药物流产不全清宫后服用屈螺酮炔雌醇片的临床疗效评价

目的探讨药物流产不全清官术后即日口服屈螺酮炔雌醇片的临床疗效。方法将64例药物流产不全清宫后患者随机分为两组,观察组32例．在预防感染及促进子宫收缩的基础上于清宫后即日口服屈螺酮炔雌醇片,连续服用21d;对照组32例,仅术后口服同剂量同种抗生素预防感染及促进子宫收缩3d。结果观察组子宫内膜恢复明显优于对照组（P〈0．05）,出血量明显减少,出血时间明显缩短,月经恢复快,宫颈管粘连及官腔粘连的发生率低。结论药物流产不全清宫后即日口服屈螺酮炔雌醇片可以促进子宫内膜修复,月经复潮快,可降低药物流产不全清宫后并发症的发生率,可作药物流产清宫后的常规用药。     

MicroRNAs,immune cells and pregnancy

MicroRNAs （miRNAs） are a recently discovered class of non-coding RNAs that are expressed in many cell types, where they regulate the expression of complementary RNAs, thus modulating the stability and translation of mRNAs, miRNAs are predicted to regulate the expression of -50% of all protein coding genes in mammals. Therefore, they participate in virtually all cellular processes investigated so far. Altered miRNAs expressions are associated with both physiological （pregnancy） and pathological processes （cancer）. As the dynamic maternal-fetal interface plays a critical role in the maintenance of successful pregnancy, it is not surprising that the miRNAs that are unique to reproductive tissues are abundantly expressed. Research in this field has demonstrated the presence and dysregulation of a distinct set of pregnancy-associated miRNAs; however, most studies have centered on localizing various miRNAs in reproductive microdomains associated with normal or complicated pregnancies. Although several independent miRNA regulatory mechanisms associated with endometrial receptivity, immune cells, angiogenesis and placental development have been studied, miRNA-mediated regulation of pregnancy remains poorly understood. This review provides a summary of the current data on miRNA regulation as well as functional profiles of miRNAs that are found in the uterus, in immune cells associated with maternal tolerance to the fetus, and those involved in angiogenesis and placental development.     

Utility of Ki‐67, p53, Bcl‐2, and Cox‐2 biomarkers for low‐grade endometrial cancer and disordered proliferative/benign hyperplastic endometrium by imprint cytology

In this report, the authors examined the characteristic features of morphology and molecular biology of Ki‐67, p53, Bcl‐2, and cyclooxygenase‐2 (Cox‐2) immunocytochemistry in low‐grade endometrioid endometrial carcinoma (LG‐ENEC) and disordered proliferative (DP)/benign hyperplastic (BH) endometrium. We carried out a prospective study by collecting endometrial imprints from freshly resected uteri over a 20‐month period and finally 104 patients were evaluated with endometrial cytology. We focused on LG‐ENECs, as well as on BH endometrium and its precursor lesion, DP endometrium, firstly because of the overlapping cytomorphology of these pathologic entities and secondly because of the lack of agreement in the differential diagnosis of atypical hyperplasia from complex hyperplasia and well‐differentiated endometrial carcinoma, even in curettage specimens. Ki‐67 expression of LG‐ENEC showed predominance in comparison with DP/BH endometrium. Furthermore, high levels of Bcl‐2 (>50%) were expressed only in DP/BH endometrium. DP/BH endometrium was negative for p53 marker, except from two cases of BH endometrium. Cox‐2 expression ≥50% was found only in LG‐ENECs. Using Ki‐67, Bcl‐2, p53, and Cox‐2 markers, we managed to distinguish fully DP/BH endometrium from LG‐ENEC. Higher Ki‐67%/Bcl‐2% rate and also higher Cox‐2 expression were found in LG‐ENEC cases with FIGO stage ≥ IC, than in cases with FIGO stage < IC. The immunocytochemical findings from a combination of Ki‐67, p53, Bcl‐2, and Cox‐2, may differentiate LG‐ENEC from DP/BH endometrium with overlapping cytomorphology. Immunocytochemistry appeared to be useful also for the correlation between LG‐ENEC and FIGO stage. Diagn. Cytopathol. 2014;42: 134–142. © 2013 Wiley Periodicals, Inc.     

促排卵时MMP-9,MMP-2在多囊卵巢综合征患者子宫内膜中的表达

目的 探讨促排卵时基质金属蛋白酶-9,2(MMP-9,MMP-2)在多囊卵巢综合征(PCOS)患者子宫内膜中表达的特点.方法 采用免疫组化法,分别测定使用促排卵药时有排卵12例和无排卵8例共20例PCOS患者与正常排卵10例子宫内膜中MMP-9,MMP-2的表达,同时测定血清雌二醇(E2)、孕酮(P)、睾酮(T)、促卵泡激素(FSH)、黄体生成素(LH)和泌乳素(PRL)的水平.结果 应用促排卵药后,12例成功排卵患者子宫内膜MMP-9、MMP-2的表达与正常对照组比较差异无显著性;8例无排卵患者子宫内膜MMP-9、MMP-2的表达明显低于对照组.经回归分析,MMP-9、MMP-2在PCOS子宫内膜的表达与血清E2、P、T、FSH、LH和PRL的水平均无明显相关性.结论 成功排卵PCOS患者的子宫内膜MMP-9,MMP-2的表达与正常排卵者差异无显著性,无排卵PCOS患者子宫内膜MMP-9、MMP-2有低表达的现象.     

子宫内膜样腺癌组织中bax的表达及与病理特征的关系

目的：探讨子宫内膜样腺癌组织中bax的表达及与临床病理特征之间的关系。方法：采用免疫组化法检测不同类型子宫内膜组织中bax的表达。结果：从单纯性增生、复杂性增生到不典型增生，bax的表达逐渐增多。不典型增生与前二者相比差异有统计学意义（P〈0．01或P〈0．05）。在内膜样腺癌中，随着分化程度的降低bax的表达逐渐降低；随着浸润深度的增加，bax的表达逐渐增加，各组间比较差异有统计学意义（均P〈0．01）。结论：bax参与了癌前病变的发生，bax与子宫内膜样腺癌癌细胞的分化程度、肌层浸润深度有关。     

β-HCG、孕酮及子宫内膜厚度诊断早期异位妊娠的价值

目的探讨早期异位妊娠诊断的方法,提高诊断准确性。方法对95例疑似异位妊娠的患者测定血清β-HCG、孕酮值及测量子宫内膜厚度。结果异位妊娠组β-HCG、孕酮值及子宫内膜厚度明显低于正常宫内妊娠组和异常宫内妊娠组(P均<0.01),三项指标联合应用可将诊断准确性提高至93.68%。结论血清β-HCG及孕酮值是确定妊娠的指标,但难以鉴别异位妊娠和尚未形成宫内孕囊的早期宫内妊娠及流产,结合子宫内膜厚度则能提高异位妊娠的准确性,可成为具有临床应用价值的早期诊断异位妊娠的指标。     

45岁以下子宫内膜癌34例临床分析

目的：探讨年龄45岁以下的子宫内膜癌患者的临床、病理特点及诊治方法。方法：对34例年龄45岁以下的子宫内膜癌患者的临床资料进行回顾性分析。10例行全子宫双附件切除＋盆腔淋巴结清扫术,23例行（次）广泛子宫双附件切除＋盆腔淋巴结清扫术,1例未行手术,29例同时辅以放、化疗。对≤35岁、36-45岁患者的临床病理特征进行比较。结果：31例平均随访6个月-10年,3例失访,5例≤35岁患者中2例死亡,1例复发,26例36~45岁患者中有8例死亡,2例复发。≤35岁者和36~45岁者在临床分期、细胞分化、病理类型及肌层浸润深度方面差异均无统计学意义（P〉0.05）。结论：年龄45岁以下的子宫内膜癌患者临床期别较早,病理类型主要为子宫内膜样癌,35岁以下者预后较好。分段诊刮是诊断内膜癌的有效方法。治疗以手术为主,对有高危因素者辅以放、化疗。     

阴道超声对不孕症患者子宫内膜病变的诊断价值

目的探讨经阴道超声对不孕症患者子宫内膜病变的诊断价值及与宫腔镜检查结果的关系。方法对准备实施体外受精-胚胎移植(in vitro fertilization embryo transferred,IVF-ET)治疗的不孕症患者,在自然周期的排卵期,采用经阴道超声对子宫内膜进行仔细监测,对内膜异常的763例患者(观察组)进行宫腔镜检查。对照组是IVF-ET前、后,超声未发现内膜异常,常规进行宫腔镜检查的80例不孕患者。结果观察组中,宫腔镜检查确诊出现异常内膜为672例(672/763,88.07%),对照者为8例(8/80,10%)。结论经阴道超声是诊断不孕症患者宫腔内病变的一种简便、经济、无损伤、诊断率高的方法,是筛除IVF-ET术前子宫内膜病变的首选方法,而宫腔镜检查可为内膜病变提供准确的诊断。