Abstract:Acute kidney injury（AKI） is a common disease in intensive care units（ICU），with high mortality. At present，the latest AKI guidelines for clinical practice issued by the Kidney Disease：Improving Global Outcomes（KDIGO） are still taking serum creatinine and urine output as the diagnostic criteria of AKI，having certain limitations to early detect AKI. In recent years，some AKI biomarkers have been verified in the clinical practice，such as neutrophil gelatinase-associated lipid carrier protein，interlukin-18，kidney injury molecule-1，L-type fatty acid binding protein，insulin-like growth factor binding protein-7 and tissue inhibitory metalloproteinases-2，MicroRNA（miRNA），etc. However，these biomarkers are not widely used in ICU because AKI patients in intensive care unit（ICU） have more complicated pathogenesis and pathophysiological changes. This article reviewed the progress in new biomarkers of AKI in critically ill patients in ICU.

Abstract:Objective：To investigate the role of activating transcription factor-4（ATF4） in palmitic acid（PA）-induced apoptosis of glomerular podocytes by regulating Parkin. Methods：Twenty Sprague Dawley rats were randomly divided into two groups：normal diet group with 10 rats and high-fat diet group with 10 rats. After 12 weeks of feeding，serum was collected for measurement of triglyceride（TG） and total cholesterol（TC） levels. Cell apoptosis in renal tissues was evaluated by Tunel staining. Immunohistochemical method and Western blot were used to measure the protein expression of cleaved cysteinyl aspartate specific proteinase-3（Cleaved caspase-3），ATF4，and Parkin in renal tissues. PA was used to stimulate glomerular podocytes in vitro，plasmids were trans－fected with overexpressed Parkin，or adenovirus was used to knock down the expression of ATF4. Western blot was used to measure the expression of Cleaved caspase-3，and flow cytom－etry was used to determine the apoptosis rate of glomerular podocytes. Results：The high-fat diet group had significantly higher expression of TG and TC compared with the normal diet group（2.700±0.565 vs. 0.780±0.165，t=-7.987，P=0.000；2.620±0.565 vs. 1.540±0.377，t=-3.895，P=0.003）. The protein expression of Cleaved caspase-3，Parkin，and ATF4 were significantly higher in the high-fat diet group than in the normal diet group（2.257±0.326 vs. 1.000±0.190，P=0.000；1.587±0.162 vs. 1.000±0.323，P=0.003；1.851±0.347 vs. 1.000±0.186，P=0.000）. After being stimu－lated with different concentrations of PA，compared with the control group，the expression of ATF4，Parkin，and Cleaved caspase-3 in podocytes was significantly increased in the 150 μmol/L PA group（1.689±0.235 vs. 1.000±0.030，P=0.002；1.529±0.057 vs. 1.000±0.066，P=0.000；1.773±0.186 vs. 1.000±0.039，P=0.000） and in the 300 μmol/L PA group（1.702±0.228 vs. 1.000±0.030，P=0.002；2.047±0.086 vs. 1.000±0.066，P=0.000；2.282±0.155 vs. 1.000±0.039，P=0.000）. After the Parkin overexpression plas－mid was transfected into podocytes，the expression of Parkin in the Parkin overexpression group was significantly increased compared with the control group（105.242±24.108 vs. 1.000±0.253，P=0.000）. After stimulation with PA，the expression of Cleaved caspase-3 in podocytes and PA-induced apoptosis rate in PA+Parkin overexpression group were significantly reduced compared with the PA+empty plasmid group[1.943±0.200 vs. 3.398±0.164，P=0.000；（9.590±0.418）% vs. （15.140±1.227）%，P=0.000]. After adenovirus transfection and knockdown of ATF4，the protein expression of ATF4 and Parkin in the shATF4 group was significantly reduced and the expression of Cleaved caspase-3 was significantly increased compared with the control group（0.175±0.064 vs. 1.000±0.112，P=0.000；0.518±0.130 vs. 1.000±0.104，P=0.004；2.305±0.150 vs. 1.000±0.279，P=0.000）. The cell apoptosis rate of podocytes was significantly higher in the shATF4 group than in the control group[（14.230±0.278）% vs.（7.020±0.773）%，P=0.000]. After podocytes were stimulated with ATF knockdown，the expression of Cleaved caspase-3 and apoptosis rate were significantly higher in the PA+shATF4 group than in the PA+shRNA group[2.483±0.114 vs. 1.926±0.215，P=0.007；（46.643±10.675）% vs.（20.943±4.194）%，P=0.018]. Conclusion：ATF4 can alleviate PA-induced apoptosis of glomerular podocytes by regulating Parkin.

Abstract:Objective：To assess the level and significance of interleukin-27（IL-27） in patients with type 2 diabetes mellitus （T2D） and diabetic nephropathy（DN）. Methods：A total of 116 patients with T2D were divided into diabetic normal urinary albumin group （DN0 group），early diabetic nephropathy group（DN1 group） and clinical diabetic nephropathy group（DN2 group） in accordance with urinary protein；healthy people were selected as the control group（H group）. Level of IL-27 was detected by enzyme-linked im－munosorbent assay（ELISA）. Hypersensitive C-reactive protein（hs-CRP），urinary albumin/creatinine，serum creatinine，triglyceride and total cholesterol were detected by automatic biochemical analyzer；glycosylated hemoglobin level was detected by high perfor－mance liquid chromatography；C-peptide level was detected by chemiluminescence；correlation between serum IL-27 concentration and those above indicators was analyzed. Results：IL-27 serum concentration of patients in the DN0 group[788.200（594.500，1010.950） pg/mL] was significantly higher than that in the H group[546.200（411.600，639.250） pg/mL]，with statistically significant difference（P=0.003）. IL-27 concentration in the DN1 group[990.780（811.480，1237.830） pg/mL] was significantly higher than that in the DN0 group，with statistically significant difference（P=0.028）. IL-27concentration in DN2 group[1213.300（996.450，1 546.200） pg/mL] was significantly higher than that in the DN1 group，with statistically significant difference（P=0.037）. IL-27 serum concentration had a positive relationship with urine protein（r=0.580，P=0.000），serum creatinine（r=0.257，P=0.002），glycosy－lated hemo-globin（r=0.343，P=0.000），serum hs-CRP（r=0.431，P=0.000） and fasting blood glucose concentration（r=0.334，P=0.000）；had no significant correlation with triglyceride，total cholesterol and serum C-peptide（P>0.05）. IL-27，as a serum marker of DN patients，had a higher potency than hs-CRP；combination of two markers was able to increase the diagnostic efficiency. Conclusion：Serum concentration of IL-27 is associated with the development of DN in patients with T2D. IL-27 may provide references to early diagnosis of DN patients.

Abstract:Objective：To analyze effects of mitochondrial activity on human spermatozoa motility. Methods：Mitochondrial specific fluorescent dye，mitotracker deep red 633（MTDR），was used to stain sperms with different motility. And the flow cytometry was used to determine the activity of sperm mitochondria（that is，value of MTDR fluorescence intensity）. Rapamycin（RP） and hydroxychloro－quine（HCQ） were used to regulate the mitochondrial activity，and then measure the change of sperm motility. Results：MTDR fluores－cence intensity value was not correlated with spermatozoa progressive motility（PR） rate（r=0.182，P=0.268）. RP of 5 nmol/L or 100 nmol/L was able to significantly decrease the mitochondrial activity，and HCQ of 50 μmol/L was able to significantly increase the mitochondrial activity（P<0.05）. However，those above concentrations had no obvious effect on sperm motility（P>0.05）. Conclusion：There is no obvious effect of mitochondrial activity on human sperm motility.

Abstract:Objective：To evaluate the clinical effect of central venous catheter for percutaneous nephrostomy in upper urinary calculi complicated with sepsis. Methods：Fifty patients with complications of unilateral upper urinary calculi and urinary sepsis were randomly divided into two groups，with 25 in each group. The percutaneous nephrostomy via central venous catheter was performed in the experimental group，while the traditional percutaneous nephrostomy was performed in the control group. Operation time，tran－soperative blood loss，puncture success rate，complication rate，and drainage tube obstruction rate were compared between two groups. Results：Upper urinary obstruction was successfully relieved in two groups，without fistula falling. Operation time in the experimental group and the control group were（25.10±4.05） min and（30.70±6.59） min，respectively（P=0.001）；transoperative blood loss were（10.30±5.01） mL and（15.20±4.24） mL，respectively（P=0.001）；success rate of puncture were 100% and 96%，respectively，without statistically significant difference. Complication rate were 4% and 12%，respectively，without statistically significant difference（P=0.297）. Drainage tube obstruction rate were 4% and 0%，respectively，without statistically significant difference（P=0.312）. Conclusion：Percutaneous nephrostomy via central venous catheter can be a safe and effective method for the treatment of upper urinary calculi complicated with sepsis.

Abstract:Objective：To explore the value of early hemodynamic monitoring in patients complicated with septic shock patients after holmium laser lithotripsy of urinary system. Methods：Clinical data of 37 patients with septic shock after holmium laser lithotripsy of urinary tract who were admitted to our department of The First Affiliated Hospital of Chongqing Medical University from January 2013 to December 2018 were retrospectively analyzed. According to the liquid resuscitation under pulse index continuous cardiac output（PiCCO），those patients were divided into the PiCCO monitoring group and the non-PiCCO monitoring group. General informa－tion，pre-treatment indicators of disease severity，pre-and-post-treatment PiCCO monitoring indicators and clinical indicators after treatment of 6h and 24 h in two groups were respectively ana－lyzed. Results：After treatment of 6h，global end diastolic volume index（GEDI），cardiac index（CI），external lung water index（EVLWI），systemic vascular resistance index（SVRI） and mean arterial pressure（MAP） in the PiCCO monitoring group were increased when compared with those before treatment（Z：-3.393，-4.059，-4.189，-3.241，-3.736；P：0.005，0.000，0.000，0.001，0.000）；after treatment of 24 h，GEDI，CI and SVRI were higher than those after treatment of 6 h（Z：-3.751，-2.738，-4.749；P：0.000，0.006，0.000）. After treatment of 6 h，levels of blood lactic acid and norepinephrine in the PiCCO monitoring group were lower than those in the PiCCO monitoring group（Z：-2.070，-3.895；P：0.038，0.000）；after treatment of 6 h and 24 h，oxygenation index（PO2/FiO2） and urine volume per hour in the PiCCO mon－itoring group were higher than those in the non-PiCCO monitoring group（Z after treatment of 6 h：-2.499，-3.314；P：0.012，0.001；Z after treatment of 24 h：-3.833，-3.466；P：0.000，0.001）；after treatment of 6 h，the total amount of crystalline liquid and colloidal fluid in the PiCCO monitoring group were increased when compared with those in the non-PiCCO monitoring group（Z：-4.845，-4.401；P：0.000，0.000）；after treatment of 24 h，the total amount of crystalline liquid and colloidal fluid in the PiCCO monitoring group were decreased when compared with those in the non-PiCCO monitoring group（Z：-2.338，-2.948；P：0.019，0.003）. After treat－ment，the duration of mechanical ventilation and ICU stay in the PiCCO monitoring group were lower than those in the non-PiCCO monitoring group（Z：-2.195，-2.173；P：0.028，0.030）. Early fluid resuscitation，dosage adjustment of vasoactive drugs，maintenance of circulation stability，improvement of tissue perfusion and reduction of complications in the PiCCO monitoring group were superior than those in the non-PiCCO monitoring group. Conclusion：Comprehensive treatment centered with precise fluid resuscitation under the guidance of PiCCO monitoring plays an important role in alleviating illness，reducing complications caused by excessive fluid resuscitation and shortening time for mechanical ventilation and ICU treatment，which may be used as a new clinical treatment strategy for patients complicated with septic shock after holmium laser lithotripsy of ureteral calculi.

Abstract:Objective：To investigate clinical and pathological characteristics of minimal change primary nephrotic syndrome（MCN） with tubulointerstitial lesions（TIL） in children. Methods：Pathological and clinical materials of 148 patients with MCN were retrospec－tively analyzed，and clinical and pathological characteristics of MCN with TIL were compared. Results：A total of 28 patients had TIL，accounting for 18.9%；the main pathological changes of TIL were inflammatory cell infiltration and tubule dilatation. The condition of children in the TIL group were more severe than that in the non-TIL group，with manifestations such as hematuria，increased protein excretion，renal inadequacy，and significantly impaired tubule function，indicating that renal function damage was closely related to development of TIL. MCN outcome was not obviously associated with TIL（P>0.05）. Conclusion：With the occurrence of TIL，the con－dition of children with MCN is aggravated，indicating that TIL may be an important factor influencing the progression of MCN.

Abstract:Objective：To investigate the association of anteroposterior renal pelvic diameter（APD） measured by ultrasound and clinical data at initial visit with timing of surgical treatment in children with unilateral hydronephrosis due to ureteropelvic junction obstruc－tion（UPJO）. Methods：A retrospective analysis was performed for the clinical data of the children with unilateral hydronephrosis due to UPJO who were diagnosed in the outpatient service of Children’s Hospital of Chongqing Medical University from September 2013 to September 2016. The children divided into groups based on sex，affected side，age at initial diagnosis，and degree of hydronephrosis at initial diagnosis，and the chi-square test was used for comparison between groups（P<0.05）. A binary logistic regression analysis was performed for related factors，and a receiver operating characteristic（ROC） curve analysis was performed for APD and age at initial diagnosis. Results：There were 170 valid cases at the end of follow-up，and among these children，41（24.11%） chose surgical treat－ment. The rate of surgical treatment increased with the increase in APD at initial diagnosis（χ2=42.534，P=0.000），and there was no significant difference in the rate of surgical treatment between the children with different sexes or affected sides. The binary logistic regression analysis showed that APD at initial diagnosis（χ2=34.465，P=0.000） and affected side（χ2=4.067，P=0.044） were independent predictive factors for surgery during follow-up. At the optimal cut-off value of 1.75 cm，APD at initial diagnosis had an area under the ROC curve（AUC） of 0.894（95%CI=0.826-0.962，P=0.000），a sensitivity of 82.9%，and a specificity of 86.8%，and age at initial diagnosis had an AUC of 0.345（P=0.003）. Conclusion：Degree of hydronephrosis at initial diagnosis is an important factor for surgical decision-making for children with hydronephrosis due to UPJO. APD>1.75 cm at initial diagnosis has a certain value in predicting surgery during follow-up，and imme－diate pyeloplasty is recommended in case of APD>4 cm at initial diagnosis. Ultrasound examination at initial diagnosis has a guiding significance in the diagnosis and treatment of hydronephrosis and surgical decision-making.

Abstract:

Abstract:

Abstract:

Abstract:Premature ovarian insufficiency（POI） refers to the decline or even failure of ovarian function in women under the age of 40. At present，the pathogenesis of POI is still not very clear. More and more studies have found that the autophagy of granulosa cells induces the occurrence of POI. This paper will elaborate the research progress of the autophagy of granulosa cells of POI.

Abstract:Objective：To explore the expression of transcription factor EB（TFEB） in the mouse endometrium during the peri-implan－tation period，and to preliminarily investigate the role of TFEB in endometrial decidualization in early pregnant mice. Methods：A normal pregnant mouse model was established，and the mouse endometrium on the 4th（D4），5th（D5），and 6th（D6） days of early pregnancy and the endometrial implantation site tissue（IS） and the inter-implantation site tissue（IIS） on D5 were collected；a pseu－dopregnant mouse model was established and the mouse endometrium on the 4th（PD4），5th（PD5），and 6th（PD6） days of pseudo－pregnancy was collected. An in vivo artificial decidualization model was established and mouse endometrial tissues of the control side and induced side of mice were collected. An in vitro artificial decidualization model was established，and the mouse endometrial stromal cells of the control group and the induced group were collected. Western blot and real-time PCR were used to measure the mRNA and protein expression of TFEB in the mouse endometrium and in mouse endometrial stromal cells. The distribution and expression of TFEB in the mouse endometrium of D5 were measured by immunohistochemistry. Results：The expression of TFEB on D4，D5，and D6 gradually decreased with increasing days of pregnancy. The mRNA and protein expression of TFEB in the endometrial IS on D5 was significantly lower than that in the IIS on D5. The mRNA and protein expression of TFEB in the endometrial tissue of the induced side was significantly lower than that in the endometrial tissue of the control side. The mRNA and protein expression of TFEB in endometrial stromal cells was significantly lower in the induced group than in the control group. Conclusion：TFEB may be involved in the endometrial decidualization in early pregnant mice，but its specific regulatory role needs to be further explored.

Abstract:Objective：To describe the expression profile of circular RNA（circRNA） in human placental tissues，explore and identify abnormal circRNAs in preeclampsia（PE） placental tissue and study its possible regulating network. Methods：RNA sequencing and evaluation analysis in PE placental tissue and normal placental tissue were performed by high-throughput RNA sequencing technology，DeSeq2 was used to analyze difference，and qRT-PCR was used to identify the analysis tissue. Bioinformatics was used to perform the gene ontology（GO） analysis and the Kyoto encyclopedia of genes and genomes（KEGG） pathway analysis in the identified differential circRNA. Results：According to the sequencing results，300 differentially expressed circRNAs were found in the severe PE placenta when compared with the normal placenta，including 151 kinds of upregulated circRNAs and 149 kinds of downregulatedcircRNAs. The qRT-PCR results showed that expression levels of hg38_circ_0014736（1.418 0±0.106 5 vs. 1.044 0±0.127 1，P=0.035） and hsa_circ_0015382（0.895 8±0.180 2 vs. 0.688 8±0.025 3，P=0.025） were significantly higher in the PE placenta tissue；ex－pression levels of hsa_circ_0007121（0.395 8±0.200 4 vs. 1.301 0±0.240 7，P=0.000） were significantly decreased in PE placenta compared with normal placenta. Bioinformatics analysis revealed that those three circRNAs，predicted target miRNAs and target gene might have a relationship with cell proliferation，response to hypoxia and post-transcriptional regulation. Conclusion：Com－pared with the normal placental tissue，abnormal expressive circRNA exists in the PE placental tissue. According to the bioinformatics，those abnormal circRNAs may play a potential role in the pathogenesis of PE.

Abstract:Objective：To investigate the role of micro-RNA-214-5p（miR-241-5p） on the HeLa cells’ cell viability and apoptosis and its mechanism. Methods：HeLa cells were divided into the HeLa group，the mimic-scramble group，the miR-214 mimic group and the miR-214 inhibitor group. The miR-214 mimic and miR-214 inhibitor were used to transfect cells，the qRT-PCR was used to measure expression levels of miR-214 and P21-activated kinases 4（PAK4），the bioinformatic approach was used to predict the rela－tionship of miR-241-5p and PAK4，and the luciferase reporter assay was used to determine their relationship. The pcDNA-PAK4 （pc-PAK4），miR-214 mimic and miR-214 inhibitor were used to transfect HeLa cells，the Western blot was used to determine pro－tein level of PAK4，the CCK-8 assay was used to measure cell viability and the flow cytometry was performed to detect apoptosis. Results：The expression level of miR-214-5p in the miR-214 mimic group（46.02±5.23） was significantly higher than that in the HeLa group （1.00±0.01）（LSD-t=31.423，P=0.000）. The expression level of PAK4 in the miR-214 mimic group（0.08±0.04） was significantly lower than that in the HeLa group（0.26±0.05）（LSD-t=4.296，P=0.002）. The expression level of miR-214-5p in the miR-214 inhibitor group（0.41±0.05） was significantly lower than that in the HeLa group（1.00±0.01）（LSD-t=18.726，P=0.000）. The expression level of PAK4 in the miR-214 inhibitor group（0.58±0.05） was significantly higher than that in the HeLa group of （0.26±0.05）（LSD-t=5.061，P=0.001）. The miR-214-5p was able to be targeted-bound with PAK4. The cell growth rate in the miR-214 mimic group（3.50±0.45） was significantly lower than that in the HeLa group（5.02±0.35）（LSD-t=8.644，P=0.000）. The apoptosis rate in the miR-214 mimic group[（11.42±0.71）%] was significantly higher than that in the HeLa group[（2.61±0.63）%]（LSD-t=4.032，P=0.003）. The cell growth rate in the miR-214 inhibitor group（5.89±0.32） was significantly higher than that in the HeLa group（5.02±0.35）（LSD-t=7.863，P=0.000）. The apoptosis rate in the miR-214 inhibitor group[（0.53±0.42）%] was significantly lower than that in the HeLa group[（2.61±0.63）%]（LSD-t=4.221，P=0.002）. Co-transfection of pc-PAK4 was able to reverse the regulation function of miR-214 mimic on cell viability and apoptosis. Conclusion：The miR-214-5p inhibits the viability of HeLa cells and induces their apoptosis by down-regulating PAK4.

Abstract:Objective：To study and analyze the differences in microbial diversity and species differences of vaginal flora caused by recurrent spontaneous abortion，and to preliminarily explain the role of vaginal microecology in the development of recurrent sponta－neous abortion. Methods：21 patients with recurrent spontaneous abortion admitted to our hospital from January 2010 to December 2016 and 20 cases of induced abortion to normal pregnancy were selected as subjects in this study. There was no significant difference in pregnancy time between the two groups（P>0.05），and various data for clinical diagnosis and treatment were collected at the same time. After the routine collection of medical history，vaginal secretions were collected. Metagenomic sequencing was used to analyze microbial types and microbial genomic data of the secretions，so as to clarify differences and functionality. Results：Clinical data showed that the incidence of vaginal inflammation in patients with recurrent spontaneous abortion was higher than that in normal pregnancy. The vaginal microbial diversity of patients with recurrent spontaneous abortion was significantly higher than that of normal pregnancy，and the microbial gene abundance was lower than that of normal pregnancy. Through differential species identification analysis，hundreds of different differential microorganisms were selected，and 16 different micro-organisms were selected according to statistical requirements and the actual conditions of the sam－ples. Five of the strains were not found in the vagina of normal pregnant people，but clearly present in the vagina of patients with recurrent spontaneous abortion and had a high abun－dance；8 strains were present in the vagina of normal pregnant people and had a high abundance，but were not detected in the vagina of patients with recurrent spontaneous abortion；the other three strains had large differences in abundance. The functional en－richment analysis of these differential microorganisms showed that there are statistical differences in molecular function，biological processes and cell composition among them，which were reflected in metabolic processes such as amino acid metabolism，glucose metabolism，energy metabolism，nucleotide metabolism and lipid metabolism，and various amino acid metabolism and energy metabolism in particular. In addition，we also found that the influence of metabolic dysfunction can also cause abnormal vaginal in－ternal cell signal transduction，endocrine and metabolic disease，causing cardiovascular disease in endocrine and metabolic diseases in return. Conclusion：The low immunity of patients with recurrent spontaneous abortion may be associated with vaginal inflammation caused by vaginal microecological disorders. In addition to the exchange of different types of lactic acid bacteria，new strains such as Gardnerella and Plasmodium may also play an important role in the occurrence and development of recurrent spontaneous abortion.

Abstract:Objective：To investigate the expressions of serum miR-21 and miR-93 in patients with polycystic ovary syndrome（PCOS） and their clinical significance. Methods：186 PCOS patients（PCOS group） and 60 healthy women （control group） were se－lected from Central Hospital of Western Hainan. PCOS patients were divided into insulin resistance group（n=121，HOMA-IR≥2.57） and non - insulin resistance group（n=65，HOMA-IR<2.57） according to insulin resistance index（HOMA-IR）. PCOS patients were divided into obese group（n=58，BMI≥28 kg/m2） and non-obese group（n=128，BMI＜28 kg/m2） according to body mass index（BMI）. Real time quantitative PCR （qRT-PCR） was used to detect the changes of serum miR-21 and miR-93 levels in each group. Receiv－er operating characteristic（ROC） curve was used to analyze the diagnostic value of serum miR-21 and miR-93 for PCOS. The correla－tions of serum miR-21 and miR-93 with HOMA-IR were determined using Pearson correlation. Results：The levels of serum miR-21（1.71±0.36 vs. 0.48±0.06） and miR-93（1.93±0.58 vs. 0.75±0.12） in PCOS group were significantly higher than those in control group（P<0.01）. The levels of serum miR-21（2.54±0.83 vs. 0.68±0.10） and miR-93（2.85±1.04 vs. 0.96±0.17） in obese group were significantly higher than those in non-obese group（P<0.01）. The levels of serum miR-21（2.61±0.78 vs. 0.53±0.08） and miR-93（2.91±1.13 vs. 0.82±0.15） in insulin resistance group were significantly higher than those in non-insulin resistance group（P<0.01）. ROC curves showed that the best cut-off values of serum miR-21 and miR-93 for PCOS diagnosis were 1.25 and 1.54，respectively. The AUC（95%CI） of the combined di－agnosis of PCOS was 0.815（0.759 to 0.874），which was significantly higher than that of diagnosis using only miR-21[0.734（0.676 to 0.795）] or miR-93[0.683（0.627 to 0.741）]. Its sensitivity was 83.6%，and its specificity was 76.0%. Pearson correlation showed that miR-21 and miR-93 were positively correlated with HOMA-IR（r=0.842，r=0.775，P<0.01）. Conclusion：Serum levels of miR-21 and miR-93 are high in PCOS patients，and they are associated with insulin resistance. The combined detection of miR-21 and miR-93 is valuable for the diagnosis of PCOS.

Abstract:Objective：To investigate the role and possible mechanism of miR-21 on the regulation of anoikis in human colon carci－noma. Methods：The expression level of miR-21 in 30 cases of colon cancer was examined by qRT-PCR，and its correlation with clinicopathologic features and prognosis was further analyzed. HT-29 cells and its derivative HT-29/AR（subpopulation of HT-29 cells that acquired resistance to anoikis） were used to explore the relationship between the expression of miR-21 and anoikis resis－tance. Western blot was used to detect changes of PDCD4 and PTEN，and dual-luciferase reporter assay was applied to verify the di－rect conjunction of miR-21 to its 3’UTR. Results：Expression of miR-21 in human colon carcinoma tissues was higher than that in adjacent tissues；was significantly correlated with poor differentiation，lymph node metastasis and TNM stage；patients with high ex－pression of miR-21 had poor prognosis. Compared with HT-29 cells，miR-21 expression in HT-29/AR cells was significantly in－creased and transfection of miR-21 mimics was able to promote the anoikis resistance of HT-29 cells. Western blot and dual-lu－ciferase reporter assay demonstrated that miR-21 was able to increase the anoikis resistance of colon carcinoma cells by inhibiting expression of PDCD4 and PTEN. Conclusion：The miR-21 can participate in regulating anoikis in human colon carcinoma cells by targeted inhibiting PDCD4 and PTEN.

Abstract:Objective：Through combined analysis of CA125 and HE4 levels to assess its diagnosis and prognosis prediction value and association with progression-free interval in patients with epithelial ovarian cancer Ⅱ. Methods：One hundred and one patients with epithelial ovarian cancer and 100 patients with ovarian epithelial benign tumors from April 2012 to October 2014 were taken as the subjects. The detection of CA125 and HE4 and the calculation of ROMA were performed to analyze the relationship between diagnosis and prognosis. Results：The levels of CA125 and HE4 in the benign tumors group and early and advanced ovarian cancer were statis－tically different from each other before treatment（P=0.000）. The sensitivity，specificity，and negative predictive value were the highest in the diagnosis of ovarian cancer，the misdiagnosis rate and the missed diagnosis rate were the lowest，and the correct diagnosis index was the highest；CA125，HE4 and ROMA had a higher diagnostic efficiency for epithelial ovarian cancer Ⅱ，especially ROMA values. Patients with CA125＞1 200 U/mL and HE4 ＞670 Pmol/L before treatment had a short recurrence time，and a shorter progression-free interval. There was statistic difference（CA125： χ2=20.926，P=0.000；HE4： χ2=11.235，P=0.001）. Conclusion：The combined diagnosis of CA125 combined with HE4 is superior in the diagnosis of epithelial ovarian cancer Ⅱ. Its preoperative level is negatively correlated with the progression-free interval of ovarian cancer patients，and it can assist the evaluation of prognosis. It is worthy of promotion and application in clinical work.

Abstract:Objective：To investigate advantages of the Da Vinci robot assisted laparoscopic surgery on radical surgery of cervical can－cer by analyzing clinical data of patients with cervical cancer received radical surgery performed by DaVinci robot assisted laparoscopy and traditional laparoscopic surgery. Methods：Clinical data of 115 patients with cervical cancer admitted to our hospital from January 2018 to October 2018 were retrospectively analyzed. Patients who underwent Da Vinci robot assisted laparoscopic surgery were classi－fied into robot group（n=50），and others were classified into traditional laparoscopic group（n=65）. Evaluation indexes of surgery and bladder function in two groups were compared. Results：The time of operation，the amount of bleeding，intraoperative fluid infusion and postoperative hospitalization time in the robot group were significantly lower than those in the traditional laparoscopic group（P<0.05）. Time of retained ureter in the robot group was longer than that in the traditional laparoscopic group（P<0.05）. There was no significant difference in intraoperative blood transfusion，ureteral replacement and short-time（≤ postoperative six months） urinary system complications after operation（P>0.05）. Conclusion：There is no significant difference in rehabilitation of bladder function between Da Vinci robot assisted laparoscopic surgery and traditional laparoscopic surgery in patients with cervical cancer，but the Da Vinci robot assisted laparoscopic surgery has shorter operation time，less bleeding amount，and shorter postoperative hospitalization time.

Abstract:Objective：To investigate the effect of kidney-tonifying and blood-activating decoction combined with intrauterine perfusion on improvement of clinical symptoms and transforming growth factor-beta1（TGF-β1），Smad2，and Smad3 in patients with intrauterine adhesions. Methods：A total of 60 patients with intrauterine adhesions admitted to our hospital from July 2017 to July 2018 were en－rolled and equally divided into the experimental group and the control group in accordance with the random number table. The con－trol group was treated with estradiol valerate，and the experimental group was treated with kidney-tonifying and blood-activating de－coction combined with intrauterine perfusion of Danshen injection. Clinical improvement in two groups was observed. Levels of matrix metalloproteinases-2（MMP-2），matrix metalloproteinases-3（MMP-3） and matrix metalloproteinases-9（MMP-9） in two groups were detected by ELISA. Levels of TGF-β1，Smad2 and Smad3 protein and mRNA in the endometrial tissues in two groups before and after treatment were detected by Western blot and Q-RT-PCR. Results：After treatment，the endometrium thickness，MMP-2，MMP-3 and MMP-9 levels were significantly increased in both groups，and the endometrial blood flow parameters of pulsatility index（PI），resistance index（RI），adhesion type，adhesion range，menstrual status and total score were all decreased. The en－dometrium thickness，MMP-2，MMP-3 and MMP-9 levels in the experimental group were higher than those in the control group；the PI，RI，adhesion type，adhesion range，menstrual status and total score were lower than those in the control group（all P<0.05）. After treatment，levels of TGF-β1，Smad2，and Smad3 protein and mRNA were reduced in both groups. Levels of TGF-β1，Smad2 and Smad3 protein and mRNA in the experimental group were lower than those in the control group（P<0.05）. Conclusion：Kidney-tonify－ing and blood-activating decoction and intrauterine perfusion can improve the blood flow parameters of intrauterine adhesion and prevent the recurrence of intrauterine adhesion. The mechanism may be related to the up-regulation of MMP-2，MMP-3 and MMP-9 expression，and the down-regulation of TGF-β1，Smad2 and Smad3 expression.

Abstract:Objectives：To develop and validate the risk prediction model for cervical intraepithelial neoplasia grade 2 or worse （CIN2+），and provide guidance for the treatment of cervical lesion. Methods：The clinical and pathological data of 1 266 patients who underwent cervical biopsy from January 2015 to December 2017 were retrospectively analyzed，and histopathological examination was used as the golden standard for the final diagnosis. A logistic regression analysis was used to identify the risk factors for predicting CIN2+，the disease risk prediction model and individualized prediction nomogram were developed，and the predictive performance and concordance of the model and nomogram were evaluated，respectively. Results：①The results of chi-square test showed that the risk factors for CIN2+ were smoking history（ χ2=29.92，P=0.000），ThinPrep cytology test（TCT）（χ2=172.89，P=0.000），human papillomavirus （HPV）（ χ2=147.03，P=0.000），colposcopy results（ χ2=340.85，P=0.000），and the ratio of lesion area to cervical area（ χ2=206.22，P=0.000）. ②The regression model was developed through multivariate logistic regression analysis，and the area under the curve of the model was 0.88. ③The nomogram was developed，and its index of concordance was 0.878 after internal validation. Conclusion：The regression model developed in the study is based on the five risk factors of smoking history，TCT，HPV，colposcopy results，and the ratio of lesion area to cervical area，with good performance and accuracy in predicting CIN2+ risk，and can help to establish individualized treatment plans.

Abstract:Objective：To explore the laboratory verification methods and clinical characteristics of cytological HPV-negative cervical cancer. Methods：From September 2015 to October 2018，33 cervical cancer patients with HPV-negative and pathologically diag－nosed by cervical exfoliated cell Hybribio 21 typing（K-21） and 60 HPV-positive cervical cancer patients in the same period were collected. Laboratory validation was carried out with pathological paraffin specimens，molecular pathology（hybribio membrane hybridization + PCR） kits（K-14，K-18 and K-37）. To analyze the clinical characteristics of HPV-negative and positive cervical cancer. Results：33 cases of cervical cancer with negative cytology were detected by tissue paraffin section and molecular pathology. The results of K-14 and K-18 kits were 13 negative and 9 of K-37 kits were negative. There were statistical differences in the first clinical manifestations between 9 patients with negative cervical cancer and 84 patients with positive cervical cancer in molecular pathology，the proportion of contact bleeding and irregular vaginal bleeding in negative group was smaller than that in positive group（3/9∶41/84，1/9∶33/84； ?字2=12.889，P=0.006）. There were statistical differences in FIGO stages at the time of treatment，the proportion of Ib2，IIa2，Ⅲ and Ⅳ stages in negative group was higher than that in positive group（3/9∶13/84，1/9∶7/84，2/9∶0/84； ?字2=12.786，P=0.021）. There were statistical differences in pathological types，the proportion of adenocarcinoma in negative group was higher than that in positive group（3/9∶5/84； ?字2=5.752，P=0.041）. There were statistical differences in tumor infiltration depth among surgical patients，the propor－tion of early infiltration，infiltration to cervical external orifice and infiltration to uterine body in negative group was higher than that in positive group（2/7∶6/64，2/7∶14/64，3/7∶11/64； ?字2=8.332，P=0.035）. Conclusion：Theoretically，HPV-negative cervical cancer exists. Clinically，HPV negative cervical cancer has the characteristics of atypical initial clinical manifestations，late FIGO stage and large proportion of adenocarcinoma.

Abstract:Objective：To explore the laboratory verification methods and clinical characteristics of cytological HPV-negative cervical cancer. Methods：From September 2015 to October 2018，33 cervical cancer patients with HPV-negative and pathologically diag－nosed by cervical exfoliated cell Hybribio 21 typing（K-21） and 60 HPV-positive cervical cancer patients in the same period were collected. Laboratory validation was carried out with pathological paraffin specimens，molecular pathology（hybribio membrane hybridization + PCR） kits（K-14，K-18 and K-37）. To analyze the clinical characteristics of HPV-negative and positive cervical cancer. Results：33 cases of cervical cancer with negative cytology were detected by tissue paraffin section and molecular pathology. The results of K-14 and K-18 kits were 13 negative and 9 of K-37 kits were negative. There were statistical differences in the first clinical manifestations between 9 patients with negative cervical cancer and 84 patients with positive cervical cancer in molecular pathology，the proportion of contact bleeding and irregular vaginal bleeding in negative group was smaller than that in positive group（3/9∶41/84，1/9∶33/84； ?字2=12.889，P=0.006）. There were statistical differences in FIGO stages at the time of treatment，the proportion of Ib2，IIa2，Ⅲ and Ⅳ stages in negative group was higher than that in positive group（3/9∶13/84，1/9∶7/84，2/9∶0/84； ?字2=12.786，P=0.021）. There were statistical differences in pathological types，the proportion of adenocarcinoma in negative group was higher than that in positive group（3/9∶5/84； ?字2=5.752，P=0.041）. There were statistical differences in tumor infiltration depth among surgical patients，the propor－tion of early infiltration，infiltration to cervical external orifice and infiltration to uterine body in negative group was higher than that in positive group（2/7∶6/64，2/7∶14/64，3/7∶11/64； ?字2=8.332，P=0.035）. Conclusion：Theoretically，HPV-negative cervical cancer exists. Clinically，HPV negative cervical cancer has the characteristics of atypical initial clinical manifestations，late FIGO stage and large proportion of adenocarcinoma.

Abstract:Objective：To observe the effect of liraglutide on metabolic and endocrine parameters in patients with polycystic ovary syndrome（PCOS） complicated with insulin resistance（IR），and evaluate the efficacy of liraglutide in the treatment of PCOS. Methods：Before-after study method was adopted，32 normal people were randomly selected as controls and 23 patients with PCOS complicated with IR were treated with liraglutide 1.8 mg/d. General conditions and metabolic indicators including oral glucose tolerance test，in－sulin release test，HbA1c，blood fat and sex hormones were measured before treatment and 24 weeks after treatment. Euglycemic-hy－perinsulinemic clamp was performed before treatment and 24 weeks after treatment，and M values were recorded. Results：After treat－ment with liraglutide in patients with complications of PCOS and IR，their weight，body mass index，body fat content，waist circumfer－ence，hip circumference，glycosylated hemoglobin and insulin resistance index were lower than those before treatment（P<0.05）；serum testosterone，fasting insulin，total cholesterol，triacylglycerol and low density lipoprotein cholestorol were decreased than those before treatment（P<0.05）. M value was higher than that before treatment（P<0.05）；free androgen index（FAI） after treatment was decreased when compared with that before treatment. In PCOS patients，FAI was positively correlated with body weight，waist circumference，hip circumference and testesterone，and negatively correlated with sex hormone binding globulin（SHBG）. Multiple stepwise linear regression analysis showed that FAI in PCOS patients was correlated with testesterone and SHBG. Conclusion：Liraglutide can improve body weight，blood glucose，insulin resistance and hyperandro－genism in patients with complications of PCOS and IR.

Abstract:Objective：To compare the analgesic effect of positive psychological suggestion and dolantin injection in in vitro fertiliza－tion-embryo transfer（IVF-ET） via vaginal puncture. Methods：A total of 1 307 patients，with age less than 37 years old and without communication barrier and drug allergy history，who experienced controlled ovarian hyperstimulation in luteal phase throuth the short-term-effect long strategy and had 5-10 ovarian follicles，and experienced the IVF-ET in our department in 2018 were selected and divided into the dolantin group of 680 patients（intramuscularly injecting dolantin of 50mg before 30 minutes of operation） and the psychological suggestion group of 627 patients（positive psychological suggestion before 30 minutes of operation）. Pre-operative anxiety score，intraoperative pain and post-operative adverse reactions were compared between two groups. Results：The anxiety score in the psychological suggestive group was lower than that in the dolantin group，with statistically significant difference（t=3.462，P=0.000），and there was no significant difference in pain feeling between two groups（ χ2=0.601，P=0.438）. Post-operative blood pressure in the psychological suggestion group was not decreased，but it was significantly decreased in the dolantin group（t=-5.059，P=0.000）. The incidence rate of dizziness，nausea and vomiting in the psychological suggestion group was lower than that in the dolantin group，with staitistically significant difference（χ2=1181.762，P=0.000）. Conclusion：Before the IVF-ET to give positive psychological suggestion to patients can reduce anxiety，obtain same analgesic effect with dolantin，and effectively avoid adverse drug reactions caused by dolantin.

Abstract:Objective：To observe the effect of single intravenous injection of remifentanil plus propofol，remifentanil plus etomidate and remifentanil plus etomidate-propofol mixture in painless abortion anesthesia，so as to explore an ideal anesthetic method for painless abortion. Methods：A total of 300 early pregnant women of ASAⅠ-Ⅱ who accepted painless abortion voluntarily were ran－domly divided into propofol group（group P），etomidate group（group E） and etomidate mixed propofol group（group EP）. Mean arte－rial pressure（MAP），heart rate（HR） and percutaneous oxygen saturation（SpO2） before anesthesia（T0），one minute after anesthesia （T1），one minute after the operation（T2） and one minute post operation（T3） were recorded in each group. Adverse events such as in－jection pain，myoclonus，nausea and vomiting were recorded. Effect of anesthesia satisfaction were evaluated for obstetrics and gy－necology doctors and patients respectively. Results：In T0 and T3，there was no significant difference in MAP，HR and SpO2 among the three groups（P>0.05）. MAP，HR and SpO2 of group E and EP in T1 and T2 were higher than those in group P（P<0.05）；the inci－dence of injection pain，intraoperative hypotension and bradycardia in group P was higher than that in group E and group EP（P<0.05）. The incidence of myoclonus in group E was higher than that in group P and EP（P<0.05）. There was no significant difference in the incidence of intraoperative movement，additional drugs，nausea，vomiting and hypoxia saturation among the three groups（P>0.05）. In terms of satisfaction with anesthesia effect，gynecologists and obstetricians had high satisfaction with group P and EP（P<0.05），while patients themselves had higher satisfaction with the two groups（P<0.05）. Conclusion：In painless abortion，single intrave－nous injection of remifentanil plus EP mixture is a better choice than remifentanil plus propofol and remifentanil plus etomidate，in maintaining hemodynamic stability，reducing in－jection pain and myoclonus，getting higher satisfaction with surgery doctors and patients.

Abstract:Objective：To investigate the clinicopathological feature，diagnosis，differential diagnosis，treatment，prognosis and misdiag－nosis causes of uterine perivascular epithelioid cell tumor（PEComa），so as to reduce misdiagnosis and mistreatment. Methods：Misdi－agnosis data of one patient with PEComa admitted to our hospital were retrospectively analyzed，and relevant literatures were re－viewed. Results：A middle-aged female patient was admitted to the hospital due to “39+5 weeks of menopause，without abdominal pain，requiring hospitalization and delivery”. During pregnancy，ultrasound examination indicated：intrauterine pregnancy and uterine fi－broids. Cesarean section + laparoscopic myomectomy were performed in our hospital. Postoperative pathological examination sug－gested PEComa. Postoperative follow-up lasted for one year and the patient is now surviving without tumor. Conclusion：Uterus PEComa is a relatively rare disease，which is easily misdiagnosed as uterine leiomyoma due to its lack of imaging and clinical characteristics. The final diagnosis requires pathological examination and immunohistochemistry. At present，surgical treatment is an effective method；efficacy of chemoradiotherapy has not been determined. Long-term follow-up is required after surgery.

Abstract: