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1.
Medicine (Baltimore) ; 98(47): e17841, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764781

RESUMO

BACKGROUND: Low endometrial receptivity is associated with infertility in women through multiple and complex mechanisms. Existing treatments are not always effective. Symptomatic drugs such as estradiol valerate and/or aspirin do not completely solve the problem. Traditional Chinese herbs have been widely used in infertility and uterine disease including low endometrial receptivity. However, their effectiveness and safety are still obscure and deserve further investigation. OBJECTIVE: To assess the effect and safety of traditional Chinese herbs in treating low endometrial receptivity. METHODS: We will summarize and meta-analyze randomized controlled trials (RCTs) of traditional Chinese herbs for the treatment of low endometrial receptivity. RCTs comparing traditional Chinese herbs with blank control, placebo, or conventional therapies will be included. RCTs comparing traditional Chinese herbs plus conventional therapies with conventional therapies alone will also be included. The following electronic databases will be searched: PubMed, Cochrane Library, EMBASE, CNKI, CBM, VIP, and WANFANG DATA. The methodological quality of RCTs will be assessed using the Cochrane risk assessment tool. All trials included will be analyzed according to the criteria of the Cochrane Handbook. Review Manager 5.3, R-3.5.1 software will be used for publication bias analysis. GRADE pro GDT web solution will be used for evidence evaluation. RESULTS: This review will evaluate the effects of traditional Chinese herbs on estradiol, progesterone, thickness, volume, and perfusion index(PI) of the endometrium, pregnancy rate, and symptoms. CONCLUSIONS: This review will provide clear evidence to assess the effectiveness and safety of traditional Chinese herbs for low endometrial receptivity. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/M85VT.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Infertilidade Feminina/tratamento farmacológico , Metanálise como Assunto , Projetos de Pesquisa , Revisão Sistemática como Assunto , Endométrio/fisiopatologia , Feminino , Humanos , Infertilidade Feminina/etiologia , Fitoterapia , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
Rev Assoc Med Bras (1992) ; 65(9): 1144-1150, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31618328

RESUMO

OBJECTIVE: In view of the high incidence of polycystic ovary syndrome (PCOS) and the unsatisfactory therapeutic effects of dimethyldiguanide or clomifene citrate alone, our study aimed to investigate the therapeutic effects of dimethyldiguanide combined with clomifene citrate in the treatment of PCOS. METHODS: A total of 79 patients with POCS and 35 healthy females were included, and endometrial biopsies were obtained. The sterol regulatory element-binding protein-1 (SREBP1) expression in endometrial tissues was detected by qRT-PCR. POC patients were randomly divided into group A (n=40) and group B (n=39). Patients in group A were treated with dimethyldiguanide combined with clomifene citrate, while patients in group B were treated with clomifene citrate alone. The number of mature follicles and cervical mucus score, follicular development rate and single follicle ovulation rate, cycle pregnancy rate, early miscarriage rate, ovulation rate, endometrial thickness, positive rate of three lines sign, follicle stimulating hormone level and luteinizing hormone level were compared between the two groups. RESULTS: The expression level of SREBP1 was higher in PCOS patients than that in the healthy control. SREBP1 expression was inhibited after treatment, while the inhibitory effects of combined treatment were stronger than those of clomifene citrate alone. Compared with clomifene citrate alone, the combined treatment improved cervical mucus score, follicle development rate, single follicle ovulation rate, endometrial thickness, positive rate of three lines sign, and follicle-stimulating hormone level. CONCLUSION: The therapeutic effect of combined treatment is better than clomifene citrate alone in the treatment of PCOS.


Assuntos
Clomifeno/uso terapêutico , Fármacos para a Fertilidade Feminina/uso terapêutico , Hipoglicemiantes/uso terapêutico , Metformina/uso terapêutico , Síndrome do Ovário Policístico/tratamento farmacológico , Adulto , Muco do Colo Uterino/efeitos dos fármacos , Clomifeno/farmacologia , Quimioterapia Combinada , Endométrio/fisiopatologia , Feminino , Fármacos para a Fertilidade Feminina/farmacologia , Regulação da Expressão Gênica/efeitos dos fármacos , Humanos , Hipoglicemiantes/farmacologia , Metformina/farmacologia , Folículo Ovariano/efeitos dos fármacos , Indução da Ovulação , Proteína de Ligação a Elemento Regulador de Esterol 1/efeitos dos fármacos , Proteína de Ligação a Elemento Regulador de Esterol 1/genética , Adulto Jovem
3.
Res Vet Sci ; 126: 164-169, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31499425

RESUMO

Endometritis is one of the most common reproductive diseases caused by bacterial infection in the cow. Ferulic acid is a major effective component extracted from Ligusticum wallichii. Ferulic acid displays pharmacological effects such as anti-inflammation and antioxidation. The aim of the present study was to investigate the protective effects of ferulic acid on inflammation induced by lipopolysaccharide (LPS) in bovine endometrial epithelial cells (BEECs). BEECs were pretreated with ferulic acid followed by LPS treatment. QRT-PCR analysis showed the mRNA expression of LPS-induced proinflammatory cytokines (IL1B, IL6, TNFA, and IL8) was decreased with ferulic acid pretreatment. Western blot analysis showed that ferulic acid inhibited the degradation of IκB and phosphorylation of NF-κB p65. Ferulic acid suppressed the phosphorylation of MAPKs, including p38 and JNK. All of these results indicated that ferulic acid may be considered as a potential anti-inflammatory drug for curing endometritis.


Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Doenças dos Bovinos/tratamento farmacológico , Ácidos Cumáricos/administração & dosagem , Endometrite/veterinária , Inflamação/veterinária , Animais , Bovinos , Doenças dos Bovinos/induzido quimicamente , Endometrite/induzido quimicamente , Endometrite/tratamento farmacológico , Endométrio/efeitos dos fármacos , Endométrio/fisiopatologia , Células Epiteliais/efeitos dos fármacos , Feminino , Inflamação/induzido quimicamente , Inflamação/tratamento farmacológico , Lipopolissacarídeos/farmacologia , Quinases de Proteína Quinase Ativadas por Mitógeno/metabolismo , NF-kappa B/metabolismo , Transdução de Sinais/efeitos dos fármacos
6.
Fertil Steril ; 111(6): 1177-1185.e3, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31029432

RESUMO

OBJECTIVE: To investigate whether the duration of estrogen administration before euploid embryo transfer affects clinical outcome. DESIGN: Retrospective cohort study. SETTING: Private, academic fertility center. PATIENT(S): Patients (n = 1,439) undergoing autologous freeze-only in vitro fertilization with preimplantation genetic testing (PGT) followed by endometrial preparation with estrogen and progesterone in a frozen, euploid blastocyst transfer cycle. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Primary outcome was live birth, and secondary outcomes included implantation, clinical pregnancy, early pregnancy loss, live birth, infant birthweight, low birth weight, infant gestational age at delivery, and preterm birth. RESULT(S): The duration of estrogen administration (mean: 17.5 ± 2.9 days; range: 10-36 days) before frozen embryo transfer did not impact implantation (odds ratio [OR] 0.99; 95% confidence interval [CI], 0.95-1.03), clinical pregnancy (OR 0.98; 95% CI, 0.94-1.01), early pregnancy loss (OR 1.03; 95% CI, 0.95-1.12), or live birth (OR 0.99; 95% CI, 0.95-1.03). The duration of estrogen exposure did not affect infant birthweight (in grams) (ß= -10.65 ± 8.91) or the odds of low birth weight (OR 0.87; 95% CI, 0.68-1.13). For every additional day of estrogen administration, we observed a reduction in gestational age at delivery (in weeks) (ß= -0.07 ± 0.03), but the odds of preterm delivery were not affected (OR 1.05; 95% CI, 0.95-1.17). CONCLUSION(S): Variation in the duration of estradiol supplementation before progesterone initiation does not impact frozen, euploid blastocyst transfer outcome. The duration of estrogen administration was inversely correlated with gestational age at delivery, but this did not translate into an increase in preterm delivery. Further studies are required on the downstream effects of endometrial preparation on the placental-endometrium interface.


Assuntos
Blastocisto , Criopreservação , Implantação do Embrião/efeitos dos fármacos , Endométrio/efeitos dos fármacos , Estradiol/administração & dosagem , Fármacos para a Fertilidade Feminina/administração & dosagem , Fertilização In Vitro , Infertilidade/terapia , Transferência de Embrião Único , Adulto , Esquema de Medicação , Endométrio/fisiopatologia , Estradiol/efeitos adversos , Feminino , Fármacos para a Fertilidade Feminina/efeitos adversos , Humanos , Infertilidade/diagnóstico , Infertilidade/fisiopatologia , Nascimento Vivo , Gravidez , Complicações na Gravidez/etiologia , Taxa de Gravidez , Estudos Retrospectivos , Fatores de Risco , Transferência de Embrião Único/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Vitrificação
7.
Cell Prolif ; 52(3): e12597, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30896075

RESUMO

OBJECTIVES: Because primary mesenchymal progenitor cells (adult-MPCs) have various functions that depend on the tissue origin and donor, de novo MPCs from human pluripotent stem cells (hPSCs) would be required in regenerative medicine. However, the characteristics and function of MPCs derived from reprogrammed hPSCs have not been well studied. Thus, we show that functional MPCs can be successfully established from a single cell-derived clonal expansion following MPC derivation from somatic cell nuclear transfer-derived (SCNT)-hPSCs, and these cells can serve as therapeutic contributors in an animal model of Asherman's syndrome (AS). MATERIALS AND METHODS: We developed single cell-derived clonal expansion following MPC derivation from SCNT-hPSCs to offer a pure population and a higher biological activity. Additionally, we investigated the therapeutic effects of SCNT-hPSC-MPCs in model mice of Asherman's syndrome (AS), which is characterized by synechiae or fibrosis with endometrial injury. RESULTS: Their humoral effects in proliferating host cells encouraged angiogenesis and decreased pro-inflammatory factors via a host-dependent mechanism, resulting in reduction in AS. We also addressed that cellular activities such as the cell proliferation and population doubling of SCNT-hPSC-MPCs resemble those of human embryonic stem cell-derived MPCs (hESC-MPCs) and are much higher than those of adult-MPCs. CONCLUSIONS: Somatic cell nuclear transfer-derived-hPSCs-MPCs could be an advanced therapeutic strategy for specific diseases in the field of regenerative medicine.


Assuntos
Ginatresia/terapia , Transplante de Células-Tronco Mesenquimais , Animais , Diferenciação Celular , Proliferação de Células , Técnicas de Reprogramação Celular , Células Clonais/transplante , Modelos Animais de Doenças , Endométrio/patologia , Endométrio/fisiopatologia , Feminino , Ginatresia/patologia , Ginatresia/fisiopatologia , Humanos , Camundongos , Camundongos Endogâmicos ICR , Neovascularização Fisiológica , Técnicas de Transferência Nuclear , Células-Tronco Pluripotentes/transplante , Medicina Regenerativa , Útero/patologia , Útero/fisiopatologia
8.
BMC Complement Altern Med ; 19(1): 61, 2019 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-30866920

RESUMO

BACKGROUND: This systematic review aimed at summarizing and evaluating the evidence of randomized controlled trials (RCTs) using acupuncture to improve endometrial receptivity (ER). METHODS: We searched 12 databases electronically through August 2018 without language restrictions. We included RCTs of women of infertility due to low ER, and excluded infertility caused by other reasons or non-RCTs. Two independent reviewers extracted the characteristics of studies and resolved the differences through consensus. Data were pooled and expressed as standard mean difference (SMD) or mean difference (MD) for continuous outcomes and risk ratio (RR) for dichotomous outcomes, with 95% confidence interval (CI). RESULTS: We found very low to moderate level of evidence that acupuncture may improve pregnancy rate (RR = 1.23 95%CI[1.13, 1.34] P < 0.00001) and embryo transfer rate (RR = 2.04 95%CI[1.13, 3.70] P = 0.02), increase trilinear endometrium (RR = 1.47 95%CI [1.27, 1.70] P < 0.00001), thicken endometrium (SMD = 0.41 95% CI [0.11, 0.72] P = 0.008), reduce resistive index (RI) (MD = -0.08 95% CI [- 0.15, - 0.02] P = 0.01), pulse index (PI) (SMD = -2.39 95% CI [- 3.85, - 0.93] P = 0.001) and peak systolic velocity/ end-diastolic blood velocity (S/D) (SMD = -0.60 95% CI [- 0.89, - 0.30] P < 0.0001), compared with medication, sham acupuncture or physiotherapy. Acupuncture was statistically significant as a treatment approach. CONCLUSION: The efficacy and safety of acupuncture on key outcomes in women with low ER is statistically significant, but the level of most evidence was very low or low. More large-scale, long-term RCTs with rigorous methodologies are needed.


Assuntos
Terapia por Acupuntura , Endométrio , Infertilidade Feminina/terapia , Gravidez , Endométrio/fisiologia , Endométrio/fisiopatologia , Feminino , Humanos , Gravidez/fisiologia , Gravidez/estatística & dados numéricos
9.
In Vivo ; 33(2): 469-472, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30804127

RESUMO

BACKGROUND: Retention of products of conception (RPOC) following delivery is rare. Clinicians often have the impression that a high proportion of patients with sonographically suspected RPOC following surgery have a negative histopathology. Hence, we aimed to report our single-center experience with suspected RPOC and histopathological outcome after surgery. PATIENTS AND METHODS: In this retrospective analysis, patients who underwent surgery due to suspected postpartum RPOC were analyzed for potential predictive clinical and sonographic parameters. RESULTS: A total of 32 patients with histopathologically-confirmed RPOC were compared with 21 patients with a negative histopathological report for RPOC. Endometrial hyperechogenic mass and clinical parameters such as pain, fever and bleedings were not predictive for RPOC. Increased age (p=0.001) and vaginal delivery (p=0.040) were significantly associated with RPOC. CONCLUSION: Clinical presentation alone is not predictive for RPOC. Vaginal delivery and younger age seem to be a risk factor and therefore have to be considered in patients with suspected RPOC.


Assuntos
Parto Obstétrico/efeitos adversos , Endométrio/cirurgia , Complicações na Gravidez/fisiopatologia , Adulto , Endométrio/fisiopatologia , Feminino , Idade Gestacional , Humanos , Gravidez , Complicações na Gravidez/cirurgia , Estudos Retrospectivos , Vagina/fisiopatologia , Vagina/cirurgia
10.
In Vivo ; 33(2): 515-521, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30804135

RESUMO

BACKGROUND/AIM: Patients diagnosed with chronic endometritis (CE) may fail to respond to standard antibiotic treatment. The driver behind the approach reported here was the imperative need for alternative therapeutic solutions. CASE REPORT: This case report presents a woman with CE and premature ovarian insufficiency having experienced repeated implantation failures following donated embryo transfers. The patient was diagnosed with CE through hysteroscopy, microbiological analysis and scanning electron microscopy. Following the suggested antibiotic treatment, she underwent a new embryo transfer, but with subsequent pregnancy loss. Following a second antibiotic scheme, all diagnostic procedures certified the persistence of CE. The patient underwent autologous, intrauterine platelet-rich plasma treatment and a subsequent embryo transfer. The diagnostic procedures indicated no signs of CE, while the embryo transfer resulted in a twin pregnancy and birth. CONCLUSION: Platelet-rich plasma may be employed as a first-line CE treatment, especially for patients who fail to respond to conventional antibiotic schemes.


Assuntos
Endometrite/terapia , Fertilização In Vitro , Infertilidade Feminina/veterinária , Nascimento Vivo , Plasma Rico em Plaquetas , Adulto , Implantação do Embrião/fisiologia , Transferência Embrionária , Endometrite/fisiopatologia , Endométrio/fisiopatologia , Feminino , Humanos , Infertilidade Feminina/fisiopatologia , Infertilidade Feminina/terapia , Gravidez , Resultado da Gravidez , Taxa de Gravidez , Transplante Autólogo/efeitos adversos
11.
J Assist Reprod Genet ; 36(4): 607-611, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30684071

RESUMO

PURPOSE: The aim of the systematic review is to describe the obstetrical complications associated with pregnancies in the context of a thin endometrial lining. METHODS: Systematic review of the literature. RESULTS: Patients who conceive in the setting of a thin endometrium have a significantly increased risk of early pregnancy loss, namely miscarriage and ectopic pregnancy. These patients also have a twofold increase in low birth weight and preterm delivery, as well as a significantly higher risk of intrauterine growth restriction and composite adverse perinatal outcomes. CONCLUSIONS: In addition to the lower probability of conception, a thin endometrium in assisted reproductive technologies appears to be associated with both early and late pregnancy complications. These pregnancies thus warrant special attention and close follow-up from obstetricians.


Assuntos
Endométrio/fisiopatologia , Fertilização In Vitro , Complicações na Gravidez/fisiopatologia , Técnicas de Reprodução Assistida , Adulto , Transferência Embrionária , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Complicações na Gravidez/epidemiologia , Taxa de Gravidez , Injeções de Esperma Intracitoplásmicas
12.
Trop Anim Health Prod ; 51(5): 1161-1166, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30684222

RESUMO

The objective of the study was to investigate the role of pro-inflammatory cytokines in the pathogenesis of endometritis in buffaloes, which can lead to early diagnosis of endometritis. The expression of CD14, TLR-4, and IL-1ß encoding gene in endometrium of buffaloes with subclinical endometritis were 1.87, 2.71, and 3.48-fold, while samples with clinical endometritis showed only 2.90, 4.76, and 8.02-fold for CD14, TLR-4, and IL-1ß, respectively, though numerical value of expression was higher in subclinical and clinical endometritis but it was at par with control. The expression profile for IL-6, IL-8, and TNF-α mRNA for subclinical endometritis were 11.95, 14.87, and 12.95-fold while for clinical endometritis, values were 18.17, 37.97, and 28.83-fold for IL-6, IL-8, and TNF-α mRNA, respectively, which were significantly higher in subclinical and clinical endometritis as compared to apparently normal samples at follicular phase. In the luteal group, the subclinical endometritis sample showed 2.13, 6.43, 14.52, 22.38, 18.64, and 2.82-fold respectively, for CD14, IL-1ß IL-6, IL-8, TNF-α, and TLR-4 mRNA. Except TLR-4, the values of expression were significantly higher when compared with apparently normal. Whereas, the expression values of clinical endometritic uteri were 4.01, 7.15, 17.20, 45.55, 52.58, and 32.95-fold respectively, for CD14, TLR-4, IL-1ß, IL-6, IL-8, and TNF-α mRNA which were significantly higher as compared to apparently normal uteri. An increase in the mRNA expression of CD14, TLR-4, and pro-inflammatory cytokines having higher diagnostic importance in uterine inflammation.


Assuntos
Búfalos , Citocinas/genética , Endometriose/fisiopatologia , Endométrio/metabolismo , Expressão Gênica , Animais , Doenças Assintomáticas , Citocinas/metabolismo , Endometriose/metabolismo , Endométrio/fisiopatologia , Feminino
13.
J Assist Reprod Genet ; 36(3): 483-490, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30610661

RESUMO

PURPOSE: To evaluate the effect of medical or surgical treatment prior to embryo transfer in women with elevated endometrial BCL6 expression and suspected endometriosis in a prospective, cohort study design at a university-associated infertility clinic. METHODS: All subjects had at least 1 year of unexplained infertility (UI) and each prospectively underwent endometrial biopsy and immunostaining for the oncogene BCL6, prior to embryo transfer during an assisted reproductive technology (ART) cycle. To be included, subjects had to have an abnormal BCL6 result, defined by elevated HSCORE ≥ 1.4. Women that were pre-treated with laparoscopy or medical suppression with GnRH agonist (depot leuprolide acetate; Lupron®, Abbvie, Inc., Chicago, IL) for 2 months were compared to a group that went untreated (controls). Endpoints included implantation rate (IR), clinical pregnancy rate (CPR), and live birth rate (LBR), and as well as cycle characteristics. Miscarriage rate were also compared between treatment and control group. RESULTS: Women in each group had similar characteristics. Those treated by medical suppression and those undergoing laparoscopy for endometriosis had a significantly higher LBR, (5/10; 50%; 95%CI 23.7 to 76.3%) and (11/21; 52.4%; 95%CI 32.4 to 71.7), respectively, compared to controls (4/54; 7.4%; 95%CI 2.9 to 17.6). An absolute benefit of 44.2% (16/31; 95%CI 24.6 to 61.2) and a number need to treat of 3 for those that received treatment (medical suppression and laparoscopy), compared to no treatment. Miscarriages were significantly more common in the control group. CONCLUSIONS: Women with suspected endometriosis and aberrant endometrial BCL6 expression have worse reproductive outcomes following embryo transfer, including a high miscarriage rate, poor IR, and low LBR and CPR compared to cycles pre-treated with medical and surgical management.


Assuntos
Implantação do Embrião/genética , Transferência Embrionária , Endométrio/efeitos dos fármacos , Proteínas Proto-Oncogênicas c-bcl-6/genética , Aborto Espontâneo/genética , Aborto Espontâneo/fisiopatologia , Adulto , Endometriose/tratamento farmacológico , Endometriose/genética , Endometriose/fisiopatologia , Endometriose/cirurgia , Endométrio/fisiopatologia , Feminino , Regulação da Expressão Gênica no Desenvolvimento/efeitos dos fármacos , Hormônio Liberador de Gonadotropina/genética , Humanos , Nascimento Vivo , Indução da Ovulação/métodos , Gravidez , Taxa de Gravidez , Técnicas de Reprodução Assistida/tendências
14.
Fertil Steril ; 111(2): 327-340, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30527836

RESUMO

OBJECTIVE: To study the pathophysiology of endometriosis. DESIGN: Overview of observations on endometriosis. SETTING: Not applicable. PATIENT(S): None. INTERVENTIONS(S): None. MAIN OUTCOME MEASURE(S): The hypothesis is compatible with all observations. RESULT(S): Endometriosis, endometrium-like tissue outside the uterus, has a variable macroscopic appearance and a poorly understood natural history. It is a hereditary and heterogeneous disease with many biochemical changes in the lesions, which are clonal in origin. It is associated with pain, infertility, adenomyosis, and changes in the junctional zone, placentation, immunology, plasma, peritoneal fluid, and chronic inflammation of the peritoneal cavity. The Sampson hypothesis of implanted endometrial cells following retrograde menstruation, angiogenic spread, lymphogenic spread, or the metaplasia theory cannot explain all observations if metaplasia is defined as cells with reversible changes and an abnormal behavior/morphology due to the abnormal environment. We propose a polygenetic/polyepigenetic mechanism. The set of genetic and epigenetic incidents transmitted at birth could explain the hereditary aspects, the predisposition, and the endometriosis-associated changes in the endometrium, immunology, and placentation. To develop typical, cystic ovarian or deep endometriosis lesions, a variable series of additional transmissible genetic and epigenetic incidents are required to occur in a cell which may vary from endometrial to stem cells. Subtle lesions are viewed as endometrium in a different environment until additional incidents occur. Typical cystic ovarian or deep endometriosis lesions are heterogeneous and represent three different diseases. CONCLUSION(S): The genetic epigenetic theory is compatible with all observations on endometriosis. Implications for treatment and prevention are discussed.


Assuntos
Endometriose/genética , Endométrio/patologia , Epigênese Genética , Animais , Endometriose/patologia , Endometriose/fisiopatologia , Endometriose/terapia , Endométrio/fisiopatologia , Feminino , Marcadores Genéticos , Predisposição Genética para Doença , Hereditariedade , Humanos , Fenótipo , Prognóstico , Fatores de Risco
15.
Reprod Sci ; 26(3): 436-444, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30458678

RESUMO

OBJECTIVE: To investigate the feasibility to restore functional endometrium using bone marrow mesenchymal stem cells (BMSCs) in the Sprague Dawley (SD["SD" has been defined as both "Sprague Dawley" and "standard deviation." Please clarify which one is to be followed.]) rat model for Asherman syndrome (AS). DESIGN: Basic research on treatment of AS utilizing an optimized rat model. SETTING: University research laboratories. ANIMAL(S): Sprague Dawley rat model in which AS was induced in accordance to an optimized protocol. INTERVENTION(S): Bone marrow mesenchymal stem cells were harvested from the rat's bone marrow and labeled with green fluorescent protein (GFP) in the second passage of BMSCs. The fifth passage of GFP-labeled BMSCs was injected systemically through the tail vein in the optimized AS rat model. MAIN OUTCOME MEASURE(S): We examined the reproliferation of the endometrial lining and the expression of markers for endometrium and endometrial receptivity. The localization of engrafted GFP-labeled BMSCs was determined by a laser scanning confocal microscope and a fluorescence microscope. The number of pregnant rats and implanted embryos in each uterus was recorded to evaluate the function of endometrium. RESULT(S): We had demonstrated that in the in vivo experiments on our rat model for AS, the group which received BMSC injection had significantly improved reproductive outcomes-70% of these rats conceived, whereas none of the rats in the control group got pregnant ( P < .01, χ2 test). The mean number of embryos undergoing implantation was 14 ± 1.24 in the sham group and 7 ± 5.70 in the BMSC group (Levene test, P = .001). There was no significant difference between the groups from the time of coitus to conception. To further determine how BMSC injection could have resulted in the improved reproductive outcomes in rats with AS, we employed immunohistochemical techniques to examine the endometrium of these treated rats. On hematoxylin-eosin staining, we noted the reproliferation of all layers of the endometrium and with Masson staining, we noted significant reduction in fibrosis in the damaged endometrium of rats treated with BMSCs. Counterstaining for GFP and cytokeratin-positive cells was noted in the endometrial lining of treated rats, which might suggest the action of BMSCs in regenerating the damaged endometrial lining. The expression of the endometrial receptivity marker, Leukemia inhibitory factor (LIF), in this regenerated endometrial lining could have resulted in the improved reproductive outcomes observed in the AS rat model treated with BMSCs. CONCLUSION: Bone marrow mesenchymal stem cells were likely to play an important role in the reconstruction of the injured endometrium and improvement of reproductive outcomes in the optimized AS rat model.


Assuntos
Endométrio/fisiopatologia , Ginatresia/fisiopatologia , Ginatresia/cirurgia , Transplante de Células-Tronco Mesenquimais , Animais , Células Cultivadas , Modelos Animais de Doenças , Endométrio/patologia , Feminino , Ginatresia/patologia , Gravidez , Resultado da Gravidez , Ratos Sprague-Dawley , Recuperação de Função Fisiológica , Regeneração
16.
Gynecol Obstet Invest ; 84(1): 35-44, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30048979

RESUMO

OBJECTIVES: To investigate the effect of metformin on endometrial receptivity in women with polycystic ovary syndrome (PCOS). METHODS: Twenty volunteer women with polycystic ovaries and oligomenorrhea were prospectively investigated. All women were treated with exogenous estradiol and progesterone to simulate a normal menstrual cycle (28-day duration) after GnRH-induced pituitary desensitization. Ten of the women received no other medication (group A, control), while the remaining 10 received metformin (group B, metformin). Endometrial biopsy was performed in all women on day 21 of the 2 simulated cycles. RESULTS: The expression of corticotropin - releasing hormone and urocortin in the endometrium was investigated. There was no significant difference between the 2 groups. A 3-day delay in the secretory maturation of the glandular epithelium relatively to the stroma was observed in 7 out of 10 women of group B (70%) as compared to only 1 out of 10 women of group A (10%, p = 0.02). CONCLUSIONS: It is shown for the first time that metformin administration to women with PCOS did not affect the expression of endometrial receptivity markers but delayed histological glandular maturation. It is suggested that metformin may have an impact on the function of the endometrium in PCOS.


Assuntos
Endométrio/efeitos dos fármacos , Endométrio/fisiopatologia , Hipoglicemiantes/farmacologia , Metformina/farmacologia , Síndrome do Ovário Policístico/tratamento farmacológico , Adulto , Hormônio Liberador da Corticotropina/metabolismo , Quimioterapia Combinada , Endométrio/patologia , Estradiol/uso terapêutico , Estrogênios/uso terapêutico , Feminino , Humanos , Hipoglicemiantes/uso terapêutico , Metformina/uso terapêutico , Oligomenorreia/etiologia , Síndrome do Ovário Policístico/complicações , Progesterona/uso terapêutico , Progestinas/uso terapêutico , Estudos Prospectivos , Urocortinas/metabolismo
17.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 47(4): 413-418, 2018 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-30511530

RESUMO

In addition to regulating calcium and phosphorus metabolism to maintain strong bones, vitamin D also has immune regulating and anti-inflammatory effects. Moreover, it is related to chronic inflammatory diseases, autoimmune diseases and cancer. Many studies indicate the roles of vitamin D in the development and progression of endometriosis including the effects on modulation of immune responses, inflammation reactions, cell proliferation and apoptosis, angiogenesis, adhesion and invasion. Vitamin D supplementation can relieve pain and improve endometrial receptivity associated with endometriosis and play a preventive and therapeutic role. This paper summarizes the roles of vitamin D in endometriosis.


Assuntos
Endometriose , Vitamina D , Doenças Autoimunes/fisiopatologia , Endometriose/fisiopatologia , Endométrio/fisiopatologia , Feminino , Humanos , Inflamação/fisiopatologia , Vitamina D/imunologia , Vitamina D/metabolismo
18.
Crit Rev Biomed Eng ; 46(3): 277-288, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30311558

RESUMO

Endometriosis is characterized as the ectopic presence of endometrium in various locations within the abdominal cavity, such as the fallopian tube, the pouch of Douglas, the ovaries, outside the ovaries, and more. The inner lining of the uterus, endometrium, is a dynamic tissue that undergoes morphological and functional changes cyclically. The proliferation of endometrial cells during menstruation is influenced by increasing circulating estrogen levels. Adult progenitor stem cells are likely responsible for this remarkable regenerative capacity and hence, enhanced capacity to generate endometriosis. This chronic estrogen-dependent disease is characterized by the ectopic endometrial implant. The disorder occurs in 6%-10% of reproductive-aged women and in 35%-50% of women with pelvic pain and infertility. Currently, the preferred diagnostic methods are laparoscopic inspection by transvaginal ultrasound, MRI, and sensors. Diagnoses with transvaginal ultrasound have 92.7% sensitivity and 97% specificity in detecting endometriotic lesions. On average, MRI diagnoses of DIE have 74% sensitivity and 95% specificity. Lastly, chemical sensors have 91.7% sensitivity and 90.0% specificity in detecting endometriosis. The standard of care includes personalizing the treatment plan based on the individual's set of symptoms and their severity. Advances in biomedical engineering have aided professionals in personalizing the course of treatments as well as to increasing the quality of life of these patients through various therapies for managing pain. Because no one theory provides a full explanation for the manifestation of the disease, hormonal therapies, targeted therapeutics, and surgical options have emerged as elements of disease management. Clinicians are in the process of developing advanced pharmaceutical drugs with specific orphan target receptors of the ectopic tissue. Possible complications that accompany the condition include dyspareunia, hyperalgesia, infertility, and many others.


Assuntos
Engenharia Biomédica/métodos , Endometriose/diagnóstico por imagem , Endometriose/diagnóstico , Endométrio/fisiopatologia , Anti-Inflamatórios não Esteroides , Biomarcadores , Proliferação de Células , Feminino , Hormônio Liberador de Gonadotropina/metabolismo , Humanos , Hipotálamo/fisiopatologia , Infertilidade/complicações , Infertilidade/fisiopatologia , Laparoscopia , Imagem por Ressonância Magnética , Doenças Ovarianas/diagnóstico por imagem , Ovário/fisiopatologia , Dor Pélvica , Hipófise/fisiopatologia , Qualidade de Vida , Sensibilidade e Especificidade , Ultrassonografia , Doenças Uterinas/diagnóstico por imagem , Útero/fisiopatologia
19.
Int J Mol Sci ; 19(8)2018 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-30061539

RESUMO

Cell contacts exhibit a considerable influence on tissue physiology and homeostasis by controlling paracellular and intercellular transport processes, as well as by affecting signaling pathways. Since they maintain cell polarity, they play an important role in cell plasticity. The knowledge about the junctional protein families and their interactions has increased considerably during recent years. In contrast to most other tissues, the endometrium undergoes extensive physiological changes and reveals an extraordinary plasticity due to its crucial role in the establishment and maintenance of pregnancy. These complex changes are accompanied by changes in direct cell⁻cell contacts to meet the various requirements in the respective developmental stage. Impairment of this sophisticated differentiation process may lead to failure of implantation and embryo development and may be involved in the pathogenesis of endometrial diseases. In this article, we focus on the knowledge about the distribution and regulation of the different junctional proteins in the endometrium during cycling and pregnancy, as well as in pathologic conditions such as endometriosis and cancer. Decoding these sophisticated interactions should improve our understanding of endometrial physiology as well as of the mechanisms involved in pathological conditions.


Assuntos
Comunicação Celular , Neoplasias do Endométrio/fisiopatologia , Endometriose/fisiopatologia , Endométrio/fisiopatologia , Junções Aderentes/metabolismo , Junções Aderentes/patologia , Animais , Implantação do Embrião , Neoplasias do Endométrio/metabolismo , Neoplasias do Endométrio/patologia , Endometriose/metabolismo , Endometriose/patologia , Endométrio/citologia , Endométrio/metabolismo , Endométrio/patologia , Feminino , Hormônios/metabolismo , Humanos , Junções Íntimas/metabolismo , Junções Íntimas/patologia
20.
Nat Rev Dis Primers ; 4(1): 9, 2018 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-30026507

RESUMO

Endometriosis is a common inflammatory disease characterized by the presence of tissue outside the uterus that resembles endometrium, mainly on pelvic organs and tissues. It affects ~5-10% of women in their reproductive years - translating to 176 million women worldwide - and is associated with pelvic pain and infertility. Diagnosis is reliably established only through surgical visualization with histological verification, although ovarian endometrioma and deep nodular forms of disease can be detected through ultrasonography and MRI. Retrograde menstruation is regarded as an important origin of the endometrial deposits, but other factors are involved, including a favourable endocrine and metabolic environment, epithelial-mesenchymal transition and altered immunity and inflammatory responses in genetically susceptible women. Current treatments are dictated by the primary indication (infertility or pelvic pain) and are limited to surgery and hormonal treatments and analgesics with many adverse effects that rarely provide long-term relief. Endometriosis substantially affects the quality of life of women and their families and imposes costs on society similar to those of other chronic conditions such as type 2 diabetes mellitus, Crohn's disease and rheumatoid arthritis. Future research must focus on understanding the pathogenesis, identifying disease subtypes, developing non-invasive diagnostic methods and targeting non-hormonal treatments that are acceptable to women who wish to conceive.


Assuntos
Endometriose/fisiopatologia , Adolescente , Adulto , Endometriose/complicações , Endometriose/epidemiologia , Endométrio/efeitos dos fármacos , Endométrio/fisiopatologia , Feminino , Humanos , Metilação , Pessoa de Meia-Idade , Neoplasias/etiologia , Neoplasias/fisiopatologia , Neoplasias/cirurgia , Dor/etiologia , Qualidade de Vida/psicologia
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