Objective To parse the current situation of obstetrics resources in Chinese Public General Hospitals,and explore a new path for the development of obstetric medical service system in public hospitals.Methods Literature search and qualitative interview methods were used to sort out the obstetric resources and services of public general hospitals.Results The obstetrics departments in public general hospitals play an important role in the obstetrics service system,which face more operation pressures and transformation difficulties in the background of low fertility.Public general hospitals can strengthen the inner horizontal integration by multidisciplinary collaboration,and external vertical with medical alliances and obstetric alliances,so as to provide high-quality and continuous obstetric services for regional pregnant women and enhance system resilience.Conclusion Centralized multidisciplinary integration inside the hospitals and alliance with other obstetrics departments outside the hospitals,namely Two"Centralized Development"may be a new path for the high-quality development of obstetrics department in public general hospitals under the background of low fertility rate.

Objective To parse the current situation of obstetrics resources in Chinese Public General Hospitals,and explore a new path for the development of obstetric medical service system in public hospitals.Methods Literature search and qualitative interview methods were used to sort out the obstetric resources and services of public general hospitals.Results The obstetrics departments in public general hospitals play an important role in the obstetrics service system,which face more operation pressures and transformation difficulties in the background of low fertility.Public general hospitals can strengthen the inner horizontal integration by multidisciplinary collaboration,and external vertical with medical alliances and obstetric alliances,so as to provide high-quality and continuous obstetric services for regional pregnant women and enhance system resilience.Conclusion Centralized multidisciplinary integration inside the hospitals and alliance with other obstetrics departments outside the hospitals,namely Two"Centralized Development"may be a new path for the high-quality development of obstetrics department in public general hospitals under the background of low fertility rate.

Objective To evaluate the efficacy,bleeding profile and safety of low-dose levonorgestrel-releasing intrauterine system (LNG-IUS 8) in Chinese healthy women of childbearing age.Methods A multi-center,open-label,single-arm clinical trial conducted at 16 centres in China enrolled 773 healthy women of childbearing age (mean age 31.6 years old,range 18 to 40 years old),who demanded contraception,from April 2006 to June 2013.All women placed LNG-IUS 8 for 3 years and then been followed up at 3,6,9,12,18,24,30,36 months.The efficacy variables including pregnancy rate and expulsion rate were analyzed using life table,while observing adverse events (AE) to evaluate the safety.The bleeding profile happened during the study was assessed using 90-day reference intervals (World Health Organization criteria).Results Eight pregnancies occurred among 773 women,resulting in a overall Pearl index of 0.42 per 100 women years.The 3-year cumulative pregnancy rate was 0.37 per 100 women years and the 3-year cumulative expulsion rate was 1.99 per 100 women years.The number of women with bleeding/spotting reduced and the bleeding/spotting days declined over time.Totally 219 AE were reported related to LNG-IUS 8 placements.The most common AE were vaginal bleeding (8.2％,63/773)and the ovarian cyst (6.2％,52/773).LNG-IUS 8 had an improving effect on dysmenorrhea that the percentage of women with dysmenorrhea as well as the days of dysmenorrhea decreased over time.The percentage of women satisfied or very satisfied with LNG-IUS 8 was 87.2％ (622/713).Conclusion LNG-IUS 8 is highly effective and safe for Chinese healthy women of childbearing age.

Objective To assess the efficacy and safety of mifepristone combined with oral or vaginal misoprostol for termination of pregnancy between 8 and 16 weeks of gestation. Methods This was a randomized, multi-center, open clinical trial. A total of 625 women at 8-16 weeks of gestation were randomized to receive 200 mg oral mifepristone followed by either oral misoprostol 400 μg every 3 hours or vaginal misoprostol 400μg every 6 hours for a maximum of 4 doses 36-48 hours later. There were 417 women in oral group with 198 at 8-9 weeks and 219 at 10-16 weeks, while 208 women in vaginal group with 99 at 8-9 weeks and 109 at 10-16 weeks. The outcome measures were the success abortion rate, induction to abortion interval, the amount of bleeding, reoccurrence of menstruation and adverse events. Results Abortion rate was significantly higher in vaginal group [98.1% (202/206)] than that in oral group [94.0%(390/415), P=0.023]; concerning termination of pregnancy at 8-9 weeks and 10-16 weeks respectively, there were no significant differences between oral and vaginal groups (P=0.156, P=0.073). The induction to abortion interval was no significant difference in oral and vaginal group in different gestational weeks ( P=0.238, P=0.273). The average induction to abortion interval was (4.1 ± 6.6) hours and (6.0 ± 4.5) hours respectively in terminating 8-9 weeks and 10-16 weeks of gestation. Concerning the amount of bleeding within 2 hours of placenta expulsion, there was significant difference between oral group [(63±46) ml] and vaginal group [(55 ± 45) ml] in terminating 8-9 weeks of gestation (P=0.047), while there was no significant difference between groups in terminating 10-16 weeks of gestation [oral group (76 ± 52) ml versus vaginal group (76 ± 61) ml, P=0.507]. The reoccurrence of menstruation was about 37 days in both oral and vaginal groups. Two cases of incomplete abortion were serious adverse events (SAE) relating to treatment. The common adverse events (AE) of nausea and vomiting were significantly higher in oral group [57.2% (239/417), 36.3% (151/417)] than those in vaginal group [45.4% (94/208), 26.1% (54/208); P=0.005, 0.011]. Conclusion Oral or vaginal misoprostol combined with mifepristone, is effective and safe for termination of pregnancy between 8 and 16 weeks of gestation.

Objective To investigate the effect of estrogen replacement therapy applied in different periods to ovariectomized rats and to evaluate the cognitive function of the rats.Methods Totally 40 rats were ovariectomized to be postmenopausal models.They were divided into early hormone replacement therapy group (n =10,managed by estradiol valerate at day 3 after surgery),early control group (n =10,managed by saline at day 3 after surgery),late hormone replacement therapy (n =10,managed by estradiol valerate at day 90 after surgery for 30 days) and late control group (n =10,managed by saline at day 90 after surgery for 30 days).The behavior indicators of the rats were evaluated by Morris watermaze and hippocampal metabolite was detected by proton magnetic resonance spectroscopy,including N-acetylaspartate (NAA),choline containing compounds (Cho),creatine(Cr),myoinositol (mI),NAA/Cr,Cho/Cr and mI/Cr.Results (1) Navigation test: escape latency were (43 ± 13) s at the early control group,(28 ± 9) s at the early HRT group,(82 ±26) s at the late control group and (48 ± 18) s at late HRT group.Swimming distance were (1 404 ± 238) cm at the early control group,(878 ± 354) cm at the early HRT group,(2411 ±818) cm at the late control group and (1 310 ±434) cm at the late HRT group.The escape latency and swimming distance of the early and late HRT groups were significantly shorter than those at the control groups (P ＜ 0.05).(2) Spatial probe test: the swimming time in the target quadrant of rats in the early HRT group (34.0 ± 3.0) s were longer than those in other groups (P ＜ 0.05).(3) Proton magnetic resonance spectroscopy: NAA/Cr were 1.12 ±0.17 at the early control group,1.26 ±0.12 at the early HRT group,1.57 ±0.21 at the late control group and 1.38 ±0.28 at the late HRT group.The late HRT group and the late control group were higher than their early groups (F =6.05,P =0.040).There was no significant difference between the HRT groups and the control groups (F =0.04,P =0.860).mI/Cr were 0.69 ±0.04 at the early control group,0.46 ±0.12 at the early HRT group,0.70 ±0.03 at the late control group and 0.75 ± 0.08 at the late HRT group.There were statistically significant differences of the experimental time between the early and late groups(F =16.45,P =0.004).The differences between the early HRT group and the early control group,and the late HRT group and the late control group were significant(F =6.01,P =0.040).And there was an interaction with the experimental time and HRT measures (F =13.79,P =0.006) ; early HRT can reduce the average level of mI/Cr.Cho/Cr were 0.95 ± 0.09 at the early control group,0.80 ±0.12 at the early HRT group,0.87 ±0.09 at the late control group and 0.85 ± 0.12 at the late HRT group.There was no significant difference among those groups (P ＞0.05).NAA/mI: there was an interaction with the experimental time and HRT measures (F =12.95,P =0.007).Early HRT can elevated levels of NAA/mI,while the late results were reversed.Conclusion Earlier estrogen replacement therapy may play a positive role in improving cognitive function of the ovariectomized rats.

Objective To explore the correlation between polymorphism of angiotensin converting enzyme (ACE) gene and hypertensive disorder complicating pregnancy (HDP) in Chinese people.Methods The 21 case-control studies on the correlation between polymorphism of ACE gene (genotype DD,DI,Ⅱ) and HDP in Chinese people were analyzed by meta-analysis.The analysis was performed on Review Manager 4.2 software.According to the result of test for heterogeneity,the random effects model was used to calculate the pooled OR value and 95% CI.Results Twenty-one case-control studies were enrolled in this meta-analysis,a total of 1486 HDP cases and 1758 controls were included.The pooled OR values (95% CI) of DD,DI,Ⅱ genotypes of ACE gene polymorphism for HDP risk were 2.60 (1.84-3.67),0.98 (0.76-1.27) and 0.46 (0.32-0.65) respectively.Conclusions Genotype Ⅱ of ACE is a protective gene against HDP and genotype DD is a susceptibility gene for HDP.

Objective To explore clinical features and pregnancy outcomes of early-ouset severe pre-eclampsia. Methods Clinical data of 96 cases of severe preeclampsia who deliveried in Southeast University from November 2004 to February 2009 were analyzed. The patients were divided into two groups, early-onset preeclampsia group(onset gestatioual weeks <34) and later-onset preeclampsia group(onset gestatianal weeks≥34 ). Resnits Significant difference of two groups were found in central nervous system symptom and urine protein (+ +) or > 2 g/24 h (P<0.05), incidence of abnormal prenatal outcome (χ~2=14.792,4.741,27.03 respectively;P<0.05). Mean birth weight in early-onset preeclampsia group (1743.86±630.34)g was lower than that in later-onset pre-eclampsia greup(2940.47±762.36)g (t=6.71 ,P<0.05). Conclusions Clinical symptoms of early-onset severe preeclampsia are severe , and have a higher incidence of abnormal prenatal outcomes. Prevention, prediction ,diagno-sis and management of preeclampsia are important for mothers and children.

AIM: To study the effect of estrogen on injury induced by ?-amyloid protein (A?) in primary cultures of rat cortical neurons. METHODS: The effect of 17?-E_2 on A?(25-35)-induced cell death in primary rat cortical neurons was observed by phase contrast light microscopy, Giemsa staining and determination of lactate dehydrohenase (LDH) release rate. RESULTS: A?(25-35) induced cell death in rat primary cortical neurons. Forty eight hours pretreatment with 17?-E_2 protected rat primary cortical neurons from A?(25-35)-induced injury. CONCLUSION: A? evokes toxicity in rat primary cortical neurons. Estrogen can protect the rat primary cortical neurons against injury induced by A? (25-35).

Objective:To study the expression of integrin ?_5,?_3 in eutopic endometrium and ectopic endometrium of endometriosis. Methods:Reverse transcription polymerase chain reaction(RT-PCR) method was utilized to detect and quantitate integrin ?_5,?_3 mRNA expression levels in eutopic and ectopic endometrial tissues from 18 patients with endometriosis and the endometrial tissues from 18 non-endometriosis women.Serum concentration of estradiol(E_2),progesterone(P) and CA125 were measured by radioimmunoassay.AFS-r marking was used to describe the state of pelvic cavity during operation. Results:Various levels of positive expression of integrin subunits ?_5,?_3 were shown in both eutopic and ectopic endometrial tissues of endometriosis and the endometrium of non-endometriosis.The expressions of integrin ?_5 mRNA in eutopic endometrium,ectopic endometrium of endometriosis group and endometrium of control group were as 0.773?0.113,1.077?0.032,0.924?0.120,respectively.(Among) the groups,the differences were statistically significant(P0.05).Both CA125 level and AFS-r were positively correlated with integrin ?_5,?_3(P

The article introduces the point of multimedia network teaching and application in gynecology and obstetrics teaching,pointing out the problems in multimedia network teaching that should be improved.