Combination Therapy of Bone Marrow Mesenchymal Stem Cell Transplantation and Electroacupuncture for the Repair of Intrauterine Adhesions in Rats: Mechanisms and Functional Recovery.

Transplantation of bone marrow mesenchymal stem cells (BMSCs) has demonstrated promising clinical utility in the treatment of endometrial injury and the restoration of fertility. However, since the efficacy of BMSCs after transplantation is not stable, it is very important to find effective ways to enhance the utilisation of BMSCs. Electroacupuncture (EA) has some positive effects on the chemotaxis of stem cells and diseases related to uterine injury. In this study, we established the intrauterine adhesion (IUA) model of the Sprague-Dawley rat using lipopolysaccharide infection and mechanical scratching. Phosphate-buffered saline, BMSCs alone, and BMSCs combined with EA were randomly administered to the rats. Fluorescent cell labelling showed the migration of transplanted BMSCs. H&E staining, Masson staining, Western blot, immunohistochemistry, ELISA, and qRT-PCR were utilised to detect changes in endometrial morphology and expressions of endometrial receptivity-related factors, endometrial pro-inflammatory factors, and fibrosis factors. Finally, we conducted a fertility test to measure the recovery of uterine function. The results showed that EA promoted transplanted BMSCs to migrate into the injured uterus by activating the SDF-1/CXCR4 axis. Endometrial morphology showed the most significant improvement in the BMSC + EA group. The expressions of endometrial pro-inflammatory factors and fibrosis indexes in the BMSC + EA group were lower than those in the model and BMSC groups. Further studies revealed that the expression of endometrial receptivity-related factors and the number of embryos implanted on day 8 of gestation increased in the BMSC + EA group compared with the model group and the BMSC group.

Photobiomodulation therapy at 632 nm wavelength ameliorates intrauterine adhesion via activation of cAMP/PKA/CREB pathway.

Intrauterine adhesion (IUA), a major cause of uterine infertility, is pathologically characterized by endometrial fibrosis. Current treatments for IUA have poor efficacy with high recurrence rate, and restoring uterine functions is difficult. We aimed to determine the therapeutic efficacy of photobiomodulation (PBM) therapy on IUA and elucidate its underlying mechanisms. A rat IUA model was established via mechanical injury, and PBM was applied intrauterinely. The uterine structure and function were evaluated using ultrasonography, histology, and fertility tests. PBM therapy induced a thicker, more intact, and less fibrotic endometrium. PBM also partly recovered endometrial receptivity and fertility in IUA rats. A cellular fibrosis model was then established with human endometrial stromal cells (ESCs) cultured in the presence of TGF-ß1. PBM alleviated TGF-ß1-induced fibrosis and triggered cAMP/PKA/CREB signaling in ESCs. Pretreatment with the inhibitors targeting this pathway weakened PBM's protective efficacy in the IUA rats and ESCs. Therefore, we conclude that PBM improved endometrial fibrosis and fertility via activating cAMP/PKA/CREB signaling in IUA uterus. This study sheds more lights on the efficacy of PBM as a potential treatment for IUA.

Synergistic effects of electroacupuncture and bone marrow mesenchymal stem cell transplantation on rat intrauterine adhesion： an observation. / 电针联合骨髓间å è´¨å¹²ç»†èƒžç§»æ¤æ²»ç–—å¤§é¼ å®«è ”ç²˜è¿žçš„ååŒæ•ˆåº”è§‚å¯Ÿ.

OBJECTIVES: To investigate the effects of electroacupuncture(EA) combined with bone marrow mesen-chymal stem cells(BMSCs) transplantation on the endometrium of rats with intrauterine adhesions(IUA), so as to explore the possible mechanisms underlying their combined therapeutic effects. METHODS: Forty adult female SD rats were randomly divided into control, model, cell, and combined groups. The IUA rat model was established using a dual injury method of mechanical scratching and lipopolysaccharide infection. After successful modeling, on days 1, 3, and 7, rats in the model group received tail vein injection of phosphate buffered solution, while rats in the cell group received tail vein injection of BMSCs suspension for BMSCs transplantation；and rats in the combined group received BMSCs transplantation combined with EA treatment (2 Hz/15 Hz, 1-2 mA), targeting the "Guanyuan"(CV4), bilateral "Zusanli"(ST36) and "Sanyinjiao"(SP6) for 20 min daily for 3 consecutive estrous cycles. After intervention, uterine tissue was collected from 5 rats in each group. Histological analysis was performed using hematoxylin and eosin staining to evaluate endometrial thickness and glandular number. Masson staining was used to assess endometrial fibrosis area. Immunohistochemistry was performed to detect the positive expressions of vascular endothelial growth factor(VEGF), proliferating cell nuclear antigen(PCNA), and estrogen receptor(ER). Western blot analysis was conducted to determine the protein expressions of homeobox A10(HoxA10) and leukemia inhibitory factor(LIF), both key regulators of endometrial receptivity. The remaining 5 rats in each group were co-housed with male rats, and the uterine function recovery was evaluated by assessing the number of embryo implantations. RESULTS: Compared with the control group, the model group showed thinning endometrium(P<0.001), decreased glandular number(P<0.001), increased endometrial fibrosis area(P<0.001), reduced positive expressions of VEGF, PCNA, ER, expressions of HoxA10 and LIF, and decreased embryo implantation number (P<0.001) on the injured side of the uterus. Compared with the model group, the combined group showed a reversal of the aforementioned indicators(P<0.001, P<0.01)；the cell group exhibited thicker endometrium(P<0.001) and reduced endometrial fibrosis area(P<0.001). Compared with the cell group, the combined group showed increased endometrial thickness(P<0.01), elevated glandular number(P<0.05), significantly decreased endometrial fibrosis area(P<0.05), enhanced positive expressions of VEGF, PCNA and ER, expressions of HoxA10 and LIF in the endometrium, and a significant increase in embryo implantation number (P<0.001, P<0.05, P<0.01) on the injured side of the uterus, indicating better results than the cell group. CONCLUSIONS: The combination of EA and BMSCs synergistically promotes the repair of damaged endometrium, improves endometrial morphology, reduces fibrosis levels, enhances vascular regeneration and matrix cell proliferation, improves endometrial receptivity, which ultimately facilitates embryo implantation.

Electroacupuncture alleviates intrauterine adhesion through regulating autophagy in rats.

Autophagy is a well-conserved metabolic system that maintains homeostasis by relying on lysosomal breakdown. The endometrium of patients with intrauterine adhesion (IUA) and an animal model exhibits impaired autophagy. Autophagy is negatively correlated with inflammation. Activation of autophagy can inhibit the inflammatory response, while defects in autophagy will activate the inflammatory response. Here, we studied whether electroacupuncture (EA) inhibits inflammation and promotes endometrial injury repair by activating endometrial autophagy. The IUA animal model was established by mechanical injury plus lipopolysaccharide infection. EA stimulation was applied to the acupoints Guanyuan (CV4), bilateral Sanyinjiao (SP6), and Zusanli (ST36). The results indicated that EA could improve endometrial morphology, attenuate endometrial fibers, and enhance endometrial receptivity in the rat. EA could increase the autophagosomes of endometrial epithelial cells, increase the levels of LC3 and Beclin1, and decrease the level of p62. Additionally, EA may also suppress the nuclear factor kappa-B (NF-κB) signaling pathway and reduce the release of inflammatory factors. Additionally, the effect of EA was comparable to that of the autophagy agonist rapamycin, and the autophagy inhibitor 3-methyladenine reversed the therapeutic effect of EA. Therefore, we assume that EA may facilitate endometrial healing by activating autophagy and reducing NF-κB signal pathway-mediated inflammation.

Bear bile use at the intersection of maternal health in Cambodia.

BACKGROUND: The consumption of bear gallbladders and bear bile in Southeast Asia is a persistent threat to bear populations. As part of a larger effort to understand the characteristics of bear part consumption in Cambodia, we uncovered a consumer base of women seeking treatment for post-partum and uterine ailments. METHODS: To better understand this aspect of consumption, we interviewed 122 women in seven different provinces in Cambodia, probing into the motivations and influences for using bear bile, as well as what types of ailments Cambodian women use it for. RESULTS: We found that it is generally used by young or expecting mothers, and for such issues as post-partum "fatigue" (toas in Khmer), which could encompass post-partum depression. A desire to be supported by kin networks seems to facilitate the continued use of bear gallbladder and bile for these purposes. CONCLUSIONS: We suggest that efforts to reduce consumption should focus on encouraging older kin to change their means of support to Western/biomedical and by extension non-wildlife alternatives.

The synergistic effect of electroacupuncture and bone mesenchymal stem cell transplantation on repairing thin endometrial injury in rats.

BACKGROUND: Tissue regeneration disorder after endometrial injury is an important cause of intrauterine adhesions, amenorrhea, and infertility in women. Both bone marrow mesenchymal stem cell (BMSC) transplantation and electroacupuncture (EA) are promising therapeutic applications for endometrial injury. This study examined their combined effects on thin endometrium in rats and the possible mechanisms underlying these effects. METHODS: A thin endometrial model was established in Sprague-Dawley (SD) rats by perfusing 95% ethanol into the right side of the uterus. The wounds were randomly treated with PBS (model group), BMSCs only (BMSC group), EA only (EA group), and BMSCs combined with EA (BMSC + EA group). Endometrial morphological alterations were observed by hematoxylin and eosin (H&E) staining. Changes in markers of epithelial and stromal endometrium cells, endometrial receptivity-related chemokines, and paracrine factors were detected using immunohistochemistry, western blotting, and quantitative reverse-transcription polymerase chain reaction (qRT-PCR). Finally, the functional recovery of the uterus was evaluated by determining the rate of embryo implantation. RESULTS: As shown by endometrial morphology, the damaged uteri in all the treatment groups recovered to some extent, with the best effects observed in the BMSC + EA group. Further studies showed that EA promoted the migration of transplanted BMSCs to damaged uteri by activating the stromal cell-derived factor-1/C-X-C chemokine receptor type 4 (SDF-1/CXCR4) axis. As compared with the other groups, upregulated expression of endometrial cytokeratin and vimentin, increased secretion of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) in endometrial lesions, and improved embryo implantation rates on the 8th day of pregnancy were found in the BMSC + EA group. CONCLUSIONS: EA plays an important role in supporting BMSCs in the repair of thin endometrium, most likely by promoting the migration of BMSCs and enhancing the paracrine effect of BMSCs.

Autologous platelet-rich plasma infusion improves clinical pregnancy rate in frozen embryo transfer cycles for women with thin endometrium.

BACKGROUND: Adequate thickness of the endometrium has been well recognized as a critical factor for embryo implantation. This was a prospective cohort study to investigate the benefits of platelet-rich plasma (PRP) for women with thin endometrium who received frozen embryo transfer (FET) program in a larger number of patients and explore the underlying mechanism. METHODS: In this study, we investigated the effects of PRP in women with thin endometrium in FET program. 64 patients with thin endometrium (<7 mm) were recruited. PRP intrauterine infusion was given in PRP group during hormone replacement therapy (HRT) cycle in FET cycles. RESULTS: After PRP infusion, the endometrium thickness in PRP group was 7.65 ±â€Š0.22 mm, which was significantly thicker than that in control group (6.52 ±â€Š0.31 mm) (P <.05). Furthermore, PRP group had lower cycle cancellation rate when compared to control group (19.05% vs. 41.18%, P <.01). The implantation rate and clinical pregnancy rate in PRP group were significantly higher than those in control group (27.94% vs 11.67%, P <.05; 44.12% vs 20%, P <.05, respectively). PRP blood contained 4 folds higher platelets and significantly greater amounts of growth factors including platelet-derived growth factor (PDGF)-AB, PDGF-BB, and transforming growth factor (TGF)-ß than peripheral blood (P <.01). CONCLUSIONS: PRP plays a positive role in promoting endometrium proliferation, improving embryo implantation rate and clinical pregnancy rate for women with thin endometrium in FET cycles.

Alternative Treatment Utilization Before Hysterectomy for Benign Gynecologic Conditions at a Large Integrated Health System.

STUDY OBJECTIVE: To investigate rates of utilization of alternative treatments before hysterectomy for benign gynecologic indications within a large integrated health care system. DESIGN: Retrospective cohort study of patients who underwent hysterectomies for benign gynecologic conditions between 2012 and 2014 (Canadian Task Force classification II-2). SETTING: Kaiser Permanente Northern California, a community-based integrated health system. PATIENTS: Women who underwent hysterectomy for a benign gynecologic condition between 2012 and 2014. INTERVENTIONS: From an eligible cohort of 6892 patients who underwent hysterectomy, a stratified random sample of 1050 patients were selected for chart review. Stratification was based on the proportion of indications for hysterectomy. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the use of alternative treatments before hysterectomy. Alternative treatments included oral hormone treatment, leuprolide, medroxyprogesterone intramuscular injections, a levonorgestrel intrauterine device, hormonal subdermal implants, endometrial ablation, uterine artery embolization, hysteroscopy, and myomectomy. Of the 1050 charts reviewed, 979 (93.2%) met the criteria for inclusion in this study. The predominant indication for hysterectomy was symptomatic myomas (54.4%), followed by abnormal uterine bleeding (29.0%), endometriosis (5.8%), pelvic pain (3.1%), dysmenorrhea (3.4%), and other (4.3%). The major routes of hysterectomy were laparoscopy (68.7%) and vaginal hysterectomy (13.4%). Before hysterectomy, 81.2% of patients tried at least 1 type of alternative treatment (33.8% with 1 treatment and 47.4% with at least 2 treatments), and 99.3% of patients were counseled regarding alternative treatments. Compared with younger women age <40 years, women age 45 to 49 years were less likely to use alternative treatments before hysterectomy (adjusted odds ratio, 0.41; 95% confidence interval, 0.21-0.76). There were no variations in treatment rates by socioeconomic status or between major racial and ethnic groups. The final pathological analysis identified myomas as the most common pathology (n = 637; 65.1%); 96 patients (9.8%) had normal uterine pathology. CONCLUSION: More than 80% of patients received alternative treatments before undergoing hysterectomy for a benign gynecologic condition. Additional investigation is warranted to assess alternative treatment use as it relates to preventing unnecessary hysterectomies.

Yeast product supplementation modulated humoral and mucosal immunity and uterine inflammatory signals in transition dairy cows.

The transition from late gestation to early lactation is characterized by substantial metabolic stress and altered immune function. The objective of this study was to assess the effects of supplementing a yeast product derived from Saccharomyces cerevisiae on immunity and uterine inflammation in transition cows. Forty multiparous Holstein cows were blocked by expected parturition date and randomly assigned within block to 1 of 4 treatments (n=10) from 21d before expected parturition to 42d postpartum. Rations were top-dressed with a product containing yeast culture plus enzymatically hydrolyzed yeast (YC-EHY; Celmanax, Vi-COR, Mason City, IA) at the rate of 0, 30, 60, or 90g/d throughout the experiment. Cows were injected subcutaneously with ovalbumin on d -21, -7, and 14 to assess their humoral response. Data were analyzed using mixed models with repeated measures over time. Concentrations of colostrum IgG were unaffected by treatments. A treatment × week interaction was observed for somatic cell linear score, reflecting a tendency for a quadratic dose effect on wk 1 (2.34, 2.85, 1.47, and 4.06±0.59 for 0, 30, 60, and 90g/d, respectively) and a quadratic dose effect on wk 5 (1.36, -0.15, -1.07, and 0.35±0.64 for 0, 30, 60, and 90g/d, respectively). Platelet count was increased by YC-EHY. Increasing YC-EHY dose linearly increased plasma anti-ovalbumin IgG levels following 3 ovalbumin challenges, suggesting that treatments enhanced humoral immunity. Increasing YC-EHY dose also quadratically increased fecal IgA concentrations in early lactation, suggesting that 30 and 60g/d doses enhanced mucosal immunity. Uterine neutrophil populations were much greater in samples collected on d 7 compared with those on d 42 (32.1 vs. 7.6±3.5% of cells), reflecting neutrophil infiltration immediately after calving, but no treatment effect was detected. Significant day effects were detected for mRNA of IL-6, IL-8, neutrophil myeloperoxidase (MPO), and neutrophil elastase (ELANE) in the uterine samples, reflecting greater abundance of these transcripts collected on d 7 compared with d 42. A quadratic dose effect was detected for IL-6, indicating that 30 and 60g/d doses decreased uterine IL-6 mRNA. The mRNA abundance of MPO and ELANE was increased linearly by YC-EHY. Supplementation with YC-EHY enhanced measures of humoral and mucosal immunity and modulated uterine inflammatory signals and mammary gland health in transition dairy cows.

Neuromuscular electrical stimulation and biofeedback therapy may improve endometrial growth for patients with thin endometrium during frozen-thawed embryo transfer: a preliminary report.

BACKGROUND: To investigate the effect of pelvic floor Neuromuscular Electrical Stimulation (NMES) Therapy in improving endometrial thickness in women with thin endometrium. METHODS: 41 patients undergoing assisted reproduction with a thin endometrium (less than or equal to7 mm) were recruited and advised to go for a pelvic floor NMES in frozen-thawed embryo transfer cycle. PHENIX Neuromuscular Electrical Stimulation Therapy System was used according to the manufacturer's recommended protocol for 20 to 30 minutes of intermittent vaginal electrical stimulation on the treatment days. RESULTS: A total of 20 and 21 were included in the NMES and non-NMES groups respectively. 12 out of 20 (60%) patients developed endometrial thickness equal to or more than 8 mm after the NMES therapy, which was the primary outcome. The mean thickness of endometrium before and after was respectively 5.60 mm (0.82 mm) and 7.93 mm (1.42 mm) in the therapy group versus 5.50 mm (1.00) and 6.78 mm (0.47) in the control group; the difference was statistically significant (P = 0.002). There was higher pregnancy rate in the NMES group (42% versus 35%) but the difference was not statistically significant. CONCLUSION: Neuromuscular Electrical stimulation therapy may be effective for the patients with a thin endometrium. Further studies are needed to investigate its effectiveness.

Five-year study assessing the feasibility and safety of autologous blood transfusion in pregnant Japanese women.

AIM: To assess the feasibility and safety of autologous blood donation during pregnancy in Japanese women. MATERIAL AND METHODS: We enrolled patients who were either at high risk for massive blood loss during delivery or had blood that was difficult to match for transfusion between March 2005 and February 2010. After delivery, we reviewed hospital records of these patients to collect data on blood donation procedures, obstetric outcome and blood transfusions received. RESULTS: We enrolled 314 patients during the study period and performed 809 blood donations. The median volume of donated blood was 1200 mL (range, 400-2000 mL). Vasovagal reflex as an adverse donor reaction occurred in 10 of the 314 patients (3.2%) during 11 of the 809 donations (1.4%). There were no cases of non-reassuring fetal heart rate patterns during blood donations. Twenty-five (7.8%) of the 322 neonates were admitted to the neonatal intensive care unit. All 322 infants were healthy 1 month after delivery. Among 314 patients, autologous blood re-transfusion was performed for 56 (17.8%) and homologous blood transfusion was performed concurrently for 5 (1.6%). Placenta previa was the indication with the highest re-transfusion rate (42.4%). All re-transfusions were performed without side-effects. CONCLUSION: Autologous blood donation is feasible and safe for pregnant women and their infants. Although indications of autologous blood donation are controversial, it should be considered for cases of placenta previa.

Incidencia de patologías uterinas y fertilidad de vacas Holstein tratadas con selenio y vitamina E antes y después del parto / Incidence of uterine pathologies and fertility of Holstein cows treated with selenium and vitamin E before and after childbirth

An antioxidant therapy based on vitamin E and selenium subcutaneous (sc) injections administered prior to and after parturition, was evaluated by measuring the incidence of uterine pathologies and fertility in lactating Holstein cows. Cows (n =353) were randomly distributed into three groups: Group pre-postpartum (n =122), cows received a sc injection of 50 mg Se and 680 IV vitamin E (/0 ml of Mu-Se) on 60 and 21 days prepartum and 30and 90 days postpartum; Group prepartum (n = 117) received a sc injection 21 days prior to parturition; control Group (n =//4), cows received sc injections of saline solution (SS, /0 ml) on 60 and 21 days prepartum and 30 and 90 days postpartum. lncidence of retained fetal membranes (RFM) in control Group (20./%) was similar (P > 0.05) to prepartum Group (/2.8%), but it differed (P 0.05). Proportion of cows with purulent metritis (PM) in control Group (37.7%)was similar (P > 0.05) to prepartum Group (33.3%), but reduced (P 0.05) for control groups(44.7%) and prepartum Group (40./%) but lower (P <0.05) for pre-postpartum Group (27%). Pregnancy rate at 150 days postpartum (PP) was greater (P < 0.08) for prepostpartum Group (70%) than control Group (58.9%). In conclusion, an antioxidant therapy based on vitamin E and selenium administration, 60 and 21 days prior to parturition and 30 and 90 days after parturition, reduces the incidence of uterine pathologies and improves pregnancy rate at 150 days postpartum in Holstein cows.

Se evaluó el efecto de una terapia antioxidante basada en inyecciones de selenio y vitamina E, administradas antes y después del parto, en la incidencia de patologías uterinas y fertilidad en vacas Holstein. Se utilizaron 353 vacas, las cuales se asignaron al azar a tres grupos: Grupo pre-posparto (n = 122), las vacas recibieron una inyección sc de 50 mg de selenio y 680 VI de vitamina E (10 ml de Mu-Se) los días 60 y 21 preparto y 30 y 90 posparto; Grupo preparto (n =117), las vacas recibieron una inyección similar al grupo anterior 21 días antes del parto; Grupo testigo (n = 114), los animales recibieron una inyección subcutánea de 10 ml de solución salina fisiológica los días 60 y 21 preparto, y 30 y 90 posparto. La incidencia de retención placentaria en el Grupo testigo (20.1%) fue similar (P > 0.05) al Grupo preparto (12.8%), pero difirió (P 0.05). El porcentaje de vacas con metritis purulenta en el Grupo testigo (37.7%) fue igual (P > 0.05) al Grupo preparto (33.3%), pero se redujo (P 0.05) entre las vacas de los grupos testigo (44.7%) y preparto (40.1 %), pero fue menor (P < 0.05) en el Grupo pre-posparto (27%). El Grupo pre-posparto tuvo mayor (P < 0.08) tasa de gestación (70%) a los 150 días posparto que el testigo (58.9%). Se concluye que la administración de selenio y vitamina E los días 60 y 21 antes del parto y 30 y 90 posparto, reducelas patologías uterinas y mejora la tasa de gestación al día 150 posparto en vacas Holstein.

[Observation on therapeutic effect of acupuncture and moxibustion on disorders of myometrial gland].

OBJECTIVE: To explore the therapeutic effect of acupuncture on disorders of myometrial gland and the mechanism. METHODS: Sixty-six cases were randomly divided into an acupuncture group and a medication group, 33 cases in each group. The acupuncture group were treated with acupuncture at Zhongji (CV 3), Shuidao (ST 28), Tainshu (ST 25), Qugu (CV 2), Zigong (EX-CA 1) as main; the medication group were treated with oral administration of Danazol. Changes of estradiol (E2) level, hemoglobin (Hb) and blood platelet counter (BPC) were observed in the acupuncture group, and the therapeutic effects of the two group were compared. RESULTS: The total effective rate was 97.0% in the acupuncture group and 72.7% in the medication group, the former being better than the latter (P<0.05). After treatment, E2 level decreased and Hb and BPC increased in the acupuncture group. CONCLUSION: Acupuncture has obvious therapeutic effect, which is better than that of simple western medicine. Acupuncture can decrease E2 level.

A simulation of gas-based, endometrial-ablation therapy.

The method of numerical simulation has been employed to evaluate the use of a gas as a heating medium for endometrial ablation for the treatment of menorrhagia and uterine fibroids. The simulations encompassed fluid flow and heat transfer within the gaseous medium which serves to heat the uterine lining and the coupled heat conduction in the uterine tissue. For the case study featured here, helium at a temperature of 140 degrees C was employed as the heating medium. A total therapy duration of 6 min was modeled. The outcome of the simulation has provided quantitative information about the detailed necrosis depths that can be attained by the application of the therapy. In particular, necrosis depths on the order of 5 mm were achieved. It was also shown that by making use of a tailored pattern of fluid flow within the uterine cavity, particular zones on the uterine lining such as fibroids can be selectively targeted. Furthermore, the duration of the therapy needed to achieve a desired degree of necrosis can be predicted in advance. The advantages of a gas-based therapy relative to a liquid-based therapy are identified. Significant among these is the capability of the gas-based therapy to target specific zones which require treatment, while sparing healthy tissue. Another significant advantage of gas-based therapy is that it enables the use of higher temperatures which, in turn, allows the therapeutic process to be performed in a shorter time duration.

Alternative medical and surgical options to hysterectomy.

The range of alternatives to hysterectomy includes 'expanded' oral medical regimens, the levonorgestrel-releasing intrauterine system (LNG-IUS), a wide range of endometrial ablative techniques, and-where fibroids are the primary pathology-myomectomy and uterine artery embolization. Since research has shown that hysterectomy is a highly effective treatment, these alternatives must be assessed against the recognized high satisfaction rates and improved quality of life reported following hysterectomy. Additional issues that would also need to be addressed include complication rates, side-effects, and cost-effectiveness. For women with prolonged abnormal uterine bleeding, recent research suggests that hysterectomy is significantly superior to an expanded medical treatment regimen for health-related quality-of-life measures. Satisfaction with treatment, and health-related quality of life and psychosocial well-being, are reportedly similar between hysterectomy and the LNG-IUS, but the latter has the advantage of reduced cost. Endometrial ablation reduces menstrual blood flow, but its benefits relative to hysterectomy lessen over time. No large-scale studies have adequately compared uterine artery embolization or myomectomy to hysterectomy. Perhaps the most telling finding from recent research with respect to the place of alternative therapies to hysterectomy is that the existence or advent of these alternatives has not reduced hysterectomy rates, but merely increased treatment options and interventions for excessive menstrual loss.

Perceptions of alternative therapies available for women facing hysterectomy or menopause.

Women's perceptions of alternative therapies available for managing symptoms related to menopause and to the need for hysterectomy were explored. Data are reported from 17 focus groups of peri- and menopausal aged women (n = 82) living in two southern U.S. coastal counties. Analysis showed that emergent themes did not vary by race or surgery experience. Herbal preparations, vitamin supplements, "healthy living" (diet & exercise), and mind/body practices (prayer & "mental healing") were mentioned as possible alternatives for managing symptoms. Participants more frequently identified "other" conventional medical approaches--prescription medication, laser surgery, dilation and curettage, and "watchful waiting"--as alternatives to hysterectomy. Alternative therapies are linked to women's desire to gain control over their own health care decisions and practices.

[Method for treating inflammatory diseases of the uterine appendages using the eplir mud preparation]. / Sposob lecheniia ostrykh vaspalitel'nykh zabolevanii pridatkov matki s primeneniem griazevogo preparata éplira.

Ultraphonophoresis of 1% oil solution of eplir in patients with acute inflammation of the uterine appendages as an adjuvant to drug therapy enhances the latter by immediate (anesthetic, antiexudative action), short-term (immunocorrection) and long-term (preservation and restoration of reproductive function, prevention of chronicity) treatment results.

Comparative treatment of mares susceptible to chronic uterine infection.

Four intrauterine treatment strategies were evaluated for effectiveness in mares that were confirmed to be susceptible to chronic uterine infection. Pretreatment samples were obtained at detection of estrus, and a genital strain of Streptococcus zooepidemicus was infused into the uterus when a preovulatory (> 35 mm) follicle was detected. At 12 hours after inoculation, mares were assigned to 1 of 4 selected treatment groups: autologous plasma, 100 ml (n = 5); potassium penicillin, 5 million U in 100 ml of phosphate-buffered saline solution (PBSS; n = 5); 10 mg of prostaglandin F2 alpha in 100 ml of PBSS (n = 5)' and large-volume lavage with normal saline solution (1,000 ml increments). A fifth group, treated with vehicle alone (100 ml of PBSS), served as a negative control (n = 7). All treatments were administered into the uterus. To assess the effectiveness of the treatment, samples for culture and cytologic examination were collected at 96 hours after bacterial inoculation. An effect of treatment was observed on the number of uterine neutrophils (P = 0.02) and growth of S zooepidemicus (P < 0.01). Intrauterine treatment with potassium penicillin, prostaglandin F2 alpha, and large-volume uterine lavage significantly reduced the growth of S zooepidemicus (P < 0.01) as well as the number of neutrophils (P < 0.02). Autologous plasma reduced the number of neutrophils (P < 0.05), but not growth of S zooepidemicus. There was significant correlation between the number of uterine neutrophils and growth of S zooepidemicus for each treatment group (r = 0.57; P < 0.05).

Therapeutic effects of moxibustion on delayed uterine involution in postpartum dairy cows.

Moxibustion on 12 specific points (Keiketsu in Japanese) was applied for treatment of delayed uterine involution in 16 cows that were diagnosed on the basis of rectal palpation and vaginoscopic examination 21 to 35 days after parturition. The treatment was continued for three consecutive days. Other 32 cows with the delayed uterine involution were either injected intramuscularly with 25 mg PGF2 alpha (17 cows) or infused in utero with 500 mg ampicillin (15 cows). The uterine involution following the treatment was monitored by rectal palpation and vaginoscopic examination. Milk samples were collected three times weekly and used for milk progesterone assay to monitor the ovarian function. No significant difference was observed in the uterine involution among the groups treated with moxibustion, PGF2 alpha or ampicillin. Percentages of cows with abnormal cervical mucus and bacterial isolation from cervical swab decreased remarkably in all groups during 4 weeks after treatment. Forty-six percent of cows with delayed uterine involution was diagnosed as having inactive ovaries. Percentage of cows that responded with ovulation and corpus luteum formation after moxibustion was 67 percent, slightly higher than those in cows treated with PGF2 alpha or ampicillin. Reproductive performance after the moxibustion was well-comparable to those after PGF2 alpha or ampicillin treatment. Result indicates that the moxibustion could be used as the alternative to PGF2 alpha and antibiotics for treating delayed uterine involution in cows.