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1.
Zhonghua Fu Chan Ke Za Zhi ; 59(6): 440-446, 2024 Jun 25.
Artigo em Chinês | MEDLINE | ID: mdl-38951079

RESUMO

Objective: To investigate the effect of autologous platelet-rich plasma (PRP) perfusion on the levels of cytokines in uterine drainage fluid in patients with moderate to severe intrauterine adhesions (IUA) following hysteroscopic adhesiolysis. Methods: Thirty patients with moderate to severe IUA who underwent hysteroscopic adhesiolysis at Beijing Obstetrics and Gynecology Hospital, Capital Medical University from November 2020 to March 2021 were randomly divided into two groups: the PRP group (15 patients with placement of intrauterine-suitable balloons and PRP infusion) and the control group (15 patients with placement of intrauterine-suitable balloons only). For all patients, the channel switch was opened 48 hours after the surgery. The drainage fluid of the uterine cavity was collected using syringes through the proximal end of the drainage channel switch at 24 hours after the surgery and through the drainage channel directly at 48, 72, 96, and 120 hours after the surgery, and the levels of related cytokines including platelet-derived growth factor BB (PDGF-BB), vascular endothelial growth factor A (VEGF-A), insulin-like growth factor 1 (IGF-1) and transforming growth factor-ß1 (TGF-ß1) in the drainage fluid of the uterine cavity were evaluated, respectively. Results: (1) The changes in volumes of uterine cavity drainage fluid: the total drainage fluid volumes of the PRP group and the control group in 120 hours after the surgery were (21.8±2.9) and (22.7±2.7) ml, respectively, and there was no statistically significant difference between the two groups (t=-0.847, P>0.05). No significant differences were found in the volumes of drainage fluid between the two groups at 72, 96, and 120 hours after the surgery (all P>0.05). (2) Variation in cytokine levels in the uterine cavity drainage fluid: ① PDGF-BB: median PDGF-BB levels at 24 and 48 hours after the surgery in the PRP group (6.6 and 9.6 µg/L, respectively) were significantly higher than those in the control group (4.7 and 2.7 µg/L, respectively; all P<0.05). There were no significant differences in PDGF-BB levels between the two groups at 72, 96, and 120 hours after the surgery (all P>0.05). ② VEGF-A: median VEGF-A levels at 24 and 48 hours after the surgery in the PRP group (3.5 and 2.8 µg/L, respectively) were significantly higher than those in the control group (1.6 and 1.2 µg/L, respectively; all P<0.05). There were no significant differences in VEGF-A levels between the two groups at 72, 96, and 120 hours after the surgery (all P>0.05). ③ IGF-1: median IGF-1 level at 48 hours after the surgery in the PRP group was significantly higher than that in the control group (39.5 vs 8.6 µg/L, P<0.05). No significant differences were found in IGF-1 levels at 24, 72, 96, and 120 hours after the surgery between the two groups (all P>0.05). ④ TGF-ß1: There were no significant differences in TGF-ß1 levles between the two groups at 24, 48, 72, 96, and 120 hours after the surgery (all P>0.05). Conclusions: PRP perfusion following hysteroscopic adhesiolysis may increase the levels of PDGF-BB, VEGF-A, and IGF-1 in the uterine cavity drainage fluid, which plays a beneficial role in improving wound microvascular formation, reducing adhesion reformation, and promoting endometrial regeneration and repair.


Assuntos
Citocinas , Drenagem , Histeroscopia , Plasma Rico em Plaquetas , Humanos , Feminino , Aderências Teciduais , Histeroscopia/métodos , Adulto , Citocinas/metabolismo , Drenagem/métodos , Doenças Uterinas/cirurgia , Doenças Uterinas/etiologia , Útero , Fator A de Crescimento do Endotélio Vascular/metabolismo , Fator de Crescimento Insulin-Like I/metabolismo , Becaplermina
2.
BMJ Case Rep ; 17(7)2024 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-38991571

RESUMO

A G4P4 woman in her 30s with a type II vesicouterine fistula, as defined by the Jozwik classification system, presented with symptoms of menouria, vaginal menses and urinary incontinence 8 years after caesarean delivery, the time of probable origination of the fistula tract. Transvaginal ultrasound identified a fistula tract communicating between the bladder and uterus, a rare finding that many years remote from caesarean delivery. Traditional surgical technique includes laparoscopic, abdominal and endoscopic methods of repair, sometimes using a transvesical approach. Transvesical repair can be associated with subsequent inpatient hospital stays and prolonged catheterisation. Our technique proposes a transvaginal surgical approach as an outpatient procedure with decreased operating time (40 min), postoperative pain and catheterisation requirement. It is the authors' belief that a transvaginal approach is less invasive and allows for better preservation of the uterus for future pregnancies and vaginal deliveries, as desired by the patient.


Assuntos
Fístula da Bexiga Urinária , Doenças Uterinas , Humanos , Feminino , Adulto , Fístula da Bexiga Urinária/cirurgia , Fístula da Bexiga Urinária/etiologia , Doenças Uterinas/cirurgia , Cesárea/efeitos adversos , Cesárea/métodos , Fístula/cirurgia , Fístula/diagnóstico por imagem , Vagina/cirurgia , Resultado do Tratamento
3.
J Obstet Gynaecol ; 44(1): 2378420, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-39007802

RESUMO

BACKGROUND: Both the trauma of endometrium and hysteroscopic adhesiolysis can lead to a high rate of placenta accreta spectrum (PAS) in women with intrauterine adhesion (IUA). This study analysed the impact of time interval from adhesiolysis to pregnancy on PAS in IUA women. METHODS: Patients diagnosed with IUA who underwent adhesiolysis in Anhui Women and Children's Medical Centre between January 2016 and December 2020 were included in this case-series study. Clinical data were obtained from electronic medical records and telephone interviews. RESULTS: Among a total of 102 IUA women with successful pregnancies, 8 (7.8%) suffered from miscarriages with PAS, and 94 (92.2%), 47 with PAS and 47 without PAS, had successful delivery. The total prevalence of PAS in pregnant women with IUA was 53.9% (55/102). The average time from adhesiolysis to pregnancy in the PAS group was significantly longer than in the non-PAS group (14.2 ± 5.7 vs. 10.3 ± 4.4 months, p = 0.000). Regression analysis showed that AFS grade (OR = 7.40, 95% CI 1.38-39.73, p = 0.020) and adhesiolysis to pregnancy interval time between 12 and 24 months (OR = 12.09, 95% CI 3.76-38.83, p = 0.000) were closely related to PAS. A Kaplan-Meier analysis showed the median interval time to PAS was 16.00 months (95% CI 15.11-16.89). CONCLUSIONS: We assume that prolonged adhesiolysis to pregnancy interval may be considered a significant risk factor for PAS in IUA women.


Both the trauma of endometrium and hysteroscopic adhesiolysis can result in a high rate of placenta accreta spectrum in women with intrauterine adhesion. This study analysed the impact of time interval from adhesiolysis to pregnancy on placenta accreta spectrum in intrauterine adhesion women. This case-series study included patients diagnosed with intrauterine adhesion who underwent adhesiolysis in Anhui Women and Children's Medical Centre between January 2016 and December 2020. Clinical data were obtained from electronic medical records and telephone interviews. We assume that prolonged adhesiolysis to pregnancy interval may be considered a significant risk factor for placenta accreta spectrum in intrauterine adhesion women.


Assuntos
Placenta Acreta , Humanos , Feminino , Gravidez , Placenta Acreta/cirurgia , Aderências Teciduais/cirurgia , Aderências Teciduais/complicações , Aderências Teciduais/etiologia , Adulto , Estudos Retrospectivos , Histeroscopia , Fatores de Tempo , Doenças Uterinas/cirurgia , Doenças Uterinas/etiologia , Doenças Uterinas/complicações , China/epidemiologia , Fatores de Risco
4.
BMC Womens Health ; 24(1): 400, 2024 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-39003483

RESUMO

BACKGROUND: Intrauterine adhesions (IUA) are a challenging clinical problem in reproductive infertility. The most common causes are intrauterine surgery and abortions. We aimed to investigate whether early second-look office hysteroscopy can prevent IUA. METHODS: A single-center, prospective, two-armed, randomized controlled trial was designed to explore the efficacy of early office hysteroscopy after first-trimester induced abortion (suction dilatation and curettage [D&C]) and to further analyze fertility outcomes. Women aged 20-45 years undergoing suction D&C and desiring to conceive were recruited. Between October 2019 and September 2022, 66 women were enrolled, of whom 33 were allocated to group A (early hysteroscopy intervention). The women in intervention group A were planned to receive 2 times of hysteroscopies (early and late). In group B, women only underwent late (6 months post suction D&C) hysteroscopy. RESULTS: The primary outcome was the IUA rate assessed using office hysteroscopy 6 months after artificial abortion. Secondary outcomes included menstrual amount/durations and fertility outcomes. In intervention group A, 31 women underwent the first hysteroscopy examination, and 15 completed the second. In group B (late hysteroscopy intervention, 33 patients), 16 completed the hysteroscopic exam 6 months after an artificial abortion. Twenty-one women did not receive late hysteroscopy due to pregnancy. The IUA rate was 16.1% (5/31) at the first hysteroscopy in group A, and no IUA was detected during late hysteroscopy. Neither group showed statistically significant differences in the follow-up pregnancy and live birth rates. CONCLUSIONS: Early hysteroscopy following suction D&C can detect intrauterine lesions. IUA detected early by hysteroscopy can disappear on late examination and become insignificant for future pregnancies. Notably, the pregnancy outcomes showed a favorable trend in the early hysteroscopy group, but there were no statistically significant differences. TRIAL REGISTRATION: ClinicalTrials.gov , ID: NCT04166500. Registered on 2019-11-10. https://clinicaltrials.gov/ct2/show/NCT04166500 .


Assuntos
Aborto Induzido , Histeroscopia , Doenças Uterinas , Humanos , Feminino , Histeroscopia/métodos , Histeroscopia/efeitos adversos , Aderências Teciduais/prevenção & controle , Adulto , Doenças Uterinas/diagnóstico , Doenças Uterinas/cirurgia , Doenças Uterinas/prevenção & controle , Gravidez , Aborto Induzido/efeitos adversos , Aborto Induzido/métodos , Estudos Prospectivos , Pessoa de Meia-Idade , Adulto Jovem , Dilatação e Curetagem/métodos , Dilatação e Curetagem/efeitos adversos
7.
Int J Surg ; 110(6): 3237-3248, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38935827

RESUMO

OBJECTIVE: To develop a multimodal learning application system that integrates electronic medical records (EMR) and hysteroscopic images for reproductive outcome prediction and risk stratification of patients with intrauterine adhesions (IUAs) resulting from endometrial injuries. MATERIALS AND METHODS: EMR and 5014 revisited hysteroscopic images of 753 post hysteroscopic adhesiolysis patients from the multicenter IUA database we established were randomly allocated to training, validation, and test datasets. The respective datasets were used for model development, tuning, and testing of the multimodal learning application. MobilenetV3 was employed for image feature extraction, and XGBoost for EMR and image feature ensemble learning. The performance of the application was compared against the single-modal approaches (EMR or hysteroscopic images), DeepSurv and ElasticNet models, along with the clinical scoring systems. The primary outcome was the 1-year conception prediction accuracy, and the secondary outcome was the assisted reproductive technology (ART) benefit ratio after risk stratification. RESULTS: The multimodal learning system exhibited superior performance in predicting conception within 1-year, achieving areas under the curves of 0.967 (95% CI: 0.950-0.985), 0.936 (95% CI: 0.883-0.989), and 0.965 (95% CI: 0.935-0.994) in the training, validation, and test datasets, respectively, surpassing single-modal approaches, other models and clinical scoring systems (all P<0.05). The application of the model operated seamlessly on the hysteroscopic platform, with an average analysis time of 3.7±0.8 s per patient. By employing the application's conception probability-based risk stratification, mid-high-risk patients demonstrated a significant ART benefit (odds ratio=6, 95% CI: 1.27-27.8, P=0.02), while low-risk patients exhibited good natural conception potential, with no significant increase in conception rates from ART treatment (P=1). CONCLUSIONS: The multimodal learning system using hysteroscopic images and EMR demonstrates promise in accurately predicting the natural conception of patients with IUAs and providing effective postoperative stratification, potentially contributing to ART triage after IUA procedures.


Assuntos
Registros Eletrônicos de Saúde , Endométrio , Histeroscopia , Humanos , Feminino , Histeroscopia/métodos , Adulto , Medição de Risco , Endométrio/lesões , Aderências Teciduais/cirurgia , Aderências Teciduais/diagnóstico , Aderências Teciduais/diagnóstico por imagem , Gravidez , Doenças Uterinas/cirurgia , Doenças Uterinas/diagnóstico , Técnicas de Reprodução Assistida
8.
Stem Cell Res Ther ; 15(1): 181, 2024 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-38902788

RESUMO

BACKGROUND: Intrauterine adhesion (IUA) as a prevalent gynecological disease is developed from infection or trauma. However, therapeutic strategies to repair damaged endometrium are relatively limited. Emerging studies have shed light on the crucial role of endometrial stromal cells (EnSCs) in the process of uterine endometrial regeneration. EnSCs isolated from the uterine endometrium have similar characteristics to mesenchymal stem cells (MSCs). However, it is still unknown whether EnSCs could be used as donor cells to treat IUA. The aim of this study was to evaluate the potential efficacy of EnSCs in treating rat IUA. METHODS: Human EnSCs were isolated from the endometrial tissue of healthy female donors and subjected to extensive expansion and culture in vitro. Immunofluorescence, flow cytometry, cell proliferation assay, trilineage differentiation experiment, and decidualization assay were used to characterize the biological properties of EnSCs. We evaluated the immunoregulatory potential of EnSCs by analyzing their secreted cytokines and conducting bulk RNA sequencing after IFN-γ treatment. After EnSCs were transplanted into the uterine muscle layer in IUA rats, their therapeutic effects and underlying mechanisms were analyzed using histological analysis, Q-PCR, fertility and pregnancy outcome assay, and transcriptome analysis. RESULTS: We successfully isolated EnSCs from the endometrium of human donors and largely expanded in vitro. EnSCs exhibited characteristics of mesenchymal stem cells and retained responsiveness to sex hormones. Following IFN-γ stimulation, EnSCs upregulated the anti-inflammatory cytokines and activated immunosuppressive molecules. Xenogeneic transplantation of EnSCs successfully repaired injured endometrium and significantly restored the pregnancy rate in IUA rats. Mechanistically, the therapeutic effects of EnSCs on IUA endometrium functioned through anti-inflammation, anti-fibrosis and the secretion of regeneration factor. CONCLUSIONS: Due to their large expansion ability, immunoregulatory properties, and great potential in treating IUA, EnSCs, as a valuable source of donor cells, could offer a potential treatment avenue for injury-induced IUA.


Assuntos
Endométrio , Células Estromais , Feminino , Animais , Endométrio/citologia , Endométrio/metabolismo , Ratos , Células Estromais/citologia , Células Estromais/metabolismo , Células Estromais/transplante , Humanos , Aderências Teciduais/terapia , Aderências Teciduais/metabolismo , Modelos Animais de Doenças , Ratos Sprague-Dawley , Células-Tronco Mesenquimais/citologia , Células-Tronco Mesenquimais/metabolismo , Diferenciação Celular , Doenças Uterinas/terapia , Transplante de Células-Tronco Mesenquimais/métodos
9.
Genes (Basel) ; 15(6)2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38927658

RESUMO

Uterine pathologies pose a challenge to women's health on a global scale. Despite extensive research, the causes and origin of some of these common disorders are not well defined yet. This study presents a comprehensive analysis of transcriptome data from diverse datasets encompassing relevant uterine pathologies such as endometriosis, endometrial cancer and uterine leiomyomas. Leveraging the Comparative Analysis of Shapley values (CASh) technique, we demonstrate its efficacy in improving the outcomes of the classical differential expression analysis on transcriptomic data derived from microarray experiments. CASh integrates the microarray game algorithm with Bootstrap resampling, offering a robust statistical framework to mitigate the impact of potential outliers in the expression data. Our findings unveil novel insights into the molecular signatures underlying these gynecological disorders, highlighting CASh as a valuable tool for enhancing the precision of transcriptomics analyses in complex biological contexts. This research contributes to a deeper understanding of gene expression patterns and potential biomarkers associated with these pathologies, offering implications for future diagnostic and therapeutic strategies.


Assuntos
Endometriose , Perfilação da Expressão Gênica , Leiomioma , Transcriptoma , Feminino , Humanos , Transcriptoma/genética , Endometriose/genética , Endometriose/patologia , Leiomioma/genética , Leiomioma/patologia , Perfilação da Expressão Gênica/métodos , Neoplasias do Endométrio/genética , Neoplasias do Endométrio/patologia , Neoplasias Uterinas/genética , Neoplasias Uterinas/patologia , Doenças Uterinas/genética , Doenças Uterinas/patologia , Algoritmos
10.
BMC Womens Health ; 24(1): 372, 2024 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-38918774

RESUMO

BACKGROUND: To investigate the impact of chronic endometritis (CE) on the recurrence of endometrial polyps (EPs) in premenopausal women after transcervical resection of endometrial polyps (TCRP). METHODS: This prospective study enrolled 507 women who underwent TCRP between January 1, 2022 and December 31, 2022. The patients were divided into a CE group (n = 133) and non-CE group (n = 374) based on the expression of CD138 in the endometrium. The EP recurrence rate at 1 year after TCRP was compared between the CE and non-CE groups and between groups with mild CE and severe CE. The impact of CD138 expression by resected EPs on EP recurrence also was investigated. RESULTS: The EP recurrence rate at 1 year post-TCRP was higher in the CE group than in the non-CE group (25.6% vs. 10.4%) and also higher in the severe CE group than in the mild CE group (34.5% vs. 18.7%). Additionally, the EP recurrence rate was higher among patients with CD138-expressing EPs than among those with EPs lacking CD138 expression (30.5% vs. 6.5%). The odds ratio (OR) for EP recurrence in the CE cohort compared with the non-CE cohort was 3.10 (95% confidence interval [CI] 1.84-5.23) after adjustment for EP number and precautions against EP recurrence. The ORs for EP recurrence in patients with mild CE and severe CE were 2.21 (95%CI 1.11-4.40) and 4.32 (95%CI 2.26-8.26), respectively. Similarly, the OR for EP recurrence in cases with CD138-expressing EPs relative to cases with EPs lacking CD138 expression was 6.22 (95%CI 3.59-10.80) after adjustment for EP number and precautions against EP recurrence. CONCLUSIONS: CE multiplied the recurrence rate of EPs in premenopausal women after TCRP, and this effect positively correlated with CE severity. CD138 expression by EPs also was associated with a higher risk for EP recurrence.


Assuntos
Endometrite , Pólipos , Recidiva , Humanos , Feminino , Estudos Prospectivos , Adulto , Pólipos/cirurgia , Endometrite/epidemiologia , Endometrite/etiologia , Doença Crônica , Sindecana-1/metabolismo , Pessoa de Meia-Idade , Doenças Uterinas/cirurgia , Doenças Uterinas/etiologia , Fatores de Risco
11.
Curr Opin Obstet Gynecol ; 36(4): 313-323, 2024 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-38837729

RESUMO

PURPOSE OF REVIEW: With a rising number of cesarean sections, the prevalence of uterine isthmoceles is increasing. We performed a rapid review to assess the most recent data on the diagnosis and management of uterine isthmoceles over the past 18 months to identify current trends and directions for continued research. RECENT FINDINGS: A comprehensive search was conducted in PubMed (NLM), Embase (Ovid), CINAHL (EBSCOhost) to find English written articles discussing the diagnosis or management of uterine isthmoceles published in the previous 18 months. Data extraction was performed on one hundred articles that met inclusion criteria. SUMMARY: This rapid review highlights agreement regarding diagnostic methods, symptoms, and recommended treatment paths for patients with symptomatic uterine niches. However, the diversity in definitions hampers the capacity to formulate detailed conclusions regarding the features of uterine niches and their impact on women's health.


Assuntos
Cesárea , Útero , Humanos , Feminino , Gravidez , Doenças Uterinas/diagnóstico , Doenças Uterinas/terapia
12.
J Radiol Case Rep ; 18(1): 1-7, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38910588

RESUMO

This case report discusses a diagnosis of uterine torsion in an 84-year-old woman who presented with five days of right lower quadrant abdominal pain, nausea, vomiting, constipation, and poor intake. Computed tomography (CT) imaging demonstrated a whorled configuration at the junction of the cervix and lower uterine segment, with the left gonadal vein crossing midline, and two previously known right leiomyomas now appearing on the left. These findings were consistent with the diagnosis of uterine torsion. She then underwent an urgent exploratory laparotomy, and the uterus was found to be dextroverted 270 degrees, with dark mottled purple tissue and engorged vessels. A supracervical hysterectomy and bilateral salpingo-oopherectomy were performed. Final pathology demonstrated extensive necrosis. This case reviews the classic presentation and imaging findings for the rare diagnosis of uterine torsion and options for management of both non-gravid and gravid patients.


Assuntos
Leiomioma , Pós-Menopausa , Tomografia Computadorizada por Raios X , Anormalidade Torcional , Neoplasias Uterinas , Humanos , Feminino , Leiomioma/cirurgia , Leiomioma/diagnóstico por imagem , Leiomioma/complicações , Leiomioma/patologia , Idoso de 80 Anos ou mais , Anormalidade Torcional/diagnóstico por imagem , Anormalidade Torcional/cirurgia , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias Uterinas/cirurgia , Neoplasias Uterinas/complicações , Neoplasias Uterinas/patologia , Doenças Uterinas/diagnóstico por imagem , Doenças Uterinas/cirurgia , Doenças Uterinas/patologia , Histerectomia , Diagnóstico Diferencial
13.
BMC Nephrol ; 25(1): 198, 2024 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-38890580

RESUMO

BACKGROUND: Sarcoidosis is a systemic disease that can affect multiple organs. While pulmonary sarcoidosis is most commonly observed, renal sarcoidosis occurs less frequently. We herein report a case of sarcoidosis with an exceptionally rare distribution including renal lesions. CASE PRESENTATION: A 51-year-old Japanese female was referred because of bilateral parotid swelling and renal dysfunction. Computed tomography scan showed the swelling of bilateral kidneys, parotid glands, and uterus. Ga scintigraphy also showed remarkable accumulation in these organs. Renal biopsy and cytological evaluations of parotid gland and uterus were performed and she was diagnosed as sarcoidosis of these organs. Treatment was initiated with prednisolone 40 mg/day and then renal dysfunction subsequently improved. In addition, the swelling of parotid glands and uterus improved and Ga accumulation in each organ had disappeared. CONCLUSION: This is a first case of renal sarcoidosis complicated by parotid glands and uterus lesions. Pathological findings and the reactivity observed in Ga scintigraphy indicated the presence of lesions in these organs.


Assuntos
Nefropatias , Sarcoidose , Humanos , Feminino , Pessoa de Meia-Idade , Sarcoidose/complicações , Sarcoidose/diagnóstico por imagem , Sarcoidose/tratamento farmacológico , Nefropatias/diagnóstico por imagem , Nefropatias/patologia , Nefropatias/complicações , Nefropatias/etiologia , Glândula Parótida/patologia , Glândula Parótida/diagnóstico por imagem , Doenças Uterinas/complicações , Doenças Uterinas/patologia , Doenças Uterinas/diagnóstico por imagem , Prednisolona/uso terapêutico , Doenças Parotídeas/diagnóstico por imagem , Doenças Parotídeas/etiologia , Doenças Parotídeas/patologia , Cintilografia , Tomografia Computadorizada por Raios X
14.
Zhen Ci Yan Jiu ; 49(6): 566-576, 2024 Jun 25.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-38897800

RESUMO

OBJECTIVES: To observe the effect of electroacupuncture (EA) on the Wnt/ß-catenin signaling pathway and epithelial-mesenchymal transition (EMT)-related proteins in rats with intrauterine adhesions (IUA), so as to explore the possible mechanisms of EA in repairing endometrial damage in IUA. METHODS: Female SD rats were randomly divided into blank, model, EA, and ICG-001 groups, with 10 rats in each group. The IUA model was established by using mechanical scraping combined with lipopolysaccharide infection for double injury. In the EA group, "Guanyuan" (CV4) was needled and EA (2 Hz/15 Hz, 1-2 mA) was applied to "Zusanli" (ST36) and "Sanyinjiao"(SP6) on both sides. In the ICG-001 group, ICG-001 (5 mg/kg), the inhibitor of ß-catenin was intraperitoneally injected. After intervention, samples were taken from 5 rats in each group, and uterine endometrium morphology, endometrial thickness, and gland counts were observed using HE staining. Masson staining was used to assess the degree of fibrosis in the endometrial tissue. Immunohistochemistry was used to detect the positive expression of transforming growth factor ß1 (TGF-ß1), α-smooth muscle actin (α-SMA), fibronectin (FN), connective tissue growth factor (CTGF), type I collagen (Col- Ⅰ), glycogen synthase kinase-3ß (GSK-3ß), ß-catenin, E-cadherin, N-cadherin, and Vimentin in the endometrial tissue. Western blot was used to detect the relative expression of GSK-3ß, ß-catenin, E-cadherin, N-cadherin, and Vimentin proteins in the endometrial tissue. Another 5 rats from each group were placed in cages with male rats after intervention to record the number of embryo implantations. RESULTS: Necrosis and loss of endometrial tissue in the model group observed after HE staining were alleviated in the EA group, better than those in the ICG-001 group. Compared with the blank group, the numbers of glands and endometrial thickness in the uterine endometrial tissue, relative expression and positive expression of E-cadherin and GSK-3ß proteins in the uterine endometrial tissue, and embryo implantation numbers were reduced(P<0.000 1, P<0.001, P<0.01) in the model group, while fibrosis area ratio in the uterine endometrial tissue, TGF- ß 1, α -SMA, FN, CTGF, Col- Ⅰ positive expressions, N-cadherin, Vimentin, and ß-catenin proteins expression and positive expression were increased(P<0.000 1, P<0.001, P<0.01). Compared with the model group, the number of glands and endometrial thickness, E-cadherin and GSK-3ß proteins expression and positive expression, and embryo implantation numbers were increased (P<0.001, P<0.05, P<0.01) in the EA and ICG-001 groups, while the fibrosis area ratio in the uterine endometrial tissue, TGF-ß1, α-SMA, FN, CTGF, Col- Ⅰ positive expression, and N-cadherin, Vimentin, and ß-catenin proteins expression and positive expression were decreased(P<0.001, P<0.01, P<0.05). Compared with the EA group, the differences of the above-mentioned indicators in the ICG-001 group were not statistically significant. CONCLUSIONS: EA may reverse the EMT process and reduce the degree of fibrosis in endometrial tissue by inhibiting the Wnt/ß-catenin signaling pathway, thereby promoting the repair of endometrial damage in IUA.


Assuntos
Eletroacupuntura , Endométrio , Transição Epitelial-Mesenquimal , Fibrose , Ratos Sprague-Dawley , Via de Sinalização Wnt , beta Catenina , Animais , Feminino , Ratos , Humanos , beta Catenina/metabolismo , beta Catenina/genética , Endométrio/metabolismo , Fibrose/terapia , Fibrose/genética , Aderências Teciduais/terapia , Aderências Teciduais/metabolismo , Aderências Teciduais/genética , Doenças Uterinas/terapia , Doenças Uterinas/metabolismo , Doenças Uterinas/genética , Caderinas/metabolismo , Caderinas/genética , Pontos de Acupuntura , Útero/metabolismo
15.
BMC Womens Health ; 24(1): 366, 2024 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-38909214

RESUMO

BACKGROUND: Insulin resistance (IR) induces hyperinsulinemia, which activates downstream signaling pathways such as the phosphatidylinositol-3-kinase/protein kinase B (PI3K/AKT) pathway, ultimately leading to abnormal proliferation and apoptosis of endometrial cells. This is thought to be a key pathogenic mechanism underlying the development of endometrial polyps (EP). This study aims to investigate the relationship between IR and the development of EP, the expression levels of downstream signaling molecules, including PI3K and AKT, and related laboratory parameters were examined. METHODS: A total of 100 patients who visited the gynecology outpatient clinic of Zhongda Hospital affiliated with Southeast University from May 2021 to March 2023 and were diagnosed with abnormal endometrial echoes by vaginal ultrasound and underwent hysteroscopic diagnostic curettage were enrolled in this study. General data and relevant hematological indicators were compared, and intraoperative specimens were obtained for pathological examination. Possible factors influencing the development of endometrial polyps were analyzed using Pearson correlation analysis and logistic regression analysis. RESULTS: In terms of body mass index, waist circumference, fasting insulin, insulin resistance index, serum total testosterone, and free testosterone index, women of childbearing age in the endometrial polyp group had higher values than those in the non-polyp group, while sex hormone-binding globulin in the endometrial polyp group was lower than that in the non-polyp group, and the differences were statistically significant (P < 0.05). The expression scores and mRNA expression levels of PI3K and AKT proteins were higher in the EP group than in the non-EP group (p < 0.05). Pearson correlation analysis showed a positive correlation between HOMA-IR and the expression scores of PI3K and AKT proteins (p < 0.01). CONCLUSIONS: Insulin resistance and abnormal activation of the phosphatidylinositol 3-kinase/protein kinase B signaling pathway may be potential pathogenic mechanisms for the development of endometrial polyps.


Assuntos
Resistência à Insulina , Fosfatidilinositol 3-Quinases , Pólipos , Proteínas Proto-Oncogênicas c-akt , Humanos , Feminino , Proteínas Proto-Oncogênicas c-akt/metabolismo , Adulto , Fosfatidilinositol 3-Quinases/metabolismo , Pessoa de Meia-Idade , Doenças Uterinas/metabolismo , Doenças Uterinas/patologia , Índice de Massa Corporal , Transdução de Sinais , Endométrio/metabolismo , Endométrio/patologia , Globulina de Ligação a Hormônio Sexual/metabolismo , Globulina de Ligação a Hormônio Sexual/análise , Testosterona/sangue , Insulina/metabolismo , Insulina/sangue
16.
Int J Biol Macromol ; 270(Pt 1): 132363, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38754675

RESUMO

The combination of pharmacological and physical barrier therapy is a highly promising strategy for treating intrauterine adhesions (IUAs), but there lacks a suitable scaffold that integrates good injectability, proper mechanical stability and degradability, excellent biocompatibility, and non-toxic, non-rejection therapeutic agents. To address this, a novel injectable, degradable hydrogel composed of poly(ethylene glycol) diacrylate (PEGDA), sodium alginate (SA), and l-serine, and loaded with platelet-rich plasma (PRP) (referred to as PSL-PRP) is developed for treating IUAs. l-Serine induces rapid gelation within 1 min and enhances the mechanical properties of the hydrogel, while degradable SA provides the hydrogel with strength, toughness, and appropriate degradation capabilities. As a result, the hydrogel exhibits an excellent scaffold for sustained release of growth factors in PRP and serves as an effective physical barrier. In vivo testing using a rat model of IUAs demonstrates that in situ injection of the PSL-PRP hydrogel significantly reduces fibrosis and promotes endometrial regeneration, ultimately leading to fertility restoration. The combined advantages make the PSL-PRP hydrogel very promising in IUAs therapy and in preventing adhesions in other internal tissue wounds.


Assuntos
Alginatos , Hidrogéis , Plasma Rico em Plaquetas , Serina , Alginatos/química , Animais , Plasma Rico em Plaquetas/química , Aderências Teciduais , Feminino , Hidrogéis/química , Ratos , Serina/química , Serina/farmacologia , Polietilenoglicóis/química , Materiais Biocompatíveis/química , Materiais Biocompatíveis/farmacologia , Injeções , Ratos Sprague-Dawley , Doenças Uterinas/tratamento farmacológico , Doenças Uterinas/terapia
17.
Obstet Gynecol ; 144(1): 40-52, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38743951

RESUMO

OBJECTIVE: To identify the optimal hysterectomy approach for large uteri in gynecologic surgery for benign indications from a perioperative morbidity standpoint. DATA SOURCES: PubMed and Embase databases were searched from inception through September 19, 2022. Meta-analyses were conducted as feasible. METHODS OF STUDY SELECTION: This review included studies that compared routes of hysterectomy with or without bilateral salpingo-oophorectomy for large uteri (12 weeks or more or 250 g or more) and excluded studies with any concurrent surgery for pelvic organ prolapse, incontinence, gynecologic malignancy, or any obstetric indication for hysterectomy. TABULATION, INTEGRATION, AND RESULTS: The review included 25 studies comprising nine randomized trials, two prospective, and 14 retrospective nonrandomized comparative studies. Studies were at high risk of bias. There was lower operative time for total vaginal hysterectomy compared with laparoscopically assisted vaginal hysterectomy (LAVH) (mean difference 39 minutes, 95% CI, 18-60) and total vaginal hysterectomy compared with total laparoscopic hysterectomy (mean difference 50 minutes, 95% CI, 29-70). Total laparoscopic hysterectomy was associated with much greater risk of ureteral injury compared with total vaginal hysterectomy (odds ratio 7.54, 95% CI, 2.52-22.58). There were no significant differences in bowel injury rates between groups. There were no differences in length of stay among the laparoscopic approaches. For LAVH compared with total vaginal hysterectomy, randomized controlled trials favored total vaginal hysterectomy for length of stay. When rates of blood transfusion were compared between these abdominal hysterectomy and robotic-assisted total hysterectomy routes, abdominal hysterectomy was associated with a sixfold greater risk of transfusion than robotic-assisted total hysterectomy (6.31, 95% CI, 1.07-37.32). Similarly, single studies comparing robotic-assisted total hysterectomy with LAVH, total laparoscopic hysterectomy, or total vaginal hysterectomy all favored robotic-assisted total hysterectomy for reduced blood loss. CONCLUSION: Minimally invasive routes are safe and effective and have few complications. Minimally invasive approach (vaginal, laparoscopic, or robotic) results in lower blood loss and shorter length of stay, whereas the abdominal route has a shorter operative time. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42021233300.


Assuntos
Histerectomia Vaginal , Histerectomia , Laparoscopia , Humanos , Feminino , Histerectomia Vaginal/métodos , Histerectomia Vaginal/efeitos adversos , Histerectomia/métodos , Histerectomia/estatística & dados numéricos , Laparoscopia/métodos , Laparoscopia/efeitos adversos , Útero/cirurgia , Duração da Cirurgia , Doenças Uterinas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Salpingo-Ooforectomia/métodos , Resultado do Tratamento
18.
mBio ; 15(6): e0102724, 2024 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-38742889

RESUMO

Escherichia coli has been attributed to playing a major role in a cascade of events that affect the prevalence and severity of uterine disease in cattle. The objectives of this project were to (i) define the association between the prevalence of specific antimicrobial resistance and virulence factor genes in E. coli with the clinical status related to uterine infection, (ii) identify the genetic relationship between E. coli isolates from cows with diarrhea, with mastitis, and with and without metritis, and (iii) determine the association between the phenotypic and genotypic antimicrobial resistance identified on the E. coli isolated from postpartum cattle. Bacterial isolates (n = 148) were obtained from a larger cross-sectional study. Cows were categorized into one of three clinical groups before enrollment: metritis, cows with purulent discharge, and control cows. For genomic comparison, public genomes (n = 130) from cows with diarrhea, mastitis, and metritis were included in a genome-wide association study, to evaluate differences between the drug classes or the virulence factor category among clinical groups. A distinct E. coli genotype associated with metritis could not be identified. Instead, a high genetic diversity among the isolates from uterine sources was present. A virulence factor previously associated with metritis (fimH) using PCR was not associated with metritis. There was moderate accuracy for whole-genome sequencing to predict phenotypic resistance, which varied depending on the antimicrobial tested. Findings from this study contradict the traditional pathotype classification and the unique intrauterine E. coli genotype associated with metritis in dairy cows.IMPORTANCEMetritis is a common infectious disease in dairy cattle and the second most common reason for treating a cow with antimicrobials. The pathophysiology of the disease is complex and is not completely understood. Specific endometrial pathogenic Escherichia coli have been reported to be adapted to the endometrium and sometimes lead to uterine disease. Unfortunately, the specific genomic details of the endometrial-adapted isolates have not been investigated using enough genomes to represent the genomic diversity of this organism to identify specific virulence genes that are consistently associated with disease development and severity. Results from this study provide key microbial ecological advances by elucidating and challenging accepted concepts for the role of Intrauterine E. coli in metritis in dairy cattle, especially contradicting the existence of a unique intrauterine E. coli genotype associated with metritis in dairy cows, which was not found in our study.


Assuntos
Doenças dos Bovinos , Infecções por Escherichia coli , Escherichia coli , Genótipo , Período Pós-Parto , Fatores de Virulência , Bovinos , Animais , Feminino , Fatores de Virulência/genética , Infecções por Escherichia coli/veterinária , Infecções por Escherichia coli/microbiologia , Escherichia coli/genética , Escherichia coli/patogenicidade , Escherichia coli/isolamento & purificação , Escherichia coli/classificação , Doenças dos Bovinos/microbiologia , Estudos Transversais , Sequenciamento Completo do Genoma , Doenças Uterinas/microbiologia , Doenças Uterinas/veterinária , Doenças Uterinas/genética , Genoma Bacteriano , Útero/microbiologia , Antibacterianos/farmacologia , Estudo de Associação Genômica Ampla , Farmacorresistência Bacteriana/genética
19.
Zhen Ci Yan Jiu ; 49(5): 487-498, 2024 May 25.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-38764120

RESUMO

OBJECTIVES: To observe the effect of electroacupuncture(EA) on endometrial fibrosis and M1-type macrophages in rats with intrauterine adhesions(IUA), so as to explore the possible mechanism of EA in the treatment of IUA. METHODS: Fifteen female SD rats were randomly divided into blank group, model group and EA group, with 5 rats in each group. The IUA rat model was established by double damage method using mechanical scraping combined with lipopolysaccharide infection. Rats in the EA group were treated with acupuncture at "Guanyuan"(CV4), and EA at bilateral "Zusanli"(ST36) and "Sanyinjiao"(SP6)for 20 minutes each time, once a day, for 3 consecutive cycles of estrus. Five rats in each group were sampled during the estrous period, and the endometrial morphology, endometrial thickness and the number of blood vessels and glands were observed after HE staining. The fibrotic area of the uterus was observed after Masson staining. The positive expressions of Runt-related transcription factor(RUNX1), transforming growth factor-ß1(TGF-ß1), connective tissue growth factor(CTGF), α-smooth muscle actin(α-SMA), collagen type I(Col-Ⅰ), cluster of differentiation 86(CD86), interleukin-1ß(IL-1ß), and tumor necrosis factor-α(TNF-α) in endometrial tissue were detected by immunohistochemistry. Western blot was used to detect relative protein expressions of RUNX1, TGF-ß1, α-SMA, CD86, and TNF receptor 2 (TNFR2), and real-time fluorescence quantitative PCR was used to detect mRNA expressions of RUNX1, TGF-ß1, α-SMA, CD86, and TNF-α in the endometrium. RESULTS: During the estrous phase, the endometrial layer in the model group was damaged, with reduced folds, disordered arrangement of epithelial cells, loose fibrous connective tissue, significant narrowing and adhesions in the uterine cavity, interstitial congestion, edema, and a significant infiltration of inflammatory cells with sparse glands. While uterine tissue structure of the EA group was basically intact, resembling a normal uterus, with more newly formed glands and a small amount of inflammatory cell infiltration. In comparison with the blank group, the endometrial thickness, the number of blood vessels, and the number of glands were significantly decreased(P<0.001) in the model group, while the ratio of uterine fibrosis area, the positive expressions of RUNX1, TGF-ß1, CTGF, α-SMA, Col-Ⅰ, CD86, IL-1ß, and TNF-α, the protein relative expressions of RUNX1, TGF-ß1, α-SMA, CD86 and TNFR2, and the mRNA relative expression levels of RUNX1, TGF-ß1, α-SMA, CD86 and TNF-α in the endometrium were significantly increased (P<0.001, P<0.01). Compared to the model group, the endometrial thickness, the number of blood vessels, and the number of glands were significantly increased(P<0.01, P<0.05) in the EA group, while the ratio of uterine fibrosis area, the positive expressions of RUNX1, TGF-ß1, CTGF, α-SMA, Col-Ⅰ, CD86, IL-1ß and TNF-α in the endometrial tissue, the protein expressions of RUNX1, TGF-ß1, α-SMA, CD86 and TNFR2, and the mRNA relative expressions of RUNX1, TGF-ß1, α-SMA, CD86 and TNF-α in the endometrium were significantly decreased (P<0.001, P<0.01, P<0.05). CONCLUSIONS: EA can improve endometrial fibrosis in IUA rats, which may be related to its function in decreasing the level of endometrial M1-type macrophages and the secretion of related inflammatory factors.


Assuntos
Eletroacupuntura , Endométrio , Macrófagos , Ratos Sprague-Dawley , Animais , Feminino , Ratos , Endométrio/metabolismo , Aderências Teciduais/terapia , Aderências Teciduais/metabolismo , Aderências Teciduais/genética , Humanos , Macrófagos/metabolismo , Fator de Crescimento Transformador beta1/metabolismo , Fator de Crescimento Transformador beta1/genética , Pontos de Acupuntura , Doenças Uterinas/terapia , Doenças Uterinas/metabolismo , Fator de Crescimento do Tecido Conjuntivo/metabolismo , Fator de Crescimento do Tecido Conjuntivo/genética
20.
Comput Biol Med ; 177: 108599, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38796878

RESUMO

Intrauterine Adhesion (IUA) constitute a significant determinant impacting female fertility, potentially leading to infertility, miscarriage, menstrual irregularities, and placental complications. The precise assessment of the severity of IUA is pivotal for the customization of personalized treatment plans, aimed at enhancing the success rate of treatments and mitigating reproductive health risks. This study proposes bTLSMA-SVM-FS, a novel feature selection machine learning model that integrates an enhanced slime mould algorithm (SMA), termed TLSMA, with support vector machines (SVM), aiming to develop a predictive model for assessing the severity of IUA. Initially, a series of optimization comparative experiments were conducted on the TLSMA using the CEC 2017 benchmark functions. By comparing it with eleven meta-heuristic algorithms as well as eleven SOTA algorithms, the experimental outcomes corroborated the superior performance of the TLSMA. Subsequently, the developed bTLSMA-SVM-FS model was employed to conduct a thorough analysis of the clinical features of 107 IUA patients from Wenzhou People's Hospital, comprising 61 cases of moderate IUA and 46 cases of severe IUA. The evaluation results of the model demonstrated exceptional performance in predicting the severity of IUA, achieving an accuracy of 86.700 % and a specificity of 87.609 %. Moreover, the model successfully identified critical factors influencing the prediction of IUA severity, including the preoperative Chinese IUA score, production times, thrombin time, preoperative endometrial thickness, and menstruation. The identification of these key factors not only further validated the efficacy of the proposed model but also provided vital scientific evidence for a deeper understanding of the pathogenesis of IUA and the enhancement of targeted treatment strategies.


Assuntos
Máquina de Vetores de Suporte , Humanos , Feminino , Adulto , Aderências Teciduais , Aprendizado de Máquina , Histeroscopia/métodos , Doenças Uterinas , Índice de Gravidade de Doença , Criocirurgia
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