Volume 88  ·   Issue 11  ·  2008

In recent years, the progress of obstetrics is relatively rapid, and it has developed to the point that obstetrics are no longer called obstetrics, or even perinatal Medicine, and then a more appropriate name, namely Maternal-Fetal Medicine, has appeared. This can be well reflected in the names of delivery institutions in North America (USA and Canada). Most obstetrics are renamed as Maternal-Fetal Medicine departments, and the basic work of obstetrics is divided into two parts, Maternal Medicine and Fetal Medicine. Fetal medicine focuses on the diagnosis and treatment of fetal birth defects, and other conditions that may endanger the normal growth and development of fetus. The indicators reflecting the quality of its work are perinatal mortality, morbidity and incidence of birth defects. The progress of fetal medicine far exceeds that of maternal medicine, which basically faces some old problems in obstetrics.

Amniotic fluid embolism is a rare serious obstetric complication. It was first described by Steiner and Luschbaugh in 1941, who found tissue fragments from the fetus in the pulmonary circulation of a group of pregnant women who died during childbirth. The incidence of amniotic fluid embolism ranged from 1:5000 to 1:80,000, 70% occurred during childbirth, 30% occurred after childbirth, and the mortality rate could be as high as 70% to 80%. In the order of maternal death causes, it usually ranks in the top 5, and its order will rise or decrease with different regions and different years. Taking Shanghai as an example, amniotic fluid embolism ranked fourth in 1995, ranked third in 1996, 1997, and ranked second in 1998.

Although postpartum hemorrhage is not a new topic, it is a common disease in childbirth (the incidence rate is 5% ~15%), and it can even endanger the life of maternity. In China, whether in urban or rural areas, postpartum hemorrhage is the first cause of maternal death in China for many years. According to the time of its occurrence, it is divided into early postpartum hemorrhage and late postpartum hemorrhage. The former refers to the bleeding volume ≥500 ml from the fetus delivery to 24 hours after delivery; Or the bleeding volume within 2 hours after delivery was ≥400 ml; The latter occurs from 24 hours to 6 weeks postpartum, which is less common than the former. Among the early postpartum hemorrhage, there is a so-called refractory postpartum hemorrhage, which is often the main content of clinical rescue.

With the development of health care during pregnancy and the improvement of obstetric quality, the maternal mortality rate decreases year by year, but due to the increase of pregnancy complicated with heart disease, the maternal mortality rate increases obviously, especially in patients with pulmonary hypertension (PAH), the risk of sudden pregnancy death is greater, the maternal mortality rate is closely related to the level of pulmonary artery pressure, and the mortality rate of severe pulmonary hypertension is more than 50% [1]. Therefore, pregnancy complicated with pulmonary artery hypertension has attracted great attention of obstetricians.

Preeclampsia-eclampsia has been understood for more than a century. Although the etiology and pathogenesis are still unclear, termination of pregnancy is the only recognized cure. In view of this, if it occurs in the third trimester of pregnancy near fetal maturity, clinicians can still save the interests of both mother and child by terminating the pregnancy in time. Therefore, some scholars abroad classify late-onset preeclampsia as clinically slow and mild even if it is severe, which means that it is not difficult to solve clinically. On the contrary, due to the difficulty of balancing the interests of both mother and child and the difficulty of clinical management, early-onset severe preeclampsia is regarded as clinically severe.

Multiple organ dysfunction syndrome (MODS) refers to two or more system or organ dysfunction or failure in simultaneous or sequential inertial form 24 hours after the body suffers from severe trauma, shock, surgery, infection and other injuries. At present, there is no uniform standard for the diagnosis of MODS in obstetrics at home and abroad, and it is believed that the diagnosis can be made if two or more dysfunctions appear on the basis of pregnancy diseases.

Maternal mortality rate is still a comprehensive indicator reflecting the medical level of a country and a region. In 2005, 536 000 women died due to pregnancy and childbirth worldwide, of which 99% occurred in developing countries, while the maternal mortality rate in developing countries was 450/100 000 live births. In 2002, the maternal mortality rate in China was 50.2/100 000, which is significantly higher than that in developed countries (9/100 000 live births). Therefore, it is necessary to explore an effective measure to reduce the maternal mortality rate. In recent years, perfect perinatal management and the use of fully equipped intensive care unit (ICU) are effective measures to reduce the maternal mortality rate.

Objective To investigate the prevalence and genotype of vancomvcin-resistant enterococci(VRE)faecium and faecalis isolates.Methods Thirty-eight non duplicate vancomycin-resistant enterococci isolates were collected from 2003 to 2007 in Bering Chaoyang hospital.The prevalence of VRE was analyzed using WHONET software.These strains were processed by brain heart infusion agar screening in the presence of vancomycin(6 ms/L),and were analyzed for genotypic characteristics using multiplex PCR.The homology of the isolates was determined by pulsed-field gel electrophoresis(PFGE).Results Most VRE strains were isolated from the ICU patients (34.2%, 13/38). The vancomycin resistance rate (vancomycin MIC≥16 ms/L)was 2.6%in 2003,1.8%in 2004,0.7%in 2005,6.8%in 2006,and 3.3%in Jan-Mar 2007.Fifteen vancomycin-resistant Enterococci faecalis isolates were identiffed as vanB genotype by PCR and sequencing. (the vancomycin MIC ranged from 16 to 48 ms/L and the teicoplanin MIC ranged from 0.38 to 0.5 ms/L).The vanA gene was confirmed by PCR and sequencing in twenty-three vancomycin-resistant Enterococus faecium(vaneomycin MIC≥256 ks/L,teicoplanin MIC=2-32 mg/L).Twelve vaneomyein-resistant Enterococus faecium isolates showed incongruence between phenotype and genotype for glycopeptides resistance(vanA genotype and vanB phenotype).The PFGE analysis revealed 10 different PFGE types. Fourteen vancomycin-resistant Enterococci feacalis isolates belonged to the same clone.21 vancomycin-resistant Emerococci feacium isolates belonged to 9 PFGE types.The four most prevalent clones was A,D,E and F.Conclusion The VRE strains isolated from Beijing Chaoyang Hospital belong to vanA and vanB genotypes.Vancomycin-resistant Enterococci feacalis is monoclonal,and vancomycinresistant Enterococci feacium is polyclonal.Some of the vancomycin-resistant Enterococus faecium isolates show incongruence between phenotype and genotype.

Objective To investigate the effects of microparticles(Mps)from different people on the vascular endothelial cell function.Methods Third generation human umbilical vein endothelial cells (HUVECs)were cultured with Mps-containing plasma samples from 5 systemic lupus erythromatosus(SLE)patients undergoing heavy steroid treatment,5 patients with steroid-induced avascular necrosis of femoral head(ANFH),4 patients with alcohol induced ANFH,and 4 healthy persons for 12 h,24 h,and 48 h respectively.Plasma samples from the above persons with the Mps filtered were used as experimental controls.HUVECs cultured with blank culture fluid were used as blank controls.Inverse phase contrast microscopy was used to observe the morphology of the HUVECs.PE-CD31 and PEcy5-CD62E were added into the flow cytometric test tubes and flow cytometry(FC)was used to count the number of CD62E+/CD31+Mps in the mediam.RT-PCR was used to measure the mRNA expression of the apoptotic gene fas (fas/beta-actin).Results Microscopy showed no distinct difference between the morphology of the HUVECs among the different groups.FC showed that the number of CD62E+/CD3 1+Mps 48 hours after the 20%Mp stimulation of the steroid-treated SLE group was significantly lower than that of the control group (P=0.035).RT-PCR showed that 48 hours after the stimulation the levels of mRNA fas/beta-actin of the steroid-treated SLE group and steroid induced ANFH group were 0.914±0.226 and 0.776±0.230respectively,both significantly higher than those of the control groups(0.832±0.200 and 0.669±0.148respectively,P=0.005 and P=0.006).Conclusion The Mps from the steroid treated patients aggravate the apoptosis of HUVECs.and the Mps from the steroid induced ANFH patients augment the production of apoptosis gene in HUVECs.The Mps from healthy people and alcohol induced ANFH patients have no relationship with HUVEC apoptosis.

Objective To investigate the role of oligodendrocyte apoptosis under the regulafion of the bcl-2/bax protein expression in brain white matter in the pathogenesis of heroin-induced spongiform leucoencephalopathy (HSLE).Methods Samples of frontal lobe,cerebellum,and corpus callosum were obtained from the brains during autopsy of 4 HSLE cases and 5 normal controls and underwent light microscopy and electron microscopy. Immunocytochemistry was used to detect the expression of myelin basic protein(MBP),caspase-3,bel-2 protein,and bax protein.Results Widespread demyelination was seen in the white matter of the frontal lobe,cerebellum and corpus callosum of the HSLE cases,most severely in the cerebellum.The levels of caspase-3 and bax expression of the HSLE group were significantly higher than those of the control group(both P＜0.05),however,the bcl-2 level of the HSLE group was no significantly different from that of the control group(P＞0.05).Conclusion Widespread demyelinafion in the white matter is a prevailed pathological change of HSLE.Oligodendrocyte apoptosis under induced by the decrease of bel-2/bax ratio may contribute to the pathogenesis.

Objective To explore the diagnosis,therapeutic strategy,and pathogenetic mechanism of chronic expanding intracerebral hematoma(CEICH).Methods The clinical presentation,radiological charactenstics,d pathology,and treatment of 22 cases of CEICH,15 males and 7 females,aged 29.3,all treated with cranmtomy and removal of the wall of the capsule and hematoma, were analyzed retrospectively.Results The clinical presentation and radiological characteristics of CEICH were atypical.After surgery 18 patients recovered quite well,3 patients suffered from hemiplegia,and 1 patient died from rebleeding.The diagnosis of CEICH of all the cases was confirmed by intraoperative finding and pathological results.Conclusion CEICH can be found in any part of the brain that has 2 major chamcteristics:its clinical symptoms always develop slowly,and the typical radiological characteristic is intracerebral hematoma-form image. Surgery to evacuate the hematoma and remove the capsule is necessary and can be with good outcome.

Objective To investigate the mean survival time and risk factors of amyotrophic lateral sclerosis(ALS).Methods Sixty-five ALS patients were followed up,and the clinical data of 33 of them who died were retrospectively analyzed.The survival time and related risk factors were analvsed with the statistic tools such as Kaplan-Meier survival curve,t test, and variance analysis.Results The mean survival time of the 33 patients was(35±19)months from onset of symptom.The mean survival time for the patients＜60 years old was(39±19)months;not signgicantly different from that of the patients aged ≥60years [(30±18)months,P＞0.05].The mean survival time from confirmed diagnosis was(22±17)montns.The risk factors influencing the survival time of ALS patyients were age,site of onset,severity of disease,and interval between symptom onset and diagnosis.Conclusion The prognosis of the ALS patients with elder age,bulbar onset,more severe symptoms and signs,and shorter confirmation time is poorer.

Objective To delineate individualized surgical management strategy for the optimal management of pulmonary atresia with intact ventricular septum(PA/IVS).Methods Between 1997 to 2005,52 consecutive patients with PA/IVS,31 male and 21 female,aged 2-9,divided into 2 groups according if right ventricle-dependent coronary circulation(RVDCC) existed, underwent individualized surgical treatment.The patients in Group Ⅰ(with:RVDCC,n=6)underwent single ventricle repair. Fortysix patients were in Group Ⅱ (without RVDCC), 13 of which with severe right ventricular hypoplasia (tricuspid valve Z value＜-4)underwent single ventricle repair and 33 of which were with mild to moderate right ventricular hypoplasia(Z value ＞-4). One critical neonate underwent systemic-pulmonary artery shunt.The other 32 of the 33 patients received right ventricular decompression procedures firstly,and 6 of them presented optimal hemodynamics and oxygenation and achieved biventricular repair. If the patients presented unstable hemodynamics or hypoxemia after right ventricular decompression procedure, an additional shunt was added.13 young infants(0-2 months)underwent additional systemic-pulmonary artery shunt,and 13 patients(＞3 months-old)underwent additional bidirectional cavopulmonary shunt(1.5ventricular repair)The patients were followed up for 1-10 years.Results There were 1 early death in Group Ⅰ and 7 early deaths in Group Ⅱ.The total early mortality was 15%. A successful definitive repair was achievd in 26 cases(50%).Follow-up reported 3 late deaths.Conclusion Individualized surgical management based on the presence of RVDCC,right ventricular hypoplasia grading,right ventricular growth potential,hemodynamic situation, and oxygen saturation after the decompression procedure is helpful to improve the surgical resuhs of PA/IVS.

Objective To investigate the biodistribution and positron emission tomography(PET)imaging of 11C-acetate(11C-AC)in a murine model of pulmonary carcinoma,and to evaluate the use of 11C-AC for diagnosis of malignant tumor.Methods A total of 30 T739 mice underwent subcutaneous injection of mouse pulmonary adenocarcinoma cells of the line LA-795 to establish adenocarcinoma models and then were randomly divided into five equal groups.Four groups underwent intravenous injection of 11 C-acetate through the caudal vein,killed 5,10,20,and 30 minutes later respectively,underwent PET,and then their organs and tumors were isolated.The mice in the control group underwent injection of 18F-fluorodeoxyglucose(18F-FDG)and were killed 60 min later.The biodistribution of 11 C-AC and that of 18 F-FDG were measured with well-gamma detector-The ratios of the levels of percentage activity of injection dose per gram of tissue between the tumor and normal tissues(T/NT ratios).were calculated.Results In the biodistribution study of 11C-AC,considerable radioactive uptake of tumor was observed, and much radioactivity was showed in kidney,liver,and spleen.The ratios of tumor/blood,tumor/muscle,and tumor/lung were all above 2.0.The tumor PET images with 11C-AC as tracer were as clear as that with 18F-FDGas tracer. The11C-ACstandard uptake value(SUV) of the tumors was 2.8±0.8,significantly lower than that of 18 F-FDG (5.3±1.6,P＜0.01).Conclusion 11C-AC call be used in PET imaging of pulmonary malignancy.The optimized imagang acquisition time point is 20 min after injection. It may become a complementary tracer in the caseswith unsatisfying 18F-FDG images.

：Objective To study thechanges of somatosensory evoked potential(SEP)and transcranial magnetic simulation motorevoked potential(TMS-MEP)in experimental spinal cord injury (SCI).Methods Thirty-tworabbits were randomly divided into 4 equal groups.All rabbits were anesthetized for 90min.A grouP(Group A) underwent only laminectomy of T12 without SCI,stimulation withdifrerent intensities was used to induce SEP and TMS-MEP to determine the most appropriatestimulation intensity.The EPs were recorded before and after the operation.The other 3groups underwent laminectomy of T12 to expose the dura,and a spinal cord compressingapparatus weighing 40 g was put on the intact dura and dorsal surface 0f spinal cordunderneath for 5,15,and 30 rain respectively(Groups B,C,and D).SEP and TMS-MEP weredetected after anesthesia,after exposure of spinal cord,and 5 and 30 min,1 and 6h,and1,3,and 7 d.The latency and amplitude of each wave were measured.The data were analyzed byanalysis of variance,t-test and linear correlation.Tarlov behavior score was used toassess the motor function before the operation and 1,3,and 7 days after SCI.Results It wasfound that 100% intensity stimulus obtained stable and reliable MEP waves.Anesthetic didnot influence the EPs.The amplitude of SEP began to decrease 5 min after SCI and thelatency began to increase 30 min after SCI.And both the amplitude and latencv,especiallythe former,of MEP began to significantly change 5 min after SCI.The latency levels of SEPand MEP increased and the amplitude decreased after compression time-dependently during acertain range of time(all P＜0.05).The latency of SEP recovered 1 d after SCI and theamplitude recovered 7 d after:and the latency of MEP recovered 3 d after SCI and theamplitude did not recover even 7 d after SCI.The Tarlov scores of all groups were all 5before operation,and the Tarlov scores of Group C and D became 1 d after operation andthen increased later,however,still lower than 5 even at day 7.Conclusion SEP and TMS-MEPare very sensitive to SCI,in particular,the change of amplitude is more sensitive then thelatency change and can more accararely reflect the degree of SCI.Combination of SEP andTMS-MEP objectively reflects the SCI degree.EP measurement,as a noninvasive technique,hasgreat value in monitoring spinal cord function.

Objective To investigate the effects of melatonin on vohage-gated delayed rectifier potassium channels.Methods Hippocampus neurons were obtained from newborn Wistar rat and cultured.Primary cuhured for 7 to 12 days of new-born Wistar rat were selected as objectives.Patch clamp whole-cell recording technique was used on the hippocampus neurons cultured for 7 to 12 day.to record the delaved rectifier potassium current to analyze the basic electrophysiological characteristics.The effects of melatonin of the concentmtions of 1 nmol/L,10 nmol/L,100 nmol/L,1 mol/L,10 mol/L,100 mol/L,and 1 mmol/L on the amplitudes and kinetics of delayed rectifier potassium currents were investigated.Results With different vohage protocols and specific blockers of potassium channel(4-AP and TEA) a delayed rectifier potassium current that activated and inactivated slowly and had the outward rectifying characteristics (Ik) from the outward potassium currents in cultured new-born hippocampus neurons was separated.The effect of melatonin on the delayed rectifier channel was rapid,reversible and voltage-dependent. Melatonin had no effect on the kinetic characteristics of the Ⅰ-Ⅴ curve. Melatonin increased the potassium current concentmtion-dependently. 1 - 100 nmol/L melatonin increased the amplitude of potassium current gradually;the effects of 1-100 μmol/L melatonin on the potassmm current increased concentration-dependently,while the action of 1 mmol/L melatonin decreased.Conclusion Melatonin reversibly increases the rectifier delayed potassium currents of the cultured hippocampus neurons of new-born rat.This may be involved in some aspects of physiological and pathological significance of potassium currents.

Objective To investigate the effect of parthenolide(PAR)on the tumor necmsis factor (TNF)-α induced aggreean catabolism of chondrocytes in ostroarthritis(OA).Methods Human chondmcytes were btained from the condyles of femur of OA patients undergoing knee joint replacement dunng operation,cultured,and randomly divided into 4 groups:control group,TNF group(cultured in medium containing 10 ng/ml TNF-α),PAR group(cultured in medium containing 10μmol/L PAR),and PAR+TNF group(cultured in medium containing 10μmol/L PAR and 10 ng/ml TNF-α).Eight davs later 1,9-dimethylmethylene blue speetrophotometrie assay was used to measure the content of glycosaminoglycan(GAG),marker of aggrecan catabolism,in the culture fluid and the cells. Using anti-aggrecan monoclonal antibodies Mab 5D4 and 383,ELISA was employed to detect the contents of 5194 and 383,aggrecan catabolic fragments. RT-PCR was used to detect the mRNA expression of the aggrecan, ADAMTS-4 and ADAMTS-5,both aggrecanases,tissue inhibitor of metalloprotease (TIMP)-1, mitogen-actirated protein kinase(MAPK)-1 and 18S,a marker.Results The GAG percentage in the culture fluid of the TNF-α was 57.1%±2.O%,significantly higher than those of the control and TNF-α+PAR groups(P=0.001 and 0.02).The 5D4 fragment level of the TNF-α group was 509 ng/m1±32 ng/ml,significantly higher than that of the control group(166 ng/ml±15 ng/ml,t=11.60,P=0.007),and the level of 5D4 fragment of the PAR+TNF-α group was 333 ng/ml±15 ng/ml,significantly lower than that of the TNF-α group(t=7.93,P=0.016).There was not significant difference in the 383 fragment level among the 4 groups(F=1.316,P=0.335).The aggreean mRNA expression level of the TNF-α group was significantly lower than those of the other 3 groups(F=133.7,P=0.000),the mRNA expression levels of ADAMTS-5 and MAPK-1 of the TNF-α group were significantly higher than those of the other 3 groups(F=209.7,117.1;P=0.000).the ADAMTS-5 mRNA expression level of the PAR group was significantly lower than that of the control group(t=11.1,P=0.008),and there was not significant differences in the mRNA expression levels of ADAMTS4and TIMP-1 among the 4 groups(F=1.87,0.73;P＞0.05).Conclusion PARinhibits TNF-α induced catabolism of aggrecan in the chondrocytes of OA and reduces the mRNA expression of ADAMTS-5 and MAPK-1.PAR may be useful in the treatment of OA and other inflammatory Joint diseases.

A 45-year-old male was admitted to the hospital due to intermittent hemoptysis accompanied by fever for 9 h and syncope once. The patient developed hemoptysis without obvious trigger at 9:00 am on August 5, 2006, with bright red color, left chest pain and fever. At 14:00 on the same day, the patient came to the respiratory clinic of our hospital, and the chest X-ray examination showed: left lower lung mass with left pleural effusion. The doctor recommended hospitalization, but the patient refused to be admitted to the hospital. After returning home, he frequently suffered hemoptysis about 40 times, with an average of about 5 ml each time, and syncope occurred once. At 18:00 on the same day, the patient came to the emergency department of our hospital, and the blood test routine: hemoglobin 115 g/L, white blood cells 17.8×109/L, neutrophils 0.92, lymphocytes 0.05, monocytes 0.02, platelets 241×109/L, blood pressure 70/50 mm Hg (1 mm Hg =0.133 kPa), oliguria all day, and was admitted to the respiratory department with the emergency department of "causes of hemoptysis to be investigated". 　　

Extranodal nasal natural killer/T cell lymphoma (ENKTCL-N) is a kind of invasive tumor with special morphology,immunophenotype and biological behavior and high level of Epstein-Barr virus infection. The tumor is more common in Asia, and it is the most common extranodal non-B cell lymphoma in China, and its incidence is on the rise in recent years.ENKTCL-N tumor cells express both natural killer (NK) cell associated antigen and some T cell differentiation antigen, and its exact cellular attribute and origin are still unknown [1]. The study of cell origin and differentiation status of this tumor is one of the bottlenecks in related research fields, mainly for two reasons: (1) About 2/3 of the tumor lesions occur in the midline face, and the biopsy tissue is small, so the related research is limited by materials; (2) The development process of normal NK cells is still unclear, which makes the research lack of necessary basic theoretical support. In recent 10 years, many scholars believe that tumor-in-cell (CSC) is the starting point of tumorigenesis, and even a single CSC has the ability to form tumors [2]. The study of the molecular mechanism of clarifying the origin of ENKTCL-N tumor cells and screening of tumor stem cells can promote its tumorigenesis and evolution is closely related to the monitoring, treatment and prognosis of this tumor, so it has important theoretical significance and potential practical application value.

The respiratory system is the main target organ of perfluorocarbons (perfluorochemicals) for biomedical applications. In 1966, Clark and Gollan [1] accidentally discovered that mice could still maintain normal spontaneous respiration and survival when they were put into oxygenated perflubron, which led to the rise of research on the use of perfluorocarbons as liquid respiratory medium. In recent 40 years, perfluorocarbons have attracted biologists and clinicians to conduct continuous in vivo and in vitro research on the application of these compounds in the treatment of acute lung injury/acute respiratory distress syndrome (ALL/ARDS) and other diseases.

A 54-year-old male was admitted to the hospital on March 7, 2007 due to dizziness for 3 months, aggravated with headache and blurred vision for 1 d. The patient was in good health before, but in January 2007, he developed dizziness without obvious trigger and occasional tinnitus, which was not treated. On March 6, the dizziness symptoms suddenly aggravated, accompanied by persistent severe distension and pain in the head and blurred vision in both eyes. Physical examination: body temperature 36.5℃, blood pressure 140/85 mm Hg (1 mm Hg =0.133kPa), skin of lips, cheeks and palms was dark red, superficial lymph nodes were not palpable, heart and lungs (1), abdomen was flat and soft, and liver, spleen and subcostal areas were not palpable. Physical examination of nervous system: blurred vision in both eyes, but no obvious abnormalities in body examination of remaining nervous system. Liver, kidney function, blood sugar and blood lipids were basically normal when admitted to the hospital. Head MRI (March 7): patchy long T1 and long T2 signals were seen in the right thalamus, considering right thalamus infarction (Figure 1). Head CT scan (March 9): small patchy high-density foci in the right occipital lobe, with a few low-density foci at the edge, suspected cerebral hemorrhage (Figure 2). Lumbar puncture Biochemical, routine, cytological assays (-).

The patient was a 30-year-old woman who had been married for 9 years and was not pregnant. She had always had thin menstruation and ovulation disorders. Luteinizing hormone/follicle stimulating hormone =13.01/4.94 IU/L. B-ultrasound examination showed polycystic changes in both ovaries, and polycystic ovary syndrome (PCOS) was diagnosed. Because hysterosalpingography showed that bilateral fallopian tubes were not patent, B-ultrasound showed that the middle and lower segments of the uterine cavity were heterogeneous and strong echoes of 1.9 cm ×1.5 cm ×0.8 cm, and blood flow was seen from the anterior wall of the uterus. Laparoscopy showed that the pelvic cavity was normal without any abnormal lesions, the bilateral fallopian tubes were soft, non-adhesive and unobstructed, and the polycystic changes of both ovaries were performed by wedge resection. The postoperative pathological examination showed that the endometrium was well differentiated adenocarcinoma (Figure 1), estrogen receptor (+ + +), progesterone receptor (+ +), and the wedge resection tissue of bilateral ovaries was multiple follicular cysts with luteinization.