目的 探讨长链非编码RNA（lnc RNA）生长停滞特异基因转录的反义RNA（GAS6-AS1）靶向调控白细胞介素11（IL-11）对子宫内膜基质细胞（ESCs）向成纤维细胞分化的影响。方法 体外传代培养ESCs，取传3～6代、对数生长期、生长状态良好的ESCs，随机分为TGF-β1未干预组和TGF-β1干预组。TGF-β1未干预组不予TGF-β1干预，TGF-β1干预组用无血清培养基饥饿培养后予TGF-β1干预，收集细胞，采用RT-q PCR法检测lnc RNA GAS6-AS1、IL-11及纤维化标志物α平滑肌肌动蛋白（α-SMA）、Ⅰ型胶原蛋白α1（COL1A1）m RNA表达。另取传3～6代、对数生长期、生长状态良好的ESCs，分别转染三条si-GAS6-AS1序列以及si-Control序列，采用RT-q PCR法验证转染效率。将转染si-GAS6-AS1的ESCs用无血清培养基饥饿培养后予TGF-β1干预，收集细胞，采用Western blotting法检测IL-11、α-SMA、COL1A1蛋白表达，采用CCK-8法检测细胞增殖活性，采用Annexin V-FITC/PI双染法检测细胞凋亡率。结果 与TGF-β1未干预组比较，TGF-β1干预组lnc RNA GAS6-AS1、IL-11、α-SMA、COL1A1 m RNA相对表达量均显著升高（P均＜0.01）。转染si-GAS6-AS1-1、si-GAS6-AS1-2、si-GAS6-AS1-3及si-Control序列的ESCs GAS6-AS1 m RNA相对表达量分别为0.22±0.04、0.27±0.06、0.81±0.07、1.00±0.00。与转染si-Control序列的ESCs比较，转染si-GAS6-AS1-1、si-GAS6-AS1-2序列的ESCs GAS6-AS1 m RNA相对表达量显著降低（P均＜0.01），而转染si-GAS6-AS1-3序列的ESCs GAS6-AS1 m RNA相对表达量降低不明显（P＞0.05）。因此，选择si-GAS6-AS1-1、si-GAS6-AS1-2序列进行后续实验。与si-Control+TGF-β1组比较，si-GAS6-AS1-1+TGF-β1组和si-GAS6-AS1-2+TGF-β1组IL-11、α-SMA、COL1A1蛋白相对表达量及细胞增殖活性均显著降低，细胞凋亡率均显著升高（P均＜0.01）。结论 lnc RNA GAS6-AS1通过靶向调控IL-11表达抑制ESCs向成纤维细胞分化。

目的:探究人脐带间充质干细胞来源的外泌体(MSC-exosomes)对盆腔器官脱垂(POP)患者阴道壁成纤维细胞的调节作用.方法:采用超速离心法提取MSC-exo-somes,应用透射电镜观察外泌体形态,Western blot法检测特异分子HSP90、CD63和TSG101表达,对外泌体进行综合鉴定.采用组织爬块和胶原酶消化法从POP患者阴道壁组织中分离培养成纤维细胞.采用PKH-67绿色荧光染料标记外泌体,添加PKH-67标记的MSC-exosomes,观察成纤维细胞对外泌体的摄取情况.分别将终浓度为50μg/mL、100μg/mL的MSC-exosomes加入成纤维细胞中,对照组加等体积PBS.MTS法检测3组细胞在12、24、36、48、60h和72h的增殖情况.收集成纤维细胞蛋白,Western blot法检测成纤维细胞胞外基质代谢相关基因CollagenⅠ、CollagenⅢ、LOXL-2、Fibronectin和MMP-2等表达,并进行相对定量统计分析.结果:分离到的外泌体特异表达标志蛋白HSP90和CD63,不表达内质网蛋白TSG101,透射电镜观察到具有双层脂膜结构的圆形囊泡小体,表明分离得到了外泌体.从脱垂患者阴道壁组织中成功培养得到成纤维细胞,其形态呈长梭型或纺锤形,细胞排列成簇状.PKH-67标记的MSC-exosomes添加24 h后,细胞内可见丰富的绿色荧光信号,表明MSC-exosomes可被阴道壁成纤维细胞有效大量摄取.50、100μg/mL MSC-exosomes均可促进阴道壁成纤维细胞的增殖.50、100μg/mL exosome作用24h后,CollagenⅠ、CollagenⅢ、LOXL-2、Fibronectin表达增加,其中Fibronectin表达升高最显著,100μg/mL exosome组较50μg/mL exosomes组促进作用更明显,Collagen I在48 h时较24 h升高作用更明显,而MMP-2在MSC-exosomes添加后均出现蛋白表达下降,表明细胞外基质分解降低.结论:MSC-exosomes可有效促进POP阴道壁成纤维细胞的增殖,并促进成纤维细胞胞外基质的合成,减少细胞外基质的降解.

随着社会人口老龄化不断进展,女性盆底功能障碍性疾病发病率逐年升高.但由于发病机制不完全明确,目前缺乏有效的预防措施及药物治疗.绝经是导致盆底功能障碍性疾病的主要危险因素之一,因此外源性雌激素补充一直是药物研究的热点.目前雌激素在盆底功能障碍性疾病的发病机制中的作用以及外源性雌激素的全身、阴道局部对盆底功能障碍性疾病的影响结论尚不统一.本文对雌激素在盆底功能障碍性疾病的基础及临床研究结果进行综述,旨在为后续治疗靶点的研究提供一定理论依据.

目的 观察平滑肌电刺激对促进重度盆腔子宫内膜异位症术后肠道功能恢复的疗效.方法 选择重度盆腔子宫内膜异位症术后患者150例,分为观察组及对照组各75例.2组患者均记录肠粘连的程度及部位,并于术后24 h开始腰腹部皮肤仿生物电刺激,观察组选择平滑肌电刺激模式,对照组使用传统横纹肌电刺激模式.对比两组患者术后规律肠鸣音出现、排气、排便、耐受普食的时间及腹胀情况.结果 观察组术后出现规律肠鸣音的时间、首次排气时间及首次耐受普食无不适的时间均早于对照组(P<0.05),观察组腹胀持续时间短于对照组(P<0.05).所有患者均未出现肠梗阻、电刺激不良反应及出血等不良事件.结论 平滑肌电刺激对重度盆腔子宫内膜异位症患者术后肠道功能恢复治疗效果优于横纹肌电刺激模式.

目的 探讨仿生物电刺激用于妇科肠粘连松解术后促进肠道功能恢复的有效性.方法 选择2019年1—12月于首都医科大学附属北京妇产医院妇科因良性疾病进行手术治疗,并于术中同时进行肠粘连松解术的患者共200例.根据术后促进肠道功能恢复的方法 分为观察组和对照组各100例,观察组术后使用腹部经皮仿生物电刺激治疗,对照组口服传统中成药物治疗.比较两组规律肠鸣音出现、首次排气、首次排便、耐受普通膳食的时间,术后住院时间,腹胀情况及肠梗阻发生情况,以及患者对腹胀缓解率的满意度.结果 与对照组相比,观察组患者规律肠鸣音出现、首次排气、首次排便、耐受普通膳食的时间更早,腹胀持续的时间、术后住院时间更短,患者对腹胀缓解的满意度更高,差异均有显著性(P<0.05).结论 仿生物电刺激对于促进妇科腹部手术合并肠粘连松解术的术后肠道功能恢复有促进作用,且患者接受度较高,扩大了临床治疗的选择,具有良好的应用前景.

目的 探讨局部麻醉用于MyoSure宫腔镜子宫内膜息肉机械旋切术的安全性及可行性.方法 2021年4～5月行局部麻醉下MyoSure宫腔镜子宫内膜息肉旋切术日间手术30例,查体宫颈质地坚韧者术前15 min静脉滴注间苯三酚40～80 mg.采用多部位局部麻醉,包括5％复方利多卡因乳膏阴道黏膜及颈管黏膜表面麻醉,0.5％罗哌卡因宫颈及宫颈旁阻滞麻醉,2％利多卡因宫腔黏膜表面麻醉.结果 30例中仅3例(10％)需扩张宫颈,手术均顺利完成,未出现因疼痛难忍需中转全身麻醉者,无迷走神经反射及并发症发生.术中局麻药物相关不良反应包括耳鸣5例,头晕1例,均于2 min内消失;未出现过敏反应及其他不良反应.患者对镇痛效果满意度100％(非常满意28例,满意2例).结论 多部位局部麻醉技术应用于MyoSure宫腔镜子宫内膜息肉机械旋切术安全可行,患者满意度高,可用于日间手术.

Endometriosis (Ems) is a common gynecological disease with the characteristics of infertility, pelvic pain, and sexual intercourse difficulty. Our present study aimed to investigate the effect of miR-199a-5p on cell mobility and epithelial-mesenchymal transition (EMT) in Ems. Ectopic endometrial stromal cells (EcSCs) and control endometrial stromal cells (CSCs) were isolated in our in vitro experiments. The level of miR-199a-5p in EcSCs was found much lower than that in CSCs. Besides, miR-199a-5p mimic suppressed the invasion and migration ability of EcSCs. At the same time, EMT was also found to be suppressed by miR-199a-5p mimic in EcSCs. Our further bioinformatics analysis and luciferase reporter assay revealed that ZEB1, a marker of EMT, was a direct target of miR-199a-5p. In addition, the combination of pcDNA3.1-ZEB1 weakened the inhibiting effect of miR-199a-5p mimic on the mobility and EMT of EcSCs. What is more, the PI3K/Akt/mTOR signal pathway was demonstrated to be inactivated by miR-199a-5p mimic. And then, the inducer of PI3K/Akt/mTOR signal pathway, IGF-1, abolished the effect of miR-199a-5p mimic on Ems progression. At last, an Ems rat model was established, and we found that miR-199a-5p agomir effectively suppressed the expression of vascular endothelial growth factor (VEGF) and EMT in vivo. The PI3K/Akt/mTOR signal pathway was also inactivated by miR-199a-5p agomir in our Ems rat model. Taken together, we concluded that miR-199a-5p targeted ZEB1 to inhibit the EMT of ovarian ectopic endometrial stromal cells via PI3K/Akt/mTOR signal pathway in vitro and in vivo, advancing our understanding of miR-199a-5p as regulators of Ems progression and making contribution to the treatment of Ems.

Objective To analyze the risk factors for previous cesarean scar defect.Methods Totally 128 patients who had received cesarean section were recruited in the study.Fifty-six of the cases came to visit a doctor because of previous cesarean scar defect between January 2013 and December 2015,while the other seventy-two cases had their scars healed under the vaginal ultrasound and with no symptoms related to previous cesarean scar defect.The medical records included general conditions (age,uterine position,gestational age,gravidity and parity history and neonatal weight) and perioperative conditions (pregnancy complications,puerperal infection,time of operation,and ways of incision suture) were collected.Risk factors for previous cesarean scar defect were analyzed.Results There were more cases of retroflexed uterus,delivery,cesarean sections,patients with gestational diabetes mellitus,cesarean sections during the second stage of labor,and more cases of single layer closure incision (P ＜ 0.05) in the group with previous cesarean scar defect.The risk factors for previous cesarean scar defect were the retroflexed uterus(OR =0.370,P ＜ 0.05),multiple cesarean sections(OR =0.147,P ＜ 0.01),cesarean sections during the second stage of labor (OR =0.543,P ＜ 0.05),and incisions with single layer closure(OR =1 1.126,P ＜ 0.05).Conclusions Rigorous control of indications,proper timing of cesarean sections,and improving surgical expertise are effective means of reducing the risk of previous cesarean scar defect.

剖宫产切口憩室是剖宫产术后远期并发症之一，可引起异常子宫出血、继发不孕、慢性盆腔痛等症状。目前发病机制尚不清楚，可能与患者年龄、子宫位置、子宫下段剖宫产次数、手术时机及感染因素有关。超声是最常用的诊断方法，也是有剖宫产史的女性再次妊娠前有效的筛查手段。治疗方案的选择多取决于患者的生育要求。手术是主要的治疗方法，目的主要是针对缓解异常子宫出血及减少妊娠并发症，手术方式主要包括宫腔镜、腹腔镜、阴式手术及联合手术。合理降低剖宫产率、选择适当的手术时机、提高缝合技巧以及预防和治疗感染是有效的预防手段。

> 分娩方式包括经阴道自然分娩,经阴道助产分娩及剖宫产。不同分娩方式可对新生儿机体产生不同影响,从而引起新生儿应激状态及免疫功能等多方面的不同表现。一、分娩方式对新生儿应激状态的影响新生儿应激主要来自于产前、产时宫缩形成的相对缺氧

OBJECTIVE:To determine whether mode of delivery is associated with the level of catecholamines in umbilical cord blood of neonates.METHODS:A study was carried out on 150 neonates. Among them 90 were healthy while 60 were diagnosed fetal distress. Then the subjects were first divided into 5 groups according to different modes of delivery: 30 were delivered by spontaneous labor for vaginal delivery without any pain relief; 30 by vaginal delivery with epidural anaesthesia; 30 by caesarean section without labor; 30 by vaginal delivery with low forceps because of fetal distress and 30 by caesarean section of emergency because of fetal distress. After delivery, umbilical cord blood of both artery and vein was collected for determination of norepinephrine (NE), epinephrine (E), and dopamine (DA).RESULTS:(1) The concentration of NE and E of umbilical artery were different in each group (P < 0.01), the group with the highest concentrations of NE and E was the ones delivered by vaginal delivery with low forceps [(73 +/- 6) ng/L, (37.8 +/- 1.8) ng/L] while caesarean section [(35 +/- 5) ng/L, (27.2 +/- 1.2) ng/L] was associated with significantly lower concentrations of NE and E of umbilical artery. The ones delivered by vaginal delivery with low forceps [(33.7 +/- 4.5) ng/L] and caesarean section of emergency [(32.9 +/- 4.5) ng/L] had higher concentrations of DA compared with any other group (P < 0.01). (2) The concentration of NE and E of umbilical vein were different in each group (P < 0.01) just like that of umbilical artery. The ones delivered by vaginal delivery with low forceps and caesarean section of emergency had higher concentrations of DA compared with any other group (P < 0.01). (3) The neonates with fetal distress had higher levels of catecholamine both in umbilical artery and umbilical vein than the healthy ones (P < 0.01); at the same time, the ones with fetal distress got lower Apgar scores 1, 5, 10 min after born contrasted to the healthy ones.CONCLUSIONS:If no indication for caesarean section exists, delivery by vaginal naturally can give higher level of catecholamines in cord blood, thus the neonate can get ready to adapt to the new environment better.

目的 观察术前补液对预防无痛人流术后发生低血压的效果.方法 选取我院计划生育科门诊手术室行无痛人流的患者600例,分为两组,观察组术前30 min静脉滴注乳酸钠林格氏液250 ml,维持至手术结束;对照组自手术开始时(麻醉时)开始静脉滴注乳酸钠林格氏液,维持至手术结束.观察患者术前、术后血压的变化情况及低血压发生率.结果 两组患者术后收缩压和舒张压与术前相比有统计学意义(P＜0.01),两组术后收缩压的降低值相比无统计学意义(P＞0.05),舒张压的降低值相比有统计学意义(P＜0.05).观察组低血压发生率为1.69%,对照组低血压发生率为5.26%,两组间差异有统计学意义(P＜0.05).结论 术前补液能有效降低无痛人流术后低血压的发生率。