The co-existence of physician-patient disharmony and the high rate of cesarean section suggest that there must be some internal relationship between the two medical phenomena.The physician-patient disharmony not only increases the rate of non-indicative cesarean section,but also leads to artificial expansion of the cesarean section indicators.Building up a harmonious physician-patient relationship is an important safeguard to reduce the rate of cesarean section and protect the benefits of mothers and infants.

Objective To investigate the expression of survivin, matrix metalloproteinase (MMP-2) and tissue inhibitor 2 of matrix metalloproteinase (TIMP-2) in cervical carcinoma and their relationship with invasion and node metastasis of the cervical cancerous tissues. Methods The expressions of survivin, MMP-2 and TIMP-2 were examined by immunohistochemical S-P method and colour pathological image computer analysis system in 10 cases of normal cervical epithelia, 10 cases of cervical carcinoma in situ, 40 cases of invasive squamous cell cervical carcinoma and 11 cases of invasive cervical adenocarcinoma. The relationship between those indexes and the factors related to clinical pathology of cervical carcinoma were analyzed statistically. Results It was found that the positive level of survivin and MMP-2 expression increased in the order of normal cervical epithelium, cervical carcinoma in situ and invasive carcinoma of cervix (P0.05). The positive expressions of survivin and MMP-2 in patients under 35 years old or with pelvic lymph node metastasis, intravascular involvement and stroma involvement were significantly higher than that in the cases without them, while TIMP-2 expression was opposite to that of MMP-2 (P

This paper analyses the factors that influence the effects of medical students'clinical practice,and explores the evaluations of effects about applying the theory of performance of evaluation to medical students'clinical practice from the perspective of performance evaluation,and points out a method to improve the effects of medical students'clinical practice,in which we can integrate the isolated factors,and make an effective planning about medical students'clinical practice and can manage them scientifically and systematically to ensure the effectiveness and pertinence of medical students'clinical practice.

Objective To explore the value of placental alpha-microglobulin-1 in vagina liquid to diagnose premature rupture of membranes. Methods A prospective observational study to initial evaluation included both the standard clinical evaluation for rupture of membranes and placental alpha-microglobulin-1 immunoassay. Rupture of membranes was diagnosed if fluid was seen leaking from the cervical os or if two of the following three conditions were present: pooling of fluid, positive nitrazine test, or feming. Rupture of membranes was diagnosed definitively on review of the medical records after delivery. Results Placental alpha-microglobulin-1 immunoassay confirmed rupture of membranes at initial presentation with a sensitivity of 100% (89/89), specificity of 91% (10/11), positive predictive value of 99% (89/90), and negative predictive value of 100% (10/10),false positive rate of 9% (1/11). Placental alpha-nricroglobulin-1 immunoassay was better than the conventional clinical assessment in confirming the diagnosis of rupture ofmembranes (P<0.01). Conclusion Measurement of placental alpha-microglobulin-1 in cervicovaginal secretions is superior to conventional clinical assessment in the diagnosis of rupture of membranes.

Background and purpose: The Writ cell-signaling pathway is the key cellular developmental pathway. Dysregulation of this pathway has been implicated in the initiation and progression of cancer. Adenomatous polyposis coli (APC) is an important tumor suppressor gene of the Writ signaling pathway. The methylation of APC promoter and the accompanying loss of the APC transcript have been shown to occur in a significant proportion of cancers. However, there are few reports on the relationship between cervical cancer and methylation of APC. This study was aimed to investigate the promoter methylation status of the APC genes in cervical cancer and its correlation between clinicopathologic characteristics and the infection of high-risk HPV DNA. Methods: Promoter methylation was evaluated using a MSP (methylation-specific polymerase chain reaction) in 95 cervical cancer tissue specimens and 20 normal controls. The relationship between clinicopathologic parameters and the methylation status was evaluated. Results: The frequencies of promoter methylation of APC in cervical cancer were 56.8%. Cervical cancer had significant higher methylation frequencies than that of the controls (10%, P<0.01). The result showed that the methylation analysis of APC promoter and high-risk HPV DNA testing had good consistency (Kappa=0.348, P<0.001). The promoter methylation of APC was significantly higher in adenocarcinoma (AC) than in squamous cell carcinoma (SCC) (74.1% vs 50.0%, respectively, P<0.05). The larger tumor size, positive lymph node metastasis and positive HPV DNA exhibited an increased promoter methylation frequency for APC (P<0.05). There were no significant associations between the methylation frequencies for APC gene to age, invasion depth, FIGO stage and histological grade. Conclusion: Our results suggested that the promoter methyiation of APC and high-risk HPV DNA testing had good consistency. APC gene promoter methylation was a frequent epigenetic event in cervical carcinoma and had a significant correlation with cancer pathological types.

Objective To investigate the prenatal emotional disorder of the primipame and the related factors,and to analyze its influence on the delivery mode.Methods In the prospective cohort study,590 healthy primiparase were asked to complete a self-compiled questionnaires for their general social mental state,state-trait anxiety inventory(STAI)and self-rating depression scale(SDS).Results Questionnaires of 159 patients were selected and these patients were divided into the anxiety group(114 cases)and the control group(455 cases),the depression group(159 cases)and the control group(410 cases).The ratio of selective cesarean section in the anxiety group was significantly higher(45.61%,32.53%,X2=6.85,P＜0.01),while the successful trial of labor were less than that of the control group(19.35%,47.88%,X2=26.30,P＜0.01).The ratio of selective cesarean section in the depression group was significandy higher than that of the control group(46.54%,31.95%,X2=10.21,P＜0.01),while the successful trial of labor were less than that of the control group(31.76%.46.59%,X2=9.13,P＜0.01).Single-factor analysis showed that prenatal anxiety related to the following factors:fear of childbirth,worried about their children,knowledge for childbirth,high economic status,maternal age and their own economic situation.Conclusions Higher incidence and risk factors of anxiety or depression before delivery,such as advanced delivery age,bad economic condition,weak family support,worrying about the safety of babies and themselves,are found in our study.Prenatal emotional disorder would affect the quality of labor and delivery options,and lead the high risk of cesarean section.

Objective:Nerve fibres distribution in the functional layer of endometrium of women with endometdosis was investigated.Methods:Histological sections of endometrial tissue were prepared from endometrialcurettings and hysterectomies performed on women with endometnosis(n=25)and without endometriosis(n=40).Immunohistochemistry was used to detect nerve fibres by highly specific polyclonal rabbit antibody PGP 9.5.The assessment of nerve fibre density was performed bv Image Pro Plus Discovery.Results:Nerve fibres were identified throughout the functional layers of the endometrium in all endometriosis patients,but not found in the functional layer of the endometrium in women without endometriosis(P<0.01).Conclusions:Nerve fibres detectad in the functional layer in all women with endometriosis may have important implications for understanding the generation of pain in these patients.

Objective To evaluate endometrial biopsy and curettage in detecting small nerve fibers in eutopic endometrium for diagnosis of endometriosis.Methods Endometrial biopsies and curettings were taken in 65 women with menorrhalgia.Endometrial nerve fibers were immunohistochemically detected using the pan-neuronal marker PGP 9.5.All patients underwent laparoseopie approach.Results The specificity,sensitivity,positive and negative predictive value were 100% of endometrial biopsy and curettings for diagnosis of endometriosis.Condusions Careful endometrial biopsy combined with immunohistochemical staining for nerve fibers may be a reliable means of diagnosing or excluding endometriosis.

Objective To explore the changes of serum vascular endothelial growth factor ( VEGF) and endostatin (ES) in patients with polycystic ovary syndrome (PCOS) and their effects on the ovarian stromal blood flow. Methods From January 2015 to January 2017,sixty cases diagnosed with polycystic ovary syndrome in the Eighth Affiliated Hospital of Sun Yat?sen University were selected into the observation group,and other 60 cases of healthy women with normal menstrual cycle in the same period were selected as the control group. Then, the levels of serum VEGF and ES of the two groups were observed, the patients in the early ovarian follicular blood flow changes were monitored by transvaginal color Doppler ultrasound to observe the bilateral ovaries and the hemodynamic indexes. Hemodynamic indexes (pulsatility index and resistance index) were compared,and the effects of serum VEGF and endostatin levels on ovarian interstitial blood flow were analyzed. Results The PI and RI of the observation group were(1. 3±0. 2) and (0. 5±0. 1),the PI and RI of the control group were (2. 4±0. 4)and(1. 0±0. 1),the differences were statistically significant(t=2. 378,2. 578,P=0. 023,0. 014);the levels of VEGF and ES in the observation group were (1083±167)ng/L and (278±23)ng/L,the levels of VEGF and ES in the control group were (625±71) ng/L and (172±21)ng/L,the differences were statistically significant( t=2. 123,2. 892,P=0. 042,0. 008);there was negative correlation among VEGF and PI and RI ( r=-0. 770,-0. 782,P<0. 01);there was negative correlation among ES and PI and RI ( r=-0. 751,-0. 799,P<0. 01);there was positive correlation between VEGF and ES ( r=0. 552,P<0. 01) . Conclusion The serum levels of VEGF and ES are significantly increase in patients with polycystic ovary syndrome, the imbalance between the two expressions may play an important role in the increase of ovarian stromal blood flow.