Accurate 16S Absolute Quantification Sequencing Revealed Vaginal Microecological Composition and Dynamics During Mixed Vaginitis Treatment With Fufang FuRong Effervescent Suppository.

Background: The diagnosis and treatment of mixed vaginitis are more complicated than single pathogenic infections, and there may be adverse reactions and several contraindications to conventional antibiotic therapy. Therefore, this study aimed to evaluate the preliminary effects of Fufang Furong Effervescent Suppository for the management of aerobic vaginitis (AV) mixed with bacterial vaginosis (BV) using Accurate 16S absolute quantification sequencing (Accu16S). Methods: In the present randomized, blind, multi-center clinical trial, women (20 to 55 years) who had received a diagnosis of AV+BV were randomly assigned into clindamycin positive control (n = 41) and Fufang Furong Effervescent Suppository (n = 39) groups. The follow-up occurred in three time periods (V1: -2~0 days; V2: 15-17 days; V3: 40 ± 3 days). At each visit, two vaginal swabs, one for clinical evaluation and one for laboratory examination, were taken from each patient. The Nugent score, Donders' score, drug-related complications, recurrence rates, and microecological changes of vaginal swabs were assessed in the time three periods. Results: At baseline, the two groups were similar in frequency of presentation with vaginal burning, odor, abnormal discharge, and itching. No meaningful differences in Nugent and Donders' scores were detected between the two groups at stage V2 (Nugent: p = 0.67; Donders': p = 0.85) and V3 (Nugent: p = 0.97; Donders: p = 0.55). The Furong group presented fewer complications compared to the Clindamycin group. However, this difference was not statistically significant (p = 0.15). Additionally, Accu16S indicated that the total abundance of bacteria in both groups sharply decreased in stage V2, but slightly increased in V3. In stage V3, the absolute abundance of Lactobacillus in the Furong group was considerably higher compared to untreated samples (p < 0.05). On the other hand, no momentous increase was detected in the Clindamycin group (p > 0.05). Conclusion: Fufang Furong Effervescent Suppository can be as effective as clindamycin cream in the management of AV+BV while may restore the vagina microecosystem better.

[Literature research and status analysis on clinical application of Guizhi Fuling Formula].

Guizhi Fuling Formula was first seen in Synopsis of Golden Chamber by ZHANG Zhongjing. It is composed of Cinnamomi Ramulus, Poria, Moutan Cortex, Persicae Semen, Peony and other drugs, commonly used in the treatment of gynecological diseases such as hysteromyoma, ovarian cyst, endometriosis, pelvic inflammation, dysmenorrhea, etc. In addition, it is also used in internal medicine and urology. This reflects the modern doctors' recognition of the famous prescriptions in ancient books. However, whether Guizhi Fuling Formula is really suitable for these diseases still needs further study for verification. The author systematically searched CNKI, Wanfang, SinoMed, PubMed, EMbase, Cochrane Library database: 2 304 papers on clinical research of Guizhi Fuling, covering 13 systems and 128 diseases. Combined with the questionnaire of experts, we investigated the knowledge of experts of traditional Chinese medicine, Western medicine and combination of Chinese and Western medicine on the applicable indications of Guizhi Fuling Formula in this paper, systematically elaborated the clinical applications of Guizhi Fuling Formula, and summarized the applicable indications of Guizhi Fuling Formula, in order to provide a reference for the clinical rational application of Guizhi Fuling Formula, and provide a reference also for clinical medication.

Randomized, Double-Blind, Placebo-Controlled Study of Modified Erzhi Granules in the Treatment of Menopause-Related Vulvovaginal Atrophy.

OBJECTIVE: To evaluate the clinical therapeutic efficacy and safety of modified Erzhi granules (MEG) in patients with menopause-related vulvovaginal atrophy (VVA). METHODS: This randomized, double-blind, placebo-controlled study comprised two groups, including the treatment and control groups. Patients receive MEG and placebo for 12 weeks, respectively. Vaginal health score (VHS), vaginitis score, vaginal maturation index (VMI), female sexual function index (FSFI), and modified Kupperman Index (modified KI) were used as efficacy endpoints and assessed at baseline, 4, 8, and 12 weeks during administration, and 4 weeks after drug withdrawal. At baseline and 12 weeks, serum estradiol (E2), follicle stimulating hormone (FSH), pelvic ultrasound, breast ultrasound, and other safety parameters were measured, recording adverse events. RESULTS: At 12 weeks, VHS, percentage of superficial cells in the vaginal epithelium and FSFI were significantly increased, while vaginitis score, percentage of basal cells in the vaginal epithelium, and modified KI were significantly decreased in comparison with baseline and control group (all P<0.05); these differences persisted for up to 4 weeks after drug withdrawal. The placebo group showed no significant change during treatment compared with baseline values (p>0.05). Serum E2 and FSH levels, endometrial thickness, and breast thickness in all patients were within the normal ranges before and after treatment, with no serious adverse reactions observed. CONCLUSION: MEG significantly alleviates menopause-related vulvovaginal atrophy, with no overt adverse effects on the endometrium, breast, hepatic, and renal functions.

In vitro transport mechanism of psoralen in a human placental cell line (BeWo cells).

The mechanism by which psoralen is transported across the placenta was investigated in the BeWo human placental cell line derived from choriocarcinoma in a transwell assay system using liquid chromatography-mass spectrometry/mass spectrometry detection. Psoralen uptake by BeWo cells increased linearly over the concentration range of 0.01 µM to 100 µM (r (2) = 0.997) and was not saturable. Psoralen uptake by BeWo cells was not affected by temperature (4 °C, room temperature, and 37 °C; p > 0.05). Psoralen transport increased linearly over 180 min (r (2) = 0.988) with 3.08 ± 0.26 %, 5.47 ± 0.21 %, 7.54 ± 0.06 %, 9.40 ± 0.37 %, 11.49 ± 0.31 %, and 12.46 ± 0.61 % transferred from the apical chamber to the basolateral chamber in the transwell assays at 30, 60, 90, 120, 150, and 180 min, respectively. The rate of transport showed the same tendency, increasing linearly from 0.13 ± 0.01 pmol/s to 0.58 ± 0.03 pmol/s over the concentration range of 25 µM to 100 µM (r (2) = 0.989). The apparent permeability coefficient for psoralen (100 µM) was 5.62 ± 0.24 × 10(-6) cm/s and 5.53 ± 0.47 × 10(-6) cm/s before and after treatment with verapamil (100 µM), respectively (p > 0.05). The efflux value for psoralen was approximately 1. These data show that psoralen is well absorbed and crosses the placental barrier via passive diffusion in the BeWo cell line.

Establishment of an in vitro model of the human placental barrier by placenta slice culture and ussing chamber.

Our purpose was to establish an in vitro model of the human placental barrier based on placenta slice culture and Ussing chamber. The villous morphology, beta-human chorionic gonadotropin (ß-hCG), mRNA and efflux function of P-glycoprotein (P-gp), and the permeability of the fluorescent marker were confirmed. The results showed that syncytiotrophoblast cells with abundant endoplasmic reticulum and mitochondria were covered with a dense microvillus in the placenta slice. The ß-hCG secretion levels in the Ussing chamber were 274.13 ± 13.52 mIU/mL at 5 h, significantly higher than that in the incubator 95.2 ± 13.14 mIU/mL, and ß-hCG continued to secrete for 48 h. P-gp mRNA was expressed in the placenta slice. The Rho123 apparent permeability coefficient (Papp) value from maternal side to the fetal side was 26.34 ± 1.87 nm/s, but it was significantly increased, to 289.55 ± 6.02 nm/s after adding verapamil. The Rho123 efflux value was >2. The fluorescein Papp value was (3.42 ± 0.24) × 10(-3) nm/s. In contrast, the fluorescein isothiocyanate-dextran (FD70) Papp value was (3.93 ± 0.08) × 10(-5) nm/s. This indicates that the placenta slice in the Ussing chamber had the activity of a placenta, and can act as a valuable in vitro model of placental barrier.

Myomectomy during cesarean delivery.

BACKGROUND: The optimal management of leiomyomas during cesarean delivery is unclear. OBJECTIVES: To assess the safety of myomectomy performed during cesarean delivery. SEARCH STRATEGY: PubMed, MEDLINE, EMBASE, and Cochrane Library were searched to identify potentially relevant studies published prior to June 30, 2012. SELECTION CRITERIA: Case-control study comparing myomectomy with no myomectomy in patients undergoing cesarean delivery. DATA COLLECTION AND ANALYSIS: The quality of the studies was assessed and data were extracted independently by 2 authors. MAIN RESULTS: Nine studies, including 1 082 women with leiomyomas, met the inclusion criteria; 443 (41.0%) women underwent cesarean myomectomy and 639 (59.1%) underwent cesarean delivery alone. The drop in hemoglobin after surgery was 0.30 g/dL greater in the cesarean myomectomy group than in the control group, but the difference was not significant. The operative time was 4.94 minutes longer in the cesarean myomectomy group, but again the difference was not significant. The overall incidence of fever was comparable in the 2 groups. No hysterectomies were performed in any of the included studies. CONCLUSIONS: Cesarean myomectomy may be a reasonable option for some women with leiomyoma. However, no definite conclusion can be drawn because the data included in the meta-analysis were of low quality.

Controlling the recurrence of pelvic endometriosis after a conservative operation: comparison between Chinese herbal medicine and western medicine.

OBJECTIVE: To compare the clinical effect of Chinese medicine (CM) and Western medicine (WM) for controlling the recurrence of pelvic endometriosis after a conservative operation. METHODS: The study was a multi-center, randomized, parallel controlled and prospective clinical trial. Patients were randomly divided into two groups: CM group (106 cases) and WM group (102 cases). Drugs were given to patients during 1-5 days of the first menstruation after a conservative operation in both groups. Patients with stages I and II (revised American Fertility Society) were treated for 3 months, while the patients with stages III and IV were treated for 6 months. The patients in the CM group were treated using three types of Chinese herbal medicine based on syndrome differentiation. Patients in the WM group were treated using gonadotropin releasing hormone agonist (GnRH-a) or gestrinone. Patients treated with GnRH-a received add-back therapy of Tibolone Tablets once a day after 4 months of treatment. Any cases of dysmenorrheal chronic pelvic pain, menstruation and any adverse reactions of patients were recorded once a month during the preoperative and postoperative periods and once every 3 months during the follow-up period. During the preoperative, postoperative and the follow-up periods, patients underwent type B ultrasonography of the pelvis and measurements of serum CA125 levels, gynecologic examination, routine evaluations of blood, urine, hepatic function (glutamate pyruvate transaminase), renal function (blood urea nitrogen) and electrocardiograms. During the follow-up period they underwent type B pelvic ultrasonography, measurement of serum CA125 levels and further gynecologic examinations. The two treatments were compared for clinical recurrence rates, pregnancy rates and the incidence of adverse reactions. RESULTS: The incidence and timing of recurrence of endometriosis were not significantly different between the two groups. The first pregnancy achieved by the patient in the CM group was significantly earlier than that in the WM group (P <0.05). Moreover, the incidence of adverse reactions in the WM group was significantly higher than in the CM group (P <0.01). CONCLUSIONS: Treatment with Chinese herbal medicines prevented the recurrence of endometriosis after a conservative operation, improved the conception rate and showed fewer and lighter adverse reactions than did treatment with WM therapy. Treatment with Chinese herbal medicine meets the need of patients wishing to have a child following endometriosis and is an appropriate form of clinical treatment.

Chinese medicine improves postoperative quality of life in endometriosis patients: a randomized controlled trial.

OBJECTIVE: To investigate the effect of Chinese medicine (CM) and Western medicine (WM) on quality of life (QOL) after conservative surgery for endometriosis. METHODS: A total of 320 patients with endometriosis were randomized into two groups by using random block design, CM group (160 cases, activating blood circulation and removing blood stasis treatment based on syndrome differentiation) and WM group (160 cases, gonadotropin-releasing hormone agonist or gestrinone treatment) after conservative surgery. Treatment was given for 3-6 months (according to the revised American Fertility Society scoring system stage), and the World Health Organization QOL-BREF (WHOQOL-BREF) was applied to patients before and after treatment to assess QOL. RESULTS: There were 136 cases in the CM group and 141 cases in the WM group completing therapy. In the CM group, the use of the WHOQOL-BREF showed that the physical, psychological and environmental scores posttreatment were significantly higher than those at pre-treatment (P < 0.05), and for 12 items (pain and discomfort, energy and fatigue, sleep and rest, mobility, activities of daily living, work capacity, negative feelings, health and social care: accessibility and quality, participation in and opportunities for recreation/leisure activities, appetite, QOL score, overall health status and QOL), the difference in scores was significant (P < 0.05). In the WM group, 4 items (pain and discomfort, opportunities for acquiring new information and skills, QOL score, overall health status and QOL) had significantly different scores post-treatment compared with those at pre-treatment (P < 0.05). Before treatment, the QOL in the two groups of patients showed no significant difference (P > 0.05). After treatment, the scores for physical health in the CM group were significantly higher than those of the WM group (P < 0.05) and the scores of 4 items (mobility, activities of daily living, sexual activity, QOL score) in the CM group were significantly higher than those in the WM group (P < 0.05). CONCLUSIONS: CM and WM treatment could improve the QOL of patients with endometriosis after conservative surgery. CM treatment is more effective than WM.

[Study on ingredients of Scutellaria Radix extract penetrable through placental barrier of pregnant rat].

OBJECTIVE: To study ingredients penetrable through placental barrier by administering pregnant rats with Scutellaria Radix extract using HPLC-MS. METHOD: Rats in early, middle and late pregnancy were intragastrically administered with Scutellaria Radix extract for 5 days. Maternal plasma and embryonic tissues were obtained at 1.5, 12 h after the final administration of Scutellaria Radix extract to determine ingredients of biological specimens. RESULT: Under the optimum experimental conditions, seven compounds were detected in all pregnant rat plasma, specifically including baicalin, wogonoside, baicalein, wogonin and oroxylin A. The seven compounds were also discovered in embryonic tissues of rats in early pregnancy, including the five detected compounds. But they were not detected in embryonic tissues of rats in middle pregnancy, and six compounds except baicalein were detected embryonic tissues of rats in late pregnancy. CONCLUSION: Ingredients contained in Scutellaria Radix are detected in pregnant rats at different stages, except those in middle pregnancy, indicating a potential in utero exposure in case of oral administration of Scutellaria Radix pregnancy. Therefore, a study of embryotoxicity shall be continued to evaluate the safety of Scutellaria Radix extract.

[Application of BeWo cell model in studies on placental transport mechanism].

As placenta barrier controls material exchanges between mother and fetus during pregnancy, studies on the placental transport mechanism of drugs is of great importance to analyze the efficacy, safety and toxicity of drugs. BeWo cells are derived from human choriocarcinomas, which can form monolayer trophoblast cells to offers an efficient placenta barrier in vitro for estimating nutrient and drug intake, efflux and transport. This essay focuses on the establishment and characteristics of BeWo cell model, and the advance on studies on nutrient and drug intake, efflux and transport mechanism by applying the model.

[Ingredients of Shuanghuanglian injection powder permeation through placental barrier of rat in pregnancy].

OBJECTIVE: Use HPLC to study the permeation of ingredients of Shuanghuanglian injection powder (SHL) through placental barriers of rats at different stages of pregnancy. METHOD: The pregnant rats were administered SHL for 5 d through caudalis vena at different stages of pregnancy. Plasma and embryonic tissues were obtained 12 h after the final administration of SHL. The componds in biological specimen were identified by HPLC. RESULT: Baicalin, luteolin and wogonoside were the main compounds in plasma. Wogonoside retained in first trimester embryonic tissues, and baicalin retained in the embryonic tissues of different pregnant stages. CONCLUSION: Baicalin is the main compound of SHL through placental barriers of rats. Embryotoxicity of baicalin should be considered as the key point to evaluate the safety of SHL.

[Study on the gestational diabetes mellitus and histocompatibility human leukocyte antigen DRB allele polymorphism].

OBJECTIVE: To investigate the allelic frequency of histocompatibility leukocyte antigen (HLA)-DRB of gestational diabetes mellitus (GDM) women, in order to find out the susceptible or protective gene associated with GDM and the relationship between HLA-DRB genes and the clinical characteristic. METHODS: Thirty GDM women served as study group, 40 normal pregnant women were selected as control group. The distribution of HLA-DRB alleles frequency of 30 GDM and 40 normalpregnant women was examed by polymerase chain reaction sequence specific primer (PCR-SSP). RESULTS: There was significantly increased gene frequency of HLA-DR6 (13) in GDM women compared with normal pregnancy (12% Vs 2%, P < 0.05, RR = 5.8). The frequency of HLA-DR3 and HLA-DR9 gene in GDM women were increased, but the statistical difference was not significant (8% Vs 4%, 23% Vs 16%, P > 0.05). A much lower frequency of HLA-DR2 (15), HLA-DR51 were observed in GDM women than in normal pregnancy (10% Vs 24%, P < 0.05; 10% Vs 38%, P < 0.05). There were relationship between HLA-DR3 gene or HLA-DR6 (13)/DR9 heterozygote and severe type of GDM, relative risk (RR) were 27.1 and 8.5 respectively; HLA-DR6 (13)/DR9 heterozygote or HLA-DR3 gene were also correlated with abnormal plasma glucose levels. CONCLUSIONS: Alleles HLA-DR6 (13) were significantly implicated in their susceptibility to GDM. Conversely, HLA-DR2 (15), HLA-DR51 alleles might confer protection against GDM. HLA-DR3 gene and HLA-DR6 (13)/DR9 heterozygote were associated with severity and prognosis of GDM. It may be a marker of grade and prognosis of GDM and may direct the treatment.