选择寒湿凝滞型痛经女大学生80例,随机分为西药组和艾灸合暖宫贴组,每组40例,共观察4个月经周期。采用中医痛经症状评分、疼痛视觉模拟评分(visual analogue scale,VAS)和匹兹堡睡眠质量指数评分(Pittsburgh sleep quality index,PSQI),评定患者治疗前、第3个月经周期(治疗期间)、第4个月经周期(停止治疗)的痛经症状、疼痛程度和睡眠质量的变化情况。结果治疗后的第3个月经周期,两组的中医痛经症状评分、VAS评分和PSQI评分均较前明显下降(P<0.05)。第4个月经周期,停止治疗后,西药组的中医痛经症状评分、VAS评分较第3个月经周期上升(P<0.05),但较治疗前评分降低(P<0.05);艾灸合暖宫贴组中医痛经症状评分、VAS评分和PSQI评分与西药组比较,差异有统计学意义(P<0.01)。结论艾灸合暖宫贴可以改善寒湿凝滞型痛经女大学生的痛经症状、疼痛程度和睡眠质量,疗效具有持久性,值得推广应用。     

高强度聚焦超声联合甲氨蝶呤在瘢痕子宫妊娠行宫腔镜微创清宫术中的应用效果分析

目的 探究采用高强度聚焦超声(HIFU)联合甲氨蝶呤(MTX)在瘢痕子宫妊娠行宫腔镜微创清宫术中的应用效果。方法 选择2018年5月—2019年5月在本院接受宫腔镜治疗的108例瘢痕子宫妊娠患者,依据随机数字表法分为研究组与对照组,每组各54例。对照组使用HIFU预处理,研究组则使用HIFU联合MTX的方式预处理,处理后两组均行宫腔镜辅助微创清宫术。通过随访分析比较两组的治疗效果及妊娠结局。结果 研究组术后7 d血清β-HCG水平为(28 598.38±2 176.52)U/L,低于对照组的(32 423.13±2 734.65)U/L,差异有统计学意义(t=8.042,P<0.001);研究组血清β-HCG转阴时间、月经恢复时间、住院时间分别为(21.33±3.78)d、(28.21±3.83)d、(6.53±2.12)d,分别短于对照组的(26.72±4.83)d、(33.82±4.91)d、(9.53±2.67)d,差异具有统计学意义(t=6.458、6.620、6.466,P均<0.001)。两组均随访≥24个月,宫内妊娠、未孕、流产、再次瘢痕子宫妊娠、异位妊娠比较,差异无统计学意义(χ2=1.895,P>0.05);宫内妊娠中足月分娩与早产比较,差异无统计学意义(χ2=0.131,P>0.05),研究组并发症发生率为22.58%,低于对照组的37.50%,差异有统计学意义(χ2=5.296,P=0.021)。结论 在宫腔镜辅助微创清宫术治疗瘢痕子宫妊娠前使用HIFU联合MTX预处理的效果优于单一使用HIFU预处理,可明显缩短患者血清β-HCG转阴时间、月经恢复时间与住院时间,但对女性的妊娠结局无影响,妇产科临床治疗前可结合患者需求择取最合适的预处理方案。     

瘢痕子宫再次妊娠产妇行椎管内分娩镇痛的效果

目的观察瘢痕子宫再次妊娠产妇行椎管内分娩镇痛的安全性和有效性。方法选择2017年5月至2018年4月我院收治的瘢痕子宫再次妊娠同意阴道试产单胎足月头位产妇101例,随机选取分娩镇痛产妇70例为观察组,其中硬膜外分娩镇痛(E组)36例,腰-硬联合分娩镇痛(C组)34例,同期未镇痛产妇31例为对照组(N组)。记录产妇各产程时间、出血量、新生儿1、5 min Apgar评分、阴道分娩、产钳助产、子宫破裂情况,记录镇痛前、给药后5、10、20 min产妇NRS评分和Bromage评分。结果与N组比较,E组和C组第二产程时间明显延长(P0.05);E组出血量高于N组及C组,但差异无统计学意义。三组第一、第三产程时间、新生儿1、5 min Apgar评分、阴道分娩、产钳助产、子宫破裂发生率差异无统计学意义;镇痛后E组和C组NRS评分均呈下降趋势。与E组比较,C组NRS评分明显降低(P0.05)。结论瘢痕子宫再次妊娠产妇采用椎管内分娩镇痛安全可行,不降低阴道分娩率,不增加出血量以及产钳助产、子宫破裂发生率。腰-硬联合分娩镇痛较硬膜外分娩镇痛的镇痛效果好。     

Guideline-concordant endometrial cancer treatment and survival in the Women's Health Initiative Life and Longevity After Cancer study

In the Women's Health Initiative (WHI) Life and Longevity After Cancer (LILAC) cohort, we examined predictors of guideline-concordant treatment among endometrial cancer (EC) survivors and associations between receipt of guideline-concordant treatment and survival. Receipt of guideline-concordant EC treatment was defined according to year-specific National Comprehensive Cancer Network (NCCN) guidelines. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for predictors of guideline-concordant treatment receipt. We estimated multivariable-adjusted hazard ratios (HRs) and 95% CIs for relationships between guideline-concordant treatment and overall survival using Cox proportional hazards regression. We included 629 women with EC, of whom 83.6% (n = 526) received guideline-concordant treatment. Receipt of guideline-concordant treatment was less common among women with nonendometrioid histology (OR = 0.24, 95% CI = 0.13–0.45) but was more common among women living in the Midwest (OR = 2.09, 95% CI = 1.06–4.12) or West (OR = 3.02, 95% CI = 1.49–6.13) compared to the Northeast. In Cox regression models adjusted for age, histology and stage, receipt of guideline-concordant EC treatment was borderline associated with improved overall survival (HR = 0.80, 95% CI = 0.60–1.01) in the overall population. Guideline-concordant treatment was also linked with better overall survival among women with low-grade uterine-confined endometrioid EC or widely metastatic endometrioid EC. Guideline-concordant treatment varies by some patient characteristics and those women in receipt of guideline-concordant care had borderline improved survival. Studies evaluating regional differences in treatment along with randomized clinical trials to determine appropriate treatment regimens for women with aggressive tumor characteristics are warranted.     

Uterine,but not ovarian,female reproductive organ involvement at presentation by diffuse large B‐cell lymphoma is associated with poor outcomes and a high frequency of secondary CNS involvement

Involvement of the internal female reproductive organs by diffuse large B‐cell lymphoma (DLBCL) is uncommon, and there are sparse data describing the outcomes of such cases. In total, 678 female patients with DLBCL staged with positron emission tomography/computed tomography and treated with rituximab‐containing chemotherapy were identified from databases in Denmark, Great Britain, Australia, and Canada. Overall, 27/678 (4%) had internal reproductive organ involvement: uterus (n = 14), ovaries (n = 10) or both (n = 3). In multivariate analysis, women with uterine DLBCL experienced inferior progression‐free survival and overall survival compared to those without reproductive organ involvement, whereas ovarian DLBCL was not predictive of outcome. Secondary central nervous system (CNS) involvement (SCNS) occurred in 7/17 (41%) women with uterine DLBCL (two patients with concomitant ovarian DLBCL) and 0/10 women with ovarian DLBCL without concomitant uterine involvement. In multivariate analysis adjusted for other risk factors for SCNS, uterine involvement by DLBCL remained strongly associated with SCNS (Hazard ratio 14·13, 95% confidence interval 5·09–39·25, P < 0·001). Because involvement of the uterus by DLBCL appears to be associated with a high risk of SCNS, those patients should be considered for CNS staging and prophylaxis. However, more studies are needed to determine whether the increased risk of secondary CNS involvement also applies to women with localized reproductive organ DLBCL.     

Noncatalytic PTEN missense mutation predisposes to organ-selective cancer development in vivo

Inactivation of phosphatase and tensin homology deleted on chromosome 10 (PTEN) is linked to increased PI3K–AKT signaling, enhanced organismal growth, and cancer development. Here we generated and analyzed Pten knock-in mice harboring a C2 domain missense mutation at phenylalanine 341 (Pten^FV), found in human cancer. Despite having reduced levels of PTEN protein, homozygous Pten^FV/FV embryos have intact AKT signaling, develop normally, and are carried to term. Heterozygous Pten^FV/+ mice develop carcinoma in the thymus, stomach, adrenal medulla, and mammary gland but not in other organs typically sensitive to Pten deficiency, including the thyroid, prostate, and uterus. Progression to carcinoma in sensitive organs ensues in the absence of overt AKT activation. Carcinoma in the uterus, a cancer-resistant organ, requires a second clonal event associated with the spontaneous activation of AKT and downstream signaling. In summary, this PTEN noncatalytic missense mutation exposes a core tumor suppressor function distinct from inhibition of canonical AKT signaling that predisposes to organ-selective cancer development in vivo.     

Melatonin‐related genes expressed in the mouse uterus during early gestation promote embryo implantation

Melatonin, a superior antioxidant, is an important molecule which regulates female reproduction due to its receptor‐mediated and receptor‐independent antioxidant actions. In this study, we investigated the effect of melatonin on early gestation in a mouse model. During early gestation, the expression of the melatonin's rate‐limiting enzyme, AANAT, gradually increased – in the uterus while the MT2 melatonin receptor was only expressed at day 2 of gestation and no MT1 was detected. Based on these findings, we conducted a melatonin injection experiment which demonstrated that 15 mg/kg melatonin significantly improved the number of implantation sites and the litter size. Also, the blastocyst and uterus were collected to identify the local action of melatonin. In the melatonin‐treated mice, the endometrium was thicker than in the control mice; melatonin also caused an increase in density of uterine glands, and the uterine gland index (UGI) was significantly elevated over that of the control. Serum steroid hormone measurements revealed that at day 6 of gestation (postimplantation), melatonin significantly downregulated the E₂ level, with no obvious effects on progesterone. Gene expression assay revealed that melatonin significantly upregulated expression of HB‐EGF, a crucial gene involved in implantation as well as its receptor ErbB1 in the blastocyst. In addition, PRA, an important gene which influences the decidual response and luminal cell differentiation, p53, which regulates uterine through leukaemia inhibitory factor (LIF), were both increased after melatonin treatment. These data suggest that melatonin and its MT2 receptor influence early gestation. Exogenous melatonin treatment can improve mouse embryo implantation and litter size, which may have important applications in human reproductive health and animal husbandry.     

高强度聚焦超声消融治疗子宫肌瘤时妊娠一例报告并文献复习

高强度聚焦超声(high-intensity focused ultrasound,HIFU)消融治疗子宫肌瘤作为一种新的非侵入性的治疗方式,已越来越广泛地用于子宫肌瘤的治疗。但是对于HIFU治疗时妊娠的处理及妊娠结局鲜有文献报道。本文报道1例HIFU消融治疗子宫肌瘤时妊娠的病例,结合文献复习,探讨子宫平滑肌瘤对妊娠的影响、子宫平滑肌瘤不同处理方式对妊娠的影响、HIFU消融治疗子宫肌瘤时机选择的问题、HIFU消融治疗子宫肌瘤若同时合并妊娠时胎儿去留的问题以及近期HIFU消融治疗子宫肌瘤后对流产手术操作的影响等,以期对HIFU治疗子宫肌瘤的适应证、选择合适的治疗时间及术后选择合适的妊娠时机展开讨论。     

Uterine physiology

The role of the uterus is to nurture the fetus until delivery. It is composed of the fundus, body and cervix. Functionally, the uterus is largely under hormonal control and undergoes significant change throughout pregnancy. At parturition a shift in the balance of hormones causes cervical remodelling and uterine contraction, leading to ejection of the fetus. A number of medicines impact uterine function and can be used to both induce or prevent labour.     

Unexpected uterine smooth muscle tumor of uncertain malignant potential and sarcoma: A single center cohort study in South Korea

ObjectiveTo evaluate the risk of encountering unexpected uterine smooth muscle tumors of uncertain malignant potential (STUMPs) or sarcomas during surgical treatment of mesenchymal tumors of the uterus using morcellation.Material and methodsData were collected retrospectively from subjects who were pathologically diagnosed with uterine leiomyoma or its variants, STUMP or other premalignant mesenchymal tumors of uterus, or sarcoma during surgical treatment between July 2014 and June 2017.ResultsA total of 3785 women were investigated; 2824 laparoscopic procedures (74.6%) were performed, and an electronic power morcellator was used in 1636 patients (43.2%). Sixteen women (0.42%) were diagnosed with STUMP and 14 (0.37%) were diagnosed with uterine sarcoma. The incidence rate of unexpected STUMP or uterine sarcoma was 0.61% (23 of 3785 women); unexpected STUMP in 13 (0.34%), and unexpected sarcoma was in 10 (0.26%). Moreover, the unexpected leiomyosarcoma rate was 0.08% (3 in 3785). The rate of unintended morcellation of STUMPs was relatively high at 0.26% (10 in 3785), however, that for uterine sarcomas was 0.05% (2 in 3785).ConclusionThe risks of unintended morcellation were very low for sarcomas and STUMPs, although the risk of the latter was approximately 5-fold that of the former. To reduce the unintended dissemination of tumors, patients suspected of having malignancies should be provided adequate information regarding their treatment options as well as their associated risks. Meanwhile, improved preoperative screening methods for STUMP and sarcoma should be established.