Background: It has been recognized that Periodic acid–Schiff (PAS) staining of amyloid deposits reveals weak or negative in the majority of AL amyloidosis. However, a subset of patients exhibits PAS-positive deposits, and their clinicopathological significance remains unclear. Methods: We retrospectively analyzed 269 patients with renal biopsy-proven AL amyloidosis from our institution; 72 were classified as PAS-positive and 197 as PAS-negative. Baseline demographics, clinical data, renal pathology features, treatment strategies, and prognostic information were collected. Multivariable linear regression and Cox proportional hazards models were used to determine the impact of PAS-positive amyloid deposition on renal function and patients’ outcomes. Results: Compared with the PAS-negative group, PAS-positive patients had higher serum creatinine (94.40 vs. 79 μmol/L, P = 0.005) and increased renal insufficiency ratio (31.94 % vs. 14.72%, P = 0.002). Histopathology showed more severe glomerular and interstitial amyloid deposition (P = 0.037, P = 0.049, respectively). In multivariable linear regression, PAS-positive deposits (β = 0.158, P = 0.005) were independently associated with higher serum creatinine. PAS-positive patients showed significantly worse renal survival (HR 3.05, 95% CI: 1.40 – 6.65, P = 0.005), independent of age, treatment regimens, renal stage, and pathological cores. Meanwhile, PAS-positive staining was an adverse prognostic factor (HR 2.34, 95% CI: 1.24 – 4.43, P = 0.009) for overall survival after adjusting for AL-type, age, treatment, organ involvement, interstitial fibrosis and tubular atrophy, and total amyloid burden. Conclusion: PAS-positive amyloid deposits are associated with more severe renal injury and poorer prognosis in AL amyloidosis.

OBJECTIVES:This study evaluates the relationship between renal amyloid deposition burden in kidney biopsy and a renal staging system based on proteinuria and estimated glomerular filtration rate (eGFR) in AL amyloidosis. METHODS:A total of 248 patients diagnosed via renal biopsy were included. The extent of amyloid deposition in glomeruli, blood vessels, and tubulointerstitium were evaluated semiquantitatively. The total amyloid load (TA) was defined by the sum of glomerular, vascular and interstitial deposits. RESULTS:Patients were categorized into three renal stages: I, II, and III. Findings showed that scores of pathological parameters increased progressive with advancing renal stage. The median TA values were 6 (IQR 3-8) in Stage I, 7 (IQR 5-8) in Stage II, and 8 (IQR 7-11) in Stage III (p < 0.001). Baseline eGFR was inversely correlated with TA (r = -0.363, p < 0.001), while proteinuria showed no significant association. Cox regression analysis identified eGFR <50 mL/min/1.73 m2 as an independent risk factor for renal survival (HR, 6.519; 95% CI, 3.110-13.665; p < 0.001), whereas proteinuria did not show such an effect. CONCLUSIONS:These findings suggest that in the renal staging system, eGFR - but not proteinuria - is significantly associated with amyloid deposition and independently affects renal survival.

Introduction and hypothesisThe objective was to retrospectively analyze the midterm efficacy of laparoscopic high uterosacral ligament suspension (HUS) and sacrocolpopexy (SC) in the treatment of moderate to severe apical prolapse.MethodsPatients who underwent laparoscopic HUS and SC in our center from 2013 to 2019 with follow-ups were included, consisting of laparoscopic HUS (group A, n=72) or SC (mesh added, group B, n=54). The general data of patients, pelvic organ prolapse quantitative examination (POP-Q) score, Pelvic Floor Distress Inventory short form 20 score (PFDI-20) before and after operation, perioperative conditions, Patient Global Impression of Improvement (PGI-I), and postoperative complications were collected for statistical analysis and comparison between groups.ResultsThere was no statistical difference in preoperative data between groups. The median follow-up time was 48 months. The objective recurrence rate of group A was higher than that of group B, without statistical significance. One patient in group B had a second operation owing to recurrence. The exposure rate of mesh in group B was 3.70%. There was no significant difference in deviation of POP-Q and PFDI-20 pre- and post-operation. The proportion of new defecation abnormalities in group A was lower. The total hospitalization expenses and surgical consumables in group B were significantly higher than those in group A.ConclusionsThe midterm curative effect of laparoscopic HUS is similar to that of SC in the treatment of moderate to severe apical prolapse. The former has the advantages of less intraoperative blood loss, shorter postoperative hospital stay, lower cost, fewer new defecation abnormalities, and there were no complications related to mesh.

The objective was to compare the differences in pelvic and levator ani muscle diameters in women with and without anterior pelvic organ prolapse. Three groups were included, including 50 nulliparous women (nulliparous group), 50 women with stage III–IV anterior vaginal prolapse (prolapse group), and 50 women of the same age as the prolapse group but without prolapse (nonprolapse control group). The ischial interspinous diameter (ISD), anterior pelvic area (APA), levator defect score (LDS), levator ani hiatus width (LH-W), H-line, M-line, levator ani plate length, levator ani plate angle, and cervix length (CL) were measured. There were no significant differences in ISD (10.6±0.8 vs 10.6±0.9 cm), LH-W (3.0±0.4 vs 3.3±0.4 cm), or CL (2.9±0.6 vs 3.0±0.5 cm) between the nulliparous group and the nonprolapse control group (p>0.05). However, there were significant differences between them and the prolapsed group (11.2±0.6 cm, 3.6±0.4 cm, 4.2±1.5 cm; p<0.05). There were no significant differences in LDS (0.70±0.61 vs 0.70±0.65) or APA (58.4±8.4 vs 60.1±7.4 cm2) between the nonprolapse control group and the prolapse group (p>0.05), but they were significantly different from those of the nulliparous group (0.08±0.34, 55.1±6.0 cm2) (p<0.05). The area under the receiver-operating characteristic curve for the ISD of nonprolapse control and prolapse groups was 0.713, and the cutoff value was 10.95 cm. The levator ani hiatus width and cervix length were larger in patients with anterior vaginal prolapse than in those without prolapse. An ischial ISD greater than 10.95 cm was associated with prolapse.

目的 探讨包块型剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)的临床特点及治疗方法.方法 回顾性分析2010年1月～2020年12月我院28例包块型CSP的临床特征及诊治情况.均有人流、药流或清宫史,术后异常阴道出血21例(其中失血性休克3例),血hCG下降不理想7例.入院距上次手术时间1～120 d,中位数21 d,其中<2周6例.包块直径14～66(35.3±14.7)mm;包块与膀胱间子宫肌层厚度1～5(1.7±1.0)mm.血β-hCG>1000 mIU/ml 18例(64.3％).行宫腔镜手术10例,宫、腹腔镜联合手术9例,腹腔镜手术5例,开腹手术4例.结果 行CSP残留组织清除27例,其中13例同时行剖宫产瘢痕修补,联合双侧子宫动脉栓塞或双侧子宫动脉上行支阻断6例,联合甲氨蝶呤治疗4例;腹腔镜全子宫双侧输卵管切除1例.手术均顺利完成,无并发症发生.其中5例术中或术后输悬浮红细胞400 ml.术后18～52 d(中位数26 d)血β-hCG降至正常范围.除全子宫切除术患者,余27例术后21～54 d月经复潮.结论 剖宫产瘢痕处剩余肌层薄和包块大是包块型CSP的两个重要特点,可采用联合治疗以减少并发症,提高疗效.

Introduction and hypothesis To investigate the tissue reactions of a novel porcine-derived urinary bladder matrix/small intestinal submucosa (UBM/SIS) biological mesh and SIS mesh implanted in a rabbit vaginal defect model. Methods Thirty-two rabbits were implanted with UBM/SIS mesh (Group A) and SIS mesh (Group B), respectively. Rabbits were sacrificed at 7, 14, 60, and 180 days after implantation. The tensile strength, elongation at break, and elastic modulus of the tissue were measured using biomechanical methods. The inflammatory response, cell infiltration, vascularization, and collagen fibers were observed. Results Compared with Group B, the tensile strength and elongation at break of group A was higher at 14, 60, and 180 days. The elastic modulus of group A was lower at 180 days. Inflammatory response of group A was milder at 14, 60, and 180 days. There was more cell infiltration in group A at 7 and 14 days. Vascularization was higher in group A at 7 days and 14 days. The order of collagen in group A was better at 14, 60, and 180 days. The proportion of thick red fibers in both groups showed an increasing trend. At 14 days, group A had more thick red fibers. Conclusions The novel UBM/SIS composite mesh had a milder inflammatory response; earlier induction of cell infiltration, angiogenesis, and collagen regeneration. Collagen fibers had a better order. It has a higher tensile strength and greater elongation at break, and can be used as a potential material for the treatment of pelvic organ prolapse.

目的 探讨女性术后慢性盆腔痛的病因、诊断流程及治疗方法.方法 回顾性分析2019年7月 ～2020年6月我院诊治的60例术后慢性盆腔痛资料.根据病因进行个体化治疗,包括加巴喷丁、神经阻滞、抗生素、口服避孕药、手术、中成药等.疗效评价标准:①完全缓解,疼痛消失,视觉模拟评分(Visual Analogue Scale,VAS)降至0分;②部分缓解,疼痛减轻,VAS评分或疼痛频率降低≥50％;③无效,VAS评分及疼痛频率降低<50％.结果 诊断神经病理性疼痛34例(56.7％),盆腔炎症性疾病11例(18.3％),子宫内膜异位症7例(11.7％),盆腔炎症性疾病合并神经病理性疼痛2例(3.3％),盆腔炎症性疾病合并子宫内膜异位症2例(3.3％),子宫内膜异位症合并神经病理性疼痛2例(3.3％),肠易激综合征1例(1.7％),原因不明1例(1.7％).除5例因备孕未治疗外,55例治疗后随访1～9个月,平均2.6月.完全缓解18例,部分缓解34例,无效3例.有效率94.5％(52/55).结论 手术相关女性慢性盆腔痛可能的病因包括神经病理性疼痛、子宫内膜异位症、盆腔炎症性疾病,亦可能为消化系统或泌尿系统疾病,诊断过程中应仔细鉴别,针对病因进行个体化治疗.

Objective: This study aims to evaluate the risk factors for subjective recurrence and complications of patients who underwent transvaginal synthetic mesh surgery. Design: This retrospective cohort study included patients who received transvaginal mesh (TVM) surgery between January 2005 and June 2019. Methods: The information of patients was collected, including basic characteristics, subjective recurrence, and mesh-related complications. The clinical characteristics of patients with and without subjective recurrence were compared. The sexual activities of patients before and after the operation were recorded. SPSS 20.0 was used for the statistical analysis. Results: A total of 257 patients were included. Among them, 62 (24.1%) patients were lost to follow-up. The median follow-up time was 80 months (12 months, 170 months). Finally, 195 patients were followed up, 11 (5.6%) patients had a subjective recurrence of pelvic organ prolapse, and 26 (13.3%) patients had mesh-related complications (11 patients with de novo pain and 15 patients with mesh exposure). We found significant differences in age (68.9 ± 5.1 vs. 63.4 ± 5.8 years old), years of postmenopause (17.5 ± 6.3 vs. 13.3 ± 6.9 years), previous hysterectomy (27.3% vs. 6.0%), and concomitant hysterectomy (45.5% vs. 81.0%) between patients with and without subjective recurrence (p < 0.05). The mesh exposure proportion of patients with total vaginal mesh (47.6%) was significantly higher than that with anterior vaginal mesh (2.9%) (p < 0.05). Furthermore, 6.7% of sexually active patients reported de novo dyspareunia. Limitation: The investigators could only record the subjective recurrence of patients, and thus there is a lack of objective recurrence data. Conclusion: Age, years of postmenopause, and previous hysterectomy are risk factors for subjective recurrence of TVM surgery; however, concomitant hysterectomy is a protective factor. Mesh exposure is the most common complication, especially for total vaginal mesh repair surgery.

剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)是剖宫产术潜在的远期并发症之一.其流行病学研究对于临床实践和公共卫生决策具有重要指导意义.本文综述了 CSP相关流行病学研究报道的现状及不足,并展望未来研究方向,以期为把握疾病发生发展规律、评估社会疾病负担提供参考资料.

Purpose The aim of the study was to investigate the sexually inactive status of patients with pelvic organ prolapse before colpocleisis and postoperative satisfaction and regret rate. Methods A retrospective study of patients with pelvic organ prolapse who underwent colpocleisis was conducted in our hospital from January 2007 to April 2019. Records were reviewed before surgery for general clinical characteristics, duration, and reasons for being sexually inactive. Follow-up was conducted by telephone about patient satisfaction, Patient Global Impression of Improvement score, and regret rate after surgery. Results The mean age of the 247 patients was 73.8 ± 5.58 years. A total of 76.9% (190/247) described the duration of being sexually inactive, and the mean time was 12.6 ± 8.69 years. The 247 patients gave the following reasons for being sexually inactive: 52.2% (129/247) were widowed and 37.2% (92/247) reported the physical health factors of their spouses or sexual partners. The first male factor was nervous system disease (37.0%, 34/92). A total of 5.3% (13/247) were patient-related factors and 5.3% (13/247) were factors of both the male and female. A total of 195 patients underwent follow-up, the rate was 78.9% (195/247), and the follow-up time was 39.7 ± 37.5 (2–140) months. A total of 98.5% (192/195) of patients were very satisfied. A total of 98.9% (193/195) of patients were very much improved or improved in Patient Global Impression of Improvement score. A total of 1.02% (2/195) of patients regretted having colpocleisis nearly 2 years later. Conclusions The main reason for being sexually inactive was having been widowed. Colpocleisis was associated with high satisfaction rates and low regret rate.

Objective: To assess surgical outcomes of implanted porcine small intestinal submucosa (SIS) mesh in the rabbit vesicovaginal space (VVS) and explore its application value in pelvic floor reconstruction surgery. Methods: Sixteen male rabbits were randomly divided into four groups, and each group had four rabbits. All groups of rabbits were implanted with SIS mesh in the vesicovaginal space. They were humanely killed after a postoperative period of 7, 30, 90 and 180 days by group. The grafted area was removed with the surrounding bladder and vaginal tissues. The specimens were embedded in paraffin and then stained with HE and Masson's trichrome stains for visual observations, cells counts, and assessment of tissues and collagen fibers. Results: (1) After HE staining, a large number of inflammatory response cells mainly eosinophils and lymphocytes infiltrated around the SIS mesh in 7 days group, and neovascularization was observed, the infiltration area of inflammatory response cells further increased in 30 days group, the infiltration area of inflammatory response cells significantly reduced in 90 days group, while the inflammatory response basically subsided in 180 days group. (2) After Masson's trichromestaining, the collagen structure of SIS mesh in 7 days group was clear and intact. While, the collagen structure of SIS mesh was partially degraded in 30 days group, the SIS meshes of 4 rabbits were completely degraded, but the collagen fragments of SIS remained in 90 days group. In 180 days group, the SIS mesh of all rabbits was degraded, and one of them had the formation of new collagen fibers. Conclusions: SIS mesh implanted into the VVS of rabbits can lead to a transient non infective inflammatory reaction, which could be completely degraded and a small amount of new collagen fibers could be produced after 180 days of implantation. Which shown that SIS mesh should be used cautiously in pelvic floor reconstruction surgery.

目的 探讨单孔腹腔镜在妇科常见手术中的应用价值.方法 选取2016年4月—2018年8月在本院实施的单孔腹腔镜手术66例作为单孔腹腔镜组,其中输卵管切除27例,附件囊肿剔除术25例,全子宫附件切除14例;选取相同疾病的传统腹腔镜手术66例作为传统腹腔镜组,比较手术时间、切口开关时间、手术操作时间、术中出血量、术后疼痛评分(采用视觉模拟评分法,简称VAS评分)、术后住院时间、患者满意度情况.结果 两组均成功实施手术,无手术并发症发生.单孔腹腔镜组附件手术总时间(37.5±11.2)min、切口开关时间(8.4±2.6)min、手术操作时间(27.4±10.4)min,均明显长于传统腹腔镜组(20.1±6.4)min、(3.5±0.4)min、(18.1±7.9)min,差异有统计学意义(P<0.001);单孔腹腔镜组术中出血量(10.2±3.9)ml、术后疼痛VAS评分(4.4±1.3)分均高于传统腹腔镜组(3.5±1.6)ml、(2.7±0.8)分,差异有统计学意义(P<0.001).单孔腹腔镜组子宫切除手术总时间(62.1±22.1)min、切口开关时间(7.9±2.9)min、手术操作时间(45.5±19.3)min,均明显长于传统腹腔镜组(41.2±12.4)min、(3.4±0.7)min、(32.1±9.9)min,差异有统计学意义(P<0.05);单孔腹腔镜组术中出血量(25.7±12.6)ml、术后疼痛VAS评分(5.1±1.6)分高于传统腹腔镜组(12.4±3.8)ml、(3.4±1.4)分,差异有统计学意义(P<0.05).单孔腹腔镜组对手术的主观评价明显优于传统腹腔镜组,非常满意率分别为72.7％(48/66)和59.1％(39/66).结论 单孔腹腔镜行妇科常见手术,手术时间、操作难度增加,但切口美观隐匿,患者治疗满意度增加,在妇科疾病的治疗中有一定的应用价值.

Various contents, relatively insufficient class hours, few practical operation opportunities and lack of teacher-student interaction are the main difficulties in clinical clerkship teaching of gynecology and obstetrics. In this study, the flipped classroom, surgery simulation training system and online self-test module are added to the clinical clerkship teaching of obstetrics and gynecology, and also the WeChat group interactive platform is established to make up for the deficiency of traditional teaching mode. The questionnaire survey showed that 59 clerkship students' satisfaction with the course was 92.6 points, 98.3% of students thought that the surgery simulation training was helpful, and 93.2% of them thought that the flipped classroom was helpful, and the students' scores of the final exam was higher than those of the previous students in the same period with the same difficulty of the exam. Therefore, rational use of flipped classroom, surgery simulation training system and other modules can improve the overall effect of clinical clerkship teaching in gynecology and obstetrics to a certain extent.

Objective: To explore the incidence, clinical characteristics, management strategies and reproductive outcomes of cesarean scar pregnancies (CSP) after in vitro fertilization-embryo transfer (IVF-ET). Methods: The patients who were diagnosed with CSP followed IVF/ET in the Center for Reproductive Medicine of Peking University Third Hospital between April 1, 2010 and March 31, 2020 were included. The clinical data of each patient were analyzed retrospectively. Results: There were a total of 1 441 patients with secondary infertility complicated with a history of cesarean section and achieved clinical pregnancy after IVF-ET treatments, of which CSP accounted for 1.94% (28/1 441). The average age of CSP patients was (34±3) years old, and 50.0% (14/28) of the patients had a history of artificial abortion. The incidence of CSP in embryo transfers at the cleavage stage had no significantly difference from transfers at the blastocyst stage (1.74% vs 2.20%, χ(2)=0.408, P=0.523), and the incidence of CSP in fresh embryo transfers had no significantly difference from frozen-thawed embryo transfers (1.77% vs 2.23%, χ(2)=0.372, P=0.542). The average gestational age at diagnosis was (47±6) days. According to the classification based on imaging examination during early pregnancy, a case of type Ⅰ CSP received expectant treatment and achieved live birth at third trimester of pregnancy. Two cases of heterotopic cesarean scar pregnancy underwent transvaginal selective reduction of CSP, and intrauterine pregnancies were followed by live births at third trimester of pregnancy. One case of type Ⅲ CSP underwent laparoscopic CSP excision and uterine repair, and 24 patients with type Ⅰ or type Ⅱ CSP underwent hysteroscopic CSP excision with/without uterine artery embolization. After CSP treatment, 5 patients achieved clinical pregnancy through embryo transfer, all of which were normal intrauterine pregnancy followed by term live birth. Conclusions: Color ultrasonography should be performed during early pregnancy to confirm the occurrence of CSP in patients receiving IVF-ET after previous cesarean section. Treatment of CSP should be individualized, and patients with Type Ⅰ CSP who are strictly selected have the opportunity for expectant treatment.

目的 探讨单一部位切口腹腔镜手术(laparoendoscopic single-site surgery,LESS)在巨大卵巢肿瘤(直径>10 cm)中的应用价值.方法 对2017年4月～2018年12月在我院因巨大卵巢囊肿行卵巢囊肿剔除或患侧附件切除的46例资料进行回顾性分析,其中LESS 23例,肿瘤直径(16.32±5.06)cm,传统三孔腹腔镜手术23例,肿瘤直径(14.08±2.78)cm,2组差异无显著性(t=1.861,P=0.069).比较2组手术时间、术中出血量、手术并发症、术后24 h疼痛视觉模拟评分(Visual Analogue Scale,VAS)、住院时间、术后满意度.结果 LESS组行卵巢囊肿剔除18例,患侧附件切除2例,卵巢肿瘤分期手术(大网膜部分切除+盆腔及腹主动脉旁淋巴结活检)3例;三孔组分别为16例、6例、1例.2组手术过程顺利,均无术中及术后并发症.LESS组无囊肿破裂,三孔组囊肿破裂5例(21.7％),差异有显著性(P=0.049),2组术式、手术时间、术中出血量、术后住院时间差异无显著性(P>0.05),但术后切口疼痛VAS评分LESS组[(4.17±1.24)分]高于三孔组[(3.47±0.94分)](t=2.157,P=0.036).术后6个月2组满意度差异无显著性(P>0.05).结论 对于巨大卵巢肿瘤,LESS手术难度低,探查全面,安全可行,患者满意度高,具有一定的应用价值.

This study compared the efficacy of neoadjuvant chemotherapy (NACT) followed by radical surgery (RS) vs primary surgical treatment (PST) in patients diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage IB2/IIA2 cervical cancer. Data of 303 cervical cancer patients who received primary therapy for stage IB2/IIA2 cervical cancer at 7 medical centers in Beijing, China between January 1, 2009 and December 31, 2016 and followed through December 31, 2017 were collected retrospectively. The response rates, surgical characteristics, and overall survival (OS) durations of patients who received NACT followed by RS were compared to those of patients who received PST. An improved short-term complete response rate was observed among patients who received intra-arterial chemotherapy compared with patients who had intravenous chemotherapy (18.3% vs 4.1%, P-difference=.020). Patients who received NACT were more likely to undergo laparoscopic surgery and to have a lower blood loss volume (555.4 +/- 520.2 ml vs PST, 682.5 +/- 509.8 ml; P=.036) and increased estimated operative time (249.9 +/- 101.9 vs PST, 225.1 +/- 76.5 min; P=.022). No differences in high-risk factors (HRFs), the effects of supplemental treatment, or 5-year OS were observed between patients who received NACT and PST. Our findings indicate that patients who received NACT for FIGO stage IB2/IIA2 cervical cancer were more likely to undergo laparoscopic surgery. These findings have important implications regarding treatment with curative intent for stage IB2/IIA2 cervical cancer and warrant a further analysis of treatment strategies to ensure adequate treatment and patient-centered care.

卵巢上皮性癌是妇科常见的恶性肿瘤之一,其死亡率位居妇科恶性肿瘤之首.循环肿瘤细胞(circulating tumor cells,CTCs)作为“液体活检”的一种方式,具有创伤小、可实时动态监测等优点,运用一定的检测方法“抓取”外周血中的CTCs,分析其在卵巢上皮性癌中的诊断价值、与分期的关系,以及其在化疗监测、评估、预后、预测复发及耐药等方面的作用,从而更好地指导临床工作.

Objective To explore the value of primary and Advanced levels of laparoscopic simulating training in different seniority of gynecologic residents.Methods 77 residents in their first to forth training-year were divided into two groups:1-2 year resident and 3-4 year resident,trained with different levels of simulating training plans respectively and then assessed in the Department of Obstetrics and Gynecology in Peking University Third Hospital.Results The qualified rate of primary and advanced simulation training was 85.7％ and 57.1％ respectively.The qualified rate of primary training (80.4％ vs.100.0％,P=0.028) and advanced training (12.5％ vs.57.14％,P=0.000) were significantly different between 1-2 year residents and 3-4 year residents.The operative skills improved significantly in all the residents.In the 1-2 year residents,the scores of the primary training increased more obviously,while in the 3-4 year residents,the scores of the advanced training increased significantly.Conclusion It might be more effective for residents with different seniority to receive different levels of simulating training accordingly,so as to improve their laparoscopic operative skills more effectively.

目的 探讨再发性剖宫产瘢痕妊娠(recurrent cesarean scar pregnancy,RCSP)的临床特征和处理选择.方法 回顾性分析我科2002年1月～2018年10月诊治的10例RCSP初次及再次瘢痕妊娠的临床特点、影像学特征、治疗及结局.结果 RCSP患者就诊孕周较初次CSP明显缩短[(6.3±1.0)周vs.(8.0±1.8)周,t=2.055,P=0.070].初次剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)超声及MR测量剖宫产瘢痕部位厚度平均2.48 mm和1.66 mm,RCSP时分别为2.53 mm和1.87 mm.10例20次CSP中,19次MR测量的切口厚度比超声测量的厚度薄,最大相差2.7 mm,差异有统计学意义(t=3.774,P=0.001).初次CSP和RCSP患者的剖宫产瘢痕缺陷均以梯型为主.仅1例术前注射甲氨蝶呤,9例单纯行宫腔镜妊娠病灶清除,其中2例可疑穿孔行腹腔镜探查和腹腔镜子宫修补术,1例因梯形切口缺陷过大同时行瘢痕切除及子宫修补手术.出血均<50 ml.结论 建议将MR作为RCSP的常规评估方法,对瘢痕的厚度评估更准确,术前药物预处理不是必要步骤,但RCSP患者瘢痕部位剩余肌层菲薄时如果单纯行宫腔镜手术应警惕子宫穿孔.

The dynamic transcriptional regulation and interactions of human germlines and surrounding somatic cells during folliculogenesis remain unknown. Using RNA sequencing (RNA-seq) analysis of human oocytes and corresponding granulosa cells (GCs) spanning five follicular stages, we revealed unique features in transcriptional machinery, transcription factor networks, and reciprocal interactions in human oocytes and GCs that displayed developmental- stage-specific expression patterns. Notably, we identified specific gene signatures of two cell types in particular developmental stage that may reflect developmental competency and ovarian reserve. Additionally, we uncovered key pathways that may concert germline-somatic interactions and drive the transition of primordial-to-primary follicle, which represents follicle activation. Thus, our work provides key insights into the crucial features of the transcriptional regulation in the stepwise folliculogenesis and offers important clues for improving follicle recruitment in vivo and restoring fully competent oocytes in vitro.