ABSTRACT
Objective Less research has been done in the influence of two-child pohcy on mode of delivery.The article aimed to investigate the rates of cesarean section before and after two-child policy along with indications and complications in order to provide scientific basis and solution for improving the vaginal delivery rate.Methods Retrospective analysis was conducted on medical record data of 7044 puerperas in Nanjing General Hospital of Nanjing Military Region before (3,526 women from January 1,2012 to December 31,2013)and after (3,518 women from January 1,2015 to December 31,2016) two-child policy.Before the two child policy there were 3122 primiparas and 404 multiparas,after two-child policy there were 2546 primiparas and 972 muhiparas.Comparison was done between two groups in the aspect of vaginal delivery rate,cesarean section rate and the distribution of primiparas in choosing the mode of delivery.Results The vaginal birth rate of women before and after the policy was 59.22％ and 63.22％ respectively,among which the rate of vaginal delivery of primiparas increased dramatically from 60.57％ before the policy to 66.10％ after the policy(P＜0.05).After two-child policy,the primiparas cesarean section indication with social factors,macrosomia decreased,which was 12.67％ vs 5.68％、16.65％ vs 11.82％,respectively.However,the rate of cesarean section with in-vitro fertilization increased,which was 5.52％ and 10.10％ respectively (P ＜ 0.05).Conclusion After two-child policy,the puerperant,especially for the primiparas were more likely to choose vaginal spontaneous delivery.At the same time,the proportion of the primiparas caesarean section also changed.The mode of delivery should depend on corresponding indications properly.
ABSTRACT
<p><b>BACKGROUND AND OBJECTIVE</b>Letrozole is an aromatase inhibitor that is used in the treatment of estrogen-sensitive tumors such as endometrial carcinoma, however, its therapeutic effect is still to be further improved. It is reported that curcumin has antitumor capability and can enhance the sensitivity of tumor cells to anticancer agents. This study was to investigate the inhibitory effect of letrozole combination with curcumin on the implanted endometrial tumor growth.</p><p><b>METHODS</b>Nude mice were implanted with endometrial carcinoma RL-952 cells. All tumor-bearing mice were randomly divided into 5 groups: control(without treatment), Let(1) (letrozole, 1 microg/d), Let(10) (letrozole, 10 microg/d), Cur [ curcumin, 300 mg/kg.d)], and Let + Cur group [10microg/d letrozole + 50mg/ (kg.d) curcumin]. The tumor growth was monitored. Tumor cells apoptosis was detected in both control and treated groups. The expressions of bcl-2 mRNA and bcl-2 protein were detected using RT-PCR and Western blot, respectively.</p><p><b>RESULTS</b>Fifty mice were successfully implanted with the endometrial tumor. Treatment with letrozole markedly inhibited tumor growth; the inhibitory effect was further enhanced by the combination of letrozole and curcumin. The inhibitory rates in Let (1), Let (10), the Cur, and the Let + Cur groups were 15.95%, 22.49%, 21.57%, and 35.89%, respectively. Treatment with curcumin inhibited the expression of bcl-2 in tumor cells at the mRNA and protein levels. The apoptosis rates in the control group and the four experimental groups mentioned above were 16.97%, 32.90%, 35.80%, 34.16%, and 47.24%, respectively. Tumor cells apoptosis were observed in mice treated with either letrozole or curcumin; however, combination of letrozole and curcumin further enhanced the inhibitory rate in tumor growth.</p><p><b>CONCLUSIONS</b>Treatment with letrozole or curcumin could inhibit the xenografted endometrial tumor growth by inducing apoptosis in tumor cells. Combination of letrozole and curcumin further enhanced the inhibitory effect of tumor growth.</p>