目的 研究人文素质教育融入妇产科学专业教育用于临床医学本科妇产科学教学中的效果。方法 选取桂林医学院2016级五年制临床医学本科专业学生314人作为研究对象，均在本院校接受妇产科学理论课及见习课的学习，将314名学生按班级随机平均分为实验组和对照组，各157名，分别采用人文素质教育融合专业教育模式和传统教育模式进行妇产科学教学，对比两组教学效果。结果 ①实验组临床医学生的理论考试、临床操作技能考试及医患沟通能力测试得分均明显高于对照组，差异有统计学意义（P<0.05）；②实验组临床医学生对妇产科学兴趣提升及对老师的教学评价均明显高于对照组，差异有统计学意义（P<0.05）。结论 临床医学本科专业学生在妇产科学教学期间采用人文素质教育与专业教育精准融合的教学模式有助于加强学生对理论知识和临床操作技能的掌握，同时也可以有效地提高他们的医患沟通能力，提升他们对妇产科学的学习兴趣，并且对老师的教学非常满意，效果确切。

目的:探讨耐药性妊娠滋养细胞肿瘤(gestational trophoblastic neoplasia,GTN)患者的临床资料,分析发生耐药的可能因素.方法:回顾性选取2010年1月-2018年1月桂林医学院附属医院收治的耐药性GTN患者40例.收集及分析40例患者的临床资料,分析40例患者耐药后治疗方案及疾病转归.结果:40例患者中,22例患者距离前次妊娠时间>1年,30例患者发生转移,30例患者初始化疗前血清β-hCG>104 U/L.初始化疗采用单药化疗方案17例,采用联合化疗方案23例,耐药后均采用联合化疗方案,其中3例患者行子宫全切术.随访3～10年,37例患者治愈,3例患者死亡,总体治愈率92.5％.结论:GTN患者具有发病潜伏期长、高水平血清β-hCG、存在转移病灶易发生耐药,耐药性GTN采用联合化疗是高度可治愈的,联合化疗辅助手术治疗可以增加患者的治愈率.

目的 分析血清人附睾蛋白(HE)4、血管内皮生长因子(VEGF)水平预测卵巢癌大鼠腹腔热化疗(IPHC)预后的效能.方法 选取成年雌性SD大鼠45只,随机抽取15只作为空白对照组,剩余30只建立为卵巢癌模型并分为模型组和IPHC组各15只,于建模后检测大鼠血清HE4、VEGF水平,对IPHC组实施IPHC治疗,评估大鼠预后,分析血清HE4、VEGF水平预测卵巢癌大鼠IPHC预后的效能.结果 饲养3 w时,模型组及IPHC组血清HE4、VEGF水平高于空白对照组,差异有统计学意义(P<0.05);干预结束时,3组间血清HE4、VEGF水平由高到低为模型组、IPHC组、空白对照组,组间比较差异有统计学意义(P<0.05);IPHC组有5只抑瘤率<50％为预后不良组,10只抑瘤率≥50％为预后良好组;初步比较预后不良组与预后良好组血清HE4、VEGF水平后,经回归分析检验结果显示,饲养3 w血清HE4、VEGF高水平是IPHC预后不良发生的危险因素(OR>1,P<0.05);绘制受试者工作特征(ROC)曲线发现,血清HE4、VEGF水平用于预测IPHC预后不良的曲线下面积(AUC)均>0.80,均有一定预测价值.结论 卵巢癌大鼠血清HE4、VEGF水平呈现表达上调,与卵巢癌大鼠IPHC预后有关,并可作为预后预测指标.

目的:分析子宫内膜癌淋巴结转移患者的危险因素及预后.方法:收集2015年9月～2019年9月在桂林医学院附属医院接受全面分期手术的198例子宫内膜癌患者的临床病理资料,探讨淋巴结转移的危险因素及与预后的关系.结果:淋巴结转移率8.6％(17/198),非子宫内膜样癌、低分化、FIGO分期晚、深肌层浸润、淋巴血管间隙浸润、MELF浸润和宫颈间质浸润是子宫内膜癌患者淋巴结转移的危险因素(P<0.05).Logistic回归分析显示,低分化、淋巴血管间隙浸润、深肌层浸润是淋巴结转移的独立危险因素(P<0.05).患者5年总生存率为94.9％,无淋巴结转移者生存率明显高于有淋巴结转移者,差异有统计学意义(P<0.05).结论:子宫内膜癌总体预后良好,存在低分化、淋巴血管间隙浸润、深肌层浸润这些危险因素时应行系统盆腔和腹主动脉旁淋巴结切除.

子宫内膜癌是女性生殖系统最常见的恶性肿瘤之一,手术治疗是最重要的治疗手段,根据术后的高危因素可以辅助放疗、化疗、靶向治疗和免疫治疗.本文简述有关子宫内膜癌治疗方面的研究进展,包括手术治疗、放疗与化疗、靶向治疗与免疫治疗等方面,旨在帮助临床制定合理的子宫内膜癌的治疗手段.

OBJECTIVE:To compare the efficacy and safety between laparoscopy and local injection with absolute ethanol (AE) for treating tubal ectopic pregnancy (EP). STUDY DESIGN:Retrospective cohort study of ectopic pregnancies in the fallopian tube from two tertiary hospitals between January 2015 and December 2017. Clinical information such as presenting symptoms, reproductive history, possible risk factors, initial diagnosis, serum beta-human chor-ionic gonadotropin (β-HCG) level, transvaginal ultrasonography findings, methods of treatment and outcomes were reviewed and analyzed. RESULTS:A total of 119 patients were identified for this study. The diagnosis was based on clinical manifestations, ultrasonography scan and dynamic serum β-HCG. 71.4% of women (85/119) had at least one risk factor for ectopic pregnancy, with the most common risk factors being a history of induced labor, uterine curettage, spontaneous abortion or tubal pregnancy. 64 patients were managed by laparoscopic surgery (Group A) and 2 subjects were failure and followed by a systemic methotrexate (MTX) prescription. The other 55 patients had local injection with absolute ethanol, of which 9 cases failed, followed by a second local injection and intramuscular MTX. The HCG decrease rate post absolute ethanol injection was a value predictive factor for prognosis. Moreover, the pregnancy rate one-year post treatment in local injection subjects (10/55, 18.2%) was higher than that of surgical subjects (5/64, 7.8%). CONCLUSION:Local injection of absolute ethanol and laparoscopic surgery for tubal ectopic pregnancy are both effective and relatively safe, but laparoscopic surgery has better efficacy and shorten hospitalization day. Local injection may be less invasiveness and thus beneficial to fertility preservation.

目的:探讨采取案例教学结合健康宣教提升妇产科临床教学效果.方法:以前来我院实习的106例学生作为研究对象,将所有学生随机分作2批各53例,分别归入研究组、对照组,两组均予以健康宣教,研究组在教学中增添案例教学法,统计两组成绩,并调查实习生对临床教学效果评分,调查学生对临床教学的满意度.结果:研究组理论、实操成绩均高于对照组,P<0.05;研究组实习生的理论联系实际效果、临床思维能力效果、临床实践能力效果、激发学习兴趣效果等评分均高于对照组,P<0.05;研究组对教学满意度高达94.34％,远高于对照组79.25％,P<0.05.结论:将案例融入到妇产科临床教学中,联合健康宣教,能够有效提升教学质量,帮助学生深入掌握各项理论、实操知识.

目的 应用加速康复外科理念(ERAS)在子宫肌瘤腹腔镜手术围手术期进行护理干预,观察对患者术后康复的影响.方法 选择该院2016年3月—2018年3月子宫肌瘤患者120例,两组各60例,随机分为对照组和研究组,对照组患者进行传统常规护理,研究组患者进行ERAS护理干预.记录患者相关临床恢复时间、并发症及住院费用.结果 研究组患者首次下床活动时间、 首次排气时间、 排便时间、 正常进食时间和住院时间分别为(12.45±2.71)h、(18.29±3.07)h、(9.89±0.30)h、(20.40±3.74)h和(6.14±0.71)d,均低于对照组(14.70±2.63)h、(21.33±3.15)h、(9.32±0.29)h、(23.19±3.82)h和(7.82±0.76)d,差异有统计学意义(u=9.84,10.33,9.41,11.05,8.96,P<0.05).研究组患者依从性、满意度分别为(97.92±5.70)分和(98.76±4.08)分、均高于对照组(92.47±5.33)分和(93.29±3.41)分,差异有统计学意义(u=12.57,13.06,P<0.05),研究组并发症总发生率和住院费用分别为3.33％(2/60)和(9520.38±224.61)元,均低于对照组11.67％(7/60)和(12463.75±253.40)元,差异有统计学意义(χ2=9.19,u=14.28,P<0.05).结论 ERAS运用于妇科子宫肌瘤腹腔镜手术围手术期护理干预安全有效,能够促进患者术后康复,提高护理依从性和满意度,减少术后并发症的发生和住院费用.

Ovarian cancer is one of the most common gynecologic malignancy with poor prognosis. Recently, long noncoding RNAs (lncRNAs) have been identified as key regulators in cancer development. The current study investigated the role of lncRNA P73 antisense RNA 1T (TP73-AS1) in ovarian cancer. Quantitative real-time polymerase chain reaction determined the expression levels of TP-73AS1, matrix metallopeptidases (MMPs) messenger RNA. Cell proliferative ability, cell invasion, and migration were CCK-8 and colony formation, and transwell invasion and migration assays, respectively. The protein levels of matrix metallopeptidase 2 (MMP2) and MMP9 were measured by Western blot. TP73-AS1 was upregulated in the ovarian cancer tissues and ovarian cancer cells, and upregulation of TP73-AS1 was associated with poor prognosis. Knockdown of TP73-AS1 significantly suppressed cell proliferation, invasion, and migration of SKOV3 cells, and overexpression of TP73-AS1 promoted cell proliferation, invasion, and migration of OVCA429 cells. In addition, knockdown of TP73-AS1 suppressed the in vivo tumor growth. Tumor metastasis RT2 profiler polymerase chain reaction array showed that MMP2 and MMP9 was significantly upregulated by TP73-AS1 overexpression in ovarian cancer cells. TP73-AS1 overexpression enhanced the expression of MMP2 and MMP9 in ovarian cancer cells. Knockdown of MMP2 and MMP9 attenuated the effects of TP73-AS1 overexpression on cell invasion and migration. The clinical data showed that MMP2 and MMP9 were upregulated and positively correlated with TP73-AS1 expression in ovarian cancer tissues. Collectively, our results demonstrated the oncogenic role of TP73-AS1 in ovarian cancer, and targeting TP73-AS1 may represent a novel approach in battling against ovarian cancer.

The molecular mechanisms of normal cervical squamous epithelium advancing to cervical intraepithelial neoplasia (CIN) and eventually to cervical squamous cell carcinoma (CSCC) are largely unknown. This study explored abnormal expression of Yin Yang 1 (YY1) in cervical cancer and its correlation with the expression of E-cadherin and human papillomavirus (HPV) 16 E6. YY1, E-cadherin and HPV16 E6 expression were detected by immunohistochemistry in 90 cervical tissue specimens collected from 30 patients with hysteromyoma, 15 patients with CIN I, 15 patients with CIN II-III, and 30 patients with CSCC. The H-score method was employed to measure the expression of YY1, E-cadherin and HPV16 E6. Increased expression of YY1 and HPV16 E6, and the decreased expression levels of E-cadherin were strongly associated with malignant transformation of the cervical epithelium and the histological progression of CSCC. The expression of YY1 in cervical tissues was inversely correlated with E-cadherin expression, and positively correlated with HPV16 E6 expression. Expression of YY1 in CSCC tissues was not significantly correlated with tumor differentiation, but was significantly correlated with an advanced clinical stage of CSCC. These results suggest that up-regulation of YY1 is closely associated with the progression of CSCC, and YY1 may play an important role in the pathogenesis of cervical cancer by modulating the expression of E-cadherin and HPV16 E6.

Endometrial cancer is the most common gynecologic malignancy and about 80% of these cancers are endometrial endometrioid carcinoma (EEC). Previously, we have demonstrated that protocadherin 10 (PCDH10) is a tumor suppressor gene in EEC, and in this study we further explored the molecular mechanisms of PCDH10 in EEC. We first detect the PCDH10 expression in EEC tissues and then investigate the mechanism in two EEC cell lines. The mRNA and protein expression levels were measured by quantitative real time PCR (qRT-PCR) and western blot, respectively; Cell growth was determined by MTS, CCK-8 and colony formation assays; Cell cycle was determined by flow cytometry, and cell apoptosis was examined by flow cytometry and TUNEL assay. The downstream mediator of PCHD10 was confirmed by Topflash luciferase reporter assay. QRT-PCR and western blot results showed that PCDH10 was down-regulated in EEC clinical tissues. Restoration of PCDH10 suppressed cell growth and induced apoptosis in EEC cells. Dishevelled, EGL-10 and Pleckstrin domain containing 1 (DEPDC1) was a potential downstream mediator of PCDH10 as revealed by RNA-sequencing, and mechanistic studies suggested that DEPDC1 is a downstream mediator and promotes cell growth and induces apoptosis in EEC cells. Western blot further showed that PCDH10 restoration activate apoptotic signaling pathway via caspase signaling in both EEC cell lines and EEC clinical tissues. Collectively, our results suggest that PCDH10-DEPDC1-caspase signaling may be a novel regulatory axis in EEC development and it will be of great interest to explore the clinical significance of PCDH10 and DEPDC1 in the future.

Objective: To observe the influence of chewing gum on the intestinal function recovery after comprehensive stage surgery in patient with gynecological malignant tumor .And to provide new ideas and theo-retical basis for clinical nursing and improve the level of postoperative care .Methods: 104 cases of gynecolog-ic malignant tumor patients, received comprehensive stage surgery , were selected as objects in our hospital from January 2014 to July 2015.They were randomly divided into the control group and the intervention group , 52 cases in each group.The patients in control group given were routine postoperative nursing , and the inter-vention group application method of chewing gum care based on the control group .Mainly observed the patient's exhaust time, defecation time, intestinal peristalsis, normal eating time and length of hospital stay , the postoperative adverse reactions incidence , and evaluated patient's quality of life, the compliance and nursing satisfaction.Results:The exhaust time, intestinal peristalsis recovery time, defecation time, normal eating time and hospital stay time of the intervention group were respectively (25.46±3.08) h, (37.62±3.77) h, (39.20±4.15) h, (2.82±0.16) d and (11.29±0.69) d, which were lower than the control group, the differ-ence was statistically significant (P<0.05).The postoperative adverse reactions incidence of the intervention group was 9.62% (5/52), which was lower than the control group 19.23% (10/52), the difference was sta-tistically significant (P<0.05).The postoperative quality of life and nursing satisfaction results of the interven -tion group were respectively (84.93±5.98) points and (96.82±7.11) points, which was higher than the con-trol group, the difference was statistically significant (P <0.05).Conclusion: Chewing gum after gynecologic malignant tumor staging comprehensive surgery can significantly shorten the intestinal function recovery time , reduce the postoperative adverse reactions ,and it can improve the quality of life and nursing satisfaction , and they have the certain nursing compliance .

Objective To observe the effect of chewing gum on the recovery of gastrointestinal tract in patients with gynecologic malignant tumor,and to provide a reference for the clinical nursing.Method 86 patients with gynecological malignant tumor staging were selected as the research group,after the surgery to give conventional care +chewing gum;92 cases of gynecological malignant tumor staging patients were selected as the control group,the control group received conventional care.Results The differences in the event of hunger,flatus,bowel movement,defecation time and hospitalization time of patients in two groups were compared,the difference was statistically significant (P <0.001);complications in the Research Group(nausea,intestinal obstruction,vomiting and abdominal distension)total incidence rate was 5.81%,compared with the control group,the difference was statistically signifi-cant (P <0.001).There was no significant difference between the two groups of patients in the 2 days after the operation,the differ-ence was not statistically significant (P >0.05).Conclusion Chewing gum is beneficial to promote the recovery of intestinal func-tion after surgery,and it is worthy of clinical application.

Objective to optimize the cleaning,disinfection and sterilization process of gynecological diagnosis uteroscope, and explore an economic, security, and efficient sterilization method. Method 120 cases of uteroscopes after used were recruited in this study. these uteroscopes were randomly divided into three groups for sterilization with 40 cases in each group: Group A were first clean with traditional method and then soaked in 2% common glutaraldehyde for 30 minutes;Group B were using enzyme and ultrasonic for cleaning, followed by 75% alcohol lavaging intra cavitary, and then soaked in 2% common glutaraldehyde for 30 minutes; Group c were using enzyme and ultrasonic for cleaning, and then soaked in 2%common glutaraldehyde for 30 minutes; all the three groups were sampling and cultivation.Result the cleaning and sterilization rate in Group a were 57.5% (23/40) and 52.5% (21/40) respectively; while both of these two rate in group B were 100%(40/40); However, the cleaning and sterilization rate in Group a were 90% (36/40) and 80% (32/40). after statistical analyzed, the cleaning rate in Group B and C were significant higher than that in Group A, Howerver, the sterilization rate in Group B was significant higher than that in group A and group C.Conclusion enzyme and ultrasonic cleaning can not only improve the uteroscope cleaning quality , but also shorten cleaning time ; 75% alcohol lavaging intracavitary can rapidly improve the sterilization rate of diagnostic uteroscope sterilization. This method is economical, efficient, safe, reliable, and especially suitable for clinical application.

Objective:To investigate the effective method of interrupting the vertical transmission of the hepatitis B virus(HBV)from father to infant.Methods:120couples with serum HBV-DNA positive in men and anti-HBs positive in women were selected as subjects and they were divided into GroupⅠand GroupⅡ based on whether they were injected with hepatitis B specific immunoglobulin.Women in Group Ⅰ were injected with hepatitis B specific immunoglobulin 200IU monthly since the 28th week duration of pregnancy;and women in GroupⅡ weren't injected with hepatitis B specific immunoglobulin.Another 60couples with serum HBV-DNA positive in men and without hepatitis virus infection in women were selected as the control group(GroupⅢ).The anti-HBs and HBV-DNA of the neonates in the 3groups were all determined after birth by testing the serum of cord blood.Results:Positive rate of anti-HBs of infants in GroupⅠ,GroupⅡand GroupⅢ were55.00%,51.67%,0.00%respectively.The positive rate of anti-HBs in GroupⅠandⅡ was obviously higher than that in the control group(P0.05).23.33%of neonates in Group I and 25.00% of neonates in GroupⅡand 43.33%of neonates in GroupⅢ were infected by HBV.The infection rate of HBV in the observation group was significantly lower than that in control group(P0.05). Conclusions:Successful passive immunity of women whose husbands were with HBV-DNA positive before pregnancy is an important way to block the paternal-fetal transmission of HBV.

Objective:To investigate the neonatal intrauterine infection by hepatitis B virus(HBV) positive fathers and the potiential correlation between HBV quantity and the neonatal infection.Methods:Take 40 cases of neonates whose mothers were HbsAg negative and fathers HbsAg positive as Group A,40 cases whose fathers were HbsAg negative as Group B,40 cases whose parents were all HbsAg negative as Group C(the control group).The neonatal serum HbsAg,HBV-DNA levels and parents' serum HBV-DNA copy numbers were inspected with fluorescence immunity test and fluorescence quantitative polymerase chain reaction(PCR),and χ2 was adopted to make statistical analysis.Results:The positive rate of Group A,Group B and Group C was 32.5%,35.0% and 0% respectively.There was no statistical difference between Group A and Group B.Fluorescence quantitative PCR found that the higher concentration of HBV-DNA of the parents,the higher infection rate of the children.Conclusion:HBV can be transmitted vertically from fathers to infants,whose infectious rate is as high as that of mathers' transmission to infants.Besides,the transmission is closely related to the HBV-DNA concentration of fathers'.

Objective:To study the application value of the sac multipoint suture hemostasis in the laparoscopic ovarian endometriosis cyst removal surgeries.Methods:69 patients admitted into our department for the first time and underwent laparoscopic ovarian endometriosis cyst removal surgeries because of the unilateral ovarian ectopic cyst were randomly and equally divided into 3 groups with according to the different hemostasis adopted due to the different ovarian stripping wounds,Group Ⅰ(the sac multipoint suture hemostasis group),Group Ⅱ(the interrupted suture hemostasis group) and Group Ⅲ(electric coagulation hemostasis).The operative time,blood loss,levels of follicle-stimulating hormone(FSH),luteotropic hormone(LH) and estradiol(E2) 6 and 12 months pre-and post-operations of patients in the three groups were recorded.Then the effect of the operations on the ovarian functions of patients was evaluated.Results:Compared the operative time and blood loss in patients between the three groups,Group Ⅰ and Group Ⅱ needed less operative time and had less blood loss than t Group Ⅲ,and Group Ⅰ needed less operative time and had less blood loss than t Group Ⅱ,which were of statistical differences(P<0.05).FSH of the patients in three groups increased 6 and 12 months after operations,while E2 decreased.The above indicators in Group Ⅲ had obvious changes 6 months after operation,which had significant differences(P<0.05).Conclusion:The laparoscopic ovarian endometriosis cyst removal surgey may result in the decrease of the ovarian reserve functions,yet the application of the sac multipoint suture hemostasis has better hemostasis effect,and can better protect the ovarian reserve functions than the application of electric coagulation hemostasis.Besides,it can effectively shorten the operation time and reduce the blood loss than the conventional interrupted suture hemostasis.

Objective: To detect the expressions of estrogen receptor(ER) and progesterone receptor(PR) in endometrial polyps and discuss their pathogenesis mechanism in endometrial polyps.Methods: Prospective study was performed on 40 patients.All the patients had received the transcervical resection of polyps,and their endometrial polyps and adjacent normal endometrial tissues had been removed in the operations.ER and PR expression levels in endometrial polyps and adjacent normal endometrial tissues were detected by immunohistochemical assay(IHCA).Results: The expression of ER was higher whereas the expression of PR was lower in endometrial polyps than those in the adjacent normal endometrial tissues(P0.05).Conclusion: The abnormal expressions of ER and PR might be involved in the pathogenesis of endometrial polyps.

Objective:To explore the pathogenesis of endometrial polyps,through detecting the expression of insulin-like growth factor I(IGF-I)and insulin-like growth factor-I receptor(IGF-IR)in endometrial polyps. Methods:Prospective study was performed for the 40 patients who had transcervical resection of polyps were rolled.Endometrial polyp and pieces of endometrium had been removed in all operations.Routine pathological diagnosis to all specimens and immunohistochemical staining studies for IGF-I,IGF-IR in endometrial polyp and endometrium. Results:Expressions of IGF-I were significantly increased in endometrial polyp group(P0.05),expressions of IGF-I R in the two groups show no significant difference(P0.05),the expression of IGF-I was negatively correlated with that of IGF-IR(P0.05). Conclusion:High expression of IGF-I may be involved in pathogenesis of endometrial polyps.

Objective To evaluate the effectiveness of transvaginal hysterectomy plus anterior and/ or posterior colporrhaphy in treating patients with uterine prolapse. Methods The postoperative conditions of vaginal hysterectomy were analyzed in 48 patients who were admitted from March 2006 to March 2008 to our department. All patients were followed up for 2 years. Results The operative effects were satisfactory and no re-operation case was found in this group. Conclusion Transvaginal hysterectomy plus anterior and/ or posterior colporrhaphy in treating patients with uterine prolapse has many merits, such as less trauma, quicker recovery, no scar in abdomen and should be widely used in clinic practice.