Cervical cancer (CC) is an important public health problem for women, and perspectives and information regarding its prevention and treatment are quickly evolving. Human papilloma virus (HPV) has been recognized as a major contributor to CC development; however, HPV infection is not the only cause of CC. Epigenetics refers to changes in gene expression levels caused by non-gene sequence changes. Growing evidence suggests that the disruption of gene expression patterns which were governed by epigenetic modifications can result in cancer, autoimmune diseases, and various other maladies. This article mainly reviews the current research status of epigenetic modifications in CC based on four aspects, respectively DNA methylation, histone modification, noncoding RNA regulation and chromatin regulation, and we also discuss their functions and molecular mechanisms in the occurrence and progression of CC. This review provides new ideas for early screening, risk assessment, molecular targeted therapy and prognostic prediction of CC.

目的 探讨评估-沟通-监测-患者-环境模式护理管理联合心理干预在急性胸痛患者治疗中的应用效果.方法 将103例急性胸痛患者按入院顺序分组,对照组(51例)予以常规护理干预,观察组(52例)在对照组基础上予以评估-沟通-监测-患者-环境模式护理管理联合心理干预,观察住院全程.比较两组康复进程、恶性心血管不良事件发生率、干预前后心理健康水平及家属PZB服务质量量表评分.结果 观察组全程抢救时间、胸痛消失时间、住院时间均显著短于对照组(P<0.01),恶性心血管不良事件发生率显著低于对照组(P<0.05).干预后两组心理健康水平均显著高于干预前(P<0.01),观察组显著高于对照组(P<0.01).观察组PZB服务质量量表总分及移情性、反应性、保证性、有形性、可靠性因子分均显著高于对照组(P<0.01).结论 评估-沟通-监测-患者-环境模式护理管理联合心理干预能加快急性胸痛患者康复进程,降低恶性心血管事件发生率,改善患者心理健康状况,提高家属对护理服务质量的满意度.

Maternal diabetes mellitus reduces oocyte quality, such as abnormalities of spindle assembly and chromosome segregation, mitochondrial dysfunction, decrease of fertilization rate, increase of ROS, and so on. So, it is important to research how to restore the decreased oocyte quality induced by maternal diabetes mellitus. Polyphenols are the most abundant bioactive components of green tea. It is reported that tea polyphenols have many health functions, for instance anti-oxidation, anti-inflammation, anti-obesity, and anti-diabetes. Thus, we hypothesize that tea polyphenols may play a crucial role in alleviating adverse effects of diabetes on oocyte quality. In the present study, we researched the effects of tea polyphenols on diabetic oocyte maturation in vitro. Compared with the control, oocytes from diabetic mice displayed a lower maturation rate and a higher frequency of spindle defects and chromosome misalignment. However, tea polyphenols significantly increased the oocyte maturation rate, and reduced the incidence of abnormal spindle assembly and chromosome segregation. Tea polyphenols also obviously decreased the reactive oxygen species (ROS) levels in diabetic oocytes, and increased the expression of antioxidant genes (Sod1 and Sod2). Abnormal mitochondrial membrane potential was also alleviated in diabetic oocytes, and the expression of genes regulating mitochondrial fusion (Opa1, Mfn1 and Mfn2) and fission (Drp1) was significantly increased while tea polyphenols were added. Meanwhile, tea polyphenols reduced DNA damage in diabetic oocytes which may be mediated by the increased expression of Rad51, related to DNA damage repair. Our results suggest that tea polyphenols would, at least partially, restore the adverse effects of diabetes mellitus on oocyte quality.

目的:观察基于风险因素管理的院前急救护理干预在急性左侧心力衰竭患者中的应用价值.方法:选取2018年5月～2020年5月我院74例急性左侧心力衰竭患者,根据建档顺序分组,各37例.对照组采取传统院前急救.在对照组基础上,研究组采取基于风险因素管理的院前急救.统计两组抢救效率、院内确诊时间、开始治疗时间、住院时间、不良事件.结果:研究组抢救总有效率89.19％高于对照组(67.57％,P<0.05).研究组院内确诊时间、开始治疗时间、住院时间短于对照组(P<0.05).研究组不良事件发生率2.70％低于对照组(24.32％,P<0.05).结论:基于风险因素管理的院前急救护理干预可改善急性左侧心力衰竭患者心功能,降低不良事件发生率,缩短院内确诊时间及住院时间,提高抢救效率.

子宫内膜异位症(以下简称内异症)在生育年龄妇女中的发病率为5％ ～10％,它的特点为子宫内膜组织生长在子宫腔以外的部位,主要包括盆腔腹膜、卵巢、直肠阴道隔等.患者可出现盆腔疼痛、不规则阴道出血、不孕等症状[1] ,其中疼痛和不孕的发生率高达 30％ ～50％[2] ,腹腔镜手术及组织病理学检查是诊断内异症的金标准.内异症虽然是良性疾病,但有0.5％ ～1％的概率发展为卵巢癌[3].国外学者将伴随内异症发生的卵巢癌命名为子宫内膜异位症相关卵巢癌( endometriosis associated ovarian cancer,EAOC),主要病理类型为卵巢透明细胞癌和子宫内膜样癌[4].目前没有较好的预测指标对内异症癌变的风险进行评估.微小 RNA (microRNA,miRNA)是一类由内源基因编码的长度约22 个核苷酸的非编码 RNA 序列,根据其高度相似的同源序列分为不同的 miRNA 家族,其在真核基因表达调控中起广泛作用,可以调控基因的表达和生物功能[5] ,与肿瘤的增殖、转移等密切相关,研究证实 miRNA 的异常表达在卵巢癌的发生中扮演重要作用[6].现对 EAOC的临床特点及miRNA的表达进行综述.

急诊医护人员是急性脑卒中患者的第一道防线,主要负责患者的快速评估及分流.急救分诊有助于急性脑卒中患者及早启动"脑卒中救治生存链",选取个性化治疗方案,是提高患者治疗效果的关键[1].面、臂、言语、时间评分量表(FAST)是英国急救人员设计的脑卒中识别工具,可对面瘫、非对称性上肢瘫痪、言语障碍三项体征进行快速评估,简单易行[2].本研究选取我院急诊就诊的疑似急性脑卒中患者216例,旨在探究院前FAST评估在其急诊分诊中的应用效果,为临床诊治提供参考依据.现报告如下.

胚胎是具有父方遗传物质的同种半异体移植物,自然妊娠是母体对胎儿的免疫耐受.因此免疫因素引起的复发性流产的研究尤为重要.本文就同种免疫型复发性流产的发病机制和治疗进行综述,以期为同种免疫型复发性流产的临床诊治提供理论基础,以提高该类患者的临床活产率.

Objective:To investigate the effect of di-2-ethylhexyl phthalate (DEHP) on oocyte development potential and its mechanism.Methods:Forty 3-week old female KM mice were randomly divided into 4 groups ( n=10, each), including control group (corn oil), the low-, medium-, and high-dose DEHP groups (300 mg/kg, 600 mg/kg, 1200 mg/kg). Mice of 4 groups were orally administered with corn oil (control) or DEHP daily for 6 weeks (5 d per week), respectively. After the treatment, female mice in each group were given ovulation induction and cooped up with male mice. The fertilized eggs were collected to observe the cleavage rate and blastocyst formation rate. Meanwhile, the levels of Ca 2+ and reactive oxygen species (ROS) of oocytes in each group were detected with the Ca 2+ fluorescence probe (Fluo-4 AM) and ROS assay kit, then the differences were compared. Results:Compared with control group, the cleavage rate and blastocyst formation rate of the low-, medium- and high-dose DEHP groups decreased, and the differences were statistically significant ( P all<0.05). The levels of Ca 2+ and ROS in oocytes increased with the increase of DEHP dosage. Compared with control group and the low-dose DEHP group, the levels of Ca 2+ and ROS in oocytes of the medium- and high-dose DEHP groups were significantly higher, and the differences were statistically significant ( P all<0.05). Conclusion:DEHP can increase the levels of Ca 2+ and ROS in mouse oocytes, reduce the quality of oocytes, and affect the early embryonic development.

Objective To investigate the effect and pregnancy outcomes of laparoscopic surgery for interstitial heterotopic pregnancy after in vitro fertilization-embryo transfer(IVF-ET). Methods The clinical data of 10 cases of interstitial heterotopic pregnancy after IVF-ET in PLA 91st Center Hospital from December 2011 to October 2018 were retrospectively analyzed. Laparoscopic surgery was performed. Results 10 patients underwent laparoscopic tubal interstitial debridement or ipsilateral salpingectomy, no conversion to laparotomy, and no intraoperative or postoperative complications occurred. 7 patients received live birth delivery and 1 patient was presently undergoing midterm pregnancy. Conclusion Laparoscopic surgery is safe and feasible in the treatment of interstitial heterotopic pregnancy. It has good pregnancy outcome.

目的:构建载吲哚菁绿二氧化硅纳米颗粒(ICG@MSNs)并探讨其对宫颈癌HeLa细胞的杀伤作用.方法:通过模板法合成了介孔二氧化硅纳米颗粒(MSNs),并物理包载光热剂吲哚菁绿(ICG),制备具有光热效应的ICG@MSNs,并将其应用到HeLa细胞的体外研究中.结果:ICG@MSNs的粒径约200 nm,粒径均一,为形态规则的球形.ICG@MSNs与单纯的ICG具有类似的光热效应.细胞内吞实验显示,ICG包载于二氧化硅纳米颗粒后更易被肿瘤细胞内吞,进而发挥光热作用杀死宫颈癌HeLa细胞;细胞毒性实验表明,在808 nm激光照射下ICG@MSNs对细胞毒性作用明显增加,可以显著杀死宫颈癌HeLa细胞.结论:ICG@MSNs稳定性和生物相容性良好,同时具有良好的产热性能,肿瘤光热治疗效果明显,应用于宫颈癌治疗的前景良好.

目的:探讨腹腔镜全子宫切除术后并发症与生殖道支原体感染的关系.方法:回顾性分析2013年1月—2017年11月住院需行腹腔镜全子宫切除术的患者,共438例作为研究对象,对所有患者进行生殖道支原体培养,根据培养结果分为观察组(支原体阳性组)及对照组(支原体阴性组),对两组患者术后并发症的发生进行分析.结果:通过对两组患者术后3个月内的观察,发现两组患者术后腹部切口感染裂开、盆腔感染、术后病率、阴道残端裂开、阴道残端出血、阴道残端息肉形成的差异均无统计学意义(P>0.05).结论:对于无急性泌尿生殖道感染症状、仅生殖道支原体阳性者,行腹腔镜全子宫切除术并未增加术后并发症的发生.

目的 探讨腹腔镜大子宫切除术的手术效果及安全性.方法 回顾性分析2012年12月至2018年1月解放军第九十一中心医院妇科行腹腔镜及开腹全子宫切除术大子宫患者216例的临床资料,将其分为腹腔镜组148例和开腹组68例,对比分析两组手术治疗效果.结果 将子宫大小细分为12～<16孕周及16～<20孕周,两组手术时间比较,差异有统计学意义(P<0.05);腹腔镜组出血量少于开腹组,差异有统计学意义(P<0.05);腹腔镜组患者术后排气时间、疼痛评分、住院时间均优于开腹组,且腹腔镜组住院费用多于开腹组,差异均有统计学意义(P<0.05);腹腔镜组中转开腹2例,中转开腹率为1.35％,开腹组切口愈合不良、脂肪液化发生1例(0.14％),两组比较,差异无统计学意义(P>0.05).结论 通过充分的术前评估,掌握手术技巧,同时配合能量器械的使用,腹腔镜大子宫切除术是安全可行的.

目的 探讨不孕患者行体外受精后新鲜周期胚胎移植与冻融周期胚胎移植的临床结局.方法 行体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)助孕女性10 921例,依据移植胚胎周期分为新鲜周期组6 367例(＜35岁4 800例,≥35岁1 567例)和冻融周期组4 554例(＜35岁3 689例,≥35岁865例).比较2组胚胎移植后的临床妊娠结局.结果 新鲜周期组胚胎移植数[(1.96±0.30)枚]、生化妊娠率(7.46％)、异位妊娠率(4.05％)均高于冻融周期组[(1.86±0.43)枚、5.37％、2.09％],临床妊娠率(43.83％)、活产率(38.07％)及新生儿体质量[(3 349.40±553.20)g]均低于冻融周期组[52.59％、44.64％、(3 511.20±593.60)g](P＜0.05);新鲜周期组＜35岁患者胚胎移植数[(1.91±0.28)枚]、生化妊娠率(7.43％)、异位妊娠率(3.84％)均高于冻融周期组[(1.79±0.41)枚、4.86％、1.71％],临床妊娠率(48.27％)、流产率(11.48％)、早期流产率(7.29％)、活产率(42.73％)均低于冻融周期组(55.22％、14.28％、9.18％、47.33％) (P＜0.05);新鲜周期组≥35岁患者胚胎移植数[(2.18±0.38)枚]高于冻融周期组[(2.10±0.30)枚],临床妊娠率(30.25％)、活产率(23.04％)均低于冻融周期组(41.39％、33.18％) (P＜0.05).结论 冻融胚胎移植可提高临床妊娠率、活产率及新生儿体质量,降低生化妊娠率、异位妊娠率.

目的 探讨人类第三天(D3)不同形态学分型胚胎自身线粒体三磷酸腺苷(adenosine triphosphate,ATP)及Ca2+对胚胎发育的影响.方法 行体外受精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)的不孕患者新鲜周期发育较差不适合移植的胚胎97枚,助孕成功且妊娠后自愿丢弃的质量较好冻胚胎80枚;根据国际胚胎评分共识标准将卵裂期胚胎分为Ⅰ级冷冻胚胎组49枚,Ⅱ级冷冻胚胎组31枚和Ⅲ级新鲜胚胎组97枚.采用多功能酶标仪和Ca2+荧光探针分别检测单个胚胎ATP和Ca2+表达水平,比较D3不同形态学分型的胚胎ATP和Ca2+水平差异.结果 Ⅲ级新鲜胚胎组ATP水平[(236.52±48.07) fmol]明显低于Ⅱ级冷冻胚胎组[(320.67±36.02) fmol]和Ⅰ级冷冻胚胎组[(380.06±28.15)fmol](P＜0.05),Ⅱ级冷冻胚胎组低于Ⅰ级冷冻胚胎组(P＜0.05);Ⅲ级新鲜胚胎组Ca2+水平(3.12±0.43)明显高于Ⅱ级冷冻胚胎组(2.29±0.38)和Ⅰ级冷冻胚胎组(1.72±0.27)(P＜0.05),Ⅱ级冷冻胚胎组高于Ⅰ级冷冻胚胎组(P＜0.05).结论 质量越好的D3胚胎ATP水平越高,Ca2+水平越低.

目的 探究多层螺旋CT (MSCT)和核磁共振成像(MRI)对肝细胞肝癌(HCC)患者经导管肝动脉化疗栓塞(TACE)治疗术后疗效评价的价值.方法 收集我院首次行TACE治疗的56例HCC患者临床资料,均于术后3个月行DSA、MSCT、MRI检查,比较术后肿瘤残余或复发情况及肿瘤包膜情况.结果 MSCT扫描与DSA标准组在有无肿瘤残余或复发的显示率上比较,差异有统计学意义(P＜0.05);MRI扫描与DSA标准组在有无肿瘤残余或复发的显示率上比较,差异无统计学意义(P＞0.05);MSCT与MRI扫描判定TACE术后肿瘤残余或复发的准确性及敏感性比较,差异均有统计学意义(P＜0.05);MSCT与MRI显示TACE术后肿瘤包膜的检出率比较,差异有统计学意义(P＜0.05).结论 MRI扫描对HCC患者经TACE治疗术后肿瘤残余或复发的诊断准确性及敏感性更高,可进一步指导临床治疗.

Continuous improvement in diagnosis and treatment has significantly increased the survival of cancer patients. Treatments for neoplastic disease, including radiotherapy, chemotherapy, and surgery or combined therapy with the above methods, may lead to premature ovarian insufficiency (POI) or substantial male germ cell loss. For the patients it is a seriously double whammy. Therefore, reproductive medicine experts strongly suggest that all young patients diagnosed with a malignant tumor should immediately undergo a consultation with suggestions for fertility and endocrine function protection and preservation. Here, we discuss the background knowledge, methods, indications, pros and cons, and experimental and clinical applications of fertility preservation, and new strategies for future fertility conservation to help physicians, especially oncologist, pediatrician, hematologist, and surgeons, become aware of the concepts, methods, and importance of fertility and endocrine function protection. We also hope to help doctors develop novel personalized strategies for fertility conservation according to patients’ own conditions, tumor types, treatment methods, recurrence rate and so on. This review focuses on changing and enhancing the fertility preservation idea, further investigations in clinical and translational medicine will help ensure the development of novel personalized treatments, to help cancer patients have healthy children or maintain endocrine function once they are in remission. This is just the ultimate dream of oncofertility.

To investigate whether cumulus cell removal after a 3 h co-incubation of gametes can affect the outcomes of in vitro fertilization.

Evidence from toxicological studies has demonstrated that phthalates can lead to reduced fertility through effects on folliculogenesis, oocyte maturation and embryonic development, but human data are limited. Concentrations of eight phthalate metabolites in 110 follicular fluid (FF) and urine samples collected from 112 women attending an infertility clinic in Wuhan, China were quantified, and correlations between paired matrices were explored. Associations between metabolite concentrations and in vitro fertilization (IVF) parameters were evaluated with multivariable models. Six metabolites were detected in >72.73% of the FF samples. MEHP and MBP were the dominant metabolites with a median level of 2.80 and 2.05ng/mL, respectively. Significant correlations between the two matrices, urine and FF, were found for MEP (rs=0.44), and MBP (rs=0.22). FF and urinary metabolite concentrations were not associated with any IVF parameters. However, given the prevalence of phthalates exposure, further work is needed to elucidate the potential hazard on female reproduction.

Objective To compare the pregnancy outcome of patients with PCOS who has been receiving ovulation induction by HMG combined with different doses of LE, and to summarize the best dosage of LE in the combined ovulation induction scheme.MethodThis is a prospective and randomized cotrolled study. 142 PCOS patients who showed no dominant follicular after the ovulation of LE were randomly included by using the random number table, and were divided into group LE 2.5 mg (n=70) and group LE 5.0 mg (n=72). The number of dominant follicles, E2 level on the day of HCG injection, endometrial thickness on the day of HCG injection, HMG usage and clinical outcome related indicators were copared.ResultsThere is no signiifcant difference in age, duration of infertility, BMI, D3 FSH, D3 E2 and D3 endometrial thicknessbetween the two groups(P>0.05). During the process of ovulation induction, there is no signiifcant difference in the number of 14-18mm follicles, the rate of ovulation , endometrial thickness on the day of HCG injection, the rate of biochemical pregnancy, the rate of multiple pregnancy, the rate of miscarriage, the rate of cancelled cycle and the rate of OHSS between the two groups (P>0.05).≥18mm follicles, E2 levels on the day of HCG injection, dosage of HMG and the days of using HMG is higher in group LE 5.0 mg than group LE 2.5 mg, and the difference is statistically signiifcant(P<0.05). Compared to group LE 2.5 mg, group LE 5.0 mg shows an increasing trend in the rate of clinical pregnancy, although the difference is not statistically signiifcant(P>0.05).Conclusions PCOS patients who showed no dominant follicular after the ovulation of LE only should receive ovulation induction by HMG combined LE, and the appropriate choice of the dosage of LE should be 5.0 mg/d rather than 2.5 mg/d.

目的 探讨在体外受精-胚胎移植(IVF-ET)周期长方案促排卵过程中晚卵泡期血清促黄体生成素(LH)低于正常值时,补充基因重组人黄体生成素(r hLH)或人绝经期尿促性腺激素(HMG)对IVF-ET助孕结局的影响.方法 采用回顾性分析,选择因女方输卵管因素行IVF-ET助孕的患者529例,所有患者均采用标准长方案,单用基因重组促卵泡激素(rFSH)促排卵.根据年龄、晚卵泡期血清LH、是否补充外源性LH将所有患者分成6组:＜35岁的A组血清LH＞1.2 mU/mL,单用rFSH促排46例,B组血清LH＜1.2 mU/mL,补充r hLH 52例,C组血清LH＜1.2 mU/mL,补充HMG 257例;≥35岁的D组血清LH＞1.2 mU/mL,单用rFSH促排34例,E组血清LH＜1.2 mU/mL,补充r-hLH 41例,F组血清LH＜1.2 mU/mL,补充HMG 99例.结果 ＜35岁的3组患者之间和≥35岁的3组患者之间在年龄、不孕年限、BMI,基础FSH、LH、E2水平,Gn使用天数、Gn用量,HCG日LH、P水平,HCG日内膜厚度及获卵数等方面差异均无统计学意义(均P＞0.05).B组及E组rFSH总量分别高于C组及F组,差异有统计学意义(均P＜0.05);B组及F组E2水平及2PN受精率分别明显高于A组及D组,差异有统计学意义(均P＜0.05);A、B、C组之间优质胚胎率及妊娠率比较差异无统计学意义(均P＞0.05);E组优质胚胎率及妊娠率明显高于D组,差异有统计学意义(均P＜0.05).结论 口服避孕药降调长方案晚卵泡期血LH值＜1.2 mU/mL时,适量添加r-hLH可以改善卵子质量,提高受精率,改善妊娠结局,尤其是明显提高≥35岁患者的临床妊娠率、受精率及优胚率.