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Song M, Ma L, Zhu Y, Gao H, Hu R. Umbilical cord mesenchymal stem cell-derived exosomes inhibits fibrosis in human endometrial stromal cells via miR-140-3p/FOXP1/Smad axis. Sci Rep 2024; 14:8321. [PMID: 38594471 PMCID: PMC11004014 DOI: 10.1038/s41598-024-59093-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/08/2024] [Indexed: 04/11/2024] Open
Abstract
Endometrial fibrosis is the histologic appearance of intrauterine adhesion (IUA). Emerging evidences demonstrated umbilical cord mesenchymal stem cell-derived exosomes (UCMSC-exo) could alleviate endometrial fibrosis. But the specific mechanism is not clear. In this study, we explored the effect of UCMSC-exo on endometrial fibrosis, and investigated the possible role of miR-140-3p/FOXP1/Smad axis in anti-fibrotic properties of UCMSC-exo. UCMSC-exo were isolated and identified. Transforming growth factor-β (TGF-β) was used to induce human endometrial stromal cell (HESC) fibrosis. Dual luciferase assay was performed to verify the relationship between miR-140-3p and FOXP1. The expressions of fibrotic markers, SIP1, and p-Smad2/p-Smad3 in HESCs stimulated with UCMSC-exo were detected by western blot. In addition, the effects of miR-140-3p mimic, miR-140-3p inhibitor and FOXP1 over-expression on endometrial fibrosis were assessed. The isolated UCMSC-exo had a typical cup-shaped morphology and could be internalized into HESCs. The expressions of fibrotic markers were significantly increased by TGF-β, which was reversed by UCMSC-exo. MiR-140-3p in UCMSC-exo ameliorated TGf-β-induced HESCs fibrosis. FOXP1 was identified as the direct target of miR-140-3p, which could inversely regulate miR-140-3p's function on HESCs fibrosis. Furthermore, we demonstrated that miR-140-3p in UCMSC-exo regulated Smad signal pathway to exert the anti-fibrotic effect in HESCs. The anti-fibrotic effect of UCMSC-derived exosomes against HESC fibrosis was at least partially achieved by miR-140-3p/FOXP1/Smad axis.
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Affiliation(s)
- Mengling Song
- Department of Reproductive Medicine, General Hospital of Ningxia Medical University (The First Clinical Medical College of Ningxia Medical University), 804 Shengli Street, Xingqing Square, Yinchuan, 750004, Ningxia, China.
| | - Lijun Ma
- Department of Human Anatomy, Histology and Embryology, School of Basic Medicine, Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Yongzhao Zhu
- Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Huimin Gao
- General Hospital of Ningxia Medical University (the First Clinical Medical College of Ningxia Medical University), Yinchuan, 750004, Ningxia, China
| | - Rong Hu
- Department of Reproductive Medicine, General Hospital of Ningxia Medical University (The First Clinical Medical College of Ningxia Medical University), 804 Shengli Street, Xingqing Square, Yinchuan, 750004, Ningxia, China.
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Güven AG, Kızılkan MP, Taşar MA, Akgül S. An Assessment of the Quality of YouTube Videos as a Resource for Adolescents Experiencing Abnormal Uterine Bleeding. J Pediatr Adolesc Gynecol 2024; 37:137-141. [PMID: 38122960 DOI: 10.1016/j.jpag.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/11/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
STUDY OBJECTIVE YouTube, the largest accessible media-sharing platform, has become an important tool for pursuing health-related information. Adolescents may find it challenging to seek counseling or access adolescent-friendly services for menstruation-related problems, so YouTube may be a useful resource. The aim of this study was to examine the reliability, quality, and accuracy of YouTube videos concerning abnormal uterine bleeding in adolescents. METHODS A YouTube search using the key words "adolescent, teens, heavy period, abnormal uterine bleeding, heavy menstrual bleeding" yielded 109 videos. Video features (duration, time since upload, likes, views, comments), sources of upload, and content were recorded. All the videos were reviewed by 2 adolescent medicine specialists and scored using the Journal of the American Medical Association, the 5-point modified DISCERN tool, and the Global Quality Scale. RESULTS Fifty-eight videos met the inclusion criteria. Most (62.1%) were created by non-professionals, and a significant portion (81%) contained general descriptions. On the basis of the DISCERN classification, 50% exhibited poor quality. Similarly, the Journal of the American Medical Association assessment indicated that only 36.2% satisfied the requirements for good quality. The videos uploaded by professionals exhibited notably superior quality in comparison with those uploaded by non-professionals. Additionally, higher-quality videos were longer (P = .040) and more recent (P = .011). CONCLUSION Mot YouTube videos about adolescent abnormal uterine bleeding provide low-quality information. We believe that increasing the number of videos tailored by health care providers specializing in adolescent gynecology to address the specific physical and psychosocial needs of adolescents with menstrual problems would be beneficial.
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Affiliation(s)
- Ayşe Gül Güven
- University of Health Sciences, Ankara Training and Education Hospital, Department of Pediatrics, Division of Adolescent Medicine, Ankara, Turkey.
| | - Melis Pehlivantürk Kızılkan
- Division of Adolescent Medicine, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Medine Ayşin Taşar
- University of Health Sciences, Ankara Training and Education Hospital, Department of Pediatrics, Division of Social Pediatrics, Ankara, Turkey
| | - Sinem Akgül
- Division of Adolescent Medicine, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Cozzolino M, Alsbjerg B, Pellicer A, Garcia-Velasco JA, Humaidan P. The adenomyosis/endometriosis IVF patient - call for clinical focus. Reprod Biomed Online 2024; 48:103737. [PMID: 38342076 DOI: 10.1016/j.rbmo.2023.103737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/14/2023] [Accepted: 11/20/2023] [Indexed: 02/13/2024]
Abstract
Endometriosis and adenomyosis are distinct clinical conditions that carry the same pathophysiological features. In recent years the clinical focus on assisted reproductive technology patients with either condition (E/A) has increased, in the recognition that this subgroup of patients might need special attention to obtain reproductive success. Endometriosis and adenomyosis are characterized by a disruption of progesterone and oestrogen signalling pathways, resulting in local oestrogen dominance and progesterone resistance at the receptor level. Recent scientific evidence suggests that the endometrial progesterone receptor resistance encountered in E/A patients can be overcome by a freeze-all policy, followed by down-regulating circulating oestradiol concentrations prior to frozen embryo transfer (FET), in combination with an increase in exogenous luteal phase progesterone supplementation in hormonal replacement therapy (HRT) FET cycles. Specifically, for adenomyosis patients who do not respond to gonadotrophin-releasing hormone agonist down-regulation in terms of a decrease in circulating oestradiol concentrations, a small case series has suggested that the addition of an aromatase inhibitor for 21 days prior to HRT-FET is a valid option. Endometriosis and adenomyosis are hormonally active diseases, which need to be treated by controlling local hyperoestrogenism and progesterone resistance. Based on physiology and recent preliminary clinical data, the authors of this opinion paper wish to stimulate discussion and spark interest in research in E/A patients.
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Affiliation(s)
- Mauro Cozzolino
- IVIRMA Global Research Alliance, IVI Roma, Rome, Italy.; IVIRMA Global Research Alliance, IVI Foundation-IIS la Fe, Valencia, Spain..
| | - Birgit Alsbjerg
- The Fertility Clinic, Skive Regional Hospital, Denmark and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Antonio Pellicer
- IVIRMA Global Research Alliance, IVI Roma, Rome, Italy.; IVIRMA Global Research Alliance, IVI Foundation-IIS la Fe, Valencia, Spain
| | - Juan Antonio Garcia-Velasco
- IVIRMA Global Research Alliance, IVI, Madrid, Spain.; Department of Obstetrics and Gynecology, Universidad Rey Juan Carlos, Madrid, Spain
| | - Peter Humaidan
- The Fertility Clinic, Skive Regional Hospital, Denmark and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Marcelin C, Brun JL, Caprais J, Molina-Andreo I, Jambon E, Le Bras Y, Hocké C, Grenier N. Percutaneous cryoablation of symptomatic uterine adenomyomas: Initial experience. J Gynecol Obstet Hum Reprod 2024; 53:102727. [PMID: 38237806 DOI: 10.1016/j.jogoh.2024.102727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 12/03/2023] [Accepted: 01/14/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVE To assess the efficacy and safety of percutaneous image-guided cryoablation of adenomyomas MATERIAL AND METHODS: Five symptomatic women who wanted to preserve their uterus and fertility underwent a single session of percutaneous image-guided cryoablation of adenomyoma. Three to six 17-gauge cryoprobes were introduced percutaneously into the adenomyoma under ultrasound and laparoscopy guidance. Clinical efficacy was defined as the diminution of the Visual Analogue Scale of pain (VAS), the decrease in uterine bleeding and the improvement of quality of life assessed by the endometriosis health profile 5 (EHP-5) 12 months after treatment. Technical efficacy was defined by the reduction in volume of each treated adenomyoma on MRI. Complications were classified using the Clavien-Dindo classification system. Hysterosonography was performed at least 3 months after the procedure. RESULTS Compared to the baseline, all symptom scores had decreased after 12 months: median VAS 8/10 (range, 5-10) to 4/10 (range, 0-7); median dyspareunia score 7/10 (range, 0-10) to 2/10 (range, 0-8); median bleeding score 335 (range, 102-920) to 76 (range, 0-88); median EHP-5 score 60/100 (range, 50-75) to 50/100 (range, 32-55). The median volume of adenomyosis decreased from 57 cm3 (range, 8-87) to 9 cm3 (range, 2-45) at 12 months. No postoperative complications occurred. Two patients had incomplete intrauterine adhesions that were easily removed hysteroscopically. CONCLUSION Cryoablation may be a promising alternative treatment for symptomatic adenomyoma in women who want to preserve their uterus.
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Affiliation(s)
- Clément Marcelin
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Jean-Luc Brun
- Service de chirurgie gynécologique, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France.
| | - Julie Caprais
- Service de chirurgie gynécologique, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Isabelle Molina-Andreo
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Eva Jambon
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Yann Le Bras
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Claude Hocké
- Service de chirurgie gynécologique, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Nicolas Grenier
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France
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Zhu J, Chen Y, Chen H, Sun Y, Yan L, Zhu M, Chen L, Wang Q, Zhang J. Comparison of microbial abundance and diversity in uterine and peritoneal fluid in infertile patients with or without endometriosis. BMC Womens Health 2024; 24:148. [PMID: 38424540 PMCID: PMC10903057 DOI: 10.1186/s12905-024-02985-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/19/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Endometriosis (EM) is a multifactorial disease that affects 10 - 15% of women of reproductive age. Additionally, 30-50% of women with EM suffer from infertility. The mechanism of infertility caused by EM has not yet been consistently explained. In recent years, studies have shown a link between infertility associated with EM and changes in the reproductive tract microbiota. METHODS In this study, we involved 26 EM patients (8 cases of stage I-II and 18 cases of stage III-IV) and 31 control subjects who were tubal obstruction-related infertility (TORI). The samples from peritoneal fluid (PF) and uterine fluid (UF) were collected and sequenced by 16 S rRNA amplicon. RESULTS In the comparison of microbial diversity, we found no significant differences in the microbial diversity of PF and UF between patients with stage I-II EM and those with TORI. However, there was a significant difference in microbial diversity among patients with stage III-IV EM compared to the previous two groups. Lactobacillus decreased in PF of EM compared to the control group, while it increased in UF. In PF, the abundance of Pseudomonas, Enterococcus, Dubosiella and Klebsiella was significantly higher in patients with stage III-IV compared to TORI patients. And in UF, the main differences existed between stage I-II EM compared to the other two groups. The abundance of pontibacter, aquabacterium, Rikenellaceae and so on at the genus level was significantly enriched in the EM patients with stage I-II. In the analysis based on KEGG database, EM may affect the receptivity related pathways of the endometrium by influencing changes in the uterine microbiota. CONCLUSION Our results indicated that as EM progresses, the microorganisms in UF and PF keep changing. These changes in the microbiota, as well as the resulting alternations in gene functional classification, may play an important role in the infertility associated with EM.
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Affiliation(s)
- Jue Zhu
- Department of Gynecology, Ningbo Women and Children's Hospital, #339 Liuting Road, Ningbo, Zhejiang, China
| | - Yichen Chen
- Department of Basic Research Laboratory, Ningbo Women and Children's Hospital, Ningbo, Zhejiang, China
| | - Huan Chen
- Department of Medicine, Ningbo University, Zhejiang, China
| | - Yuhui Sun
- Department of Basic Research Laboratory, Ningbo Women and Children's Hospital, Ningbo, Zhejiang, China
| | - Lifeng Yan
- Department of Gynecology, Ningbo Women and Children's Hospital, #339 Liuting Road, Ningbo, Zhejiang, China
| | - Miaohua Zhu
- Department of Gynecology, Ningbo Women and Children's Hospital, #339 Liuting Road, Ningbo, Zhejiang, China
| | - Liang Chen
- Department of Gynecology, Ningbo Women and Children's Hospital, #339 Liuting Road, Ningbo, Zhejiang, China
| | - Qiming Wang
- Department of Gynecology, Ningbo Women and Children's Hospital, #339 Liuting Road, Ningbo, Zhejiang, China
| | - Jing Zhang
- Department of Gynecology, Ningbo Women and Children's Hospital, #339 Liuting Road, Ningbo, Zhejiang, China.
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Singh SK, Chauhan K, Tripathi V. Key drivers of hysterectomy among women of reproductive age in three states in India: comparative evidence from NFHS-4 and NFHS-5. BMC Womens Health 2024; 24:107. [PMID: 38336664 PMCID: PMC10854047 DOI: 10.1186/s12905-024-02886-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 01/04/2024] [Indexed: 02/12/2024] Open
Abstract
PURPOSE According to the 4th and 5th rounds of National Family Health Survey (NFHS), there is high prevalence of hysterectomies in the three states of Andhra Pradesh Telangana and Bihar. The three said states have more than double the number of hysterectomies taking place than the national average. Our purpose is to analyse whether these rates are increasing, decreasing or have stabilized and their reasons thereof. Such an analyses will help the policy makers in recommending good clinical practices within their states. MATERIAL AND METHODS We used data from NFHS-4 (2015-16) and NFHS-5 (2019-2021) rounds. We calculated the differences in predicted probabilities for various factors, performed a Fairlie Decomposition analyses to quantify the positive and negative contributors in the prevalence of hysterectomy across the three states over two time points, and assessed the association of various socio-demographic characteristics to hysterectomy through a multilevel logistic regression model. RESULTS AND CONCLUSION The results show that out of a total of 80,976 eligible respondents from the states under study, 5826 respondents self-reported that they had a hysterectomy done. It was found that older age, living in rural areas, belonging to other backward classes and higher wealth quintile, and higher parity positively contributed to the increased prevalence of hysterectomies in the three states. Higher educational attainment and previous use of family planning methods acted as protective factors. Characteristics at the household level had the highest intra-class correlation value in the prevalence of hysterectomy among women, followed by the Primary Sampling Unit and District levels, indicating high clustering in the prevalence of hysterectomy at the household level in all three states. Heavy menstrual bleeding/pain was the leading cause of hysterectomies in all three states, followed by fibroids/cysts in Andhra Pradesh and Telangana and Uterine disorder/ prolapse in Bihar. Over 80% of hysterectomies took place in the private hospitals. RECOMMENDATIONS The study recommends better, more efficient and accountable hysterectomy surveillance to ensure more sustainable woman's reproductive health services in India. Government should adopt and implement standard regulatory guidelines to prevent provider-driven avoidable hysterectomies. Moreover, we recommend informing primary care professionals about the long-term health effects of hysterectomy and promoting alternate therapies for treating uterine fibroids and heavy bleeding.
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Affiliation(s)
- Shri Kant Singh
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Kirti Chauhan
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, Maharashtra, India.
- Department of Biostatistics and Demography, International Institute for Population Sciences, Mumbai, Maharashtra, India.
| | - Vrijesh Tripathi
- Department of Mathematics and Statistics, The University of the West Indies, St. Augustine, Trinidad and Tobago
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Zhou SG, Lu LJ, Yao YP, Shi L, Dai L, Hui YZ. [Florid cystic endosalpingiosis of uterine subserosa: report of a case]. Zhonghua Bing Li Xue Za Zhi 2024; 53:204-205. [PMID: 38281796 DOI: 10.3760/cma.j.cn112151-20230926-00219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Affiliation(s)
- S G Zhou
- Department of Pathology, Beijing Wuzhou Women and Children's Hospital, Beijing 100022, China
| | - L J Lu
- Department of Pathology, Beijing Wuzhou Women and Children's Hospital, Beijing 100022, China
| | - Y P Yao
- Department of Pathology, Beijing Wuzhou Women and Children's Hospital, Beijing 100022, China
| | - L Shi
- Department of Gynecology, Beijing Wuzhou Women and Children's Hospital, Beijing 100022, China
| | - L Dai
- Department of Pathology, Peking University People's Hospital, Beijing 100044, China
| | - Y Z Hui
- Department of Pathology, Beijing Wuzhou Women and Children's Hospital, Beijing 100022, China
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Elsherbeny M, Abdelhay S, Mousa M. Neonatal Single-Stage Surgical Management of Complicated Distal Vaginal Atresia: Revisiting an Appropriate and Feasible Technique. J Pediatr Adolesc Gynecol 2024; 37:63-66. [PMID: 37704035 DOI: 10.1016/j.jpag.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/26/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND/PURPOSE Hydrometrocolpos is distension of the vagina and uterus with fluid other than pus or blood. It is due to distal vaginal obstruction, and one of its possible causes is agenesis of the distal vagina. Patients with distal vaginal atresia may present in the neonatal period due to stimulation of uterine and cervical glands by maternal estrogen. In this study, we presented our results in managing neonates with complicated hydrometrocolpos due to distal vaginal atresia through a single-stage abdomino-perineal pull-through vaginoplasty. METHODS During the period from July 2003 to June 2018, neonates presented to the Department of Pediatric Surgery, Faculty of Medicine, Ain Shams University with complicated hydrometrocolpos (complicated with obstructive uropathy, intestinal obstruction, urinary tract infection, or systemic sepsis) due to distal vaginal atresia were included in the study. All the patients underwent single-stage abdomino-perineal pull-through vaginoplasty with drainage of the accumulated fluid. The patients were followed up for re-accumulation of fluid or vaginal stenosis for at least 4 years after the procedure. RESULTS During the specified period, 14 neonates with complicated hydrometrocolpos due to distal vaginal atresia (complicated with obstructive uropathy, intestinal obstruction, urinary tract infection, or systemic sepsis) presented to the Department of Pediatric Surgery, Faculty of Medicine, Ain Shams University and underwent single-stage abdomino-perineal pull-through vaginoplasty with drainage of the accumulated fluid. Their age ranged between 4 and 18 days (mean 10, median 8). Two patients (14%) developed vaginal stenosis, which responded well to dilatation, and none of the patients had re-accumulation of the fluid during the follow-up period. CONCLUSION Single-stage abdomino-perineal pull-through vaginoplasty in neonates with complicated distal vaginal atresia (complicated with obstructive uropathy, intestinal obstruction, urinary tract infection, or systemic sepsis) is an appropriate and feasible technique with a satisfactory outcome. TYPE OF THE STUDY Treatment study. LEVEL OF EVIDENCE RATING IV.
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Affiliation(s)
- Mohammed Elsherbeny
- Department of Pediatric Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Sameh Abdelhay
- Department of Pediatric Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohammed Mousa
- Department of Pediatric Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Zhao J, Li Q, Liao E, Shi H, Luo X, Zhang L, Qi H, Zhang H, Li J. Incidence, risk factors and maternal outcomes of unsuspected placenta accreta spectrum disorders: a retrospective cohort study. BMC Pregnancy Childbirth 2024; 24:76. [PMID: 38262978 PMCID: PMC10804779 DOI: 10.1186/s12884-024-06254-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/03/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND To identify incidence and underlying risk factors for unsuspected placenta accreta spectrum (PAS) and compare the maternal outcomes between suspected and unsuspected cases in three large academic referral centers. METHODS A retrospective cohort study was conducted in three university-based tertiary referral centers from Jan 1st, 2013, to Dec 31st, 2022. All cases of PAS confirmed by pathology were included in the study. Unsuspected PAS cases were diagnosed at the time of delivery, while suspected cases served as the control group. Potential risk factors were compared between the two groups. Multivariable regression model was also performed to identify risk factors. Maternal outcomes were also evaluated. RESULTS A total of 339 pathology-confirmed PAS cases were included in the study out of 415,470 deliveries, of which 35.4% (n = 120) were unsuspected cases. Unsuspected PAS cases were 7.9 times more likely to have a history of intrauterine adhesions (adjusted odds ratio [aOR] 7.93; 95% confidence interval [CI] 2.35-26.81), 7.0 times more likely to have a history of clinically confirmed PAS (aOR, 6.99; 95% CI 2.85-17.18), 6.3 times more likely to have a posterior placenta (aOR, 6.30; 95% CI 3.48-11.40), and 3.4 times more likely to have a history of placenta previa (aOR, 3.41; 95% CI 1.18-9.82). On the other hand, cases with gravidity > 3, placenta previa, and/or a history of previous cesarean delivery were more likely to be diagnosed antenatally (aOR 0.40, 0.19, 0.36; 95% CI 0.22-0.74, 0.09-0.40, 0.19-0.70). Although the suspected PAS group had a higher proportion of invasive cases and abdominal and pelvic organ injuries (74.4% vs. 25.8%, p < 0.001; 6.8% vs. 1.7%, p = 0.037), the maternal outcomes were more favorable in the sPAS group, with a lower median volume of 24-hour blood loss and blood product transfusion (estimated blood loss in 24 h, 1000 [800-2000] vs. 2000 [1400-2400], p < 0.001; RBC unit transfusion, 0 [0-800] vs. 800 [600-1000], p < 0.001; fresh-frozen plasma transfusion, 0 [0-450] vs. 600 [400-800], p < 0.001). CONCLUSIONS Our findings indicate that 35% of patients with PAS were unsuspected prior to delivery. Factors associated with PAS being unsuspected prior to delivery include a history of intrauterine adhesions, a history of clinically confirmed PAS, a posterior placenta, and a history of placenta previa. Additionally, gravidity > 3, a history of previous cesarean delivery, and placenta previa increase the likelihood of antenatal diagnosis.
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Affiliation(s)
- Jianlin Zhao
- The Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Chongqing Key Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing, 400016, China
| | - Qin Li
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, Women and Children's Hospital of Chongqing Medical University, Chongqing, 401147, China
| | - E Liao
- Department of Obstetrics and Gynecology, Maternal and Child Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, Hubei Province, China
| | - Haijun Shi
- The Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Chongqing Key Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing, 400016, China
| | - Xin Luo
- The Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Chongqing Key Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing, 400016, China
| | - Lan Zhang
- The Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Chongqing Key Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing, 400016, China
| | - Hongbo Qi
- The Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Chongqing Key Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing, 400016, China
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, Women and Children's Hospital of Chongqing Medical University, Chongqing, 401147, China
| | - Hua Zhang
- The Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
- Chongqing Key Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing, 400016, China.
| | - Junnan Li
- The Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
- Chongqing Key Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing, 400016, China.
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Xin X, Liu H, Zhang S, Li P, Zhao X, Zhang X, Li S, Wu S, Zhao F, Tan J. S100A8/A9 promotes endometrial fibrosis via regulating RAGE/JAK2/STAT3 signaling pathway. Commun Biol 2024; 7:116. [PMID: 38253716 PMCID: PMC10803310 DOI: 10.1038/s42003-024-05814-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
Intrauterine adhesion (IUA) is characterized by endometrial fibrosis. S100A8/A9 plays an important role in inflammation and fibroblast activation. However, the role of S100A8/A9 in IUA remains unclear. In this study, we collect normal and IUA endometrium to verify the expression of S100A8/A9. Human endometrial stromal cells (hEnSCs) are isolated to evaluate fibrosis progression after S100A8/A9 treatment. A porcine IUA model is established by electrocautery injury to confirm the therapeutic effect of menstrual blood-derived stromal cells (MenSCs) on IUA. Our study reveals increased S100A8/A9 expression in IUA endometrium. S100A8/A9 significantly enhances hEnSCs proliferation and upregulates fibrosis-related and inflammation-associated markers. Furthermore, S100A8/A9 induces hEnSCs fibrosis through the RAGE-JAK2-STAT3 pathway. Transplantation of MenSCs in a porcine IUA model notably enhances angiogenesis, mitigates endometrial fibrosis and downregulates S100A8/A9 expression. In summary, S100A8/A9 induces hEnSCs fibrosis via the RAGE-JAK2-STAT3 pathway, and MenSCs exhibit marked effects on endometrial restoration in the porcine IUA model.
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Affiliation(s)
- Xing Xin
- Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, No. 39 Huaxiang Road, Tiexi District, 110022, Shenyang, China
- Key Laboratory of Reproductive Dysfunction Disease and Fertility Remodeling of Liaoning Province, No. 39 Huaxiang Road, Tiexi District, 110022, Shenyang, China
| | - Hao Liu
- State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Sciences, Shenyang, China
- Institutes for Robotics and Intelligent Manufacturing, Chinese Academy of Sciences, Shenyang, China
- Key Laboratory of Minimally Invasive Surgical Robot, Liaoning Province, Shenyang, China
| | - Siwen Zhang
- Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, No. 39 Huaxiang Road, Tiexi District, 110022, Shenyang, China
- Key Laboratory of Reproductive Dysfunction Disease and Fertility Remodeling of Liaoning Province, No. 39 Huaxiang Road, Tiexi District, 110022, Shenyang, China
| | - Pingping Li
- Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, No. 39 Huaxiang Road, Tiexi District, 110022, Shenyang, China
- Key Laboratory of Reproductive Dysfunction Disease and Fertility Remodeling of Liaoning Province, No. 39 Huaxiang Road, Tiexi District, 110022, Shenyang, China
| | - Xinyang Zhao
- Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, No. 39 Huaxiang Road, Tiexi District, 110022, Shenyang, China
- Key Laboratory of Reproductive Dysfunction Disease and Fertility Remodeling of Liaoning Province, No. 39 Huaxiang Road, Tiexi District, 110022, Shenyang, China
| | - Xudong Zhang
- Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, No. 39 Huaxiang Road, Tiexi District, 110022, Shenyang, China
- Key Laboratory of Reproductive Dysfunction Disease and Fertility Remodeling of Liaoning Province, No. 39 Huaxiang Road, Tiexi District, 110022, Shenyang, China
| | - Shuyu Li
- Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, No. 39 Huaxiang Road, Tiexi District, 110022, Shenyang, China
- Key Laboratory of Reproductive Dysfunction Disease and Fertility Remodeling of Liaoning Province, No. 39 Huaxiang Road, Tiexi District, 110022, Shenyang, China
| | - Shanshan Wu
- Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, No. 39 Huaxiang Road, Tiexi District, 110022, Shenyang, China
- Key Laboratory of Reproductive Dysfunction Disease and Fertility Remodeling of Liaoning Province, No. 39 Huaxiang Road, Tiexi District, 110022, Shenyang, China
| | - Fujie Zhao
- Obstetrics and Gynecology Department, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, 110022, Shenyang, China
| | - Jichun Tan
- Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, No. 39 Huaxiang Road, Tiexi District, 110022, Shenyang, China.
- Key Laboratory of Reproductive Dysfunction Disease and Fertility Remodeling of Liaoning Province, No. 39 Huaxiang Road, Tiexi District, 110022, Shenyang, China.
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Zhu H, Li T, Xu P, Ding L, Zhu X, Wang B, Tang X, Li J, Zhu P, Wang H, Dai C, Sun H, Dai J, Hu Y. Effect of autologous bone marrow stem cells-scaffold transplantation on the ongoing pregnancy rate in intrauterine adhesion women: a randomized, controlled trial. Sci China Life Sci 2024; 67:113-121. [PMID: 37751064 DOI: 10.1007/s11427-023-2403-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 06/20/2023] [Indexed: 09/27/2023]
Abstract
Intrauterine adhesion is a major cause of female reproductive disorders. Although we and others uncontrolled pilot studies showed that treatment with autologous bone marrow stem cells made a few patients with severe intrauterine adhesion obtain live birth, no large sample randomized controlled studies on this therapeutic strategy in such patients have been reported so far. To verify if the therapy of autologous bone marrow stem cells-scaffold is superior to traditional treatment in moderate to severe intrauterine adhesion patients in increasing their ongoing pregnancy rate, we conducted this randomized controlled clinical trial. Totally 195 participants with moderate to severe intrauterine adhesion were screened and 152 of them were randomly assigned in a 1:1 ratio to either group with autologous bone marrow stem cells-scaffold plus Foley balloon catheter or group with only Foley balloon catheter (control group) from February 2016 to January 2020. The per-protocol analysis included 140 participants: 72 in bone marrow stem cells-scaffold group and 68 in control group. The ongoing pregnancy occurred in 45/72 (62.5%) participants in the bone marrow stem cells-scaffold group which was significantly higher than that in the control group (28/68, 41.2%) (RR=1.52, 95%CI 1.08-2.12, P=0.012). The situation was similar in live birth rate (bone marrow stem cells-scaffold group 56.9% (41/72) vs. control group 38.2% (26/68), RR=1.49, 95%CI 1.04-2.14, P=0.027). Compared with control group, participants in bone marrow stem cells-scaffold group showed more menstrual blood volume in the 3rd and 6th cycles and maximal endometrial thickness in the 6th cycle after hysteroscopic adhesiolysis. The incidence of mild placenta accrete was increased in bone marrow stem cells-scaffold group and no severe adverse effects were observed. In conclusion, transplantation of bone marrow stem cells-scaffold into uterine cavities of the participants with moderate to severe intrauterine adhesion increased their ongoing pregnancy and live birth rates, and this therapy was relatively safe.
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Affiliation(s)
- Hui Zhu
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
| | - Taishun Li
- Department of Biostatistics, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
| | - Peizhen Xu
- Department of Gynecology, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213004, China
| | - Lijun Ding
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
| | - Xianghong Zhu
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
| | - Bin Wang
- Clinical Center for Stem Cell Research, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
| | - Xiaoqiu Tang
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
| | - Juan Li
- Department of Hematology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
| | - Pengfeng Zhu
- Department of Gynecology, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213004, China
| | - Huiyan Wang
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
| | - Chenyan Dai
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
| | - Haixiang Sun
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China.
| | - Jianwu Dai
- Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, 100190, China.
| | - Yali Hu
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China.
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Apple A, Mulugeta-Gordon L, Zafman K, Leitner K. An unusual cause of small bowel obstruction: Case report of spontaneous uteroenteric fistula. Int J Gynaecol Obstet 2024; 164:349-351. [PMID: 37723887 PMCID: PMC11095829 DOI: 10.1002/ijgo.15122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/27/2023] [Accepted: 08/27/2023] [Indexed: 09/20/2023]
Abstract
SynopsisUteroenteric fistulae in the setting of degenerating leiomyomas may present with small bowel obstruction and require multidisciplinary surgical management to perform fertility‐sparing myomectomy.
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Affiliation(s)
- Annie Apple
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lakeisha Mulugeta-Gordon
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kelly Zafman
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kirstin Leitner
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Hong IS. Endometrial Stem Cells: Orchestrating Dynamic Regeneration of Endometrium and Their Implications in Diverse Endometrial Disorders. Int J Biol Sci 2024; 20:864-879. [PMID: 38250149 PMCID: PMC10797688 DOI: 10.7150/ijbs.89795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 12/24/2023] [Indexed: 01/23/2024] Open
Abstract
The human endometrium, a vital component of the uterus, undergoes dynamic changes during the menstrual cycle to create a receptive environment for embryo implantation. Its remarkable regenerative capacity can be attributed to the presence of tissue-resident stem cell populations within the endometrium. Despite variations in characteristics among different subtypes, endometrial stem cells exhibit notably robust self-renewal capacity and the ability to differentiate into multiple lineages. This review offers a comprehensive insight into the current literature and recent advancements regarding the roles of various endometrial stem cell types during dynamic regeneration of the endometrium during the menstrual cycle. In addition, emerging evidence suggests that dysfunction or depletion of endometrial stem cells may play critical roles in the development and progression of various endometrial disorders, such as endometriosis, uterine fibroids, adenomyosis, infertility, and endometrial cancer. Therefore, we also highlight potential roles of endometrial stem cells in the development and progression of these endometrial diseases, including their ability to accumulate genetic mutations and express genes associated with endometrial diseases. Understanding the dynamic properties of the endometrium and the roles of endometrial stem cells in various endometrial disorders will shed light on potential therapeutic strategies for managing these conditions and improving women's fertility outcomes.
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Affiliation(s)
- In-Sun Hong
- Department of Health Sciences and Technology, GAIHST, Gachon University, Incheon, 21999, Republic of Korea
- Department of Molecular Medicine, School of Medicine, Gachon University, Incheon 406-840, Republic of Korea
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Gianfaldoni A, Roa C, dos Santos Simões R, Baracat MCP, Maggio da Fonseca A, Bagnoli VR, Sopreso ICE, Silva Rivas FW, Monteleone P, Baracat EC, Soares Júnior JM. Association of intrauterine synechiae with pituitary gonadotrophin pulse patterns: A pilot study. PLoS One 2023; 18:e0289075. [PMID: 38100407 PMCID: PMC10723672 DOI: 10.1371/journal.pone.0289075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 07/11/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Intrauterine synechiae (IS) is an acquired uterine condition that occurs when scar tissues (adhesions) form within the uterus and/or cervix, causing menstrual disturbance. However, approximately 50% of patients with IS are refractory to treatment. Therefore, other endocrine disturbances, such as gonadotropin disturbance, may affect treatment success. STUDY AIM To analyze gonadotropin levels in women with and without IS. METHODS Ten women with refractory IS experiencing amenorrhea since at least 6 months and nine with normal menstrual cycles (control group) were included in this study. Blood sample were collected every 10 minutes during a 4-h period. The serial ultrasound was performed in both groups for evaluating the cycle phase. Blood was collected when the follicles size was between 5-10 mm. Serum LH, FSH, progesterone and estradiol concentrations were measured. To detect LH and FSH pulses, the technique proposed by Santen and Bardin was adopted; therefore, one pulse was defined as a 20% increase in the concentrations as to the preceding point, followed by an important decrease. RESULTS No differences were observed between the study groups at baseline. Estradiol levels were lower in the IS group than in the control group, but the difference was not statistically significant. During the first hour of monitoring, cumulative FSH pulsatile frequency of IS group was lower than one of control. CONCLUSION Our data suggest that the estradiol levels of IS participants are lower than those of women with normal menstrual cycle. The role of this finding in the physiology of uterine synechiae requires further investigation.
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Affiliation(s)
- Arlete Gianfaldoni
- Disciplina de Ginecologia, do Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Cristiane Roa
- Disciplina de Ginecologia, do Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Ricardo dos Santos Simões
- Disciplina de Ginecologia, do Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Maria Cândida P. Baracat
- Disciplina de Ginecologia, do Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Angela Maggio da Fonseca
- Disciplina de Ginecologia, do Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Vicente Renato Bagnoli
- Disciplina de Ginecologia, do Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Isabel Cristina Espósito Sopreso
- Disciplina de Ginecologia, do Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Fernando Wladimir Silva Rivas
- Disciplina de Ginecologia, do Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Pedro Monteleone
- Disciplina de Ginecologia, do Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Edmund C. Baracat
- Disciplina de Ginecologia, do Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - José Maria Soares Júnior
- Disciplina de Ginecologia, do Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
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15
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McEvoy A, Aboseif C, Fogel J, Alles A, Khutti S, Kapoor U, Saad A. Sharp Versus Electric Suction Curettage in Gynecologic Patients Undergoing Evaluation for Abnormal Uterine Bleeding. J Minim Invasive Gynecol 2023; 30:983-989. [PMID: 37661082 DOI: 10.1016/j.jmig.2023.08.428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/11/2023] [Accepted: 08/28/2023] [Indexed: 09/05/2023]
Abstract
STUDY OBJECTIVE Suction curettage is preferred over sharp curettage in obstetric settings. We compare the quality of operative tissue sampling between sharp curettage and suction curettage using electric vacuum aspiration for nonobstetric abnormal uterine bleeding in reproductive-aged women. DESIGN A retrospective cohort study. SETTING Community hospital in Long Island, New York. PATIENTS Women ages 21 to 45 years (n = 257) who underwent operative curettage procedure for nonobstetric abnormal uterine bleeding. INTERVENTIONS Independent ratings of specimens from suction curettage using electric vacuum aspiration and sharp curettage by 2 pathologists blinded to method of tissue collection. MEASUREMENTS AND MAIN RESULTS The primary outcome was percentage of organized tissue, indicative of a higher-quality pathology specimen. Specimens obtained by electric suction curettage (p <.001) had a significantly higher percentage of organized tissue (M = 66.28, SD = 20.33) than sharp curettage (M = 55.51, SD = 24.17). There were no differences between the curettage groups for operative time, blood loss, intraoperative complications, or pathology diagnosis. CONCLUSION Specimens obtained with suction curettage contained more organized tissue with similar pathologist satisfaction and confidence scores than sharp curettage. We suggest clinicians consider electric suction curettage in the diagnostic workup of abnormal uterine bleeding in reproductive-aged women. In addition, patient-centered benefits include no increase in operative time, blood loss, or complication rate compared with sharp curettage.
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Affiliation(s)
- Austin McEvoy
- Department of Obstetrics and Gynecology (Drs. McEvoy, Aboseif, and Fogel), Nassau University Medical Center, East Meadow, NY
| | - Christine Aboseif
- Department of Obstetrics and Gynecology (Drs. McEvoy, Aboseif, and Fogel), Nassau University Medical Center, East Meadow, NY
| | - Joshua Fogel
- Department of Obstetrics and Gynecology (Drs. McEvoy, Aboseif, and Fogel), Nassau University Medical Center, East Meadow, NY; Department of Business Management (Dr. Fogel), Brooklyn College of the City University of New York, Brooklyn, NY
| | - Ajit Alles
- Department of Pathology and Laboratory Medicine (Drs. Alles, Khutti, and Kapoor), Northwell Health, Massapequa, NY
| | - Seema Khutti
- Department of Pathology and Laboratory Medicine (Drs. Alles, Khutti, and Kapoor), Northwell Health, Massapequa, NY
| | - Urvashi Kapoor
- Department of Pathology and Laboratory Medicine (Drs. Alles, Khutti, and Kapoor), Northwell Health, Massapequa, NY
| | - Andre Saad
- Director Minimally Invasive Gynecology (Dr. Saad), Northwell Health, Plainview, NY.
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16
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Fang Y, Wei Y, Liu X, Qin L, Gao Y, Yu Z, Xu X, Cha G, Zhu X, Wang X, Xu L, Cao L, Chen X, Jiang H, Zhang C, Zhou Y, Zhu J. A self-supervised classification model for endometrial diseases. J Cancer Res Clin Oncol 2023; 149:17855-17863. [PMID: 37947870 PMCID: PMC10725391 DOI: 10.1007/s00432-023-05467-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/09/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE Ultrasound imaging is the preferred method for the early diagnosis of endometrial diseases because of its non-invasive nature, low cost, and real-time imaging features. However, the accurate evaluation of ultrasound images relies heavily on the experience of radiologist. Therefore, a stable and objective computer-aided diagnostic model is crucial to assist radiologists in diagnosing endometrial lesions. METHODS Transvaginal ultrasound images were collected from multiple hospitals in Quzhou city, Zhejiang province. The dataset comprised 1875 images from 734 patients, including cases of endometrial polyps, hyperplasia, and cancer. Here, we proposed a based self-supervised endometrial disease classification model (BSEM) that learns a joint unified task (raw and self-supervised tasks) and applies self-distillation techniques and ensemble strategies to aid doctors in diagnosing endometrial diseases. RESULTS The performance of BSEM was evaluated using fivefold cross-validation. The experimental results indicated that the BSEM model achieved satisfactory performance across indicators, with scores of 75.1%, 87.3%, 76.5%, 73.4%, and 74.1% for accuracy, area under the curve, precision, recall, and F1 score, respectively. Furthermore, compared to the baseline models ResNet, DenseNet, VGGNet, ConvNeXt, VIT, and CMT, the BSEM model enhanced accuracy, area under the curve, precision, recall, and F1 score in 3.3-7.9%, 3.2-7.3%, 3.9-8.5%, 3.1-8.5%, and 3.3-9.0%, respectively. CONCLUSION The BSEM model is an auxiliary diagnostic tool for the early detection of endometrial diseases revealed by ultrasound and helps radiologists to be accurate and efficient while screening for precancerous endometrial lesions.
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Affiliation(s)
- Yun Fang
- Quzhou People's Hospital, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou, 324000, Zhejiang, China
| | - Yanmin Wei
- Tianjin Normal University, Tianjin, 300387, China
| | - Xiaoying Liu
- Quzhou People's Hospital, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou, 324000, Zhejiang, China
| | - Liufeng Qin
- Quzhou People's Hospital, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou, 324000, Zhejiang, China
| | - Yunxia Gao
- The Second People's Hospital of Quzhou, Quzhou, 324000, Zhejiang, China
| | - Zhengjun Yu
- Kaihua County People's Hospital, Quzhou, 324300, Zhejiang, China
| | - Xia Xu
- Changshan County People's Hospital, Quzhou, 324200, Zhejiang, China
| | - Guofen Cha
- People's Hospital of Quzhou Kecheng, Quzhou, 324000, Zhejiang, China
| | - Xuehua Zhu
- Quzhou Maternal and Child Health Care Hospital, Quzhou, 324000, Zhejiang, China
| | - Xue Wang
- Quzhou People's Hospital, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou, 324000, Zhejiang, China
| | - Lijuan Xu
- Quzhou People's Hospital, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou, 324000, Zhejiang, China
| | - Lulu Cao
- Quzhou People's Hospital, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou, 324000, Zhejiang, China
| | - Xiangrui Chen
- Changshan County People's Hospital, Quzhou, 324200, Zhejiang, China
| | - Haixia Jiang
- Kaihua County People's Hospital, Quzhou, 324300, Zhejiang, China
| | - Chaozhen Zhang
- People's Hospital of Quzhou Kecheng, Quzhou, 324000, Zhejiang, China
| | - Yuwang Zhou
- Quzhou People's Hospital, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou, 324000, Zhejiang, China.
| | - Jinqi Zhu
- Tianjin Normal University, Tianjin, 300387, China.
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Zhao F, Wang Z, Du H, He X, Cao X. Self-Supervised Triplet Contrastive Learning for Classifying Endometrial Histopathological Images. IEEE J Biomed Health Inform 2023; 27:5970-5981. [PMID: 37698968 DOI: 10.1109/jbhi.2023.3314663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
Early identification of endometrial cancer or precancerous lesions from histopathological images is crucial for precise endometrial medical care, which however is increasing hampered by the relative scarcity of pathologists. Computer-aided diagnosis (CAD) provides an automated alternative for confirming endometrial diseases with either feature-engineered machine learning or end-to-end deep learning (DL). In particular, advanced self-supervised learning alleviates the dependence of supervised learning on large-scale human-annotated data and can be used to pre-train DL models for specific classification tasks. Thereby, we develop a novel self-supervised triplet contrastive learning (SSTCL) model for classifying endometrial histopathological images. Specifically, this model consists of one online branch and two target branches. The second target branch includes a simple yet powerful augmentation module named random mosaic masking (RMM), which functions as an effective regularization by mapping the features of masked images close to those of intact ones. Moreover, we add a bottleneck Transformer (BoT) model into each branch as a self-attention module to learn the global information by considering both content information and relative distances between features at different locations. On public endometrial dataset, our model achieved four-class classification accuracies of 77.31 ± 0.84, 80.87 ± 0.48 and 83.22 ± 0.87% using 20, 50 and 100% labeled images, respectively. When transferred to the in-house dataset, our model obtained a three-class diagnostic accuracy of 96.81% with 95% confidence interval of 95.61-98.02%. On both datasets, our model outperformed state-of-the-art supervised and self-supervised methods. Our model may help pathologists to automatically diagnose endometrial diseases with high accuracy and efficiency using limited human-annotated histopathological images.
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Affiliation(s)
- Yiu-Tai Li
- Department of Obstetrics and Gynecology, Kuo General Hospital, Tainan, Taiwan
| | - Szu-Ting Yang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Female Cancer Foundation, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
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Allameh Z, Rouholamin S, Rasti S, Adibi A, Foroughi Z, Goharian M, Rad MR, Dabaghi GG. A transvaginal ultrasound-based diagnostic calculator for uterus post-cesarean scar defect. BMC Womens Health 2023; 23:558. [PMID: 37891612 PMCID: PMC10612219 DOI: 10.1186/s12905-023-02715-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND A cesarean scar defect (CSD) is incomplete healing of the myometrium at the site of a prior cesarean section (CS), complicating more than half of all cesarean sections. While transvaginal ultrasound (TVU) is the most common modality for diagnosing this defect, hysteroscopy remains the gold standard. We aimed to develop an efficient diagnostic tool for CSD among women with abnormal uterine bleeding (AUB) by integrating TVU findings and participants' demographic features. METHODS A single-center cross-sectional study was conducted on 100 premenopausal and non-pregnant women with a history of CS complaining of AUB without a known systemic or structural etiology. Each participant underwent a hysteroscopy followed by a TVU the next day. The defect dimensions in TVU, patients' age, and the number of previous CSs were integrated into a binary logistic regression model to evaluate their predictive ability for a hysteroscopy-confirmed CSD. RESULTS Hysteroscopy identified 74 (74%) participants with CSD. The variables age, the number of CSs, defect length, and defect width significantly contributed to the logistic regression model to diagnose CSD with odds ratios of 9.7, 0.7, 2.6, and 1.7, respectively. The developed model exhibited accuracy, sensitivity, and specificity of 88.00%, 91.89%, and 76.92%, respectively. The area under the receiver operating curve was 0.955 (P-value < 0.001). CONCLUSION Among non-pregnant women suspected of CSD due to AUB, looking at age, the number of previous CSs, and TVU-based defect width and length can efficiently rule CSD out.
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Affiliation(s)
- Zahra Allameh
- Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Ostad Motahari St., Felezi Bridge, Isfahan, Iran
| | - Safoura Rouholamin
- Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Ostad Motahari St., Felezi Bridge, Isfahan, Iran
| | - Sina Rasti
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Atoosa Adibi
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Foroughi
- Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Ostad Motahari St., Felezi Bridge, Isfahan, Iran
| | - Maryam Goharian
- Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Ostad Motahari St., Felezi Bridge, Isfahan, Iran.
| | - Mehrdad Rabiee Rad
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Husnain A, Arshad U, Zimpel R, Schmitt E, Dickson MJ, Perdomo MC, Marinho MN, Ashrafi N, Graham SF, Bishop JV, Hansen TR, Jeong KC, Gonella-Diaza AM, Chebel RC, Sheldon IM, Bromfield JJ, Santos JEP. Induced endometrial inflammation compromises conceptus development in dairy cattle†. Biol Reprod 2023; 109:415-431. [PMID: 37540198 PMCID: PMC10577276 DOI: 10.1093/biolre/ioad088] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/24/2023] [Accepted: 07/28/2023] [Indexed: 08/05/2023] Open
Abstract
Endometrial inflammation is associated with reduced pregnancy per artificial insemination (AI) and increased pregnancy loss in cows. It was hypothesized that induced endometritis alters histotroph composition and induces inflammatory signatures on conceptus that compromise development. In Experiment 1, lactating cows were assigned to control (CON; n = 23) or to an intrauterine infusion of Escherichia coli and Trueperella pyogenes (ENDO; n = 34) to induce endometritis. Cows received AI 26 days after treatment, and the uterine fluid and conceptuses were collected on day 16 after AI. In Experiment 2, Holstein heifers were assigned to CON (n = 14) or ENDO (n = 14). An embryo was transferred on day 7 of the estrous cycle, and uterine fluid and conceptuses were recovered on day 16. Composition of histotroph and trophoblast and embryonic disc gene expression were assessed. Bacterial-induced endometritis in lactating cows altered histotroph composition and pathways linked to phospholipid synthesis, cellular energy production, and the Warburg effect. Also, ENDO reduced conceptus length in cows and altered expression of genes involved in pathogen recognition, nutrient uptake, cell growth, choline metabolism, and conceptus signaling needed for maternal recognition of pregnancy. The impact of ENDO was lesser on conceptuses from heifers receiving embryo transfer; however, the affected genes and associated pathways involved restricted growth and increased immune response similar to the observed responses to ENDO in conceptuses from lactating cows. Bacterial-induced endometrial inflammation altered histotroph composition, reduced conceptus growth, and caused embryonic cells to activate survival rather than anabolic pathways that could compromise development.
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Affiliation(s)
- Ali Husnain
- Department of Animal Sciences, DH Barron Reproductive and Perinatal Biology Research Program, University of Florida, Gainesville, FL, USA
| | - Usman Arshad
- Department of Animal Sciences, DH Barron Reproductive and Perinatal Biology Research Program, University of Florida, Gainesville, FL, USA
| | - Roney Zimpel
- Department of Animal Sciences, DH Barron Reproductive and Perinatal Biology Research Program, University of Florida, Gainesville, FL, USA
| | - Eduardo Schmitt
- Department of Animal Sciences, DH Barron Reproductive and Perinatal Biology Research Program, University of Florida, Gainesville, FL, USA
| | - Mackenzie J Dickson
- Department of Animal Sciences, DH Barron Reproductive and Perinatal Biology Research Program, University of Florida, Gainesville, FL, USA
| | - Milerky C Perdomo
- Department of Animal Sciences, DH Barron Reproductive and Perinatal Biology Research Program, University of Florida, Gainesville, FL, USA
| | - Mariana N Marinho
- Department of Animal Sciences, DH Barron Reproductive and Perinatal Biology Research Program, University of Florida, Gainesville, FL, USA
| | - Nadia Ashrafi
- Metabolomics Department, Beaumont Health, Royal Oak, MI, USA
| | - Stewart F Graham
- Metabolomics Department, Beaumont Health, Royal Oak, MI, USA
- Oakland University-William Beaumont School of Medicine, Rochester, MI, USA
| | - Jeanette V Bishop
- Animal Reproduction and Biotechnology Laboratory, Department of Biomedical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Thomas R Hansen
- Animal Reproduction and Biotechnology Laboratory, Department of Biomedical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Kwang C Jeong
- Department of Animal Sciences, DH Barron Reproductive and Perinatal Biology Research Program, University of Florida, Gainesville, FL, USA
| | | | - Ricardo C Chebel
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - I Martin Sheldon
- Swansea University Medical School, Swansea University, Swansea, UK
| | - John J Bromfield
- Department of Animal Sciences, DH Barron Reproductive and Perinatal Biology Research Program, University of Florida, Gainesville, FL, USA
| | - José E P Santos
- Department of Animal Sciences, DH Barron Reproductive and Perinatal Biology Research Program, University of Florida, Gainesville, FL, USA
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21
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Zhang Y, Luo Z, Jia Y, Zhao Y, Huang Y, Ruan F, Ying Q, Ma L, Luo J, Zhou J. Development and validation of a predictive model of abnormal uterine bleeding associated with ovulatory dysfunction: a case-control study. BMC Womens Health 2023; 23:536. [PMID: 37828525 PMCID: PMC10571233 DOI: 10.1186/s12905-023-02589-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 08/04/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Abnormal uterine bleeding associated with ovulatory dysfunction (AUB-O) is a typical gynecological disease that can affect women of various ages. Being able to identify women at risk of AUB-O could allow physicians to take timely action. This study aimed to identify the influencing factors of AUB-O in Chinese women, and then develop and validate a predictive model. METHODS In this multicenter case-control study, 391 women with AUB-O and 838 controls who came from nine hospitals in Zhejiang province were recruited between April 2019 and January 2022. All the participants completed a structured questionnaire including general characteristics, lifestyle and habits, menstrual and reproductive history, and previous diseases. The predictive model was developed on a group of 822 women and validated on a group of 407 women. Logistic regression was adopted to investigate the influencing factors and develop the model, and validation was then performed. RESULTS The independent predictive factors of AUB-O were age (OR 1.073, 95% CI 1.046-1.102, P < 0.001), body mass index (OR 1.081, 95% CI 1.016-1.151, P = 0.015), systolic blood pressure (OR 1.016, 95% CI 1.002-1.029, P = 0.023), residence (OR 2.451, 95% CI 1.727-3.478, P < 0.001), plant-based diet (OR 2.306, 95% CI 1.415-3.759, P < 0.001), fruits eating (OR 1.887, 95% CI 1.282-2.776, P = 0.001), daily sleep duration (OR 0.819; 95% CI 0.708-0.946, P = 0.007), multiparous (parity = 1, OR 0.424, 95% CI 0.239-0.752, P = 0.003; parity > 1, OR 0.450, 95% CI 0.247-0.822, P = 0.009), and history of ovarian cyst (OR 1.880, 95% CI 1.305-2.710, P < 0.001). The predictive ability (area under the curve) in the development group was 0.77 (95% CI 0.74-0.81), while in the validation group it was 0.73 (95% CI 0.67-0.79). The calibration curve was in high coincidence with the standard curve in the development group, and similar to the validation group. A tool for AUB-O risk calculation was created. CONCLUSIONS Nine influencing factors and a predictive model were proposed in this study, which could identify women who are at high risk of developing AUB-O. This finding highlights the importance of early screening and the lifelong management of ovulatory disorders for women.
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Affiliation(s)
- Yue Zhang
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang, China
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Zhejiang, China
| | - Zhou Luo
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang, China
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Zhejiang, China
| | - Yingxian Jia
- Guizhou Provincial People's Hospital, Guiyang, 550001, Guizhou, China
| | - Yunxiu Zhao
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang, China
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Zhejiang, China
| | - Yizhou Huang
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang, China
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Zhejiang, China
| | - Fei Ruan
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang, China
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Zhejiang, China
| | - Qian Ying
- Zhejiang Cancer Hospital, Hangzhou, 310022, Zhejiang, China
| | - Linjuan Ma
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang, China
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Zhejiang, China
| | - Jie Luo
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang, China.
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Zhejiang, China.
| | - Jianhong Zhou
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang, China.
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Zhejiang, China.
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22
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Hon JX, Wahab NA, Karim AKA, Mokhtar NM, Mokhtar MH. MicroRNAs in Endometriosis: Insights into Inflammation and Progesterone Resistance. Int J Mol Sci 2023; 24:15001. [PMID: 37834449 PMCID: PMC10573326 DOI: 10.3390/ijms241915001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/15/2023] Open
Abstract
Endometriosis, a non-malignant gynecological disorder influenced by estrogen, involves the growth of endometrial tissue outside the uterus. Its development includes processes such as inflammation, progesterone resistance, angiogenesis, and cell proliferation. Epigenetic factors, particularly the dysregulation of microRNAs (miRNAs), have emerged as key factors in these mechanisms in endometriosis. This review aims to unveil the intricate molecular processes that control inflammation, progesterone resistance, and miRNA functions in endometriosis. In addition, it provides a comprehensive overview of the current understanding regarding the involvement of miRNAs in the inflammatory aspects of this condition. This synthesis encompasses research investigating the molecular underpinnings of inflammation, along with the biogenesis and roles of miRNAs in endometriosis. Furthermore, it examines human studies and functional analyses to establish the intricate connection between miRNAs, inflammation, and progesterone resistance in the context of endometriosis. The results highlight the significant impact of dysregulated miRNAs on the inflammatory pathways and hormonal imbalances characteristic of endometriosis. Consequently, miRNAs hold promise as potential non-invasive biomarkers and targeted therapeutic agents aimed at addressing inflammation and enhancing the response to progesterone treatment in individuals with endometriosis.
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Affiliation(s)
- Jing-Xian Hon
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Norhazlina Abdul Wahab
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
- GUT Research Group, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Abdul Kadir Abdul Karim
- Department of Obstetrics & Gynecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Norfilza Mohd Mokhtar
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
- GUT Research Group, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Mohd Helmy Mokhtar
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
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23
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Hiraoka T, Osuga Y, Hirota Y. Current perspectives on endometrial receptivity: A comprehensive overview of etiology and treatment. J Obstet Gynaecol Res 2023; 49:2397-2409. [PMID: 37527810 DOI: 10.1111/jog.15759] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/23/2023] [Indexed: 08/03/2023]
Abstract
Recurrent implantation failure (RIF) remains a challenging problem in assisted reproductive technology (ART). Further insights into uterine abnormalities that can disturb embryo implantation should be obtained. This review provides an overview of the effects of organic and non-organic uterine disorders on endometrial receptivity. The results suggest that various uterine pathologies can lead to defective embryo implantation via multiple mechanisms. In particular, uterine adenomyosis dysregulates molecular and cellular interactions that are vital for successful embryo implantation with a background of chronic inflammation, which may be alleviated by pretreatment with a gonadotropin-releasing hormone agonist. Uterine myomas can cause endometrial deformation and adverse alterations in uterine contractility. Nonetheless, the effectiveness of myomectomy remains debated, and endometrial polyp removal may be considered, particularly in patients with RIF. Chronic endometritis abrogates the appropriate uterine immunological environment critical for embryo implantation. Abnormal endometrial microbiota have been suggested to influence endometrial receptivity; however, supporting evidence is currently scarce. Platelet-rich plasma therapy may be a potential treatment for thin endometria; nevertheless, further validation is required. Endometrial receptivity analysis can detect dysregulation of the window of implantation, and new non-invasive methods for predicting endometrial receptivity have recently been proposed. However, numerous issues still need to be fully clarified. Further clinical and basic studies are necessary to investigate the pathophysiology of defective endometrial receptivity and identify optimal treatments for patients undergoing ART, especially those with RIF.
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Affiliation(s)
- Takehiro Hiraoka
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasushi Hirota
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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24
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Zhang YY, Li MZ, Shen HH, Abudukeyoumu A, Xie F, Ye JF, Xu FY, Sun JS, Li MQ. Ginsenosides in endometrium-related diseases: Emerging roles and mechanisms. Biomed Pharmacother 2023; 166:115340. [PMID: 37625321 DOI: 10.1016/j.biopha.2023.115340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/30/2023] [Accepted: 07/12/2023] [Indexed: 08/27/2023] Open
Abstract
Ginsenosides, agents extracted from an important herb (ginseng), are expected to provide new therapies for endometrium-related diseases. Based on the molecular types of ginsenosides, we reviewed the main pharmacological effects of ginsenosides against endometrium-related diseases (e.g., endometrial cancers, endometriosis, and endometritis). The mechanism of action of ginsenosides involves inducing apoptosis of endometrium-related cells, promoting autophagy of endometrium-related cells, regulating epithelial-mesenchymal transition (EMT) in endometrium-related cells, and activating the immune system to kill cells associated with endometrial diseases. We hope to provide a theoretical foundation for the treatment of endometrium-related diseases by ginsenosides.
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Affiliation(s)
- Yang-Yang Zhang
- Institute of Obstetrics and Gynecology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai 200080, People's Republic of China; Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China
| | - Mao-Zhi Li
- Institute of Obstetrics and Gynecology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai 200080, People's Republic of China; Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China
| | - Hui-Hui Shen
- Institute of Obstetrics and Gynecology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai 200080, People's Republic of China
| | - Ayitila Abudukeyoumu
- Department of Gynecology, Shanghai Jiading Maternal Child Health Hospital, Shanghai 201800, People's Republic of China
| | - Feng Xie
- Medical Center of Diagnosis and Treatment for Cervical and Intrauterine Diseases, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, People's Republic of China
| | - Jiang-Feng Ye
- Institute for Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore 138632, Singapore
| | - Feng-Yuan Xu
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jian-Song Sun
- School of Life Science and Health Engineering, Jiangnan University, Wuxi 214122, People's Republic of China
| | - Ming-Qing Li
- Institute of Obstetrics and Gynecology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai 200080, People's Republic of China; Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai 200080, People's Republic of China.
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25
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Shi X, Guo J, Saravelos S, Huang X, Xia E, Feng L, Li TC. The use of intrauterine balloon therapy in reproductive medicine and surgery: a guidance for practice. HUM FERTIL 2023; 26:742-756. [PMID: 37778373 DOI: 10.1080/14647273.2023.2255745] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/15/2023] [Indexed: 10/03/2023]
Abstract
The use of balloon therapy in obstetric practice especially in postpartum haemorrhage (PPH) is well established and has recently been reviewed. However, little attention has been drawn regarding the use of intrauterine balloon (IUB) in gynaecological practice. This study focuses on the various usage of IUB in gynaecological practice. An electronic literature search through Medline, EMBASE and Clinicaltrial.gov from inception to August 2022 was conducted. The study focuses on the three following areas: (1) Indications: prevention and removal of intrauterine adhesions, management of ectopic pregnancy, facilitation of endoscopic surgery and other clinical usages; (2) Practical aspects of balloon therapy including ultrasound guidance, choice of balloon, inflation volume, duration of balloon therapy; and (3) Potential complications including pain, infection, uterine rupture and how they can be avoided. IUB therapy is a simple, inexpensive and effective method that can be applied in various gynaecological conditions ranging from IUA to intrauterine haemorrhage. Complications are rare, but in most cases can be avoided with correct use.
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Affiliation(s)
- Xiaoyu Shi
- Department of Obstetrics and Gynecology, Beijing Tiantan Hospital, The Fifth Clinical Medical College, Capital Medical University, Beijing, P. R. China
| | - Jun Guo
- Department of Obstetrics and Gynecology, Beijing Tongren Hospital, The Fourth Clinical Medical College, Capital Medical University, Beijing, P. R. China
| | - Sotirios Saravelos
- Department of Obstetrics and Gynaecology, IVF Unit, Hammersmith Hospital, Imperial College London, London, UK
| | - Xiaowu Huang
- Department of Hysteroscopic Centre, Fuxing Hospital, Capital Medical University, Beijing, P. R. China
| | - Enlan Xia
- Department of Hysteroscopic Centre, Fuxing Hospital, Capital Medical University, Beijing, P. R. China
| | - Limin Feng
- Department of Obstetrics and Gynecology, Beijing Tiantan Hospital, The Fifth Clinical Medical College, Capital Medical University, Beijing, P. R. China
| | - Tin-Chiu Li
- Department of Hysteroscopic Centre, Fuxing Hospital, Capital Medical University, Beijing, P. R. China
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26
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Humaidan P, Garcia Velasco JA, Cozzolino M. Local intraendometrial estrogen biosynthesis leading to progesterone resistance impacts implantation in adenomyosis and endometriosis. Fertil Steril 2023; 120:927. [PMID: 37295742 DOI: 10.1016/j.fertnstert.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 05/26/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Affiliation(s)
- Peter Humaidan
- The Fertility Clinic, Skive Regional Hospital, Skive, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Mauro Cozzolino
- IVIRMA Global Research Alliance, IVI, Rome, Italy; IVIRMA Global Research Alliance, IVI Foundation-IIS la Fe, Valencia, Spain
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27
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Tomita T, Toda M, Kaneko A, Murakumo K, Miyamoto K, Sato K. Successful delivery of viviparous lantern shark from an artificial uterus and the self-production of lantern shark luciferin. PLoS One 2023; 18:e0291224. [PMID: 37756258 PMCID: PMC10530027 DOI: 10.1371/journal.pone.0291224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
Our recent success in the long-term maintenance of lantern shark embryos in artificial uterine systems has provided a novel option for the medical treatment of premature embryos for captive viviparous elasmobranchs. The remaining issue with this system is that the embryos cannot survive the abrupt change in the chemical environment from artificial uterine fluid (AUF) to seawater during delivery. To overcome this issue, the present study developed a new protocol for seawater adaptation, which is characterized by a long-term and stepwise shift from AUF to seawater prior to delivery. This protocol was employed successfully, and the specimen survived for more than seven months after delivery, the longest captive record of the species. During the experiment, we unexpectedly detected bioluminescence of the embryonic lantern shark in the artificial uterus. This observation indicates that lantern sharks can produce luciferin, a substance for bioluminescence. This contradicts the recent hypothesis that lantern sharks lack the ability to produce luciferin and use luciferin obtained from food sources.
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Affiliation(s)
- Taketeru Tomita
- Okinawa Churashima Research Institute, Okinawa Churashima Foundation, Motobu, Okinawa, Japan
- Okinawa Churaumi Aquarium, Okinawa Churashima Foundation, Motobu, Okinawa, Japan
| | - Minoru Toda
- Okinawa Churaumi Aquarium, Okinawa Churashima Foundation, Motobu, Okinawa, Japan
| | - Atsushi Kaneko
- Okinawa Churaumi Aquarium, Okinawa Churashima Foundation, Motobu, Okinawa, Japan
| | - Kiyomi Murakumo
- Okinawa Churashima Foundation Veterinary Hospital, Okinawa Churashima Foundation, Motobu, Okinawa, Japan
| | - Kei Miyamoto
- Okinawa Churashima Research Institute, Okinawa Churashima Foundation, Motobu, Okinawa, Japan
- Okinawa Churaumi Aquarium, Okinawa Churashima Foundation, Motobu, Okinawa, Japan
| | - Keiichi Sato
- Okinawa Churashima Research Institute, Okinawa Churashima Foundation, Motobu, Okinawa, Japan
- Okinawa Churaumi Aquarium, Okinawa Churashima Foundation, Motobu, Okinawa, Japan
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28
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Wójtowicz A, Molcan T, Lukasik K, Żebrowska E, Pawlina-Tyszko K, Gurgul A, Szmatoła T, Bugno-Poniewierska M, Ferreira-Dias G, Skarzynski DJ, Szóstek-Mioduchowska A. The potential role of miRNAs and regulation of their expression in the development of mare endometrial fibrosis. Sci Rep 2023; 13:15938. [PMID: 37743390 PMCID: PMC10518347 DOI: 10.1038/s41598-023-42149-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 09/06/2023] [Indexed: 09/26/2023] Open
Abstract
Mare endometrial fibrosis (endometrosis), is one of the main causes of equine infertility. Despite the high prevalence, both ethology, pathogenesis and the nature of its progression remain poorly understood. Recent studies have shown that microRNAs (miRNAs) are important regulators in multiple cellular processes and functions under physiological and pathological circumstances. In this article, we reported changes in miRNA expression at different stages of endometrosis and the effect of transforming growth factor (TGF)-β1 on the expression of the most dysregulated miRNAs. We identified 1, 26, and 5 differentially expressed miRNAs (DEmiRs), in categories IIA (mild fibrosis), IIB (moderate fibrosis), and III (severe fibrosis) groups compared to category I (no fibrosis) endometria group, respectively (Padjusted < 0.05, log2FC ≥ 1.0/log2FC ≤ - 1.0). This study indicated the potential involvement of miRNAs in the regulation of the process associated to the development and progression of endometrosis. The functional enrichment analysis revealed, that DEmiRs target genes involved in the mitogen-activated protein kinases, Hippo, and phosphoinositide-3-kinase (PI3K)-Akt signalling pathways, focal adhesion, and extracellular matrix-receptor interaction. Moreover, we demonstrated that the most potent profibrotic cytokine-TGF-β1-downregulated novel-eca-miR-42 (P < 0.05) expression in fibroblasts derived from endometria at early-stage endometrosis (category IIA).
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Affiliation(s)
- Anna Wójtowicz
- Department of Reproductive Immunology and Pathology, Institute of Animal Reproduction and Food Research of Polish Academy of Sciences, Tuwima 10, 10-748, Olsztyn, Poland
| | - Tomasz Molcan
- Molecular Biology Laboratory, Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Tuwima 10, 10-748, Olsztyn, Poland
| | - Karolina Lukasik
- Department of Reproductive Immunology and Pathology, Institute of Animal Reproduction and Food Research of Polish Academy of Sciences, Tuwima 10, 10-748, Olsztyn, Poland
| | - Ewelina Żebrowska
- Department of Reproductive Immunology and Pathology, Institute of Animal Reproduction and Food Research of Polish Academy of Sciences, Tuwima 10, 10-748, Olsztyn, Poland
| | - Klaudia Pawlina-Tyszko
- Department of Animal Molecular Biology, National Research Institute of Animal Production, Cracow, Poland
| | - Artur Gurgul
- Department of Animal Reproduction, Anatomy and Genomics, The University of Agriculture in Krakow, Cracow, Poland
| | - Tomasz Szmatoła
- Department of Animal Molecular Biology, National Research Institute of Animal Production, Cracow, Poland
- Center for Experimental and Innovative Medicine, University of Agriculture in Krakow, Cracow, Poland
| | - Monika Bugno-Poniewierska
- Department of Animal Reproduction, Anatomy and Genomics, The University of Agriculture in Krakow, Cracow, Poland
| | - Graca Ferreira-Dias
- Faculty of Veterinary Medicine, CIISA - Center for Interdisciplinary Research in Animal Health, University of Lisbon, Lisbon, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), Lisbon, Portugal
| | - Dariusz J Skarzynski
- Department of Reproduction and Clinic of Farm Animals, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Anna Szóstek-Mioduchowska
- Department of Reproductive Immunology and Pathology, Institute of Animal Reproduction and Food Research of Polish Academy of Sciences, Tuwima 10, 10-748, Olsztyn, Poland.
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Santamaria X, Roson B, Perez-Moraga R, Venkatesan N, Pardo-Figuerez M, Gonzalez-Fernandez J, Llera-Oyola J, Fernández E, Moreno I, Salumets A, Vankelecom H, Vilella F, Simon C. Decoding the endometrial niche of Asherman's Syndrome at single-cell resolution. Nat Commun 2023; 14:5890. [PMID: 37735465 PMCID: PMC10514053 DOI: 10.1038/s41467-023-41656-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 09/12/2023] [Indexed: 09/23/2023] Open
Abstract
Asherman's Syndrome is characterized by intrauterine adhesions or scarring, which cause infertility, menstrual abnormalities, and recurrent pregnancy loss. The pathophysiology of this syndrome remains unknown, with treatment restricted to recurrent surgical removal of intrauterine scarring, which has limited success. Here, we decode the Asherman's Syndrome endometrial cell niche by analyzing data from over 200,000 cells with single-cell RNA-sequencing in patients with this condition and through in vitro analyses of Asherman's Syndrome patient-derived endometrial organoids. Our endometrial atlas highlights the loss of the endometrial epithelium, alterations to epithelial differentiation signaling pathways such as Wnt and Notch, and the appearance of characteristic epithelium expressing secretory leukocyte protease inhibitor during the window of implantation. We describe syndrome-associated alterations in cell-to-cell communication and gene expression profiles that support a dysfunctional pro-fibrotic, pro-inflammatory, and anti-angiogenic environment.
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Affiliation(s)
- Xavier Santamaria
- Carlos Simon Foundation, INCLIVA Health Research Institute, Valencia, Spain.
- Department Ob/Gyn Vall d'Hebron Institut de Recerca, Barcelona, Spain.
| | - Beatriz Roson
- Carlos Simon Foundation, INCLIVA Health Research Institute, Valencia, Spain
| | - Raul Perez-Moraga
- Carlos Simon Foundation, INCLIVA Health Research Institute, Valencia, Spain
- Igenomix R&D, Valencia, Spain
| | - Nandakumar Venkatesan
- Department of Pediatrics Obstetrics & Gynecology, University of Valencia, Valencia, Spain
| | | | | | - Jaime Llera-Oyola
- Carlos Simon Foundation, INCLIVA Health Research Institute, Valencia, Spain
| | | | - Inmaculada Moreno
- Carlos Simon Foundation, INCLIVA Health Research Institute, Valencia, Spain
| | - Andres Salumets
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Competence Centre on Health Technologies, Tartu, Estonia
- Division of Obstetrics and Gynaecology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Hugo Vankelecom
- Department of Development and Regeneration, Cluster of Stem Cell and Developmental Biology, Unit of Stem Cell Research, University of Leuven (KU Leuven), Leuven, Belgium
| | - Felipe Vilella
- Carlos Simon Foundation, INCLIVA Health Research Institute, Valencia, Spain
| | - Carlos Simon
- Carlos Simon Foundation, INCLIVA Health Research Institute, Valencia, Spain.
- Department of Pediatrics Obstetrics & Gynecology, University of Valencia, Valencia, Spain.
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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Luongo C, Llamas-López PJ, Garrappa G, Rodríguez-Tobón E, Grudzinska P, García-Vázquez FA. Impact of inclusion of post-spermatic ejaculate fraction in boar seminal doses on sperm metabolism, quality, and interaction with uterine fluid. Sci Rep 2023; 13:15258. [PMID: 37709904 PMCID: PMC10502139 DOI: 10.1038/s41598-023-42254-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/07/2023] [Indexed: 09/16/2023] Open
Abstract
Boar ejaculate is composed of sperm cells and seminal plasma (SP) and is emitted in different fractions (pre-sperm fraction; spermatic-rich fraction; intermediate fraction; post-spermatic fraction), with different composition of SP and volume, which could influence the sperm quality during seminal doses preparation, conservation, and interaction with the female reproductive tract. In artificial insemination (AI) centers, seminal doses are usually prepared with the spermatic-rich and intermediate fractions, but the inclusion of other ejaculate fractions, although controversial, is beginning to be applied. The objective was to evaluate the synergic effect of accumulative ejaculated fractions on sperm functionality during seminal doses preparation, throughout storage and after incubation with uterine fluid (UF). For this purpose, a total of 57 ejaculates were collected, and the following experimental groups were prepared (n = 19 per group): (F1) spermatic-rich fraction; (F2) F1 plus intermediate fraction; (F3) F2 plus post-spermatic fraction. Each group was stored for 5 days at ∼16 °C, and the following parameters were evaluated: sperm metabolism of pure and diluted semen (day 1), sperm quality parameters (days 1, 3, 5), thermal-resistance test (TRT) and incubation with uterine fluid (UF) (day 5). Sperm metabolic rates between accumulative ejaculate fractions from pure and diluted semen did not show differences. Also, sperm quality parameters were not affected by the ejaculate fraction during storage. However, sperm subjected to TRT showed similar results except for progressive motility, which was better in F2 and F3 than F1. When sperm were incubated with UF, the quality decreased in each group, but sperm from F2 and F3 were less affected than those from F1. In conclusion, the post-spermatic fraction can be included in seminal doses for their use in AI-centers, with functionality of sperm of different SP origins not being impaired throughout the storage, and responding better to thermal and UF stress. However, further research in AI-centers is necessary to test the sperm behaviour under presented conditions.
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Affiliation(s)
- Chiara Luongo
- Departamento de Fisiología, Facultad de Veterinaria, Campus de Excelencia Mare Nostrum, Universidad de Murcia, Murcia, Spain
| | | | - Gabriela Garrappa
- Departamento de Fisiología, Facultad de Veterinaria, Campus de Excelencia Mare Nostrum, Universidad de Murcia, Murcia, Spain
- Instituto de Investigación Animal del Chaco Semi-Arido (IIACS), Centro de Investigación Agropecuaria (CIAP), Instituto Nacional de Tecnología Agropecuaria (INTA), Tucuman, Argentina
| | - Ernesto Rodríguez-Tobón
- Departamento de Fisiología, Facultad de Veterinaria, Campus de Excelencia Mare Nostrum, Universidad de Murcia, Murcia, Spain
- Departamento de Biología de La Reproducción, Universidad Autónoma Metropolitana, Unidad Iztapalapa, Ciudad de México, México
| | - Paulina Grudzinska
- Departamento de Fisiología, Facultad de Veterinaria, Campus de Excelencia Mare Nostrum, Universidad de Murcia, Murcia, Spain
| | - Francisco Alberto García-Vázquez
- Departamento de Fisiología, Facultad de Veterinaria, Campus de Excelencia Mare Nostrum, Universidad de Murcia, Murcia, Spain.
- Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain.
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Dan J, Cao Y. Yangmo decoction versus hyaluronic acid gel in women with intrauterine re-adhesion after hysteroscopic adhesiolysis: a retrospective efficacy and safety analysis. BMC Womens Health 2023; 23:480. [PMID: 37689637 PMCID: PMC10493015 DOI: 10.1186/s12905-023-02598-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/10/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Hysteroscopic adhesiolysis is the preferred primary method for intrauterine adhesion. However, there is about a 60% of chance of re-adhesion after surgery. The objectives of the study were to evaluate the efficacy and safety of Yangmo decoction as a secondary treatment in preventing intrauterine re-adhesion against those of hyaluronic acid gel. METHODS Women received oral Yangmo decoction (YD cohort, n = 105) or intrauterine hyaluronic acid gel (HA cohort, n = 125) or did not receive secondary re-adhesion prevention treatments (EP cohort, n = 165) after hysteroscopic adhesiolysis for 6 months. In addition, all women have received 3 mg of oral estrogen and 20 mg oral progesterone combination after hysteroscopic adhesiolysis for 3 months. Intrauterine re-adhesion after hysteroscopic adhesiolysis after 6 months with or without secondary treatment(s) was detected using hysteroscopy. The extent of the cavity, type of adhesion, and the menstrual pattern were included to define the American Fertility Society classification of intrauterine re-adhesions (AFS) score. RESULTS Fewer numbers of women suffered from intrauterine re-adhesion after hysteroscopic adhesiolysis in the YD cohort than those of the HA (15(14%) vs. 40(32%), p = 0.0019) and the EP (15(14%) vs. 58(35%). p = 0.0001) cohorts. Among women who developed intrauterine re-adhesion, AFS score was fewer for women of the YD cohort than those of HA (2(2-1) vs. 4(4-3), p < 0.001) and the EP (2(2-1) vs. 4(4-4), p < 0.001) cohorts. AFS score after surgery was fewer for women of the HA cohort than those of the EP cohort (p < 0.05). Higher numbers of women of the YD cohort retained pregnancies after 6-months of treatment than those of the HA (55(52%) vs. 45(36%), p = 0.0161) and EP (55(52%) vs. 35(21%), p < 0.0001) cohorts. Among women who develop re-adhesion, 10(10%) women of the YD cohort only had successful pregnancies. CONCLUSIONS Yangmo decoction for 6 months after hysteroscopic adhesiolysis can reduce AFS score, prevent intrauterine re-adhesion, and increases the chances of successful pregnancies of women. LEVEL OF EVIDENCE IV. TECHNICAL EFFICACY Stage 5.
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Affiliation(s)
- Jiaxin Dan
- Department of Gynecology of Jinshan Campus, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Yi Cao
- Department of Gynecology of Jinshan Campus, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
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32
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Ng JKM, Cheung BHC, Lee DHY, Li JJX, Ip PPC, Lee JHS, Yeung CSY, Yu M. Detection rates and factors affecting thereof in endometrial hyperplasia, endometrial carcinoma, and cervical glandular lesions on cervical smear. Cancer Med 2023; 12:17581-17591. [PMID: 37501510 PMCID: PMC10523982 DOI: 10.1002/cam4.6376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 07/08/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION Endometrial lesions are morphologically diverse and uncommon on cervical smears, with its detection rate and associated diagnostic categories uncharacterized. In this study, cervical smears matched to histologically proven endometrial hyperplasias and carcinomas were reviewed and compared with cervical in-situ-carcinomas/carcinomas, aiming to detail the diagnostic performance of cervical smears for upper tract and glandular lesions. METHODS Pathology reports of cervical smears, hysterectomies, endometrial and cervical biopsies from 1995 to 2021 were retrieved. Diagnoses of cervical smears were matched to endometrial hyperplasias and carcinomas, or cervical carcinomas and reviewed. RESULTS Totally 832 cervical smears (272 cervical carcinomas, 312 endometrial carcinomas, and 248 hyperplasias) were included. Considering all cytologic glandular diagnosis as positive, the detection rate of cervical adenocarcinoma-in-situ was the highest (64.3%), followed by cervical adenocarcinoma (63.8%), endometrial carcinoma (31.7%), and hyperplasia (with atypia-8.5%; without atypia-2.3%) (p < 0.001). Endometrial hyperplasia was most often diagnosed as atypical squamous cells of undetermined significance (ASCUS) (5.0%) or atypical glandular cells, not otherwise specified (3.6%) without indication of endometrial origin. For endometrial carcinomas, higher FIGO grading and endocervical involvement were associated with higher detection rates across all diagnostic categories (p = 0.002-0.028). High FIGO grade was associated with suspicious/favor neoplastic (C4) (31.1%vs10.3%, p < 0.001) and carcinoma (C5) (17.8% vs. 5.6%, p = 0.005) categories, but not for all glandular diagnoses combined (33.3% vs. 31.0%, p = 0.761). CONCLUSION Detection rates for endometrial lesions are lower than cervical lesions but not insignificant. Endometrial hyperplasia should be recognized as a differential of human papilloma virus-negative ASCUS and prompt consideration of investigation of the upper genital tract.
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Affiliation(s)
- Joanna K. M. Ng
- Department of Anatomical and Cellular PathologyPrince of Wales Hospital, The Chinese University of Hong KongSha TinHong Kong
| | - Bryan H. C. Cheung
- Department of Anatomical and Cellular PathologyPrince of Wales Hospital, The Chinese University of Hong KongSha TinHong Kong
| | - Dennis H. Y. Lee
- Department of Anatomical and Cellular PathologyPrince of Wales Hospital, The Chinese University of Hong KongSha TinHong Kong
| | - Joshua J. X. Li
- Department of Anatomical and Cellular PathologyPrince of Wales Hospital, The Chinese University of Hong KongSha TinHong Kong
| | - Philip P. C. Ip
- Department of PathologyQueen Mary Hospital, School of Clinical Medicine, The University of Hong KongPok Fu LamHong Kong
| | - Jacqueline H. S. Lee
- Department of Obstetrics and GynaecologyPrince of Wales Hospital, The Chinese University of Hong KongSha TinHong Kong
| | - Carol S. Y. Yeung
- Department of Obstetrics and GynaecologyPrince of Wales Hospital, The Chinese University of Hong KongSha TinHong Kong
| | - Mei‐Yung Yu
- Department of Anatomical and Cellular PathologyPrince of Wales Hospital, The Chinese University of Hong KongSha TinHong Kong
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Zamarripa Leyva JM, Kway VB, Zamora Zamora KY, Jimenez Esquivel RM, Ling Garcia JP, Martinez Martinez R, Gomez Hernandez NJ, Martinez Trejo Z, Gonzalez Garcia GK, Mendoza Huerta M. Abnormal uterine bleeding in a 2-month-old infant: Workup, instrumentation, and endoscopic management-A case report. Int J Gynaecol Obstet 2023; 162:1108-1110. [PMID: 37309257 DOI: 10.1002/ijgo.14916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/15/2023] [Accepted: 05/21/2023] [Indexed: 06/14/2023]
Abstract
SynopsisA case report of a 2‐month‐old patient with severe abnormal uterine bleeding and vascular neoplastic malformation who was diagnosed and managed by endoscopic and vessel embolization therapy.
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Affiliation(s)
- Jose Manuel Zamarripa Leyva
- Department of Gynecology and Obstetrics, Central Hospital Dr. Ignacio Morones Prieto, San Luis Potosí, Mexico
| | - Venance Basil Kway
- Department of Gynecology and Obstetrics, Central Hospital Dr. Ignacio Morones Prieto, San Luis Potosí, Mexico
| | | | | | - Jose Pablo Ling Garcia
- Department of Gynecology and Obstetrics, Central Hospital Dr. Ignacio Morones Prieto, San Luis Potosí, Mexico
| | - Raul Martinez Martinez
- Department of Radiology, Central Hospital Dr. Ignacio Morones Prieto, San Luis Potosí, Mexico
| | | | - Zulema Martinez Trejo
- Department of Gynecology and Obstetrics, Central Hospital Dr. Ignacio Morones Prieto, San Luis Potosí, Mexico
| | | | - Manuel Mendoza Huerta
- Department of Gynecology and Obstetrics, Central Hospital Dr. Ignacio Morones Prieto, San Luis Potosí, Mexico
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Teworte S, Aleandri S, Weber JR, Carone M, Luciani P. Mucoadhesive 3D printed vaginal ovules to treat endometriosis and fibrotic uterine diseases. Eur J Pharm Sci 2023; 188:106501. [PMID: 37339708 DOI: 10.1016/j.ejps.2023.106501] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/06/2023] [Accepted: 06/16/2023] [Indexed: 06/22/2023]
Abstract
Gynaecological health is a neglected field of research that includes conditions such as endometriosis, uterine fibroids, infertility, viral and bacterial infections, and cancers. There is a clinical need to develop dosage forms for gynecological diseases that increase efficacy and reduce side effects and explore new materials with properties tailored to the vaginal mucosa and milieu. Here, we developed a 3D printed semisolid vaginal ovule containing pirfenidone, a repurposed drug candidate for endometriosis. Vaginal drug delivery allows direct targeting of the reproductive organs via the first uterine pass effect, but vaginal dosage forms can be challenging to self-administer and retain in situ for periods of more than 1-3 h. We show that a semisoft alginate-based vaginal suppository manufactured using semisolid extrusion additive manufacturing is superior to vaginal ovules made using standard excipients. The 3D-printed ovule showed a controlled release profile of pirfenidone in vitro in standard and biorelevant release tests, as well as better mucoadhesive properties ex vivo. An exposure time of 24 h of pirfenidone to a monolayer culture of an endometriotic epithelial cell line, 12Z, is necessary to reduce the cells' metabolic activity, which demonstrates the need for a sustained release formulation of pirfenidone. 3D printing allowed us to formulate mucoadhesive polymers into a semisolid ovule with controlled release of pirfenidone. This work enables further preclinical and clinical studies into vaginally administered pirfenidone to assess its efficacy as a repurposed endometriosis treatment.
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Affiliation(s)
- Sarah Teworte
- Department of Chemistry, Biochemistry and Pharmaceutical Sciences, University of Bern, Freiestrasse 3, Bern 3012, Switzerland
| | - Simone Aleandri
- Department of Chemistry, Biochemistry and Pharmaceutical Sciences, University of Bern, Freiestrasse 3, Bern 3012, Switzerland
| | - Jessica R Weber
- Department of Chemistry, Biochemistry and Pharmaceutical Sciences, University of Bern, Freiestrasse 3, Bern 3012, Switzerland
| | - Marianna Carone
- Department of Chemistry, Biochemistry and Pharmaceutical Sciences, University of Bern, Freiestrasse 3, Bern 3012, Switzerland
| | - Paola Luciani
- Department of Chemistry, Biochemistry and Pharmaceutical Sciences, University of Bern, Freiestrasse 3, Bern 3012, Switzerland.
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Peng X, Zhu Y, Wang T, Wang S, Sun J. Integrative analysis links autophagy to intrauterine adhesion and establishes autophagy-related circRNA-miRNA-mRNA regulatory network. Aging (Albany NY) 2023; 15:8275-8297. [PMID: 37616056 PMCID: PMC10497020 DOI: 10.18632/aging.204969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/06/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Intrauterine adhesion (IUA) is a troublesome complication characterized with endometrial fibrosis after endometrial trauma. Increasing number of investigations focused on autophagy and non-coding RNA in the pathogenesis of uterine adhesion, but the underlying mechanism needs to be further studied. METHODS mRNA expression profile and miRNA expression profile were obtained from Gene Expression Omnibus database. The autophagy related genes were low. Venn diagram was used to set the intersection of autophagy genes and DEGs to obtain ARDEGs. Circbank was used to select hub autophagy-related circRNAs based on ARDEMs. Then, the differentially expressed autophagy-related genes, miRNAs and circRNAs were analyzed by functional enrichment analysis, and protein-protein interaction network analysis. Finally, the expression levels of hub circRNAs and hub miRNAs were validated through RT-PCR of clinical intrauterine adhesion samples. In vitro experiments were investigated to explore the effect of hub ARCs on cell autophagy, myofibroblast transformation and collagen deposition. RESULTS 11 autophagy-related differentially expressed genes (ARDEGs) and 41 differentially expressed miRNA (ARDEMs) compared between normal tissues and IUA were identified. Subsequently, the autophagy-related miRNA-mRNA network was constructed and hub ARDEMs were selected. Furthermore, the autophagy-related circRNA-miRNA-mRNA network was established. According to the ranking of number of regulated ARDEMs, hsa-circ-0047959, hsa-circ-0032438, hsa-circ-0047301 were regarded as the hub ARCs. In comparison of normal endometrial tissue, all three hub ARCs were upregulated in IUA tissue. All hub ARDEMs were downregulated except has-miR-320c. CONCLUSIONS In the current study, we firstly constructed autophagy-related circRNA-miRNA-mRNA regulatory network and identified hub ARCs and ARDEMs had not been reported in IUA.
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Affiliation(s)
- Xiaotong Peng
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai 200092, China
- Department of Gynaecology and Obstetrics, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Yiping Zhu
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Tao Wang
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Shuo Wang
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| | - Jing Sun
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai 200092, China
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Munro MG, Critchley HOD. Our path from abnormal uterine bleeding and iron deficiency to impaired fetal development: A long and winding road. Int J Gynaecol Obstet 2023; 162 Suppl 2:3-6. [PMID: 37538012 DOI: 10.1002/ijgo.14942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
SynopsisAbnormal uterine bleeding adversely impacts the lives of reproductive‐aged girls and women; furthermore, the resulting periconceptual iron deficiency risks enduring neurological sequelae in the child.
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Affiliation(s)
- Malcolm G Munro
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, The University of California, Los Angeles, Los Angeles, California, USA
- FIGO Committee on Menstrual Disorders and Related Health Impacts (MDRHI), London, UK
| | - Hilary O D Critchley
- FIGO Committee on Menstrual Disorders and Related Health Impacts (MDRHI), London, UK
- Centre for Reproductive Health, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
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Hutchison JC, Evans J, Edgell TA, Nie G, Gardner DK, Salamonsen LA. Detrimental actions of obesity-associated advanced glycation end-products on endometrial epithelial cell proliferation are alleviated by antioxidants. Reprod Biomed Online 2023; 47:35-50. [PMID: 37142478 DOI: 10.1016/j.rbmo.2023.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/04/2023]
Abstract
RESEARCH QUESTION Advanced glycation end-products (AGE) are elevated in the uterine environment of obese infertile women. Can the detrimental effects of AGE on endometrial epithelial cells be mitigated with therapeutics, and recapitulated in a more physiologically relevant primary model (organoids)? DESIGN Human endometrial epithelial cells (ECC-1) were exposed to AGE at concentrations physiologically representative of uterine fluid in lean or obese individuals, and three potential therapeutics: 25 nmol/l receptor for AGE (RAGE) antagonist FPS-ZM1, 100 μmol/l metformin, or a combination of antioxidants (10 μmol/l N-acetyl-l-cysteine, 10 μmol/l N-acetyl-l-carnitine and 5 μmol/l α-lipoic acid). Real-time cell analysis (xCELLigence, ACEA Biosciences) determined the rate of adhesion and proliferation. The proliferation of organoid-derived cells and secretion of cytokines from organoids was characterized in the presence of AGE (n = 5). The uterine fluid of women undergoing assisted reproduction was profiled for AGE-associated inflammatory markers (n = 77). RESULTS ECC-1 proliferation was reduced by AGE from obese versus lean conditions and vehicle control (P = 0.04 and P < 0.001, respectively), and restored to a proliferation corresponding to lean conditions by antioxidants. AGE influenced organoid derived primary endometrial epithelial cell proliferation in a donor-dependent manner. AGE increased the organoid secretion of the proinflammatory cytokine CXCL16 (P = 0.006). Clinically, CXCL16 correlated positively to maternal body mass index (R = 0.264, P = 0.021) and intrauterine glucose concentration (R = 0.736, P < 0.0001). CONCLUSIONS Physiologically relevant concentrations of AGE alter endometrial epithelial cell function. Antioxidants restore the rate of proliferation of AGE-treated endometrial epithelial (ECC-1) cells. Primary endometrial epithelial cells, cultured as organoids, demonstrate altered proliferation and CXCL16 secretion in the presence of AGE equimolar with the uterine fluid from obese individuals.
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Affiliation(s)
- Jennifer C Hutchison
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, Victoria, Australia; Department of Molecular and Translational Science, Monash University, Clayton, Victoria, Australia; School of BioSciences, University of Melbourne, Parkville, Victoria, Australia
| | - Jemma Evans
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Tracey A Edgell
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, Victoria, Australia; Department of Molecular and Translational Science, Monash University, Clayton, Victoria, Australia
| | - Guiying Nie
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, Victoria, Australia; Department of Molecular and Translational Science, Monash University, Clayton, Victoria, Australia; School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - David K Gardner
- School of BioSciences, University of Melbourne, Parkville, Victoria, Australia
| | - Lois A Salamonsen
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, Victoria, Australia; Department of Molecular and Translational Science, Monash University, Clayton, Victoria, Australia.
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Xiao J, Gong Y, Chen F, Chen L, Xie Y, Sui L. Clinical Diagnostic Value of Atypical Glandular Cells in Cervical Cytology: A Single Center Experience From China. J Low Genit Tract Dis 2023; 27:202-206. [PMID: 36946382 DOI: 10.1097/lgt.0000000000000730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
OBJECTIVE This study aimed to investigate the diagnostic value of atypical glandular cells (AGCs) by analyzing the prevalence and histopathology of AGCs according to cervical cytology. METHODS The authors retrospectively reviewed and analyzed the demographic characteristics and histopathological outcomes including pathological diagnosis, pathological site, and epithelial distribution of the AGC cases that were diagnosed by cervical cytology. RESULTS A total of 387 AGC patients with follow-up records were included. Among them, the prevalence of AGC-not otherwise specified (NOS) and AGC-favor neoplastic (FN) was 73.39% (284/387) and 26.62% (103/387), respectively. The high-risk human papillomavirus (hr-HPV)-positive rate was higher in AGC-FN than in AGC-NOS ( p = .002). The difference in pathological severity was statistically significant between hr-HPV-positive and negative AGC patients ( p = .010). Hr-HPV-positive AGC mainly occurs in cervical diseases, whereas hr-HPV-negative AGC is mainly related to endometrial lesions. Precancerous or malignant lesions were found in 36.43% (141/387) of AGC cases and were more commonly seen in AGC-FN than AGC-NOS ( p < .001). The histopathological severity and the incidence of uterine disease were higher among AGC women aged 40 years and older than those younger than 40 years ( p < .05). The possibility of the abnormal origin of glandular epithelial was higher than that of squamous epithelial in AGC patients aged 40 years and older ( p = .0003). CONCLUSIONS The management of AGC women by age triage is reasonable because the incidence of the glandular epithelial lesion and uterine disease increases in AGC patients 40 years or older. Standardized clinical diagnosis and regular follow-up are recommended for all AGC patients.
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Urban A, Warzecha D, Laudanski P, Pietrzak B, Wielgos M. Personalized embryo transfer (pET) guided by endometrial receptivity (ER) assessment - a possibility to increase effectiveness of IVF procedures. Review of available methods. Ginekol Pol 2023; 94:1004-1010. [PMID: 37162136 DOI: 10.5603/gp.a2023.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 10/16/2022] [Indexed: 05/11/2023] Open
Abstract
The continuous development of assisted reproductive techniques (ART) implies the search for solutions that could increase the effectiveness ofavailable methods. In the context of in vitro fertilization (IVF), a significant proportion of failures are due to unsuccessful embryo transfers. At this stage the most important issue is proper dialogue between implanting embryo and the maternal endometrium. Therefore, it seems justified to assess endometrial receptivity (ER), defined as the tissue's ability to accept an embryo to attach and invade into the mucosa. Window of implantation (WOI), is a certain period in which implantation of the properly developed embryo is possible. The cause of endometrial receptivity disorders is believed to be the disturbed expression of cytokines and endometrial surface proteins, the presence of which has been proven in commonly diagnosed diseases such as endometriosis or chronic endometritis. Despite many years of research on endometrial receptivity, the area of diagnostic methods enabling clinical monitoring of ER still remains undeveloped. The aim of this study is to review the utility of selected markers and the available methods of ER assessment, ranging from noninvasive ultrasound, through endometrial fluid analysis, to genomic studies based on endometrial biopsy, in order to increase the effectiveness of IVF. Such an approach could potentially be a significant step towards personalizing medical procedures especially in patients diagnosed with repeated implantation failure (RIF).
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Affiliation(s)
- Aleksandra Urban
- III Faculty and Clinic of Obstetrics and Gynaecology, Medical University of Warsaw, Warsaw, Poland
| | - Damian Warzecha
- OVIklinika Infertility Center, Warsaw, Poland.
- Poludniowy Hospital, Warsaw, Poland, Poland.
| | - Piotr Laudanski
- Department of Obstetrics, Gynecology and Gynecological Oncology, Medical University of Warsaw, Poland
- Women's Health Research Institute, Calisia University, Kalisz, Poland
- III Faculty and Clinic of Obstetrics and Gynaecology, Medical University of Warsaw, Warsaw, Poland
| | | | - Miroslaw Wielgos
- Faculty of Medicine, Lazarski Uniwersity, Warsaw, Poland, Poland
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Li D, Jiang T, Wang X, Yin T, Shen L, Zhang Z, Zou W, Liu Y, Zong K, Liang D, Cao Y, Xu X, Liang C, Ji D. Serum Essential Trace Element Status in Women and the Risk of Endometrial Diseases: a Case-Control Study : Serum Essential Trace Element Status in Women and the Risk of Endometrial Diseases: a Case-Control Study. Biol Trace Elem Res 2023; 201:2151-2161. [PMID: 35725996 DOI: 10.1007/s12011-022-03328-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 06/11/2022] [Indexed: 11/02/2022]
Abstract
Endometrial diseases, including uterine fibroids, polyps, intrauterine adhesion, endometritis, etc., are the major causes of infertility among women. However, the association between essential trace element status in women and the risk of endometrial disease is limited and unclear. This study aimed to investigate this association using a case-control study design; a total of 302 women patients with endometrial diseases and 302 healthy women were included. Compared to women in the control group, serum selenium (Se) (p = 0.024) and zinc (Zn) (p = 0.017) levels were significantly lower, while copper (Cu) (p = 0.004) and molybdenum (Mo) (p = 0.005) levels were significantly higher among women with endometrial diseases. In addition, compared to women in the first quartile of the copper/zinc (Cu/Zn) ratio value group, the adjusted ORs (95% CIs) of endometrial diseases were 1.50 (1.05, 2.14), 1.68 (1.18, 2.39), and 1.47 (1.02, 2.10), respectively, in the second, third, and fourth quartile of the Cu/Zn ratio value group (p trend = 0.047). In addition, the results from restricted cubic splines showed that the dose-response relationships of serum levels of these essential elements with the risk of endometrial diseases were nonlinear for Se, Cu, and Zn and relatively linear for Mo and Cu/Zn ratio. The present study showed serum levels of Zn and Se among women with endometrial diseases were significantly lower compared to that among healthy women, while serum levels of Cu and Mo were significantly higher, in addition, the serum Cu/Zn ratio value was also significantly and positively associated with the risk of endometrial diseases.
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Affiliation(s)
- Danyang Li
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, Anhui, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Engineering Research Center of Biopreservation and Artificial Organs, No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Institute of Translational Medicine, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Tingting Jiang
- School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Xin Wang
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, Anhui, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Engineering Research Center of Biopreservation and Artificial Organs, No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Institute of Translational Medicine, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Tao Yin
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, Anhui, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Engineering Research Center of Biopreservation and Artificial Organs, No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Institute of Translational Medicine, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Lingchao Shen
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, Anhui, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Engineering Research Center of Biopreservation and Artificial Organs, No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Institute of Translational Medicine, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Zhikang Zhang
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, Anhui, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Engineering Research Center of Biopreservation and Artificial Organs, No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Institute of Translational Medicine, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Weiwei Zou
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, Anhui, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Engineering Research Center of Biopreservation and Artificial Organs, No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Institute of Translational Medicine, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Yajing Liu
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, Anhui, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Engineering Research Center of Biopreservation and Artificial Organs, No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Institute of Translational Medicine, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Kai Zong
- Technical Center of Hefei Customs District, No. 329 Tunxi Road, Hefei, 230022, Anhui, China
| | - Dan Liang
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, Anhui, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Engineering Research Center of Biopreservation and Artificial Organs, No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Institute of Translational Medicine, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Yunxia Cao
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, Anhui, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Engineering Research Center of Biopreservation and Artificial Organs, No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Institute of Translational Medicine, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Xiaofeng Xu
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, Anhui, China.
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No. 81 Meishan Road, Hefei, 230032, Anhui, China.
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei, 230032, Anhui, China.
- Anhui Province Key Laboratory of Reproductive Health and Genetics, No. 81 Meishan Road, Hefei, 230032, Anhui, China.
- Anhui Provincial Engineering Research Center of Biopreservation and Artificial Organs, No. 81 Meishan Road, Hefei, 230032, Anhui, China.
- Anhui Provincial Institute of Translational Medicine, No. 81 Meishan Road, Hefei, 230032, Anhui, China.
| | - Chunmei Liang
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, Anhui, China.
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No. 81 Meishan Road, Hefei, 230032, Anhui, China.
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei, 230032, Anhui, China.
- Anhui Province Key Laboratory of Reproductive Health and Genetics, No. 81 Meishan Road, Hefei, 230032, Anhui, China.
- Anhui Provincial Engineering Research Center of Biopreservation and Artificial Organs, No. 81 Meishan Road, Hefei, 230032, Anhui, China.
- Anhui Provincial Institute of Translational Medicine, No. 81 Meishan Road, Hefei, 230032, Anhui, China.
- School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China.
| | - Dongmei Ji
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, Anhui, China.
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No. 81 Meishan Road, Hefei, 230032, Anhui, China.
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei, 230032, Anhui, China.
- Anhui Province Key Laboratory of Reproductive Health and Genetics, No. 81 Meishan Road, Hefei, 230032, Anhui, China.
- Anhui Provincial Engineering Research Center of Biopreservation and Artificial Organs, No. 81 Meishan Road, Hefei, 230032, Anhui, China.
- Anhui Provincial Institute of Translational Medicine, No. 81 Meishan Road, Hefei, 230032, Anhui, China.
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Ruiz-Magaña MJ, Puerta JM, Llorca T, Méndez-Malagón C, Martínez-Aguilar R, Abadía-Molina AC, Olivares EG, Ruiz-Ruiz C. Influence of the ectopic location on the antigen expression and functional characteristics of endometrioma stromal cells. Reprod Biomed Online 2023; 46:460-469. [PMID: 36586747 DOI: 10.1016/j.rbmo.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/28/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
RESEARCH QUESTION Are the alterations observed in the endometriotic cells, such as progesterone resistance, already present in the eutopic endometrium or acquired in the ectopic location? DESIGN The response to decidualization with progesterone and cyclic AMP for up to 28 days was compared in different endometrial stromal cell (EnSC) lines established from samples of endometriomas (eEnSC), eutopic endometrium from women with endometriosis (eBEnSC), endometrial tissue from healthy women (BEnSC) and menstrual blood from healthy donors (mEnSC). RESULTS Usual features of decidualized cells, such as changes in cell morphology and expression of prolactin, were similarly observed in the three types of eutopic EnSC studied, but not in the ectopic cells upon decidualization. Among the phenotypic markers analysed, CD105 was down-regulated under decidualization in all cell types (mEnSC, P = 0.005; BEnSC, P = 0.029; eBEnSC, P = 0.022) except eEnSC. mEnSC and BEnSC underwent apoptosis during decidualization, whereas eBEnSC and eEnSC were resistant to the induction of cell death. Lastly, migration studies revealed that mEnSC secreted undetermined factors during decidualization that inhibited cell motility, whereas eEnSC showed a significantly lower ability to produce those migration-regulating factors (P < 0.0001, P < 0.001 and P = 0.0013 for the migration of mEnSC at 24, 48 and 72 h, respectively; P < 0.0001 for the migration of eEnSC at all times studied). CONCLUSIONS This study provides novel insights into the differences between endometriotic and eutopic endometrial cells and reinforces the idea that the microenvironment in the ectopic location plays additional roles in the acquisition of the alterations that characterize the cells of the endometriotic foci.
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Affiliation(s)
- María José Ruiz-Magaña
- Instituto de Biopatología y Medicina Regenerativa, Centro de Investigación Biomédica, Universidad de Granada, Armilla, Granada, Spain
| | - José M Puerta
- Instituto de Biopatología y Medicina Regenerativa, Centro de Investigación Biomédica, Universidad de Granada, Armilla, Granada, Spain; Hospital Quirón Ruber Juan Bravo, Madrid, Spain
| | - Tatiana Llorca
- Instituto de Biopatología y Medicina Regenerativa, Centro de Investigación Biomédica, Universidad de Granada, Armilla, Granada, Spain; Departamento de Bioquímica y Biología Molecular III e Inmunología, Universidad de Granada, Granada, Spain
| | - Cristina Méndez-Malagón
- Instituto de Biopatología y Medicina Regenerativa, Centro de Investigación Biomédica, Universidad de Granada, Armilla, Granada, Spain; Departamento de Bioquímica y Biología Molecular III e Inmunología, Universidad de Granada, Granada, Spain
| | - Rocío Martínez-Aguilar
- Instituto de Biopatología y Medicina Regenerativa, Centro de Investigación Biomédica, Universidad de Granada, Armilla, Granada, Spain; Departamento de Bioquímica y Biología Molecular III e Inmunología, Universidad de Granada, Granada, Spain; Medical Research Council Centre for Reproductive Health, University of Edinburgh, Scotland, UK
| | - Ana Clara Abadía-Molina
- Instituto de Biopatología y Medicina Regenerativa, Centro de Investigación Biomédica, Universidad de Granada, Armilla, Granada, Spain; Departamento de Bioquímica y Biología Molecular III e Inmunología, Universidad de Granada, Granada, Spain
| | - Enrique G Olivares
- Instituto de Biopatología y Medicina Regenerativa, Centro de Investigación Biomédica, Universidad de Granada, Armilla, Granada, Spain; Departamento de Bioquímica y Biología Molecular III e Inmunología, Universidad de Granada, Granada, Spain; Unidad de Gestión Clínica Laboratorios, Complejo Hospitalario Universitario de Granada, Granada, Spain.
| | - Carmen Ruiz-Ruiz
- Instituto de Biopatología y Medicina Regenerativa, Centro de Investigación Biomédica, Universidad de Granada, Armilla, Granada, Spain; Departamento de Bioquímica y Biología Molecular III e Inmunología, Universidad de Granada, Granada, Spain.
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Wu X, Yang X, Tian Y, Xu P, Yue H, Sang N. Bisphenol B and bisphenol AF exposure enhances uterine diseases risks in mouse. Environ Int 2023; 173:107858. [PMID: 36881955 DOI: 10.1016/j.envint.2023.107858] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/26/2023] [Accepted: 02/26/2023] [Indexed: 06/18/2023]
Abstract
Bisphenol A (BPA) analogs, bisphenol B (BPB) and bisphenol AF (BPAF) have been widely detected in the environment and human products with increasing frequency. However, uterine health risks caused by BPB and BPAF exposure need to be further elucidated. The study aimed to explore whether BPB or BPAF exposure will induce adverse outcomes in uterus. Female CD-1 mice were continuously exposed to BPB or BPAF for 14 and 28 days. Morphological examination showed that BPB or BPAF exposure caused endometrial contraction, decreased epithelial height, and increased number of glands. Bioinformatics analysis indicated that both BPB and BPAF disturbed the immune comprehensive landscape of the uterus. In addition, survival and prognosis analysis of hub genes and tumor immune infiltration evaluation were performed. Finally, the expression of hub genes was verified by quantitative real-time PCR (qPCR). Disease prediction found that eight of the BPB and BPAF co-response genes, which participated in the immune invasion of the tumor microenvironment, were associated with uterine corpus endometrial carcinoma (UCEC). Importantly, the gene expression levels of Srd5a1 after 28-day BPB and BPAF exposure were 7.28- and 25.24-fold higher than those of the corresponding control group, respectively, which was consistent with the expression trend of UCEC patients, and its high expression was significantly related to the poor prognosis of patients (p = 0.003). This indicated that Srd5a1 could be a valuable signal of uterus abnormalities caused by BPA analogs exposure. Our study revealed the key molecular targets and mechanisms of BPB or BPAF exposure induced uterine injury at the transcriptional level, providing a perspective for evaluating the safety of BPA substitutes.
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Affiliation(s)
- Xiaoyun Wu
- College of Environment and Resource, Research Center of Environment and Health, Shanxi University, Taiyuan, Shanxi 030006, PR China
| | - Xiaowen Yang
- College of Environment and Resource, Research Center of Environment and Health, Shanxi University, Taiyuan, Shanxi 030006, PR China
| | - Yuchai Tian
- College of Environment and Resource, Research Center of Environment and Health, Shanxi University, Taiyuan, Shanxi 030006, PR China
| | - Pengchong Xu
- College of Environment and Resource, Research Center of Environment and Health, Shanxi University, Taiyuan, Shanxi 030006, PR China
| | - Huifeng Yue
- College of Environment and Resource, Research Center of Environment and Health, Shanxi University, Taiyuan, Shanxi 030006, PR China.
| | - Nan Sang
- College of Environment and Resource, Research Center of Environment and Health, Shanxi University, Taiyuan, Shanxi 030006, PR China
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Ruan H, Chen S, Li J, Ma L, Luo J, Huang Y, Ying Q, Zhou J. Development and Validation of a Nomogram Prediction Model for Endometrial Malignancy in Patients with Abnormal Uterine Bleeding. Yonsei Med J 2023; 64:197-203. [PMID: 36825346 PMCID: PMC9971439 DOI: 10.3349/ymj.2022.0239] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 11/22/2022] [Accepted: 12/10/2022] [Indexed: 02/17/2023] Open
Abstract
PURPOSE This study aimed to identify the risk factors and sonographic variables that could be integrated into a predictive model for endometrial cancer (EC) and atypical endometrial hyperplasia (AEH) in women with abnormal uterine bleeding (AUB). MATERIALS AND METHODS This retrospective study included 1837 patients who presented with AUB and underwent endometrial sampling. Multivariable logistic regression was developed based on clinical and sonographic covariates [endometrial thickness (ET), resistance index (RI) of the endometrial vasculature] assessed for their association with EC/AEH in the development group (n=1369), and a predictive nomogram was proposed. The model was validated in 468 patients. RESULTS Histological examination revealed 167 patients (12.2%) with EC or AEH in the development group. Using multivariable logistic regression, the following variables were incorporated in the prediction of endometrial malignancy: metabolic diseases [odds ratio (OR)=7.764, 95% confidence intervals (CI) 5.042-11.955], family history (OR=3.555, 95% CI 1.055-11.971), age ≥40 years (OR=3.195, 95% CI 1.878-5.435), RI ≤0.5 (OR=8.733, 95% CI 4.311-17.692), and ET ≥10 mm (OR=8.479, 95% CI 5.440-13.216). A nomogram was created using these five variables with an area under the curve of 0.837 (95% CI 0.800-0.874). The calibration curve showed good agreement between the observed and predicted occurrences. For the validation group, the model provided acceptable discrimination and calibration. CONCLUSION The proposed nomogram model showed moderate prediction accuracy in the differentiation between benign and malignant endometrial lesions among women with AUB.
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Affiliation(s)
- Hengchao Ruan
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Suhan Chen
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingyi Li
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Linjuan Ma
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jie Luo
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yizhou Huang
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qian Ying
- Institute of Cancer and Basic Medicine, Zhejiang Cancer Hospital, Hangzhou, China
| | - Jianhong Zhou
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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He A, Wu H, Zou Y, Wan C, Zhao J, Zhang Q, Liu N, Liu D, Li Y, Fu J, Li H, Huang X, Yang T, Hu C, Hou Z, Sun Y, Dong X, Wu J, Lu S, Li Y. Can biomarkers identified from the uterine fluid transcriptome be used to establish a noninvasive endometrial receptivity prediction tool? A proof-of-concept study. Reprod Biol Endocrinol 2023; 21:20. [PMID: 36805767 PMCID: PMC9938621 DOI: 10.1186/s12958-023-01070-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 02/04/2023] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND Embryo implantation in a receptive endometrium is crucial for successful pregnancy. Endometrial receptivity (ER) prediction tools based on endometrial transcriptome biomarkers by endometrial biopsy have been used to guide successful embryo implantation in in vitro fertilization (IVF) patients. However, no reliable noninvasive ER prediction method has been established, and one is greatly needed. We aimed to identify biomarkers from uterine fluid transcriptomic sequencing data for establishing noninvasive ER prediction tool and to evaluate its clinical application potential in patients undergoing IVF. METHODS The non-invasive RNA-seq based endometrial receptivity test (nirsERT) was established by analyzing transcriptomic profile of 144 uterine fluid specimens (LH + 5, LH + 7, and LH + 9) at three different receptive status from 48 IVF patients with normal ER in combination with random forest algorithm. Subsequently, 22 IVF patients who underwent frozen-thaw blastocyst transfer were recruited and analyzed the correlation between the predicted results of nirsERT and pregnancy outcomes. RESULTS A total of 864 ER-associated differentially expressed genes (DEGs) involved in biological processes associated with endometrium-embryo crosstalk, including protein binding, signal reception and transduction, biomacromolecule transport and cell-cell adherens junctions, were selected. Subsequently, a nirsERT model consisting of 87 markers and 3 hub genes was established using a random forest algorithm. 10-fold cross-validation resulted in a mean accuracy of 93.0%. A small cohort (n = 22) retrospective observation shows that 77.8% (14/18) of IVF patients predicted with a normal WOI had successful intrauterine pregnancies, while none of the 3 patients with a displaced WOI had successful pregnancies. One patient failed due to poor sequencing data quality. CONCLUSIONS NirsERT based on uterine fluid transcriptome biomarkers can predict the WOI period relatively accurately and may serve as a noninvasive, reliable and same cycle test for ER in reproductive clinics. TRIAL REGISTRATION Chinese Clinical Trial Registry: ChiCTR-DDD-17013375. Registered 14 November 2017, http://www.chictr.org.cn/index.aspx .
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Affiliation(s)
- Aihua He
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410000, Hunan Province, China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha, 410000, Hunan, China
- Department of Reproductive Medicine, Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China
| | - Hong Wu
- Department of ENT, Xiangya Hospital, Central South University, Changsha, 410000, Hunan, China
| | - Yangyun Zou
- Department of Clinical Research, Yikon Genomics Company, Ltd., #301, Building A3, No. 218, Xinghu Street, Suzhou, 215123, Jiangsu, China
| | - Cheng Wan
- Department of Clinical Research, Yikon Genomics Company, Ltd., #301, Building A3, No. 218, Xinghu Street, Suzhou, 215123, Jiangsu, China
| | - Jing Zhao
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410000, Hunan Province, China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha, 410000, Hunan, China
| | - Qiong Zhang
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410000, Hunan Province, China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha, 410000, Hunan, China
| | - Nenghui Liu
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410000, Hunan Province, China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha, 410000, Hunan, China
| | - Donge Liu
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410000, Hunan Province, China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha, 410000, Hunan, China
| | - Yumei Li
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410000, Hunan Province, China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha, 410000, Hunan, China
| | - Jing Fu
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410000, Hunan Province, China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha, 410000, Hunan, China
| | - Hui Li
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410000, Hunan Province, China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha, 410000, Hunan, China
| | - Xi Huang
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410000, Hunan Province, China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha, 410000, Hunan, China
| | - Tianli Yang
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410000, Hunan Province, China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha, 410000, Hunan, China
| | - Chunxu Hu
- Department of Clinical Research, Yikon Genomics Company, Ltd., #301, Building A3, No. 218, Xinghu Street, Suzhou, 215123, Jiangsu, China
| | - Zhaojuan Hou
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410000, Hunan Province, China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha, 410000, Hunan, China
| | - Yue Sun
- Department of Clinical Research, Yikon Genomics Company, Ltd., #301, Building A3, No. 218, Xinghu Street, Suzhou, 215123, Jiangsu, China
| | - Xin Dong
- Department of Clinical Research, Yikon Genomics Company, Ltd., #301, Building A3, No. 218, Xinghu Street, Suzhou, 215123, Jiangsu, China
| | - Jian Wu
- Department of Clinical Research, Yikon Genomics Company, Ltd., #301, Building A3, No. 218, Xinghu Street, Suzhou, 215123, Jiangsu, China
| | - Sijia Lu
- Department of Clinical Research, Yikon Genomics Company, Ltd., #301, Building A3, No. 218, Xinghu Street, Suzhou, 215123, Jiangsu, China.
| | - Yanping Li
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410000, Hunan Province, China.
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha, 410000, Hunan, China.
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Li Q. Clinical Effect of Intrauterine 3-Dimensional Ultrasound on the Function of the Intrauterine Cavity of Puerpera With Intrauterine Adhesions and Safety of Pregnancy. Ultrasound Q 2022; 38:267-271. [PMID: 35363666 DOI: 10.1097/ruq.0000000000000607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT This study aimed to analyze the diagnostic value of intrauterine 3-dimensional ultrasound and the functional characteristics of the intrauterine cavity for puerpera with intrauterine adhesions, and to explore the safety of pregnancy after treatment. A total of 102 puerperas with intrauterine adhesions were randomly selected, and intrauterine 3-dimensional ultrasound and 2-dimensional ultrasound were performed, respectively. Patients were followed up for 3 years to observe the pregnancy outcome and safety. The overall accuracy of diagnosing intrauterine adhesions through intrauterine 3-dimensional ultrasound was significantly higher than that through 2-dimensional ultrasound, and the accuracy of detecting mild intrauterine adhesions was significantly higher than that through 2-dimensional ultrasound, with statistically significant difference ( P < 0.05). There was no significant difference in the accuracy between intrauterine 3-dimensional and 2-dimensional ultrasound in detecting moderate and severe intrauterine adhesions ( P > 0.05). The difference in missed diagnosis and misdiagnosis rates between the 2 methods was statistically significant ( P < 0.05). All patients received hysteroscopic surgery, and 78 cases (76.47%) were naturally fertilized during postoperative follow-up, including 24 cases of mature delivery, 45 cases of cesarean delivery, and 9 cases of spontaneous abortion. The intrauterine 3-dimensional ultrasound examination of the intrauterine cavity will provide intuitive and comprehensive diagnostic information for a parturient with intrauterine adhesion. Its detection accuracy is higher, and the clinical application is noninvasive and safe, which has certain guiding significance for treatment.
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Affiliation(s)
- Qin Li
- Department of Ultrasound, Taizhou People's Hospital, Taizhou, Jiangsu, China
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Lv M, Yu J, Huang Y, Ma J, Xiang J, Wang Y, Li L, Zhang Z, Liao H. Androgen Signaling in Uterine Diseases: New Insights and New Targets. Biomolecules 2022; 12:1624. [PMID: 36358974 PMCID: PMC9687413 DOI: 10.3390/biom12111624] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 10/30/2022] [Accepted: 10/31/2022] [Indexed: 12/06/2023] Open
Abstract
Common uterine diseases include endometriosis, uterine fibroids, endometrial polyps, endometrial hyperplasia, endometrial cancer, and endometrial dysfunction causing infertility. Patients with uterine diseases often suffer from abdominal pain, menorrhagia, infertility and other symptoms, which seriously impair their health and disturb their lives. Androgens play important roles in the normal physiological functions of the uterus and pathological progress of uterine diseases. Androgens in women are synthesized in the ovaries and adrenal glands. The action of androgens in the uterus is mainly mediated by its ligand androgen receptor (AR) that regulates transcription of the target genes. However, much less is known about the signaling pathways through which androgen functions in uterine diseases, and contradictory findings have been reported. This review summarizes and discusses the progress of research on androgens and the involvement of AR in uterine diseases. Future studies should focus on developing new therapeutic strategies that precisely target specific AR and their related signaling pathways in uterine diseases.
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Affiliation(s)
- Mu Lv
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Juanjuan Yu
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Yan Huang
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai 200032, China
| | - Jie Ma
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Jun Xiang
- Department of Urology, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Yanqiu Wang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Linxia Li
- Department of Obstetrics and Gynecology, Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine, 358 Datong Road, Shanghai 200137, China
| | - Zhenbo Zhang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200135, China
| | - Hong Liao
- Department of Clinical Laboratory Medicine, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 200040, China
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Ryu KJ, Kim MS, Lee JY, Nam S, Jeong HG, Kim T, Park H. Risk of Endometrial Polyps, Hyperplasia, Carcinoma, and Uterine Cancer After Tamoxifen Treatment in Premenopausal Women With Breast Cancer. JAMA Netw Open 2022; 5:e2243951. [PMID: 36441547 PMCID: PMC9706361 DOI: 10.1001/jamanetworkopen.2022.43951] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
IMPORTANCE The association of tamoxifen use with the risk of uterine diseases, such as endometrial cancer, in premenopausal women with breast cancer remains controversial. However, many studies have reported an increased risk of uterine disease among postmenopausal tamoxifen users. OBJECTIVE To investigate the association of tamoxifen use with the risk of endometrial cancer and other uterine diseases in premenopausal women with breast cancer. DESIGN, SETTING, AND PARTICIPANTS A nationwide, population-based, retrospective longitudinal cohort study with an 18-year study period was conducted using data obtained from the Korean National Health Insurance Service. Participants included premenopausal women aged 20 to 50 years with breast cancer diagnoses between January 2003 and December 2018. Data were analyzed from April to December 2021. EXPOSURES Tamoxifen treatment. MAIN OUTCOMES AND MEASURES The incidence of uterine diseases, including endometrial cancer, hyperplasia, polyps, and other uterine cancers, was identified in the study cohort using insurance claim codes. The incidence of uterine diseases per 1000 person-years was compared between women receiving tamoxifen and those not treated with adjuvant hormone therapy. Multivariable Cox proportional hazard regression analysis was performed to determine the risk of each uterine disease. RESULTS Among 78 320 female participants with a mean (SD) age of 42.1 (6.1) years, 34 637 (44.2%) were categorized into the tamoxifen group and 43 683 (55.8%) were categorized into the control group. Among tamoxifen users, during the mean (SD) follow-up duration of 6.13 (4.15) years, the incidence of newly diagnosed endometrial polyps was 20.13 cases per 1000 person-years, that of endometrial hyperplasia was 13.49 cases per 1000 person-years, that of endometrial cancer was 2.01 cases per 1000 person-years, and that of other uterine cancers was 0.45 cases per 1000 person-years. The risk of endometrial cancer was higher in the tamoxifen group than in the control group (hazard ratio, 3.77; 95% CI, 3.04-4.66) after adjusting for age, body mass index, history of diabetes, hypertension, dyslipidemia, polycystic ovary syndrome, gonadotropin-releasing hormone agonist treatment, and trastuzumab treatment. CONCLUSIONS AND RELEVANCE In this longitudinal cohort study, premenopausal Korean women with breast cancer who received tamoxifen as adjuvant hormone therapy had a significantly increased risk of endometrial hyperplasia, polyps, carcinoma, and other uterine cancers compared with those who were not treated with adjuvant hormone therapy. These findings suggest that clinicians should consider the risk of uterine disease among tamoxifen users, including premenopausal women.
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Affiliation(s)
- Ki-Jin Ryu
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Korea University College of Medicine, Seongbuk-gu, Seoul, Republic of Korea
| | - Min Sun Kim
- Department of Biostatistics, Korea University Anam Hospital, Korea University College of Medicine, Seongbuk-gu, Seoul, Republic of Korea
| | - Ji Yoon Lee
- Department of Biostatistics, Korea University Anam Hospital, Korea University College of Medicine, Seongbuk-gu, Seoul, Republic of Korea
| | - Seunghyun Nam
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Korea University College of Medicine, Seongbuk-gu, Seoul, Republic of Korea
| | - Hye Gyeong Jeong
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Korea University College of Medicine, Seongbuk-gu, Seoul, Republic of Korea
| | - Tak Kim
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Korea University College of Medicine, Seongbuk-gu, Seoul, Republic of Korea
| | - Hyuntae Park
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Korea University College of Medicine, Seongbuk-gu, Seoul, Republic of Korea
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Akbari Sene A, Farzaneh F, Mehrnami A, Faizei AM, Alizadeh A, Saadat Mostafavi SR, Ghaffari E. Diagnostic value and agreement of transrectal in comparison with transvaginal sonography among women with abnormal uterine bleeding. J Ultrasound 2022; 25:687-697. [PMID: 35032024 PMCID: PMC9402856 DOI: 10.1007/s40477-021-00647-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 12/02/2021] [Indexed: 11/25/2022] Open
Abstract
AIMS Transvaginal sonography (TVS) is not applicable for evaluating the endometrium in some cases with abnormal uterine bleeding (AUB) such as virgin women. The aim of the present study was to investigate the diagnostic value of transrectal sonography (TRS), as a non-invasive alternative for TVS, among women with AUB. METHODS In this cross-sectional study, 40 women over 40 years of age with AUB first underwent TRS and then TVS. Endometrial biopsy was also performed as a gold standard method to evaluate endometrial pathologies. The findings of the two endometrial ultrasound methods were compared with the biopsy results. Also, the findings of the two methods were compared in terms of the agreement on other uterine markers and adnexal findings. RESULTS There was a high agreement between the findings of TVS and TRS for uterine size, endometrial thickness and homogeneity, endomyometrial junction, myometrial homogeneity, uterine lesions, uterine lesions size, ovarian size and ovarian echogenicity. When comparing the results of these two methods with biopsy findings, sensitivity, specificity as well as positive and negative predictive values of both methods were similar (82%, 100%, 100%, and 0%, respectively). CONCLUSION When it is not possible to use TVS in women with AUB, TRS is a suitable, non-invasive and inexpensive alternative method for evaluating the endometrium and other genital organs.
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Affiliation(s)
- Azadeh Akbari Sene
- Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Farah Farzaneh
- Preventive Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Afsaneh Mehrnami
- Shahid Akbar-Abadi Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Mohammad Faizei
- Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahad Alizadeh
- Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Seyed Reza Saadat Mostafavi
- Radiology Department of Radiology, School of Medicine, Hazrat-e Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Elnaz Ghaffari
- Preventive Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Morais M, Moura M, Correia A, Fan Y. Urinary tract obstruction in the second trimester: a report of an incarcerated gravid uterus. BMJ Case Rep 2022; 15:15/9/e249986. [PMID: 36175041 PMCID: PMC9528483 DOI: 10.1136/bcr-2022-249986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Incarceration of the gravid uterus (IGU) is a rare obstetric disorder that may lead to pregnancy-related complications. Acute urinary retention (AUR) is one of the associated symptoms in IGU and it is mostly observed in the first semester and early second trimester. A case of a woman, in her 30s, is described, who presented AUR and lower abdominal pain in the early second trimester. The diagnosis was confirmed upon pelvic examination, and abdominal and transvaginal ultrasound. Management included long-term bladder catheterisation, manual reduction manoeuvres and passive positioning manoeuvres at home. At 24 weeks of gestation, the uterus returned in its correct polarity, the Foley catheter was removed and the patient was able to void spontaneously. A healthy infant was delivered vaginally at term. No specific guidelines have been published for IGU treatment. However, prompt diagnosis and tight follow-up of these patients are essential to define strategies, reduce complications and prevent recurrences.
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Affiliation(s)
- Mariana Morais
- Obstetrics and Gynecology, Centro Hospitalar de Trás-os-montes e Alto Douro EPE, Vila Real, Portugal
| | - Mário Moura
- Obstetrics and Gynecology, Centro Hospitalar de Trás-os-montes e Alto Douro EPE, Vila Real, Portugal
| | - Ana Correia
- Obstetrics and Gynecology, Centro Hospitalar de Trás-os-montes e Alto Douro EPE, Vila Real, Portugal
| | - Yida Fan
- Obstetrics and Gynecology, Centro Hospitalar de Trás-os-montes e Alto Douro EPE, Vila Real, Portugal
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Gynecologic Endocrinology Subgroup, Chinese Society of Obstetrics and Gynecology, Chinese Medical Association. [Guideline on diagnosis and treatment of abnormal uterine bleeding: 2022 revisions]. Zhonghua Fu Chan Ke Za Zhi 2022; 57:481-90. [PMID: 35902781 DOI: 10.3760/cma.j.cn112141-20220421-00258] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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