Objective To detect and explore the expression and clinical significance of dual specificity tyrosine phosphorylation regulated kinase1b (Dyrk1b) in the specimens and cells of cervical lesions. Methods (1)All the data were collected from 75 patients with cervical cancer and 52 cases with squamous intraepithelial lesion(SIL)admitted in the First Affiliated Hospital of Dalian Medical College during Jan. 2011 to Dec. 2013 and confirmed by pathological examination, included 60 cases of stageⅠand 15 cases of stageⅡ, 12 cases with low-grade squamous intraepithelial lesion(LSIL)and 40 cases with high-grade squamous intraepithelial lesion(HSIL). While, 28 cases with chronic cervicitis were chosen as the control group. The protein expression of Dyrk1b was detected by immunohistochemistry among the four groups.(2)The expression of Dyrk1b in HeLa and SiHa cells were detected by western blot method and the expression of Dyrk1b protein were also detected after treatment of AZ191 (5, 10 μmol/L) for 48 hours in HeLa and SiHa cells.(3)The cellular survival and proliferation of HeLa and SiHa cells treated by different concentrations of AZ191(2.5, 5, 10, 25, 50, 100 μmol/L)for 48 hours were detected by methyl thiazolyl tetrazolium (MTT) assay.(4)The rate of apoptosis of HeLa and SiHa cells was detected by flowcytometry after treatment of AZ191 (5, 10μmol/L) for 48 hours. Results (1)The positive rates of Dyrk1b protein in chronic cervicitis, LSIL, HSIL and cervical squamous cancer by immunohistochemistry were 11%(3/28), 1/12, 42%(17/40)and 71%(53/75), respectively. The expression of Dyrk1b in cervical squamous cancer and HISL were higher than those in LSIL and chronic cervicitis (P<0.01), there were significant difference between cervical squamous cancer and HSIL, or between HSIL and LSIL(all P<0.05), while there were not significant difference between LSIL and chronic cervicitis(P>0.05). Expression of Dyrk1b was correlated with stromal invasion depth of cervical cancer (P<0.05), but not with age, clinical stage, lymph node metastasis, and serum squamous cell carcinom antigen(SCC-Ag)levels (all P>0.05). (2) Dyrk1b protein was expressed in different levels in HeLa and SiHa cells, and the expression of Dyrk1b was decreased gradually as the increased of the concentration of AZ191 in both HeLa and SiHa cells by treatment of AZ191 for 48 hours. (3) Different concentration of AZ191 treated on cervical cancer cells could inhibit the cellular proliferation and induce cell apoptosis in a concentration-dependent manner(P<0.01), concomitant to the decreased cell survival rate. The apoptosis rate of HeLa and SiHa were increased significantly after 10μmol/L AZ191-treatment for 48 hours, but no any difference induced by 5 μmol/L AZ191-treatment compared to control group. Also,there was no any difference between Hela and SiHa cells in either inhibitory effect or apoptosis rate induced by AZ191. Conclusions Dyrk1b is over-expressed in either specimens or cells of cervical cancer. The expression of Dyrk1b protein in cervical lesions is increased as the progression of disease. Dyrk1b inhibitor AZ191 could inhibit cellular proliferation and induce apoptosis in a concentration-dependent manner in cervical cancer cells.

Objective To investigate the clinical significance of transvaginal ultrasound, hysteroscopy and MRI in the assessment of endometrial cancer lesions size. Methods Data from 56 patients who successively underwent transvaginal ultrasound, MRI and hysteroscopy inspection preoperative endometrial carcinoma were retrospectively analyzed to assess the accuracy of lesions size. Results The pathologic lesions size measured mean maximum diameter of 56 cases was (3.05 ± 0.23) cm, while the mean maximum diameter measured by vaginal ultrasound, MRI and hysteroscopy were respectivelly (2.46±0.31) cm, (3.12± 0.08) cm, and (3.18 ± 0.21) cm. Compared with the pathologic measured values, the compliance rates of transvaginal ultrasound, hysteroscopy and MRI were respectively 54%(30/56), 71%(40/56)and 75%(42/56), which vaginal ultrasound measurement value was significantly different than that by pathologic measured ( P=0.031), while there were significant difference between the hysteroscopy measured lesion size and pathologic measured, or between MRI measured values and pathologic measured (all P>0.05). Conclusion Preoperative assess the endometrial cancer lesions size, significance of vaginal ultrasound examination is limited, and MRI and hysteroscopy examination is accurate, but easy to over-estimated lesion size.

Objective To evaluate the effect of amniotic products after transcervical resection of uterine adhesions (TCRA). Methods This study was carried out in 57 patients with intensive degree of intrauterine adhesions (IUA) who had been treated by TCRA between Jun. 2013 to Jun. 2014. These patients were devided into two groups randomly. In group amnion, 29 patients were placed amniontic scaffold balloon after TCRA;in group balloon, 28 patients were placed Foley′s balloon after TCRA. The two groups′balloons were taken out after TCRA 7 days. All patients were taken artificial cycle treatment. The uterine cavity form and the menstruation of 2 groups were observed in 3 months after TCRA. Results In group amnion, IUA score dropped from 10.1±0.5 preoperatively to 3.2±1.5 postoperative (P<0.01), in group balloon, IUA score dropped from 10.1 ± 0.5 preoperatively to 6.3 ± 2.5 postoperative (P<0.01). In group amnion, the menstrual score increased from 13.3 ± 4.4 preoperatively to 32.6 ± 5.5 postoperative (P<0.01), in group balloon, the menstrual score increased from 11.1±5.8 to 26.5±5.6 (P<0.01). The menstrual improvement of group amnion was better than that of group balloon significantly (P=0.002). In group amnion, the recurrence rate of adhesion was 21%(6/29), in group balloon, the recurrence rate of adhesion was 36%(10/28). There was no significant difference (P=0.248). The pregnancy rate of group amnion was 28%(8/29), the pregnancy rate of group balloon was 21%(6/28). The difference of pregnancy rate in two groups was not significant (P=0.760). Conclusion This small sample observation indicate that amniotic products used in the treatment of intensive IUA could improve menstrual, reduce the recurrence of adhesion, but the impovement of the pregnancy rate should be confirmed by large sample observation.

Objective To research the important of prenatal diagnosis and effect of intervention to fetal hydrothorax. Methods The cases of fetal hydrothorax (n=5) were obtained from the Shengjing Hospital,China Medical University between December 2014 and May 2015. All pregnancies were uncomplicated, excluded congenital organic and chromosomal abnormalities during prenatal diagnosis and with a 37 average gestational weeks. The case 1, 2, 4 were unilateral hydrothorax and the case 3, 5 were bilateral. We performed an antenatal thracocentesis to case 1, 2, 3. In case1, the hydrothorax increased rapidly after 5 days, and the patient underwent a cesarean section and ex utero intrapartum treatment (EXIT);in case 2, the fetal heart rate was decreased to 40-50 bpm suddenly during thracocentesis, and we performed an emergent cesarean section and EXIT for the patient; in case 3, the patient underwent thracocentesis and a meanwhile cesarean section and EXIT procedure. We performed a conservative management to case 4, 5, the hydrothorax resolved spontaneously during the pregnancy and after birth, both patients underwent cesarean section. Results All fetuses were survived, the neonates of case 1, 2 and 3 underwent assited mechanical ventilation, thoracic close drainage, then discharged after hydrothorax resolved and feeding tolerance;in case 4, there was no respiratory distress and hospital treatment;in case 5, the neonate underwent assited mechanical ventilation and conservative management, the hydrothorax has resolved gradually. Conclusions The prenatal diagnosis and antenatal intervention (thracocentesis) may play an important role in fetal hydrothorax treatment. In clinical, we should choose different plan according to the gestation weeks and classification of hydrothorax of the patient.

Objective To evaluate the effect on maternal blood dilution of fetoscopic laser occlusion of chorioangiopagous vessels (FLOC) in treating twin to twin transfusion syndrome(TTTS). Methods The clinical data of 71 cases of TTTS who had FLOC in Peking University Third Hospital were reviewed. Fluid intake, blood pressure, heart rate, red blood cell count, hemoglobin and hematocrit in perioperative 24 hours were analyzed. Results (1)According to the Quintero staging, 9 cases were stageⅠ, 24 were stageⅡ,28 were stageⅢand 10 cases were stageⅣ.(2)The average operation time of FLOC was (64.0±16.3) minutes. One case had placental abruption after the procedure;one had placental vessel rupture and 6 women refused to take blood counting. These 8 cases were excluded and 63 cases were included in the study. (3) The perioperative bleeding volume was 3 (1, 5) ml, and the volume of fluid intake, urine, amniotic fluid drainage and net fluid intake in the perioperative 24 hours was 2 050 ml(1 530 ml, 3 700 ml), 2 300 ml (1 100 ml, 3 500 ml), 1 900 ml (1 400 ml, 2 700 ml) and -1 760 ml (-100 ml,-3 350 ml), respectively. There was no significant difference between maternal blood pressure or heart rate preoperatively and postoperatively.(4)The maternal red blood cell count [(3.47±0.36)×1012/L versus (3.01± 0.37) × 1012/L, P=0.000], hemoglobin [(107.8 ± 12.1) g/L versus (95.1 ± 11.2) g/L, P=0.000] and hematocrit [0.313(0.238, 0.387) versus 0.276(0.213, 0.800), P=0.000] decreased significantly 24 hours after FLOC.(5) The postoperative hematocrit decreased more in the group which the amniotic fluid drainage volume was 2 000- 3 000 ml than that in the group which the amniotic fluid drainage volume was 1 000-1 999 ml. Conclusions The blood dilution can not be ignored after the FLOC in TTTS patients. The more the amniodrainage volume during the FLOC, the more the maternal blood dilution would be. It might result from amniodrainage during the FLOC, improved maternal-placenta circulation and tocolytics used after FLOC. More attention should be take about maternal cardiac function and complications related with anemia after FLOC.

Objective To investigate the results of follow-up visits of pregnancy course, delivery and infants of women who got clinically pregnant by assisted reproductive technique after gonadotropin-releasing hormone agonist (GnRH-a) added for luteal support, and to analyse the influence of adding GnRH-a in luteal support on the safety of mother and infant. Methods A retrospective analysis was carried out on the medical record from 215 patients who got clinically pregnant after luteal phase long regimen fresh-cycle transfer was operated. According to the differences in luteal support methods, the patients were assigned to Group A (124 patients, progesterone+dydrogesterone group), Group B (91 patients, GnRH-a added group). The patients′ pregnancy course, delivery time, and the growth and development of infants within 1-2 years were followed up. Results (1)There was no obvious difference between Group A and Group B in terms of the abortion ratio during the early pregnancy (8.1%, 12.1%), the rate of abortion villous deformity (50.0%, 9.1%), the rate of heterotopic pregnancy (10.5%, 5.5%) and rate of twin pregnancy (19.4%, 28.6%;all P>0.05).(2)Compared to group A, during the middle and late pregnancy of single or twin pregnancy in Group B , there was no obvious difference in the rate of fetal chromosomal abnormality, organ malformation incidence, late abortion rate and stillbirth rate (all P>0.05).(3)As to childbirth, in the case of twin pregnancy, there was a higher rate of premature delivery (60.0%, 39.1%;P=0.041), as well as rate of lower birth weight of newborn (56.0%, 34.8%; P=0.037) in group B.(4)The statistics on general growth and development as well as infantile common diseases within 2 years after birth indicated that there was no obvious difference between the two groups in single birth and twin birth subgroup (all P>0.05). Conclusion On the basis of controlling of implanted embryos and reducing the occurrence of twins, GnRH-a luteal support maybe relatively safe and effective.

Objective To investigate the clinical value of prenatal MRI in the diagnosis and differential diagnosis of congenital bronchopulmonary sequestration (BPS). Methods From January 2009 to December 2014, 16 fetuses with BPS were diagnosed by fetal MRI in Huzhou Maternity and Child Care Hospital and Shanghai Children′s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine. The clinical data of these cases were analyzed retrospectively. All were singleton pregnancy, and MRI was carried out within 24-48 hours after routine prenatal ultrasound. All the neonates underwent postnatal enhanced CT scan or surgical biopsy after birth, and the results were compared to prenatal MRI diagnosis. Results (1)With prenatal MRI, 16 cases were diagnosed BPS. The lesions located in left lung in 10 cases, and right lung in 6 cases. As the scope of the lesion, 3 cases located in the whole left lung, 6 cases limited to the left lower lobe, and 1 case was subdiaphragmatic on the left side. 2 cases located in the whole right lung and 4 cases limited to the right lower lobe. One case complicated oligoamnios, and one had pleural effusion. Supplying vessels could be found in 14 cases.(2)When the postnatal results were compared with prenatal MRI, 15 cases were comfirmed as BPS (15/16), including 10 intralobar cases 5 extralobar cases. One that was diagnosed as BPS by prenatal MRI was confirmed to be congenital cystic adenomatoid malformation (CCAM) by pathology. The accuracy of prenatal MRI diagnosis of BPS was 15/16. Prenatal ultrasound missed one case and misdiagnosed two cases, as one was mistakened as CCAM and the other as cystic teratoma. Conclusion Prenatal MRI has good clinical value in the diagnosis and differential diagnosis of fetal BPS.

Objective To evaluate the efficacy and safety of domestic human recombinant FSH (rhFSH) in women with anovulation of WHO groupⅡ. Methods A randomized, blind, parallel-controlled, non-inferiority and multicenter study was performed. A total of 534 admitted to 13 hospitals from May 2008 to August 2009. There were 531 women with ovulatory disorder was included in the statistical analysis, were randomly divided into test group (domestic rhFSH, n=352) and control group (imported rhFSH, n=179). Percentage of cycle with mature follicle, ovulation rate, clinical pregnancy rate, multiple pregnancy rate, ovarian hyperstimulation syndrome (OHSS) and adverse events were observed. Results No statistical significant differences (P>0.05) were observed between the two groups in terms of the efficiency on mature follicle [91.8%(323/352) versus 88.8%(159/179)], ovulation rate [91.3%(295/323) verus 90.6%(144/159)], clinical pregnancy rate [19.2%(62/323) verus 18.2%(29/159)], the number of the follicles<14 mm, the level of serum LH and progesterone, the thickness of endometrium on the day of hCG administration. The number of follicle≥18 mm and 14 mm≤follicle<18 mm and the level of serum estradiol on the day of hCG in the test group were significantly higher than those in the control group (P<0.05). The number of days of rhFSH administration in the test group was significantly less than that in the control group [(9.8±2.2) versus (11.4± 0.6) days, P<0.05], the dosage of rhFSH was significantly lower than that in the control group [(879 ± 419) versus (1 043 ± 663) U, P<0.05]. The multiple pregnancy rate in the test group was significantly higher than that in the control group [21% (13/62) versu 10% (3/29), P<0.05]. The incidence of OHSS and adverse events were similar between the two groups (P>0.05), and no other adverse events were observed in test group during treatment. Conclusion Ovarian stimulation with domestic rhFSH is effective, safe and economical in women with anovulation of WHO groupⅡ.

Objective To explore the correlation between thyroid peroxidase antibody (TPOAb) and outcomes during pregnancy and the effects of treatment on outcomes. Methods PubMed, Cochrane Library, Science Direct, Embase, Chinese Biomedicine, and Wanfangdata had been searched. Case-control and cohort studies about TPOAb and pregnancy outcomes were searched according to the inclusion and exclusion criteria. Fifty studies were finally recruited (all of cohort-studies, 10 for English and 5 for Chinese). Review Manager 5.3 were used to test the heterogeneity of the results among the different studies and amalgamate the effect size using fixed or random effect models. Results Meta-analysis showed TPOAb (+)with normal thyroid function increase the risks of miscarriage,and premature delivery, OR calculated were 2.02(95%CI:1.13-3.62, P=0.001)and 1.39(95%CI:1.11-1.76, P=0.005), while showed no relative risk to hypertensive disease,placental abruption in pregnancy and fetal growth restriction, OR calculated were 1.29(95%CI:1.00-1.67, P=0.080),0.42(95%CI:0.12-1.43, P=0.210)and 1.61(95%CI:0.23-11.12, P=0.100). TPOAb(+)with normal thyroid function increase miscarriage in in vitro fertilization and embryo transfer (IVF-ET), OR calculated were 2.14(95%CI:1.43-3.21, P=0.000). Levothyroxine (LT4) for patients of TPOAb(+)with normal thyroid dysfunction decrease adverse obstetric outcomes, OR calculated were 0.43(95%CI:0.22-0.85, P=0.020). Conclusions TPOAb(+)with normal thyroid function increase the risks of miscarriage,and premature delivery. TPOAb(+) with normal thyroid function increase miscarriage in IVF-ET. LT4 for patients of TPOAb(+)with normal thyroid dysfunction decrease adverse obstetric outcomes.

Objective To investigate treatment effects of levonorgestrel-releasing intrauterine system (LNG-IUS) for adenomyosis with severe dysmenorrhea in a prospective cohort study. Methods From December 2006 to December 2014, patients of symptomatic adenomyosis diagnosed by transvaginal ultrasound in outpatient or inpatient clinics of Peking Union Medical College Hospital were given the treatment of LNG-IUS. Before and after placement of LNG-IUS, all the patients′parameters were recorded prospectively, including symptoms and scores of dysmenorrhea, menstruation scores, biochemical indicators, physical parameters, carrying status of LNG-IUS, menstruation patterns and adverse effects. Changes of scores and patterns of pain during follow-up were analyzed. Results Totally 1 100 women meets inclusion criteria, among which 640 cases (58.18%, 640/1 100) had severe dysmeorrhea, with median follow-up period of 35 months (range 1-60 months), and accumulative carrying rate of 65% at 60 months follow-up. After placement of LNG-IUS, scores of pain and ratio of severe dysmenorrhea had decreased significantly compared with baselines (all P<0.01), the scroes of visual analog scale (VAS) were 8.1 ± 0.9, 5.5 ± 2.4, 4.6 ± 2.4, 3.3 ± 2.2, 2.2 ± 2.1, 2.2 ± 1.8, 1.4 ± 1.6 and 1.3 ± 1.3 at 0, 3, 6, 12, 24, 36, 48 and 60 months respectively. During 36 months after placement of LNG-IUS, scores of pain had improved significantly compared with preceding period (all P<0.01). We found no universal dependent factors predicting improvement of pain, which was neither relevant with simultaneous changes of menstruation patterns nor adverse effects (all P>0.05). Conclusion LNG-IUS is effective for adenomyosis of severe dysmenorrhea. Improvement of pain is independent on patients characters, menstruation patterns or adverse effects.