Objective To compare the efficacy of oral and transdermal estrogens in improving the quality of life in perimenopausal and recently postmenopausal women.Methods 257 women aged 40-55 years, within three years after their final menstrual period were randomized to receive transdermal oestrogel (t-E2) (n = 128) or oral estradiol valerate (o- E2V) (n = 129; both with micronized progesterone 200 mg for 14 days each month). Menopausal symptoms were recorded at screening and at 4, 12, and 24 weeks post-randomization. Menopausal symptoms were evaluated using the Menopause-Specific Quality of Life (MENQOL) questionnaire.Results Significant improvements of MENQOL scores were observed in both groups compared with baseline. The decrease of MENQOL scores after treatment showed almost no difference between the two groups (p > 0.05) except the VMS domain which indicated a better result in oral estrogen group after 24 weeks.Conclusions This study showed that both transdermal and oral estrogens were highly effective in relieving the overall menopausal symptoms for recently-menopausal women, with little difference in treatment efficacy between the two routes.

Postoperative gastrointestinal disorder (POGD) was a common complication after surgery under anesthesia. Strategies in combination with Traditional Chinese Medicine and Western medicine showed some distinct effects but standardized clinical practice guidelines were not available. Thus, a multidisciplinary expert team from various professional bodies including the Perioperative and Anesthesia Professional Committees of the Chinese Association of Integrative Medicine (CAIM), jointly with Gansu Province Clinical Research Center of Integrative Anesthesiology/Anesthesia and Pain Medical Center of Gansu Provincial Hospital of Traditional Chinese Medicine and WHO Collaborating Center for Guideline Implementation and Knowledge Translation/Chinese Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Center/Gansu Provincial Center for Medical Guideline Industry Technology/Evidence-based Medicine Center of Lanzhou University, was established to develop evidence-based guidelines. Clinical questions (7 background and 12 clinical questions) were identified through literature reviews and expert consensus meetings. Based on systematic reviews/meta-analyses, evidence quality was analyzed and the advantages and disadvantages of interventional measures were weighed with input from patients' preferences. Finally, 20 recommendations were developed through the Delphi-based consensus meetings. These recommendations included disease definitions, etiologies, pathogenesis, syndrome differentiation, diagnosis, and perioperative prevention and treatment.

BACKGROUND:Alzheimer's Disease (AD) is a highly prevalent form of age-related dementia. However, the underlying mechanisms of AD are largely unexplored. MATERIALS AND METHODS:In this study, bioinformatics analysis was performed to identify the possible therapeutic targets for AD. The GEO database was used to screen the Differentially Expressed Genes (DEGs). Enrichment analysis, protein-protein interaction network, and LASSO model analyses were successfully performed. Furthermore, an ELISA assay was also conducted to determine the expression of principal genes within the AD and control samples. RESULTS:A total of 416 differentially expressed genes (DEGs) were recognized based on the GSE48350 and GSE28146 datasets. The IL-1β and CXCR4 levels were markedly elevated in the AD samples relative to the control. CONCLUSION:The IL-1β and CXCR4 genes were identified as principal AD-related genes that can be targeted for anti-AD therapy.

目的 研究Claudin-7、Slug和E-cadherin在子宫内膜癌组织中的表达及相关性.方法 本研究采用免疫组织化学染色技术检测 2013 年 1 月至 12 月江西省妇幼保健院收集的 65 份子宫内膜癌、30 份子宫内膜不典型增生及 25 份正常子宫内膜组织中的Claudin-7、Slug及E-cadherin的表达.结果 子宫内膜癌组、不典型增生组的Claudin-7 表达率均低于正常子宫内膜组,差异有统计学意义(P＜0.017);子宫内膜癌组的Slug表达率高于正常子宫内膜组及不典型增生组,差异有统计学意义(P＜0.017);子宫内膜癌组的E-cadherin表达率低于正常子宫内膜组,差异有统计学意义(P＜0.017).临床分期较高、组织学分级较低、肿瘤深肌层浸润及淋巴结转移的子宫内膜癌患者中,Claudin-7 表达明显下调,差异有统计学意义(P＜0.05).在临床分期较高、肿瘤深肌层浸润及淋巴结转移的子宫内膜癌患者中,Slug表达明显上调,差异有统计学意义(P＜0.05).在临床分期较高、深肌层浸润及淋巴转移子宫内膜癌患者中,E-cadherin表达明显下调,差异有统计学意义(P＜0.05).Spe arman相关性分析显示在子宫内膜癌组织中,Claudin-7 的表达和E-cadherin的表达呈正相关(r=0.810,P＜0.001),同时Claudin-7 的表达和Slug的表达呈负相关(r=-0.706,P＜0.001).Kaplan-Meier生存分析显示Claudin-7 阳性表达患者的生存时间长于其阴性表达组患者(P＜0.05).Cox多因素分析结果提示,深肌层浸润是影响子宫内膜癌患者预后的危险因素(HR=5.934,95%CI:3.115～11.306),Claudin-7表达是影响子宫内膜癌患者预后的保护因素(HR=1.932,95%CI:1.114～3.349).结论 Claudin-7 在子宫内膜癌中发挥抑癌作用;通过启动上皮间质转化抑制Claudin-7 的表达,导致肿瘤细胞更具侵袭性.Claudin-7 可能成为预测子宫内膜癌发展、转移的指标.

目的:建立并验证局部晚期宫颈癌(LACC)患者放疗学结局的列线图.方法:回顾分析江西省妇幼保健院肿瘤科2013 年1 月至2017 年12 月收治的1567 例LACC患者的临床病理资料.结果:随机将 1567 例LACC患者分为训练集(1097 例)和验证集(470 例).收集的数据包括临床特征和随访信息.缺失数据采用多重推断方法进行估计.单因素分析发现,年龄、FIGO分期、T分期、N分期、肿瘤最大径线、治疗方案、总治疗时间是影响LACC患者放疗学结局的危险因素,通过正向逐步选择对多变量Cox比例风险模型中的变量进行识别并创立列线图,包括T分期、N分期、年龄、肿瘤最大经线、治疗方式、总治疗时间.C指数与AUC显示,列线图模型具有良好的预测能力.列线图在临床适用性校准和决策曲线分析中表现良好.按列线图评分分层的 3 个风险组中,患者的OS存在显著差异(P<0.001).结论:本研究开发了一种新的列线图来预测LACC患者经标准治疗的总生存率.列线图具有显著的鉴别能力和预测精度,有助于临床医生评估LACC患者的预后,并制定个体化的治疗和随访策略.

Rationale:Cancer with unknown primary site is a kind of disease that is difficult to deal with clinically, accounting for 2% to 9% of all newly diagnosed cancer cases. Here, we report such a case with pelvic metastatic squamous cell carcinoma of an unknown primary site and review the relevant literature.Patient concerns & Diagnoses:A 43-year-old Chinese female patient was referred to our hospital and initially diagnosed as "malignant tumor of right adnexal area?, obstruction of right ureter, secondary hydronephrosis".Interventions:Thereafter cytoreductive surgery was performed which included a total hysterectomy, left adnexectomy, partial omentum resection, pelvic lymph node dissection, and para-aortic lymph node dissection. The primary lesion could not be identified by supplementary examination and postoperative pathology. The patient was diagnosed as pelvic metastatic squamous cell carcinoma whose primary site was unknown. To prevent a recurrence, we administered adjuvant chemotherapy for the patient.Outcomes:The patient was followed up after treatment, complete remission has been maintained for 72 months, and no recurrence or metastasis has been found.Lessons:Our case demonstrates that surgery combined with chemotherapy could be helpful for pelvic metastatic squamous cell carcinoma of unknown primary site.

目的 探讨改良式缝合在妇科恶性肿瘤肥胖患者开腹手术中的应用效果.方法 回顾性选取 2021 年 1 月至2022 年 11 月江西省妇幼保健院肿瘤科就诊的 90 例妇科恶性肿瘤肥胖患者作为研究对象,按照手术缝合方法不同分为对照组 1(30 例)、对照组 2(30 例)、观察组(30 例),对照组 1 采用分层间断缝合,对照组 2 采用分层连续缝合+腹壁全层减张缝合,观察组则采用改良式缝合法.比较三组患者的临床指标(关腹缝合时间、腹部切口渗液量、住院时间)、视觉模拟评分法(VAS)评分和切口瘢痕状态(POSAS)评分.比较各组患者手术后切口愈合率和感染率.结果 观察组关腹缝合时间、手术切口瘢痕宽度、住院时间短于对照组 1、对照组 2,差异有统计学意义(P＜0.05);对照组 1与对照组 2 关腹缝合时间、手术切口瘢痕宽度、住院时间比较,差异无统计学意义(P＞0.05);观察组VAS评分和POSAS评分低于对照组 1、对照组 2,差异有统计学意义(P＜0.05);对照组 1 与对照组 2VAS评分和POSAS评分比较,差异无统计学意义(P＞0.05);三组患者切口愈合情况、感染率比较,差异无统计学意义(P＞0.05);各组间切口愈合情况、感染率两两比较,差异无统计学意义(P＞0.05).结论 改良式缝合在妇科恶性肿瘤肥胖患者开腹手术中的应用效果较好,能够缩短缝合时间以及住院时间,降低术后感染率和疼痛程度.

Abstract Objective: To develop a nomogram for Overall Survival (OS) prediction in 2018 FIGO staging IB cervical cancer patients. Methods and Materials: A total of 1185 2018 FIGO staging IB cervical cancer patients were analyzed. They were randomly divided into the training set (n=889,75%) and the validation set (n=296,25%). Data collected included demographics, clinical characteristics, and follow-up information. Missing data were estimated by multiple imputations. LASSO and Cox analysis was used to evaluate risk factors of OS rate. Nomograms were developed and internally validated. Three risk groups were identified based on the nomo-score of the patient. Results: The 5-year OS of IB1 patients was 96.0%, for IB2 patients was 93.1%, and for IB3 patients was 90.3%. We established a multivariate Cox regression model, including 2018 FIGO staging, age, Lvsi and deep stromal invasion. The c-index and AUC for 2-, 3-, and 5-year OS revealed that the nomogram model significantly outperformed the 2018 FIGO staging. Furthermore, nomograms performed well in clinical applicability calibration and decision curve analysis. The OS of patients differed significantly (P<0.001) across the three risk groups stratified by the nomo-score. Conclusions: This study developed a novel nomogram to predict overall survival in 2018 FIGO IB cervical cancer patients. The nomogram had significant discrimination ability and prediction accuracy, making it an excellent supplement to FIGO staging.

目的:探讨FIGO新分期的合理性,探索可能影响预后的相关因素.方法:回顾分析江西省妇幼保健院肿瘤科2011年1月至2017年12月收治的2018年FIGO分期Ⅰb期宫颈癌病例资料.结果:1185例患者使用2018年FIGO分期系统重新分期并进入研究,宫颈癌Ⅰb1期、Ⅰb2期、Ⅰb3期患者的5年总生存率分别为96.1％、93.2％和90.3％,差异有统计学意义(P=0.0095).多因素分析显示,年龄、LVSI状态、肿瘤浸润深度、FIGO分期是影响Ⅰb期宫颈癌患者总生存率的独立危险因素.结论:2018 FIGO宫颈癌分期中Ⅰb期各亚期设置合理,在新的FIGO分期中可考虑LVSI与肿瘤浸润深度.

目的 研究和验证红藤灌肠方联合CT引导下介入治疗妇科恶性肿瘤患者术后盆腔淋巴囊肿的有效性和安全性.方法 选取 2021 年 1 月至 2022 年 10 月在我院行妇科恶性肿瘤根治手术(术式中包含系统性盆腔淋巴结清扫或腹主动脉旁淋巴结切除者)后出现症状性盆腔淋巴囊肿的患者共 40 例纳入研究.将患者随机选入对照组与实验组,各 20 例.对照组应用 16 排螺旋CT及 8Fr PTCD穿刺套件行常规CT引导下介入治疗,实验组在对照组治疗基础上给予自拟红藤灌肠方行保留灌肠治疗.观察患者治疗前和治疗 14 天后中医症候积分变化,比较两组治疗后临床疗效相关指标并计算两组不良反应发生率.结果 实验组的治疗后中医证候总积分显著低于对照组,差异有统计学意义(P<0.05),实验组治疗前后的积分变化明显优于对照组,差异有统计学意义(P<0.05).实验组的治疗总有效率明显高于对照组,且治愈人数显著高于对照组,差异有统计学意义(P<0.05).实验组的置管时间明显短于对照组,差异有统计学意义(P<0.05).然而,在囊肿完全消退时间及复发人数方面,两组差异无统计学意义(P＞0.05).两组总体副反应和并发症发生率差异无统计学意义(P＞0.05).结论 红藤灌肠方联合CT引导下介入治疗妇科恶性肿瘤患者术后盆腔淋巴囊肿是一套实施简便、疗效确切、安全可靠、副作用小的中西医结合精准治疗方案.

绝经激素治疗(menopausal hormone therapy,MHT)是改善绝经期症状最有效的方法,可提高患者生活质量.目前MHT从药物选择到用药途径各有不同,不同个体适合的方案也不同,因此患者需要在专科医师的指导下用药[1].虽然市面上的药物多样,但缺乏具体药物和方案的综述,可能导致更年期门诊医生不能给患者提供最合适的建议.本文就MHT方案和具体药物选择作一综述.

目的 探讨宫颈高级别鳞状上皮内病变锥切术后接种二价HPV疫苗是否能降低宫颈病变的复发率.方法 在2019年1月至2020年1月期间,对257名年龄在21-45岁之间宫颈高级别鳞状上皮内病变接受了锥切术的患者进行了随访.术后接种二价HPV疫苗组110例,未接种组147例.随访时间为术后3、6、12、18个月.结果 随访结束时共9例(3.50％)患者出现复发,其中接种疫苗组复发率为1.82％(2/110),未接种疫苗组复发率为4.76％(7/147),两组比较无统计学差异(P>0.05);剔除所有切缘阳性后接种疫苗组复发0例,未接种疫苗组复发率为2.16％(3/139),两组差异无统计学意义(P>0.05).随访结束时高危型HPV感染率接种疫苗组为2.27％(3/110),未接种HPV疫苗组9.52％(14/147),差异有统计学意义(P<0.05);所有切缘阴性中接种HPV疫苗组高危型HPV感染率0.96％(1/104),未接种HPV疫苗组感染率6.47％(9/139),两组差异有统计学意义(P<0.05).结论 宫颈高级别鳞状上皮内病变锥切术后接种二价HPV疫苗较未接种疫苗组复发率降低,但差异无统计学意义(P>0.05),而高危型HPV感染率疫苗接种组较未接种组明显降低(P<0.05).

目的:探究加味四妙汤配合重组人干扰素α-2b凝胶在高危型人乳头瘤状病毒(HPV)感染患者中的应用效果.方法:选取2020年10月-2021年10月江西省妇幼保健院收治的80例高危型HPV感染患者,按照随机数字表法将其分为对照组与观察组,每组40例.对照组采用重组人干扰素α-2b凝胶治疗,观察组采用加味四妙汤配合重组人干扰素α-2b凝胶治疗.比较两组疗效、中医症状积分、HPV转阴率、阴道免疫微环境及不良反应发生情况.结果:观察组总有效率及HPV转阴率均高于对照组,差异均有统计学意义(P<0.05).治疗后,观察组接触性出血、带下异常、腰骶酸痛、外阴瘙痒评分均低于对照组,差异均有统计学意义(P<0.05).治疗后,观察组白细胞介素-17(IL-17)、白细胞介素-23(IL-23)与白细胞介素-6(IL-6)水平均低于对照组,γ-干扰素(IFN-γ)水平高于对照组,差异均有统计学意义(P<0.05).两组不良反应发生率比较,差异无统计学意义(P>0.05).结论:经加味四妙汤配合重组人干扰素α-2b凝胶治疗可有效改善患者阴道免疫微环境,促使患者各项症状改善,促使HPV转阴,显著提高临床治疗效果,值得推广.

目的 探讨卵巢成熟性畸胎瘤鳞癌变的临床特点、诊断、治疗及预后.方法 对江西省妇幼保健院肿瘤科2008年1月至2019年12月收治的31例卵巢成熟性畸胎瘤鳞癌变患者的病历资料进行回顾性分析.结果 31例患者的中位年龄为57岁,临床症状以下腹部胀痛为主,血清鳞状细胞癌抗原(SCC-Ag)平均值20.2 μg/L,影像学表现缺乏特征性.平均肿瘤直径(13.0±5.4)cm.治疗均采用肿瘤细胞减灭术联合化疗.31例患者总的中位无进展生存时间为18个月,2年累计无瘤生存率为48.4％.比较了多个可能影响预后的因素,国际妇产科联盟(FIGO)分期是影响预后的主要因素(P=0.045),紫杉醇+铂类联合化疗总生存率优于BEP方案(依托泊苷+顺铂+博来霉素),但差异无统计学意义.结论 卵巢成熟性畸胎瘤鳞癌变是一种罕见的恶性肿瘤,临床表现及影像学均缺乏特异性,目前仍缺乏足够的资料为这种恶性肿瘤的治疗提供普遍的指导方针.

Epithelial ovarian cancer (EOC) accounts for approximately 90% of all ovarian cancer cases and is the most common cause of gynecological cancer death. Understanding the molecular mechanisms of EOC will help develop better diagnostics and more effective treatments. This study aimed to investigate whether long non-coding RNA ADAMTS9-AS1 (ADAMTS9-AS1) could regulate solute carrier family 7 member 11 (SLC7A11) expression and inhibit ferroptosis by sponging micoRNA-587 in EOC progression. Quantitative real-time polymerase chain reaction (qRT-PCR) and western blotting results showed that ADAMTS9-AS1 expression was elevated in EOC cells; microRNA-587 expression was up-regulated and SLC7A11 expression was down-regulated after knocking down ADAMTS9-AS1 by transfection with siRNAs; however, microRNA-587 inhibitor reversed SLC7A11 expression in ADAMTS9-AS1 knocking down cells. Ferroptosis related marker detection and cell function assay confirmed that knocking down ADAMTS9-AS1 inhibited EOC cells proliferation and migration by promoting ferroptosis. Overexpression of micoRNA-587 also promoted ferroptosis while inhibited cells proliferation and migration in EOC cells. Additionally, micoRNA-587 inhibitor reversed the effect of ADAMTS9-AS1 silence on the ferroptosis and cell function. Moreover, dual-luciferase reporter gene assay and RNA immunoprecipitation assay confirmed that miR-587 was as a sponge for ADAMTS9-AS1 and SLC7A11. In conclusion, our study found that ADAMTS9-AS1 attenuated ferroptosis by targeting miR-587/SLC7A11 axis in EOC. Our study provides a new therapeutic target for EOC.

目的 检测新鲜子宫内膜癌组织及癌旁正常组织中miR-128-2基因启动子区DNA甲基化水平以及miR-128-2和DJ-1(RS/PARK7/CAP1)表达水平,并分析其相关性,拟从组织学水平寻找miR-128-2基因启动子DNA甲基化可能参与子宫内膜癌DJ-1表达调控的相关证据.方法 收集江西省妇幼保健院经手术切除的63例子宫内膜癌组织标本及其相配对的癌旁正常子宫内膜组织,采用荧光实时定量甲基化特异性PCR(qMSP)方法检测组织中miR-128-2基因启动子区DNA甲基化水平、荧光实时定量PCR(qRT-PCR)检测miR-128-2以及DJ-1 mRNA表达丰度、Western blot检测DJ-1蛋白表达水平,同时比较分析miR-128-2基因启动子DNA甲基化与miR-128-2、DJ-1表达与临床病理因素间的相关性.结果 与癌旁正常子宫内膜组织相比较,子宫内膜癌组织中miR-128-2启动子区DNA甲基化水平显著增加(P<0.01),同时miR-128-2表达下调而DJ-1 mRNA及蛋白表达上调(P<0.01);通过相关性分析发现子宫内膜癌组织中miR-128-2基因启动子区DNA甲基化程度与miR-128-2表达负相关(Pearson相关系数r=-0.9693,P<0.01)而与DJ-1 mRNA表达正相关(Pearson相关系数r=0.8762,P<0.01).此外,通过临床病理资料发现miR-128-2甲基化水平、miR-128-2以及DJ-1 mRNA表达水平均与子宫内膜癌患者的病理类型、分化程度无关,而与肿瘤浸润深度、淋巴结转移和临床分期相关(P<0.05).结论 在组织水平佐证了子宫内膜癌中DJ-1表达上调可能与miR-128-2基因启动子区高DNA甲基化及其表达沉默有关.

Previous studies reported that miR-330-3p was involved in the progression of several cancers, but the potential roles of miR-330-3p in ovarian cancer (OC) were unclear. In the current study, we aimed to explore the expression pattern and functions of miR-330-3p in OC. The expression level of miR-330-3p in OC tissues and cell lines was detected using RT-qPCR. The proliferation, migration and invasion of OC cells were detected using CCK-8 assay and transwell assay, respectively. Bioinformatics analysis and luciferase reporter assay were used to analyze the targeted binding site of miR-330-3p and RIPK4. The results showed that miR-330-3p was significantly downregulated in OC tissues and cell lines. Overexpression of miR-330-3p inhibited the proliferation, migration and invasion of OC cells. Mechanistically, a dual-luciferase reported assay showed that RIPK4 is a target gene of miR-330-3p. Furthermore, rescue experiments revealed that miR-330-3p suppressed the proliferation, migration and invasion of OC cells by targeting RIPK4. In summary, our findings indicated that miR-330-3p suppressed the progression of OC by targeting RIPK4. Our results indicated that miR-330-3p/RIPK4 axis might act as a novel therapeutic target for OC treatment.

目的 确定HPV病毒与影响生殖健康的关系.方法 检索PubMed及ScienceDirect数据库,文献时间选取1994年1月至2014年1月,以下搜索术语与"人乳头瘤状病毒"组合使用:生育力、受精、不孕、流产、不育和生殖健康.所选出文献进行摘要筛选,排除非HPV感染和生殖健康的研究,并进行全文阅读.结果 HPV感染与影响生殖健康的一些负面效应有显著相关性,并且影响受孕过程的负面效应与HPV病毒亚型有关.结论 HPV定量检测和基因分型测定在不孕症诊断中有较高价值,扩大样本研究有助于进一步阐明HPV感染对生殖健康的影响.

目的 探讨抗苗勒管激素(AMH)在女性卵巢储备功能评估中的价值.方法 选取2016年8月-2018年7月在江西省妇幼保健院妇科门科进行生育咨询的437例女性为研究对象,根据年龄分为研究组(35 ～ 45岁,216例)和对照组(25～34岁,221例),分析两组女性血清AMH与性激素结果,探讨AMH预测女性卵巢储备功能的价值.结果 研究组女性AMH水平低于对照组,研究组卯泡刺激素(FSH)、基础雌激素(bE2)水平高于对照组,差异均有统计学意义(均P＜0.05).经AMH评估两组卵巢储备下降率,研究组(39.81％)高于对照组(18.10％),差异有统计学意义(P＜0.05).经FSH评估两组卵巢储备下降率,研究组(19.44％)高于对照组(16.29％),差异无统计学意义(P＞0.05).评估AMH和FSH对所有研究对象卵巢储备下降的检出情况,AMH的阳性检出率(28.83％)高于FSH的阳性检出率(17.85％),差异有统计学意义(P＜0.05).结论 随着年龄增长,卵巢储备功能具有明显下降趋势;AMH在评价女性卵巢储备功能的灵敏度上要优于FSH,能更早反映妇女生育潜力的下降,值得临床推广.

Aim PCOS often showed abnormal follicular development. Previous studies have found that the increased apoptosis of granulosa cells (GCs) is one of the key factors leading to follicular dysplasia. It has been found that the decrease or deletion of PATL2 function can significantly inhibit the development and maturation of human oocytes. We found that PATL2 was also expressed in human ovarian GCs, suggesting that PATL2 may be involved in the regulation of related biological events in GCs. This study aims to explore the function of PATL2 on regulation of GCs apoptosis, and the potential role of PATL2 in the development of PCOS-related abnormal follicles. Materials and Methods The follicular GCs of PCOS patients and normal ovulating female patients were collected. Moreover, human granular cell line (KGN) was used for in vitro experiments. Results (1) The maturation rate and fertilization rate of oocytes in the PCOS group were significantly lower than those in the normal control group (p < 0.05). (2) Flow cytometry and TUNEL staining showed that the apoptosis level of GCs in the PCOS group was significantly increased. (3) Immunofluorescence and Western Blot showed that the PATL2 expression level of GCs in the PCOS group was significantly reduced. (4) Knocking down the expression of PATL2 by siRNA significantly prevented the apoptosis of GCs. Conclusions Reduced PATL2 could resulted in the increased apoptosis level of ovarian GCs, which might be closely related to the occurrence and development of abnormal follicles in PCOS.