[Clinical study of hysteroscopy combined with laparoscopy in the diagnosis and treatment of unexplained infertility].

Objective: To explore the importance of the diagnosis and treatment value of laparoscopy and hysteroscopy in patients with unexplained infertility. Methods: A total of 519 cases diagnosed as unexplained infertility, received laparoscopy and hysteroscopy in Peking Union Medical College Hospital from May 2012 to December 2015. The causes of infertility were evaluated, and the subjects were followed up to observe the nature pregnancy rate. Results: Among 519 unexplained infertility patients, pelvic abnormalities had been explored in 466 (89.8%, 466/519) cases. Pelvic endometriosis combined with adhesions, pelvic adhesion alone, uterine leiomyoma and uterine cavity polyp were 72.4% (376/519), 12.3% (64/519), 3.7% (19/519) and 1.3% (7/519) respectively. The total natural pregnancy rate within the 3 years of follow up was 53.9% (208/386), and the natural pregnancy rate was 29.8% (31/104) in patients aged 35 years and over. Conclusions: The patients with clinical diagnosis of unexplained infertility should be examined by hysteroscopy and laparoscopy. Under the examination, the causes of infertility could be found more intuitively, and targeted treatment could be carried out to improve the pregnancy rate. The natural pregnancy rate of the elderly patients decrease obviously after operation, and the time of natural trying pregnancy should not be too long.

[Effect of low-dose or standard-dose conjugated equine estrogen combined with different progesterone on bone density in menopause syndrome women].

Objective: To explore the effect of low-dose or standard-dose conjugated equine estrogen (CEE) combined with natural progesterone or dydrogesterone on bone density in menopause syndrome women. Methods: Totally 123 patients with menopause syndrome were recruited and randomly assigned to 3 treatment groups: group A (low-dose CEE+progesterone) , group B (standard-dose CEE+progesterone) , group C (standard-dose CEE+dydrogesterone) . Using continuous sequential regimen, the duration of intervention was 12 cycles. The bone mineral density of lumbar 2-4 and neck of femur, the bone metabolic markers, the level of FSH and estradiol were examined just before the drug administration and 12 months after the beginning of experiment. Results: There were 107 cases completed the one year trial. (1) Bone density: after 12 cycles of treatment, there was no significant change in bone density in group A (P>0.05) ; lumbar vertebrae of group B and C increased significantly, at 3.0% and 2.1%respectively (all P<0.05) . The bone density of left femoral neck of group C significantly increased by 2.9% (P=0.029) . There was no significant difference among the treatment groups at the beginning of experiment (P>0.05) . (2) Bone metabolic markers: after 12 cycles of treatment, the levels of calcium, phosphorus, alkaline phosphatase, Ca/Cr decreased significantly, the difference were statistically significant (all P<0.05) . There was no significant difference among the treatment groups at the beginning of experiment (P>0.05) . (3) Levels of FSH and estradiol: after 12 cycles of treatment, the levels of FSH in three groups were decreased significantly (all P<0.01) . The levels of estradiol in three groups were increased significantly (all P<0.01) . There was no significant difference among the treatment groups at the beginning of experiment (P>0.05) . Conclusions: Both low-dose and standard-dose menopause hormone therapy (MHT) could elevate the level of estradiol, reduce bone turnover, prevent bone loss of postmenopausal women effectively. The standard dose of MHT could also increase the density of vertebrae and femoral neck, and generate more clinical benefits.

[Analysis of the effects on menopausal symptoms, quality of Life, and cardiovascular risk factors of five different therapy in women at early stage of menopause].

OBJECTIVE: To explore the effects of five different therapy in women at early stage of menopause on menopausal symptoms, quality of Life and cardiovascular risk factors. METHODS: A total of 140 women at early stage of menopause were randomly divided into five groups. Thirty women took Conjugated estrogen and medroxyprogesterone acetate(CEE+ MPA) sequential therapy, 27 women took estradiol valerate and medroxyprogesterone acetate(E2V+ MPA) sequential therapy, 26 women took estradiol valerate and Progesterone Soft Capsules(E2V+ P) sequential therapy, 30 women took Kuntai capsule, and 27 took Cohosh extract.Patients in the Menopausal Hormone Therapy(MHT) groups took twelve cycles of treatment course, in the botanical drug and Chinese patent drug groups took twelve months. The KMI scalewas used to measure the level of menopausal symptoms. MENQOL scale was used to measure the health-related quality of life before and at the 3(rd) month, 6(th) month, 9(rd) month and 12(th) month after the treatment. Some serological indicators which related to cardiovascular risk factors were collected before and at the 12(th) month after the treatment. RESULTS: (1) KMI: It showed that the KMI in five groups after the treatment were significantly different(P<0.01), the group of CEE+ MPA decreased most(13±1). The KMI after the treatment were all significantly lower than that before. (2)MENQOL: It showed that the MENQOL in five groups were significantly different(P<0.01), the group of CEE+ MPA decreased most (84±3), then the group of Kuntai(85±3). The MENQOL after the treatment were all significantly lower than that before. (3)The change of cardiovascular risk factors: it showed that the serological indicators FBGin group of CEE+ MPA after the treatment were significantly lower than that before(P<0.05); the TC, LDL, FI in group of E2V+ MPA after the treatment were significantly lower than that before(P<0.05); the FBG, FI in group of E2V+ P after the treatment were significantly lower than that before(P<0.05). CONCLUSION: The MHT, botanical drug and Chinese patent drug have great clinical curative effects in treating perimenopause syndrome, improving the health-related quality of life and decreasing risk factors of cardiovascular disease.With rare adverse events and good clinical medication safety, they could be widely applied to clinic to women at early stage of menopause who was suffering menopausal symptoms.

The therapeutic effect of rosuvastatin on cardiac remodelling from hypertrophy to fibrosis during the end-stage hypertension in rats.

End-stage hypertensive heart disease is an increasing cause of cardiac mortality. Therefore, the current study focused on the cardiac remodelling from hypertrophy to fibrosis in old-aged spontaneously hypertensive rats (SHRs), and explored the therapeutic effects of Rosuvastatin and its possible mechanism(s) of action. Spontaneously hypertensive rats at age 52 weeks were randomly divided into three groups, the first two to receive Rosuvastatin at a dose of 20 mg/kg/day and 40 mg/kg/day, respectively, and the third to receive placebo, which was to be compared with Wistar-Kyoto as controls. After 2-month treatment, SBP, heart to body weight ratio (HW/BW%) and echocardiographic features were evaluated, followed by haematoxylin and eosin and Masson trichrome staining in conjunction with qPCR of foetal gene expressions. Transferase-mediated dUTP nick-end labelling assay and immunofluorescent labelling for active caspase-3 were used to detect the apoptotic cardiomyocytes. Signaling pathways involved were examined by using western blot. Old-aged SHR developed end-stage hypertensive heart disease characterized by significant enhancement of HW/BW%, LVAWd and LVPWd, and decreased LVEF and LVFS, accompanied by cardiomyocytes enlargement and fibrosis along with activation of foetal gene programme. Cardiac apoptosis increased significantly during the transition process. Rosuvastatin reduced hypertrophy significantly via AT(1) Receptor-PKCß2/α-ERK-c-fos pathway; protected myocardium against apoptosis via Akt-FOXO1, Bcl-2 family and survivin pathways and consequently suppressed the caspase-3 activity. The present study revealed that old-aged SHRs developed cardiac remodelling from hypertrophy to fibrosis via cardiac apoptosis during the end stage of hypertensive heart disease. These pathological changes might be the consequence of activation of AT(1) Receptor-PKCß2/α-ERK-c-fos and AKT-FOXO1/Bcl-2/survivin/Caspase3 signaling. Rosuvastatin effectively attenuated the structural changes by reversing the signaling transductions involved.

Relationship of leptin and sex hormones to bone mineral density in men.

Sex hormones are strongly associated with bone mineral density (BMD) in adult humans. Leptin, a hormonal product of the OB gene, also appears to be associated with BMD, but results from previous studies are conflicting. Most of the studies in this area have been in women and apparently none have simultaneously analyzed the relationship of estradiol, testosterone, and leptin with BMD in healthy men. To address these issues, serum sex hormones, sex-hormone-binding globulin (SHBG), leptin, dehydroepiandrosterone sulfate (DHEAS), and insulin were measured in 50 apparently healthy men, 18-66 years of age. After controlling for age and body mass index (BMI), BMD correlated positively with estradiol ( p=0.007) and testosterone ( p=0.019), but negatively with leptin ( p=0.001). No significant correlations between BMD and SHBG, DHEAS, or insulin were observed. In multiple regression analysis with age, BMI, estradiol, testosterone, and leptin as the independent variables, only age ( p<0.05), BMI ( p<0.001), and leptin ( p=0.004) were significantly related to BMD. These findings suggest that in men, leptin may have an important negative relationship with BMD.

Is there an association between skeletal muscle mass and bone mineral density among African-American, Asian-American, and European-American women?

Skeletal muscle strength is a factor in the growth and maintenance of bone density and both skeletal muscle mass and bone mineral density are related to bone fracture risk. We studied the relationship between total body bone mineral density (TBBMD) and total appendicular skeletal muscle mass (TASM) estimated by dual-energy X-ray absorptiometry (DEXA) in African-American (AA), Asian-American (AsA), and European-American (EA) premenopausal (PRM) and postmenopausal (POM) women. The age- and weight-adjusted TBBMD-TASM association was positive in all PRM race groups and in POM EA, but was negative in POM AA and POM AsA. Body weight and age were positively and negatively associated with TBBMD, respectively, and the relationship was stronger in POM. In all race groups the variability in TBBMD was significantly greater in POM women.

[Identification of genes related to cell phenotypic transition by differential display analysis].

To identify the genes that are differentially expressed during the phenotypic transition from vascular adventitial fibroblasts to myofibroblasts, the adventitial fibroblasts were cultured from rat thoracic aorta, and myofibroblasts were obtained by treatment of fibroblasts with TGF-beta1. Differential display PCR (DD-PCR) was used to screen for differentially expressed genes by comparison of mRNA extracted from the two cell populations. Bands upregulated or downregulated on DD gels were excised, reamplified, cloned and sequenced. DD results were verified by quantitative PCR and Northern blot analysis.Antisense oligonucleotide was transfected to study the effect of osteopontin on migration of AF. Differential display showed a significant difference in gene expression profile between the two cell types. A transcript that was downregulated in myofibroblasts showed high DNA sequence homology to part of the gene for NADH dehydrogenase subunit 5. An upregulated transcript showed significant sequence homology to osteopontin gene. Quantitative PCR and Northern blot analysis confirmed the DD results. Among the other differential bands detected, 4 candidate sequences showed no homology to the known genes. The AF numbers of migration were significantly decreased by use of OPN antisense oligonucleotide. This study suggests that the downregulation of gene encoding NADH dehydrogenase subunit 5 and upregulation of osteopontin gene and several other unknown genes may be involved in the phenotypic transition of adventitial fibroblasts to myofibroblats. Inhibition of the expression of OPN may play an important role in the process of vascular remodeling.

[Roentgen findings in bronchial tuberculosis]. / Röntgenbefunde bei Bronchialtuberkulose.

To determine the value of chest roentgenographic findings in the diagnosis and therapy of endobronchial tuberculosis we analysed roentgenograms of 41 patients with endoscopically confirmed tuberculous involvement of the intrathoracic airways. 40 patients had infiltrates typical for pulmonary tuberculosis predominantly in the upper lobes. Signs of diminished air entry in form of collapse or consolidations were found in 52%. 10 patients had cavities and two had a destroyed lung. In only one patient the chest roentgenogram was completely normal demonstrating a case of isolated endobronchial tuberculosis. During antituberculosis drug therapy radiological signs improved in 38 of 41 patients, but in more than half of the cases stenoses persisted as verified by bronchoscopy. We conclude that endobronchial tuberculosis is usually accompanied by lung parenchyma involvement and that roentgenological findings are characterised by signs of pulmonary tuberculosis in most cases. A normal chest roentgenogram does not exclude endobronchial tuberculosis. Despite roentgenographic improvement during therapy tracheobronchial stenoses may persist. These findings justify to perform early fibreoptic bronchoscopy. Sputum conversion during the clinical course may indicate the most appropriate time for this examination.

[The expression of C-FOS, C-JUN and phosphotyrosine gene products in lung cancer].

An immunohistochemical study on C-FOS, C-JUN and phosphotyrosine (P-Tyr) cancer gene products was performed. The results showed that C-FOS had the lowest frequency of expression and P-Tyr had the highest. The positive reactions of the three cancer gene products were observed in the nucleus, nuclear membrane and cytoplasm. The expression of C-FOS in normal bronchial and alveolar tissue was 3.8% and 1.6% respectively. But in lung cancer it was 60%. The simultaneous positive expression of C-FOS and C-JUN was 56% (54 cases). Negative C-FOS and positive C-JUN was 32%. Positive C-FOS and negative C-JUN was less than 4% (4 cases). Although C-FOS and C-JUN formed a hetero-dimer by zipper structure, the C-FOS had the ability of single expression.

[Involvement of the central nervous system in disseminated tuberculosis]. / Beteiligung des Zentralnervensystems bei disseminierter Tuberkulose.

Four weeks after starting tuberculostatic treatment (with isoniazid, rifampicin, streptomycin and pyrazinamide) a 21-year-old man with pulmonary tuberculosis developed symptoms of a radiculomyelopathy as well as mild renal failure. After isoniazid and streptomycin had been discontinued and ethambutol and high doses of vitamin B6 had been added all signs and symptoms improved. However, 4 weeks later tuberculous meningitis occurred which at first seemed to respond to administration of 5 antituberculosis drugs and dexamethasone. But 3 weeks later the patient sustained a partial hemiparesis. Its cause was proven to be a tuberculoma in the region of the brainstem. During further administration of tuberculostatic drugs and glucocorticoids the symptoms gradually receded over 8 months. A 54-year-old man with pulmonary tuberculosis developed cranial nerve pareses and symptoms of cerebellar involvement (trunk ataxia, intention tremor, dysdiadochokinesia) 3 weeks after starting tuberculostatic treatment. Computed tomography revealed multiple intracerebral tuberculomas which gradually shrank with continuation of the tuberculostatic treatment plus glucocorticoids. These two case reports illustrate that in tuberculosis involvement of the CNS can express itself clinically through complex symptoms, sometimes even after the start of tuberculostatic treatment.

Cutaneous vasculitis associated with tuberculosis and its treatment.

Two patients with pulmonary tuberculosis developed cutaneous vasculitis after antituberculosis treatment and a patient with tuberculous lymphadenitis developed vasculitis at presentation before drug therapy. The cutaneous vasculitis probably represented immunological reactions to tubercle bacilli and/or rifampicin with antibodies and immune complex formation.

Bronchoscopic aspiration and bronchoalveolar lavage in the diagnosis of sputum smear-negative pulmonary tuberculosis.

The ability to make a definitive diagnosis in sputum smear-negative pulmonary tuberculosis by bronchoscopic aspiration, bronchoalveolar lavage (BAL), and examination of postbronchoscopy sputum were compared. Thirty-four patients with lesions on chest x-rays suspected of being pulmonary tuberculosis were entered into the study. The diagnosis of pulmonary tuberculosis was subsequently confirmed in 28 patients and the method of arriving at the final diagnosis was analyzed. A positive acid-fast bacilli (AFB) smear result was obtained in 4/28 (14%) of cases by a combination of bronchoscopic techniques and postbronchoscopy sputum examination. Prebronchoscopy sputum culture was positive in 12/28 (43%). Combined with bronchoscopy specimens, a positive AFB culture result was obtained in 26/28 (93%). Sputum examination, bronchoscopic aspiration, and BAL are complementary techniques and together they give a high yield of definitive diagnosis of pulmonary tuberculosis.