[Relative factors of expectant management of ectopic pregnancy].

OBJECTIVE: To analyze select patients of ectopic pregnancy for expectant management. METHODS: Retrospective analyses were conducted for the relative factors of 180 cases of ectopic pregnancy with expectant management at Department of Family Planning of our hospital from August 2004 to January 2012. Their general clinical data, clinical manifestations and laboratory tests were collected. The cases requiring neither surgery nor drug therapy belonged to the cure group while the rest fell into the failure group. RESULTS: A total of 140 patients were successfully managed with a cure rate of 75.27%. There was no significant difference between two groups in size of mass on ultrasonography (P > 0.05). The cases with gestational sac of mass on ultrasonography had statistical difference between two groups (P < 0.05). Statistical difference existed between two groups (P < 0.01) in initial blood beta-human chorionic gonadotropin (ß-hCG), initial bloodß-hCG and D3-5/D0 (ratio of bloodß-hCG at day 3 - 5 and initial) were the variables for predicting the likelihood of successful expectant management under the ROC curve. The Youden Index was the largest at an initial bloodß-hCG of 634 IU/L or D3-5/D0 of 0.711. CONCLUSION: At blood ß-hCG ≤ 634 IU/L or D3-5/D0 < 0.711, expectant management may be offered. And mass with gestational sac on ultrasonography is a relative factor of expectant management.

[Comparison of ultrasound plus radiography versus computed tomography in the diagnosis of ectopic intrauterine devices].

OBJECTIVE: To compare the effectiveness of ultrasound plus radiography versus computed tomography (CT) in the diagnosis of ectopic intrauterine device (IUD) and analyze the ratio of cost and effectiveness (C/E) so as to provide scientific rationales for the selection of appropriate diagnostic methods. METHODS: A total of 70 cases were recruited from two major Chinese hospitals in 2009. They were examined with ultrasound plus radiography and CT respectively. The gold diagnostic criterion was postoperative diagnosis to compare the sensitivity, specificity, diagnostic index (DI), accuracy and C/E for different diagnostic methods. The SPSS 13.0 statistical analysis software was employed for data analysis. RESULTS: The data of 65 subjects were collected and analyzed. For ultrasound plus radiography, the sensitivity, specificity, DI, accuracy and C/E were 82.1%, 88.9%, 171.0%, 83.1% and 137.3 respectively. As for CT, the above indices were 96.4%, 55.6%, 152.0%, 90.8% and 170.7 respectively. CONCLUSION: Considering the higher levels of specificity and DI and a lower C/E, ultrasound plus radiography is superior to CT so that the former modality shall become a first-choice in the diagnosis of ectopic IUD, especially at the grass-root family planning service stations.

Biological characteristics of human placental mesenchymal stem cells and their proliferative response to various cytokines.

The placenta is an attractive new source of mesenchymal stem cells (MSCs), but the biological characteristics of placenta-derived MSCs (P-MSCs) have not yet been characterized. We successfully isolated, cultured and expanded P-MSCs using routine methods. Under appropriate induction conditions, these cells can differentiate into bone, cartilage, fat and hepatocyte-like cells. In addition, the proliferative response of P-MSCs to different cytokines was monitored using the MTT assay. The results show that low concentrations of proinflammatory cytokines, e.g. RANTES, interleukin (IL)-1, IL-6 and IL-8 can stimulate the proliferation of P-MSCs in a dose-dependent manner, peaking at concentrations of 40 ng/ml of RANTES, 10 ng/ml of IL-1 and IL-6, and 150 ng/ml of IL-8 (p < 0.01). The level of proliferation decreased when the concentration of these four cytokines increased beyond these values. On the other hand, anti-inflammatory cytokines hepatocyte growth factor and IL-4 had an inhibitory effect on P-MSCs. In conclusion, the placenta contains MSCs that are consistent with the characteristics of bone marrow MSCs. Low concentrations of proinflammatory chemokines stimulated the proliferation of P-MSCs while anti-inflammatory cytokines inhibited the growth of P-MSCs in a dose-dependent manner.

[Effects of long-term installation of intrauterine devices on intrauterine microenvironment].

OBJECTIVES: To study the effect of long-term installation of intrauterine devices (IUD) on the intrauterine microenvironment. METHODS: Eighty-nine healthy 26 - 50-year-old women undergoing physical examination or having their IUD removed were recruited. Among them 62 had used IUDs, including 32 inert IUD (I-IUD) and 30 copper releasing IUD (T-IUD), for 5 - 20 years, and 27 women without installation of IUD were used as controls. In the 3rd to 13th day of menstrual cycle, 3 ml of irrigation of intrauterine cavity were collected to examine the concentrations of tumor necrosis factor-alpha (TNF-alpha), interleukin 2 (IL-2) and secretary IgA (SIgA) by radioimmunoassay (RIA). Hysteroscopy was used to obtain 3 pieces of endometrium at the place where the IUD was attached for each subject. Three pieces of endometrium were curretted from each control during the proliferative stage. Thirty specimens of endometrium, including 10 cases with I-IUD, 10 cases with T-IUD, and 10 control cases were used to examine the distribution of T cell subset by immunohistochemistry. Fifteen specimens of endometrium, including 6 cases with I-IUD, 6 cases with T-IUD, and 3 control cases, were used to examine the endometrial ultrastructure by scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Twenty-five specimens of endometrium, including 10 cases with I-IUD, 10 cases with T-IUD, and 5 control cases, were used to detect the expression and mutation of P16, P53 and K-ras by PCR-SSCP technique. RESULTS: There was no significant difference in TNF-alpha level in the irrigation among the three groups (P > 0.05). IL-2 and SIgA levels (0.39 +/- 0.18) microg/L and (2000 +/- 1224) microg/L respectively) in the T-IUD group were significantly lower than those in the control group (0.96 +/- 0.15) microg/L and (3377 +/- 1906) microg/L respectively, both (P < 0.05). There was a significant difference in the population of T lymphocytes (CD(8)(+) and CD(4)(+) lymphocytes) between the T-IUD group and control group (P < 0.05). SEM and TEM showed no necrosis and atypia in the endometrial cells of I-IUD group and T-IUD group. There was no positive expression of gene p16, p53 and K-ras in the endometrium of the three groups. CONCLUSION: It is safe and effective using I-IUD or T-IUD for a long time, however, T-IUD has some effects on intrauterine local immune function.

Expansion of decidual CD45RO⁺ T cells with high expression of CEACAM1 in the early stage of pregnancy.

The aim of the present study was to investigate the mechanism involved in the expansion of CD45RO+ T cells in the decidual microenvironment, and in the expression of the inhibitory carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1) on the surface of decidual CD45RO+ T cells. Twenty-one healthy nonpregnant females and seventeen healthy pregnant females in the first trimester were included in the study. Peripheral blood samples from nonpregnant and pregnant females, and decidual tissues from pregnant females following elective abortion, were obtained and analyzed by flow cytometry. The percentages of CD45RO+ T cells and CEACAM1-expressing CD45RO+ T cells were significantly higher in first trimester human decidua than in the peripheral blood. Conditioned medium from the coculture of monocytes and the human trophoblast HTR8/SVneo cell line (MHM) was added to the model for the generation of CD45RO+ T cells in vitro. MHM caused an increase in the percentage of CD45RO+ T cells in a monocyte chemoattractant protein-1 (MCP-1)­dependent manner and an increase in the percentage of CEACAM1-expressing CD4+CD45RO+ T cells in the model. In conclusion, our results implied that trophoblast cells and monocytes may be involved in the increase of decidual CD45RO+ T cells and the high expression of CEACAM1 on their surfaces.