Effects of Atractylodes Macrocephala on the Cytomembrane Ca^(2+)-activated K^+ Currents in Cells of Human Pregnant Myometrial Smooth Muscles

The study examined the inhibitory effect of Atractylodes macrocephala （AM） on the uterine contraction during premature delivery and explored its electrophysiological mechanism by studying the effects of AM on the Ca^2＋-activated K^＋ currents of pregnant human myometrial smooth muscle cells with or without the treatment with intedeukin-6. Single cells were acutely isolated from pregnant human myometrial smooth muscles. Whole-cell Ca^2＋-activated K^＋ currents were recorded by using an Axopatchl-D amplifier. The cells were divided into three groups： group A in which AM was added into perfusate, group B, in which interleukin-6 was added into perfusate） and group C in which AM was added into perfusate after addition of interleukin-6. IL-6 10 ng/mL inhibited BKca by 36.9%±13.7% as compared with control （P〈0.01）. AM at 2 mg/mL raised BKca by 36.7%±22.6% or 45.2%±13.7% with or without the treatment of IL-6, respectively （P〈0.01）. It is concluded that AM was able to enhance the BKca of pregnant human myometrial smooth muscle cells treated or untreated with interleukin-6 and its effect on the BKca IL-treated cells was stronger that its effect on BKca of untreated cells. Our results suggested that AM can help to maintain the membrane potentials and the resting status of pregnant human myometrial smooth muscle cells.

Correlation between Depth of Myometrial Invasion and Degree of Lymph Node Affection in Cases of Endometrial Cancer

Introduction: Endometrial cancer is the fourth most frequent cancer in females. Many factors can affect prognosis of this type of cancer, these mainly are the degree of myometrial invasion by the tumour, pelvic and paraaortic lymph node spread as well as the tumour histological type (endometrioid vs non-endometrioid type). transvaginal ultrasound (TVS) is a highly accurate and easy method for preoperative evaluation of myometrial invasion. Aim of the Work: The aim of this work is to assess if there is relation between the depth of myometrial invasion by the tumor and the rate of lymph node involvement in cases of endometrial cancer. Results: It was found that there was a significant relation between lymph node affection and the depth of myometrial invasion, all the positive lymph node affections cases had myomterial invasion > 50.0%. Conclusion: The incidence of pelvic lymph node affection is very high in cases where the myometrium is deeply infiltrated with the tumor. Assessment of myometrial invasion preoperatively by TVU and microscopically by pathological examination of the myometrium after hysterectomy provides an accurate estimation of the rate of pelvic lymph node affection and hence necessitates lymphadenectomy procedures in cases where myometrium is deeply infiltrated by the tumor and omitted in cases where it is tumor free.

Transvaginal 3D Ultrasound Evaluation of Post-Cesarean Section Uterine Diverticulum

Objectives: This study focused on evaluating the value of transvaginal 3D ultrasound for the diagnosis and prognostic assessment of post-cesarean section uterine diverticulum. Materials and Methods: We retrospectively analyzed the data from 32 patients with post-cesarean section uterine diverticulum over three recent years. In all patients, transvaginal 3D ultrasound was used to measure the size of the uterine diverticulum and the thickness of the lower uterine segment (LUS) and myometrium. Patients with a LUS with a myometrial thickness under 4 mm underwent resection and repair surgery;those with a LUS with a myometrial thickness over 4 mm underwent hysteroscopic resection. The postoperative sonograms were compared with preoperative images to evaluate the efficacy of various treatments. Results: The mean length, width and depth of the uterine diverticula were 18.30 ± 2.80 mm, 9.14 ± 3.20 mm and 11.49 ± 2.71 mm, respectively. The average LUS myometrial thickness was 3.40 ± 0.80 mm (with a range of 1.6 mm - 6.3 mm). After surgery, two patients’ sonograms still showed diverticula at the post-cesarean section scar, measuring 6 mm × 7 mm × 6 mm and 6 mm × 8 mm × 4 mm. There were significant differences in the size of uterine diverticula between preoperative and postoperative sonograms (P < 0.05) and the effective rate of surgery was 93.75% (30/32). Conclusions: Transvaginal 3D ultrasound is an accurate method for detecting post-cesarean section uterine diverticulum and is helpful for assessing surgical options and prognosis. The LUS myometrial thickness, which is considered as an optional index of post-cesarean section uterine diverticulum, should be measured routinely.

Mechanical response of uterine tissue under the influence of hemostatic clips: A non-linear finite-element approach

A modeling strategy to predict the ability of surgical clips to achieve mechanical hemostasis when applied to the cut edge of a thick and muscular tissue is presented in this work. Although such a model may have broad utility in the design of hemostatic clips and other surgical and wound closure applications, our particular focus was on uterine closure following a Cesarean delivery. Mechanical closure of a blood vessel, which is the first step in the hemostatic process, is established when the compressive forces on the outer surface of a blood vessel are sufficient to overcome the local blood pressure and collapse the vessel. For thick tissue, forces applied to the tissue surface set up a stress distribution within the tissue that, if sufficient to mechanically close all vessels, will lead to cessation of local blood flow. The focus of the current work was on utilization of a planar and nonlinear finite element model to predict the pressure distribution within uterine tissue under the influence of hemostatic clips. After experimental model validation with a polymer tissue phantom, design curves were numerically developed, which consisted of the clip force necessary to achieve hemostasis for a given thickness tissue as well as the resulting deformed tissue thickness. Such curves could form the basis for a preliminary clip design, which would provide initial design guidance before more expensive experimental studies were required.

Ultrasound Evaluation of Caesarean Scar of Prelabour and Labour Caesarean Sections: A Cross Sectional Analytical Study

Caesarean section is dramatically increased throughout the world in recent years. Rupture of the uterus is a devastating complication in trial of labour following previous Caesarean section. Evidence suggests that the size of the uterine scar and the residual myometrial thickness (RMT) are associated directly with the risk of uterine rupture and risk of dehiscence in subsequent deliveries. Impact of the prelabour and labour Cesarean section on the RMT has not been studied in detail. Objectives: To compare RMT, Caesarean scar defects and to evaluate the elasticity of the Caesarean scar between women who underwent prelabour and labour Caesarean sections. Methods: This was a Cross sectional analytical study. Women who underwent Caesarean section in their first pregnancy were recruited. Sample was stratified to prelabour and labour Caesarean section groups. Transvaginal ultrasound scan was performed six months following the Caesarean section. Dimensions of the uterus, uterine scar defect, RMT and elastosonography of the uterine scar were assessed. Results: A total of 240 postpartum women were analyzed. Uterine niche was detectable in 194 subjects. Prelabour CS group had demonstrated 91.7% (n = 110) scar defects (uterine niche) out of 120 cases and the rate among labour CS group was 70% (n = 84). There was a significant difference in the presence of uterine niche among 2 groups as Prelabour group was found to have more scar defects (p mm (SD 1.2) and 4.99 mm (SD 1.3) respectively and there was no significant difference (t = 0.38, p = 0.71). There was no significant difference between the dimensions of the uterine CS defects of the studied groups. Prelabour CS group had significantly higher Target strain [0.28 vs. 0.24 (t = 2.12, p = 0.04)] and significantly less strain ratio [1.45 vs. 1.55 (t -2.42, p = 0.04)] than labour CS group indicating a better scar in prelabour group. Conclusion: There was no significant difference in RMT and uterine scar defects between prelabour and labour Caesarean section groups. But prelabour Caesarean section scars were less stiff than labour Caesarean section scars. Further studies are warranted to elaborate on the association.

A Comparative Study of Transvaginal Sonography and Pelvic MRI in Patients with Endometrial Cancer

Background:The most prevalent type of gynecological cancer is endometrial cancer.Accurate surgical staging is the most important aspect in the management of endometrial cancer.Preoperative evaluation of myometrial invasion and appropriate management could be achieved by transvaginal sonography and pelvic MRI.Methods:A total of 53 patients with endometrial cancer,who were referred to a gynecology oncology department of an academic hospital in Mashhad University of Medical Sciences from 2018 to 2020,were evaluated in this study.Data were collected using a questionnaire on endometrial cancer.All the patients underwent preoperative transvaginal sonography and pelvic MRI to evaluate myometrial invasion.The involvement of myometrium thickness and histological findings were compared between two imaging modalities,and SPSS 23.0 was used to analyze the data.Results:Junctional irregularity was the most prevalent finding on transvaginal sonography.Based on transvaginal sonography,myometrial invasion of less than 50%was found in 73%of patients,while invasion of more than 50%was observed in 26.31%.In 57.44%of MRIs,there was less than 50%myometrial invasion,while in 42.55%of MRIs,there was more than 50%myometrial invasion.In both modalities,the most common finding was myometrial invasion of less than 50%.The accuracy,sensitivity,and specificity of transvaginal sonography were 0.47,0.27,and 0.75,respectively,whereas the accuracy,sensitivity,and specificity of MRI were 0.54,0.45,and 0.61,respectively.Conclusion:MRI can be the modality of choice for evaluating myometrial invasion and optimizing endometrial cancer treatment planning,as well as reducing the complications of non-indicated lymphadenectomy.

Validity and reliability of three methods of stiffness assessment

Background：Stiffness is commonly assessed in relation to injury and athletic performance.The purpose of this research was to compare the validity and reliability of 3 in vivo methods of stiffness assessment using 1 cohort of participants.Methods：To determine inter-day reliability,15 female netballers were assessed for stiffness twice within 1 week using unilateral hopping（vertical stiffness）,free oscillations of the calf,and myometry of various muscles of the triceps surae.To establish convergent construct validity,stiffness was compared to static and dynamic strength measurements.Results：Test–retest stiffness results revealed that vertical stiffness produced moderate to high reliability results and myometry presented moderate to very high reliability.In contrast,the free oscillation technique displayed low to moderate reliability.Vertical stiffness demonstrated a significa t correlation with rate of force development during a squat jump,whilst myometer stiffness measurements from 3 sites in the lower limb revealed significan correlations with isometric rate of force development.Further,significan negative correlations were evident between the eccentric utilisation ratio and various myometer stiffness results.No relationships were established between the free oscillation technique and any of the performance measurements.Conclusion：These results suggest that vertical stiffness and myometry are valid and reliable methods for assessing stiffness.

Use of contrast-enhanced ultrasound during preoperative evaluation of endometrial carcinoma

Objective:To explore the clinical role of contrast-enhanced ultrasound(CEUS)in a preoperative evaluation of early endometrial carcinoma.Methods:This study included 14 patients who underwent preoperative CEUS and contrast-enhanced magnetic resonance imaging(CEMRI)and were ultimately diagnosed with stage I endometrial carcinoma from December 2019 to December 2020.The parameters of the time-intensity curve(TIC)were compared with the endometrial carcinoma group,the invaded myometrium group,and the normal myometrium group.Results:TIC parameters between the endometrial carcinoma group and the invaded myometrium group were similar.Compared with the normal myometrium group,the time to peak(TTP)was significantly shorter and the ascending slope(AS)was significantly higher in the endometrial carcinoma group.The TTP of the invaded myometrium group was shorter than that of the normal myometrium group and the peak intensity(PI)was higher than that of the normal myometrium group.We then compared the TIC parameters between the endometrial carcinoma group and the invaded myometrium group after adjusting for the normal myometrium group,and the results still did not show any difference.Of the 14 cases of endometrial carcinoma,9 cases were diagnosed by CEMRI and were consistent with the pathology results,1 case was underestimated,and 4 cases were overestimated;while 11 cases diagnosed were diagnosed by CEUS and were consistent with the pathology results,1 case was underestimated,and 2 cases were overestimated.Conclusions:The contrast pulse sequencing technique used in the CEUS examinations performed well in evaluating the extent of the endometrial carcinoma.Future studies with larger sample sizes are needed to determine the applicability and value of this new procedure during preoperative assessments of early endometrial carcinoma.