In recent years, more and more studies have shown that autophagy is closely related to female reproductive process. Autophagy is a widespread and highly conserved degradation system in eukaryotes that can be activated under conditions such as hypoxia, starvation, lack of nutrients, or extreme pH. In terms of reproductive health, autophagy can improve reproductive dysfunction by removing damaged organelles and regulating cell growth and metabolism. Appropriate regulation of autophagy helps to improve oocyte quality, delay ovarian aging, fine-regulate endometrial growth, and ensure successful implantation of embryos. However, the abnormality of autophagy pathway may cause problems such as activation of pelvic inflammatory cytokines, reduced endometrial receptivity, abnormal follicle development, and weakened invasion ability of trophoblast cells, thus leading to the occurrence and development of reproductive disorders such as endometriosis, chronic endometritis, polycystic ovary syndrome, early-onset ovarian insufficiency, and recurrent spontaneous abortion. This article reviews the mechanism and therapeutic targets of autophagy in female reproductive diseases, providing clinical ideas and diagnosis and treatment strategies for improving female reproductive health.

Objective:To comprehensively evaluate treatment outcomes and assisted reproductive approaches in infertility patients with CYP17A1-deficient congenital adrenal hyperplasia [including 17α-hydroxylase/17,20-lyase deficiency (17-OHD) and isolated 17,20-lyase deficiency (IDL)]. Methods:In this study, PubMed, Embase, Web of Science, Ovid, CNKI, Wanfang Data base, and the Chinese Biomedical Literature Database were systematically searched. The data extracted included basic patient information, treatment plans, and pregnancy outcomes, which were then analyzed descriptively.Results:Totally 19 articles were included, covering 23 cases of successful live births. Among the 23 patients with successful live births, there were 19 patients with 17-OHD, including 17 cases became pregnant through in vitro fertilization and embryo transfer (IVF-ET), 1 case through natural pregnancy, and 1 case through oocyte donation pregnancy; there were 4 cases with IDL, including 2 cases through natural pregnancy and 2 cases through IVF-ET pregnancy. Conclusion:IVF-ET is the preferred fertility treatment option for patients with partial form of 17-OHD. For IDL patients who have natural ovulation, natural pregnancy can be attempted. Glucocorticoids play a crucial role in improving pregnancy outcomes, but their use needs to be individualized.

In recent years, more and more studies have shown that autophagy is closely related to female reproductive process. Autophagy is a widespread and highly conserved degradation system in eukaryotes that can be activated under conditions such as hypoxia, starvation, lack of nutrients, or extreme pH. In terms of reproductive health, autophagy can improve reproductive dysfunction by removing damaged organelles and regulating cell growth and metabolism. Appropriate regulation of autophagy helps to improve oocyte quality, delay ovarian aging, fine-regulate endometrial growth, and ensure successful implantation of embryos. However, the abnormality of autophagy pathway may cause problems such as activation of pelvic inflammatory cytokines, reduced endometrial receptivity, abnormal follicle development, and weakened invasion ability of trophoblast cells, thus leading to the occurrence and development of reproductive disorders such as endometriosis, chronic endometritis, polycystic ovary syndrome, early-onset ovarian insufficiency, and recurrent spontaneous abortion. This article reviews the mechanism and therapeutic targets of autophagy in female reproductive diseases, providing clinical ideas and diagnosis and treatment strategies for improving female reproductive health.

Objective:To comprehensively evaluate treatment outcomes and assisted reproductive approaches in infertility patients with CYP17A1-deficient congenital adrenal hyperplasia [including 17α-hydroxylase/17,20-lyase deficiency (17-OHD) and isolated 17,20-lyase deficiency (IDL)]. Methods:In this study, PubMed, Embase, Web of Science, Ovid, CNKI, Wanfang Data base, and the Chinese Biomedical Literature Database were systematically searched. The data extracted included basic patient information, treatment plans, and pregnancy outcomes, which were then analyzed descriptively.Results:Totally 19 articles were included, covering 23 cases of successful live births. Among the 23 patients with successful live births, there were 19 patients with 17-OHD, including 17 cases became pregnant through in vitro fertilization and embryo transfer (IVF-ET), 1 case through natural pregnancy, and 1 case through oocyte donation pregnancy; there were 4 cases with IDL, including 2 cases through natural pregnancy and 2 cases through IVF-ET pregnancy. Conclusion:IVF-ET is the preferred fertility treatment option for patients with partial form of 17-OHD. For IDL patients who have natural ovulation, natural pregnancy can be attempted. Glucocorticoids play a crucial role in improving pregnancy outcomes, but their use needs to be individualized.

Objective:To investigate the clinical efficacy of tamoxifen and granulocyte colony stimulating factor (G-CSF) in the treatment of refractory thin endometrium.Methods:Prospective cohort study was performed. Patients treated in the Department of Reproductive Medicine of the Second Affiliated Hospital of Kunming Medical University from December 2019 to December 2020 were included, they all suffered from cancellation of fresh transplantation cycle due to endometrial thickness less than 7 mm, and estrogen treatment was given in the following frozen-thawed embyro transfer cycle but the thickness of endometrium still under 7 mm. They were divided into three groups according to their wishes: group A was treated with tamoxifen ( n=40), group B was treated with intrauterine perfusion of G-CSF ( n=38), and group C was treated with tamoxifen combined with intrauterine perfusion of G-CSF ( n=36). The endometrial receptivity and pregnancy outcomes among the three groups were compared. Results:There were no significant differences in the clinical characteristics of patients and the thickness of endometrium before treatment among the three groups (all P>0.05). The endometrial thickness after treatment was significantly improved compared with those before treatment among the three groups ( P<0.001). After treatment, endometrial thickness of group A [8.00(8.00, 9.00) mm] and group C [8.00(8.00, 10.00) mm] was higher than that of group B [7.00(7.00, 8.00) mm, P=0.002, P=0.001]. The type of Ⅲ endometrial blood flow of group C [72.2% (26/36)] was significantly improved compared with group A [40.0% (16/40), P=0.005)] and group B [42.1% (16/38), P=0.009]. The resistance index (RI), pulsatility index (PI) and systolic peak velocity/diastolic velocity (S/D) of group B (0.61±0.08, 0.81±0.11, 2.05±0.12) and group C (0.60±0.11, 0.78±0.15, 1.99±0.19) were lower than those of group A (0.66±0.04, 0.94±0.10, 2.17±0.06), and the differences among the three groups were statistically significant (RI: P=0.009, P=0.001; PI: P<0.001, P<0.001; S/D: P<0.001, P<0.001). The embryo implantation rate and the clinical pregnancy rate of group C were higher than those of group A and group B, and the early abortion rate of group C was lower than that of group A and group B, but there were no significant differences among the three groups (all P>0.05). Conclusion:Three treatment schemes have certain curative effects on improving the endometrial receptivity and pregnancy outcome of patients with refractory thin endometrium, among which tamoxifen combined with G-CSF is superior to single drug in improving the endometrial receptivity, but the combined group has not shown significant advantages in pregnancy outcome.

Objective:To investigate the clinical efficacy of tamoxifen and granulocyte colony stimulating factor (G-CSF) in the treatment of refractory thin endometrium.Methods:Prospective cohort study was performed. Patients treated in the Department of Reproductive Medicine of the Second Affiliated Hospital of Kunming Medical University from December 2019 to December 2020 were included, they all suffered from cancellation of fresh transplantation cycle due to endometrial thickness less than 7 mm, and estrogen treatment was given in the following frozen-thawed embyro transfer cycle but the thickness of endometrium still under 7 mm. They were divided into three groups according to their wishes: group A was treated with tamoxifen ( n=40), group B was treated with intrauterine perfusion of G-CSF ( n=38), and group C was treated with tamoxifen combined with intrauterine perfusion of G-CSF ( n=36). The endometrial receptivity and pregnancy outcomes among the three groups were compared. Results:There were no significant differences in the clinical characteristics of patients and the thickness of endometrium before treatment among the three groups (all P>0.05). The endometrial thickness after treatment was significantly improved compared with those before treatment among the three groups ( P<0.001). After treatment, endometrial thickness of group A [8.00(8.00, 9.00) mm] and group C [8.00(8.00, 10.00) mm] was higher than that of group B [7.00(7.00, 8.00) mm, P=0.002, P=0.001]. The type of Ⅲ endometrial blood flow of group C [72.2% (26/36)] was significantly improved compared with group A [40.0% (16/40), P=0.005)] and group B [42.1% (16/38), P=0.009]. The resistance index (RI), pulsatility index (PI) and systolic peak velocity/diastolic velocity (S/D) of group B (0.61±0.08, 0.81±0.11, 2.05±0.12) and group C (0.60±0.11, 0.78±0.15, 1.99±0.19) were lower than those of group A (0.66±0.04, 0.94±0.10, 2.17±0.06), and the differences among the three groups were statistically significant (RI: P=0.009, P=0.001; PI: P<0.001, P<0.001; S/D: P<0.001, P<0.001). The embryo implantation rate and the clinical pregnancy rate of group C were higher than those of group A and group B, and the early abortion rate of group C was lower than that of group A and group B, but there were no significant differences among the three groups (all P>0.05). Conclusion:Three treatment schemes have certain curative effects on improving the endometrial receptivity and pregnancy outcome of patients with refractory thin endometrium, among which tamoxifen combined with G-CSF is superior to single drug in improving the endometrial receptivity, but the combined group has not shown significant advantages in pregnancy outcome.

Objective:To investigate the feasibility and clinical efficacy of the bilobed anterolateral femoral perforator flap pidicled with the oblique branch of lateral femoral circumflex artery in repair of the wounds in extremities.Methods:A study was conducted on 36 patients with complex limb wounds from December, 2014 to May, 2020. Thirty patients had single-wound sized from 10.0 cm×10.0 cm to 23.0 cm×17.0 cm, and 6 patients had 2 adjacent and discontinuous wounds sized from 4.0 cm×5.0 cm to 11.0 cm×9.0 cm. A total of 78 perforators were identified in routine preoperative CDU examination, and 67 perforators were confirmed. According to the actual requirement of the perforator confirmed in surgery, 19 flaps were designed with completely split up into bilobed flaps and 17 bilobed fascial flaps were designed with segmented skin and deep fascia. The blood supply of flaps relies on the anastomosis of oblique branch with the recipient vessels, therefore bridged blood Flow-through anastomosis was performed in 8 flaps. All thigh donor sites were sutured directly. Regular follow-up were made after surgery.Results:In this group, 35 cases of bilobed flaps survived successfully. Venous crisis was found in 1 case of flap repairing 2 wounds after the operation and was relieved 7 days later by remove some stitches and bloodletting. The donor sites healed by first intension, and the wound healing time was 11-83 days. All patients were followed-up for 6-39 months. The flaps had good colour and texture with S 2-S 3 sensory. All the donor sites left linear scars except 1 where left with a large scar without contracture and pain. Conclusion:The repair of the wounds in extremities by bilobed anterolateral thigh perforator flaps pedicled with the oblique branch of the lateral femoral circumflex artery could obtain a more concealed donor site. It acts as a beneficial supplement when a bilobed flap cannot be harvested on the descending branch of the lateral femoral circumflex artery.

Degloving injury of distal thumb is common in hand surgery. Generally, the degloving tissue is severely damaged without conditions for replantation. It is often treated by methods of stump revision, local flap coverage, free second toe reconstruction, and so on. It inevitably leads to a shortening of distal phalanx, sacrifice of the whole toe and poor appearance after repair. The hallux nail flap is considered to be the best to treat this kind of injury. However, the traditional wrap-around flap excises the toe in a large range and has many complications in the donor site. In April, 2010, a case of degloving injury of the distal thumb was repaired with a combined wrap-around flap of the hallux nail flap and the tibial flap of the second toe. The patient was followed-up for 10 years in our hospital. Both of the appearance and function of the patient's thumb are well recovered.

Objective:To investigate the clinical efficacy of external fixators combined with anterolateral thigh musculocutaneous flap for treatment of Gustilo type IIIB/C open tibiofibular fractures.Methods:A retrospective case series study was conducted to analyze clinical data of 15 patients with Gustilo type IIIB/C open tibiofibular fractures admitted to Ruihua Hospital of Soochow University from March 2016 to June 2019. There were 11 males and 4 females, with the age of (48.5±12.6)years (range, 22-67 years). All patients underwent emergency debridement in stage I, the major blood vessels, nerves and tendons were inspected and repaired, and the fracture ends were fixed by external fixator. There were different degrees of wounds necrosis, infection and bone defect after operation. After debridement in stage II, the soft tissue defects with the dimension of 10.0 cm×5.0 cm to 30.0 cm×8.0 cm were repaired with anterolateral thigh musculocutaneous flaps whose areas ranged from 10.5 cm×5.5 cm to 30.5 cm×8.5 cm. All donor areas of the musculocutaneous flaps were sutured directly in stage I. The healing of the donor areas and musculocutaneous flaps were observed within 2 weeks after operation. At the last follow-up, the shape and sensory recovery of the flap, healing of fractures and related complications were observed. The lower extremity functional scale (LEFS) was used to evaluate the injured limb function.Results:All patients were followed-up for 12-32 months [(22.0±5.8)months]. All donor areas were healed by first intention, leaving only linear scars. The musculocutaneous flaps survived completely in all patients. Partial necrosis of large area of musculocutaneous flap occurred in 2 patients, and healed after debridement and skin grafting. Another patient had vascular crisis after musculocutaneous flap operation and survived after the embolized vein repaired by contralateral great saphenous. At the last follow-up, the shape of flap recovered well, and the feeling partially recovered with the two-point discrimination of 18-26 mm. All fractures healed well, and there were no serious infection-related complications such as osteomyelitis. The LEFS score was 47-69 points [(59.0±9.5)points].Conclusion:Theexternal fixator combined with anterolateral thigh musculocutaneous flaps for treatment of Gustilo type IIIB/Copen tibiofibular fractures can better restore the appearance of soft tissue defect of the lower leg, and can effectively reduce the occurrence of severe infection-related complications.

Objective:To investigate the clinical effect of flow-through anterolateral thigh perforator flap with fascia lata for repairing dorsal wounds of the hand and foot with extensor tendon defects.Methods:A retrospective case series study was conducted to analyze the clinical date of 14 patients with hand and foot wounds associated with extensor tendon defects admitted to Ruihua Affiliated Hospital of Soochow University from January 2015 to December 2019. There were 13 males and 1 female，aged 10-57 years［（39.2±13.4）years］. The wounds were all single with the area of 10 cm×4 cm to 23 cm×12 cm，including 8 wounds on the back of the hand and 6 wounds on the back of the foot. There was 1 patient accompanied with 1 tendon defect，10 with 4 tendon defects and 3 with 5 tendon defects，with the length of tendon defects ranging from 2.0 to 6.0 cm［（3.8±1.4）cm］. The dimension of flaps ranged from 12 cm×5 cm to 23 cm×13 cm，with the fascia lata from 11 cm×5 cm to 20 cm×7 cm. The deficient extensor tendons were repaired with the fascia lata and vascular pedicles were anastomosed by flow-though. A bilobed flap was harvested in 3 patients and a single flap in 11 patients. Donor sites were sutured directly. The survival of the flap and healing of the donor area were detected after operation. The extremity revascularization and shape and sensation recovery of the flap were measured at the last follow-up. The upper extremity functional evaluation standard set up by Hand Surgery Society of the Chinese Medical Association and Maryland foot functional score were used to evaluate the hand and foot function before operation and at the cast follow-up，respectively. The donor site complications and performance of tendon release or flap thinning in the second stage were recorded.Results:All patients were followed up for 8-30 months［（15.3±6.2）months］. All flaps survived successfully，with wounds and thigh donor areas healed by first intension. No significant effect of revascularization was observed on recipient sites，and acceptable cosmetic outcomes and sensation recovery of the flap were achieved at the final follow-up. For patients with dorsal wounds of the hand，the extensor function recovered in different degrees，and the flexion activities of the fingers were not limited. The total active movement was 180°-250°［（226.3±21.7）°］at the last follow-up，compared to preoperative 110°-170°［（145.6±13.2）°］（ P<0.01）. According to the upper extremity functional evaluation standard，the function was excellent in 4 patients，good in 2 and fair in 2. For patients with wounds of the foot，the flexion and extension function was good，with no obvious deformity of toes，and the Maryland foot functional score ranged from 60 to 92 points［（76.0±12.7）points］at the last follow-up，significantly improved from preoperative 18-45 points［（27.4±7.8）points］（ P<0.01），including excellent results in 2 patients，good in 3 and fair in 1. Only linear scars were left in the thigh donor area，and there was no discomfort such as scar contracture or pain. Four patients underwent skin flap thinning at 4-8 months after operation and none underwent a tenolysis. Conclusion:Repair of dorsal wounds with extensor tendon defects of the hand and foot by flow-through anterolateral thigh perforator flap with fascia lata can reduce interference to recipient sites and repair wounds and extensor tendons simultaneously，which can obtain good flexion and extension function and minor damage to the donor area.