子宫内膜增生症128例超声诊断体会

目的探讨子宫内膜增生症的超声图像特点。方法回顾性分析我院128例诊断为子宫内膜增生症的超声图像特征,并与病理结果比较。结果超声诊断为子宫内膜增生128例中病理结果为子宫内膜增生82.8%,子宫内膜息肉14.1%,子宫内膜癌3.1%。结论超声对子宫内膜增生症的诊断率较高,结合病理检查可以减少漏诊和误诊,为临床提供有利的治疗依据。

三花益肾汤治疗子宫内膜异位症临床效果研究

目的：研究三花益肾汤在子宫内膜异位症治疗中的应用价值。方法选取我院在2013年8月～2014年12月间收治的78例子宫内膜异位症患者的临床资料，将患者分为观察组与对照组，对照组给予常规治疗（孕三烯酮），观察组采用三花益肾汤治疗，比较两组患者治疗前后的盆腔包块、子宫体积、痛经评分、性交痛评分情况。结果观察组治疗后的子宫体积、盆腔包块缩小程度优于对照组，与对照组相比， P＜0.05，差异具有统计学意义。结论三花益肾汤能够使子宫内膜症患者的临床症状得以改善，缓解疼痛，缩小盆腔包块。

Induction of the LRP16 gene by estrogen promotes the invasive growth of Ishikawa human endometrial cancer cells through the downregulation of E-cadherin

LRP16 was previously identified as an estrogen-induced gene in breast cancer cells. The responsiveness of LRP16 to estrogen and its functional effects in endometrial cancer （EC） cells are still unclear. Here, we show that the mRNA level and promoter activity of the LRP16 gene were significantly increased by 17β-estradiol （E2） in estrogen receptor ot （ERα）-positive Ishikawa human EC cells. Although the growth rate of Ishikawa cells was not obviously affected by ectopic expression of LRP 16, the results of a Transwell assay showed an approximate one-third increase of the invasive capacity ofLRP 16-overexpressing cells. As a result of molecular screening, we observed that the expression of E-cadherin, an essential adhesion molecule associated with tumor metastasis, was repressed by LRP16. Further promoter analyses demonstrated that LRP 16 inhibited E-cadherin transactivation in a dose-dependent manner. However, the inhibition was abolished by estrogen deprivation, indicating that the downregulation of E-cadherin transcription by LRP16 requires ERα mediation. Chromatin immunoprecipitation analyses revealed that the binding of ERα to the E-cadherin promoter was antagonized by LRP 16, suggesting that LRP 16 could interfere with ERα-mediated transcription. These results suggest that the upregulation of LRP 16 by estrogen could be involved in invasive growth by downregulating E-cadherin in human ECs.

CHANGES OF SOLUBLE FAS AND SOLUBLE FAS LIGANDIN SERUM AND PERITONEAL FLUID OF INFERTILEPATIENTS WITH ENDOMETRIOSIS

Objective To evaluate the relationship between levels of soluble Fas(sFas)and soluble Fas ligand(sFasL)in serum and peritoneal fluid of endometriosis-associated infertility. Methods The soluble Fas ligand and soluble Fas levels in serum and peritoneal fluid of 20 infertile patients with endometriosis were assessed with enzyme-linked immunosorbent assay, and were compared with 14 infertile patients due to chronic pelvic infectious disease and 16 fertile controls. Results The sFasL levels were significantly higher in infertile patients with endometriosis(175.09 ± 80.55 pg/mL in serum and 284.50 ± 152.38 pg/mL in peritoneal fluid)than those of infertile controls (88.47 ± 43.55 pg/mL in serum and 17.30 ± 9.62 pg/mL in peritoneal fluid)and fertile controls(16.13 ± 11.75 pg/mL in serum and 8.84 ± 2.31 pg/mL in peritoneal fluid). In contrast, as for the sFas levels, infertile patients with endometriosis(828.60 ± 429.65 pg/mL in serum and 349.61 ± 288.89 pg/mL in peritoneal fluid)did not show any significant difference compared with those in infertile patients resulting from pelvic infectious disease(868.75 ± 570.48 pg/mL in serum and 181.76 ± 157.78 pg/mL in peritoneal fluid)and fertile control(822.26 ± 129.12 pg/mL in serum and 318.42 ± 145.16 pg/mL in peritoneal fluid). Conclusions Based upon these results, high level of sFasL in serum and peritoneal fluid and thus apoptosis mediated by it may be implicated in the mechanism involved in endometriosis-related infertility.

ABDOMINAL SCAR ENDOMETRIOSIS:REPORT OF 28 CASES

Twenty-eight cases of abdominal scar endometriosis from Janurary, 1980 to December, 1993 are reported. Of these patients, twenty-four underwent term cesarean section, and four underwent a midtrimester abortion by abdominal hysterotomy, The majority of patients manifested symptoms 1 year after the operation. The most common was a painful mass of scar tissue that became swollen and tender during menstruation. The pathogenesis, diagnosis and treatment are discussed. In correlation with the pathological findings, the effects of drug therapy are evaluated. It was found that surgical excision is the best method of treatment.

MANAGEMENT OF URETERAL ENDOMETRIOSIS: A REPORT OF TEN CASES

Objective To investigate the clinical features and management of ureteral endometriosis. Methods Patients surgically and histologically diagnosed as ureteral endometriosis from January 2001 to January 2007 in Peking Union Medical College Hospital were retrospectively reviewed. Results Ten patients were diagnosed as ureteral endometriosis among 7 561 cases with surgically and histologically proved diagnosis of endometriosis, with an incidence of 0.132%. Nine out of 10 patients were extrinsic ureteral endometriosis and concomitant with severe pelvic endometriosis, and the other was intrinsic ureteral endometriosis. Hormone therapy failed in 2 patients with urinary tract obstruction. Ureterolysis was performed in 6 patients and ureterectomy was performed in 4 patients. One case of ureteral recurrence was observed in a postmenopausal woman without hormonal replacement therapy who received laparoscopic ureterolysis and hysterectomy with bilateral adnexectomy. No relapse was observed in the other 9 patients. Conclusions Ureteral endometriosis is a rare entity. The upper urinary tract should be evaluated in patients with severe endometriosis, even in postmenopausal women. The treatment of ureteral endometriosis usually requires surgery, while ureterolysis should not be performed in patients with extensive disease. As a form of adjuvant therapy of surgery, hormonal therapy is an appropriate option.

Gallbladder endometriosis as a cause of occult bleeding

A 17-year-old girl with colicky abdominal pain andchronic anemia presented to the gastrointestinal serviceof the University Hospital of Essen. In the routineworkup, there were no pathological findings despitethe anemia. Because of the fluctuation of symptomswith a climax at the time of menstruation, consecutiveultrasound studies were performed revealing a visiblemass inside the gallbladder. This finding was confirmedby a magnetic resonance imaging (MRI) study performedat the same time. Because of the severe anemia by thattime, a cholecystectomy was performed, and histologyreconfirmed the diagnosis of isolated gallbladderendometriosis. The patient recovered well and has hadno recurrence of the disease to date.

A CASE-CONTROL EPIDEMIOLOGIC STUDY OF ENDOMETRIOSIS

A case-control study involving 203 cases of pelvic endometriosis seen from 1987- 1989 , and 406 randomly selected and age-matched community controls was conducted in order to provide information relevant to effective prophylxais of the disease. The diagnosis was confirmed by pathology from laparotomy and/or laparoscopy. A questionnaire focused on menstrual, marital and reproductive status , professional exposure and physical activities ,and the results were analyzed by a conditional logistic regression model. Women characterized by earlier menarche(≤ 12 years) and longer period(≥8 days) were found to be associated with an elevated incurring risk, and a trend of increasing risk associated with primary dysmenorrhea (RR =2. 1 for mild to moderate and RR= 5. 2 for severe dysmenorrhea), energetic physical activity during menstruation (RR =2. 1) , and allergic diathesis(RR=1 . 8) was seen. An inverse relationship was observed between the number of pregnancies and risk of endometriosis,and the protective effect was most significant when only the number of full-term pregnancies was counted.The risk factors of endometriosis are discussed, and intensive treatment of primary dysmenorrhea and avoidance of strenuous exercise during menstruation are identified as important measures in the prevention of endometriosis.

The therapeutics and prognosis of endometrial cancer

Objective: To investigate the relative factors in the prognosis of endometrial cancer. Methods: From 1991 to 1999, 125 patients with endometrial cancer were treated in our hospital. Among them, 96 cases were received operation. Their clinical and pathological data were analyzed retrospectively. Results: The overall survival rate at 5-year were 77.6%, stage I to stage IV were 85.9%, 68.8%, 53.8% and 0%, respectively. The survival rates at 5-year in histological grade 1, grade 2 and grade 3 were 100%, 77.1% and 38.1% respectively. There’s no significant difference between grade 1 and grade 2 (P > 0.05). As to grade 1 and grade 3, grade 2 and grade 3, there were significant differences (P < 0.05). The survival rate was 100% in patients with endometrium or superficial myometrial invasion and 35.3% in cases of deeper invasion (P < 0.01). Conclusion: Therapy based on operation is presently accepted as the first line management of endometrial cancer. Clinical stage, histo- logical grade, depth of myometrial invasion and lymph node metastasis are relative factors of prognosis.

Endometrial stromal sarcoma:a case diagnosed during infertility treatment

The patient with irregular menstruation went to our Department(Gynecological Department,the Third Affiliated Hospital,Sun Yat-sen University,Guangzhou,China) with the complaint of no pregnancy at the age of 26 in 2007,and oral contraceptive pills were given when simple type of endometrial hyperplasia was pathologically diagnosed,and then ovulation induction was performed.But after nearly two years from the beginning of infertility treatment,endometrial stromal sarcoma was diagnosed and radical treatment was performed for the young patient.And the relative relationship between endometrial stromal sarcoma and infertility is worth discussing.

Catalpol ameliorates LPS-induced endometritis by inhibiting inflammation and TLR4/NF-κB signaling

Catalpol is the main active ingredient of an extract from Radix rehmanniae,which in a previous study showed a protective effect against various types of tissue injury.However,a protective effect of catalpol on uterine inflammation has not been reported.In this study,to investigate the protective mechanism of catalpol on lipopolysaccharide(LPS)-induced bovine endometrial epithelial cells(bEECs)and mouse endometritis,in vitro and in vivo inflammation models were established.The Toll-like receptor 4(TLR4)/nuclear factor-κB(NF-κB)signaling pathway and its downstream inflammatory factors were detected by enzyme-linked immunosorbent assay(ELISA),quantitative real-time polymerase chain reaction(qRT-PCR),western blot(WB),and immunofluorescence techniques.The results from ELISA and qRT-PCR showed that catalpol dose-dependently reduced the expression of pro-inflammatory cytokines such as tumor necrosis factorα(TNF-α),interleukin(IL)-1β,and IL-6,and chemokines such as C-X-C motif chemokine ligand 8(CXCL8)and CXCL5,both in bEECs and in uterine tissue.From the experimental results of WB,qRT-PCR,and immunofluorescence,the expression of TLR4 and the phosphorylation of NF-κB p65 were markedly inhibited by catalpol compared with the LPS group.The inflammatory damage to the mouse uterus caused by LPS was greatly reduced and was accompanied by a decline in myeloperoxidase(MPO)activity.The results of this study suggest that catalpol can exert an anti-inflammatory impact on LPS-induced bEECs and mouse endometritis by inhibiting inflammation and activation of the TLR4/NF-κB signaling pathway.

Clinical study on warming-needle moxibustion for infertility patients with thin endometrium

Objective： To explore the effect of warming-needle moxibustion on the endometrial thickness and pregnancy outcome.Methods： Forty infertility women, selected from those who visited the TCM department of Maternity and Child Care Centers in Fujian Province from October 2015 to October 2016, were enrolled in this study.These women had mature follicle and successful ovulation according to B ultrasound monitoring, but their endometrial thickness was thinner than 7 mm. The women were divided into warming-needle moxibustion group（group A. 20 cases） and medication group（group B, 20 cases）. In group A, acupuncture,warming-needle moxibustion and electroacupuncture were conducted at different clinical stage. In group B, progynova was given to the patients from the 7 th day of menstruation to the 14 th day after ovulation（2 tablets, bid oral administration in the morning and evening）. The treatment lasted for 3 menstrual cycles, and the endometrial thickness changes and pregnancy rate of the patients in the two groups were compared after treatment.Results： The endometrial thickness of patients in the two groups increased after treatment when compared with the thickness before treatment. The average endometrial thickness in group A increased from（5.23 ±1.57） mm before treatment to（8.31 ±2.80） mm after treatment, while the average endometrial thickness in group B increased from（5.27 士 0.99） mm before treatment to（8.32 ±1.97） mm after treatment, and the differences were statistically significant（both P〈0.05）. The increase of endometrial thickness of the patients in group A after treatment was slightly larger than that in group B, and the difference was not statistically significant（P〉0.05）. After treatment for 3 menstrual cycles, the pregnancy rate of infertility women in group A was 25%（5/20） and 15%（3/20） in group B.Conclusion： Warming-needle moxibustion can increase the endometrial thickness to a certain extent,thus improving the endometrial receptivity, enhancing the embryo implantation rate, and improving the pregnancy outcome.

Effect of Bushenwenyanghuayu decoction on nerve growth factor and bradykinin/bradykinin B_1 receptor in a endometriosis dysmenorrhea mouse model

OBJECTIVE:To observe the effects of Bushenwenyanghuayu decoction(BD),a Traditional Chinese Medicine(TCM),on the serum concentration of nerve growth factor(NGF) and bradykinin(BK),and protein and mRNA levels of NGF and bradykinin B_1receptor(BKB1R) in a mouse model of endometriosis dysmenorrhea.METHODS:Seventy-five experimental female BALB/c mice were randomly divided into five groups,15 mice each:sham,model,BD high dose(61.67 g/kg),BD low dose(15.42 g/kg),and gestrinone(0.4 mg/kg) groups.All the mice except for those in the sham group underwent auto-transplantation surgery and were gavaged estradiol valerate(0.5 mg/kg,daily for 12 days) after surgery.On the 12 th day,1 h after administration,writhing response was induced by intraperitoneal injection of oxytocin at 2 U/mouse.The writhing frequency and latency were recorded and the volume of the ectopic foci was measured.The concentration of serum NGF and BK was detected by enzyme-linked immunosorbent assay,the protein expression of NGF and BKB1 R was tested by immunohistochemistry and western blotting,and NGF and BKB1 R mRNAs were detected by real-time PCR.RESULTS:Compared with the model group,the volume of the ectopic foci in the treatment groups was significantly lower(P < 0.01),the writhing frequency was decreased(P < 0.05),and the writhing latency was prolonged(P < 0.01).Compared with the sham group,serum NGF and BK levels in the model group were significantly increased(P <0.01).There were positive correlations for writhing frequency among the NGF and BK groups(P <0.01).The serum NGF and BK levels were significantly lower in the treatment groups than the model group(P < 0.05).The protein expression of NGF,BKB1 R was significantly decreased in the treatment groups compared with the model group(P < 0.01).NGF and BKB1 R mRNA expression was significantly decreased in the treatment groups compared with the model group(P < 0.01).CONCLUSION:NGF and BK/BKB1 R may play an important role in the development of endometriosis-associated dysmenorrhea,and BD was found to inhibit the development of endometriosis and relieve dysmenorrhea by influencing NGF and BK/BKB1 R mRNA and protein levels.

Effect of Yikun Neiyi Wan on the Expression of Aromatase P450,COX-2,and ER Related Receptor in Endometrial Cells in Vitro from Patients with Endometriosis

To investigate the effect of Yikun Neiyi Wan （益坤内异丸YKNYW） and gestrinone on the expression of aromatase P450 （P450arom）, cyclo-oxygenase-2 （COX-2） and estrogen receptor （ER） in isolated ectopic and normal endometriat stroma cells in vitro. Methods： Digestion and serial filtration were used to isolate and culture the ectopic and eutopic endometrial cells from patients with chocolate cyst in virto Transformation of the cell morphology was observed in a inverted microscope. The effect of YKNYW on the expression of aromatase P450, cyclo-oxygenase-2, estrogen receptor in cultured endometriosis cells were detected by immunohistochemical method. Results： The expression levels of P450arom, COX-2 in glandular epithelium cells in vitro were decreased significantly by YKNYW compared with gestrinone （P〈0.05）. ER expression in mesenchymal cells of endometriosis was increased by YKNYW in the large and medium dosage groups compared with gestrinone. Conclusion： The mechanism by which YKNYW alleviates endometriosis pain is possibly related to the decrease in ectopic endometrial P450 arom and COX-2 expression in glandular epithelium, contrary to gestrinone, and the increase in ER expression in mesenchymalis, consistent with gestrione in patients with endometriosis.

Punicalagin protects bovine endometrial epithelial cells against lipopolysaccharide-induced inflammatory injury

Objective：Bovine endometritis is one of the most common reproductive disorders in cattle.The aim of this study was to investigate the anti-inflammation potential of punicalagin in lipopolysaccharide（LPS）-induced bovine endometrial epithelial cells（bE ECs）and to uncover the underlying mechanisms.Methods：bE ECs were stimulated with different concentrations（1,10,30,50,and 100μg/ml）of LPS for 3,6,9,12,and 18 h.MTT assay was used to assess cell viability and to identify the conditions for inflammatory injury and effective concentrations of punicalagin.Quantitative real-time polymerase chain reaction（q RT-PCR）was used to assess gene expression of pro-inflammatory cytokines.Western blotting was used to assess levels of inflammation-related proteins.Results：Treatment of b EECs with 30μg/ml LPS for 12 h induced cell injury and reduced cell viability.Punicalagin（5,10,or 20μg/ml）pretreatment significantly decreased LPS-induced productions of interleukin（IL）-1β,IL-6,IL-8,and tumor necrosis factor-α（TNF-α）in bE ECs.Molecular research showed that punicalagin inhibited the activation of the upstream mediator nuclear factor-κB（NF-κB）by suppressing the production of inhibitorκBα（IκBα）and phosphorylation of p65.Results also indicated that punicalagin can suppress the phosphorylation of mitogen-activated protein kinases（MAPKs）including p38,c-Jun N-terminal kinase（JNK）,and extracellular signal-regulated kinase（ERK）.Conclusions：Punicalagin may attenuate LPS-induced inflammatory injury and provide a potential option for the treatment of dairy cows with Escherichia coli endometritis.

Clinical Observation on Treatment of Endometriosis with Acupuncture plus Herbs

Objective： To compare the clinical efficacy of combined acupuncture and herbs with danazol in treating endometriosis. Methods： Seventy-eight patients were randomly divided into a combined acupuncture and herbs group （n= 40） and a Western medicine control group （n= 38）. Observation was made on changes in clinical symptoms, signs, serum CA125,β-EP, PGE2 and PGF2α, and adverse reaction to the medicine in the two groups. Results： The overall efficacy was similar in the two groups, but the effects on lumbosacral pain, anal downbearing distention, irregular menstruation and infertility were significantly better in the treatment group than in the control group （P（0.05）, and in the treatment group serum CA125, PGE2 and PGF2α were significantly lower and serum β-EP was significantly higher after treatment than before （P（0.05）. Conclusion： Combined use of acupuncture and herbs has a marked effect on endometriosis and the adverse reaction is lower than the control group.

Effect of warming Yang and removing blood stasis method on matrix metalloproteinases/tissue inhibitor metalloproteinases levels secreted by cultured endometrial cells from patients with endometriosis

OBJECTIVE:To investigate the effect of Chinese medicines using the warming Yang and removing blood stasis method on levels of matrix metalloproteinases(MMPs)/tissue inhibitor metalloproteinases(TIMPs) secreted by cultured endometrial cells from patients with endometriosis.METHODS:Ectopic and eutopic endometrial cells obtaind from 15 endometriosis patients were cultured in vitro,and divided randomly into five groups:high dose;moderate dose;low dose;nemestran;blank control.The three dose groups were treated with a decoction prepared according to the principle of warming Yang and removing blood stasis;nemestran and 0.9%NaCI were administered to the nemestran group and balnk control group,respectively.Eutopic endometrial cells obtaind from 10 hysteromyoma patients were cultured in vitro,as the normal control group,0.9%NaCI were administered to the normal control group.Cell culture supernatants were collected and levels of matrix metalloproteinase-1(MMP-1),matrix metalloproteinase-2(MMP-2),matrix metalloproteinase-9(MMP-9),tissue inhibitor metalloproteinase-1(TIMP-1) and tissue inhibitor metalloproteinase-2(TIMP-2) detected by enzyme-linked immuno sorbent assay(ELISA).RESULTS:Compared with the normal control group,levels of MMP-1,MMP-2,and MMP-9 in eutopic and ectopic endometrium cell supernatants in the blank control group were increased,whereas levels of TIMP-1 and TIMP-2 were decreased(P <0.05).Compared with the blank control group,levels of MMP-1 and MMP-2 in ectopic and eutopic endometrium cell supernatants cultured in low-dose,middle-dose,and high-dose groups were decreased,whereas levels of TIMP-1 and TIMP-2 were increased significantly(P < 0.05).CONCLUSION:The warming Yang and removing blood stasis method affects expression of MMPs andTIMPs.