Association of polymorphisms in the estrogen receptor β (ESR2) with unexplained recurrent spontaneous abortion (URSA) in Chinese population

Objectives: To investigate the association of 1082G > A(RsaI) (rs1256049) and 1730A > G(AluI) (rs4986938) single nucleotide polymorphisms(SNPs), respectively – located on estrogen receptor β (ESR2) gene with recurrent spontaneous abortion (RSA) in Chinese population. Methods: The study group consisted of 196 patients with RSA and 182 fertile women as control. Two functional polymorphisms 1082G > A (a silent mutation in exon 5) and 1730A > G (3′ nontranslated region of the exon 8) of ESR2 were studied by association analysis. Results: There were no significant differences between ESR2 gene polymorphisms and RSA (χ²?=?1.793, P?=?0.408; χ²?=?1.432, P?=?0.489, respectively). Conclusion: The present data indicate that the studied SNPs on ESR2 gene may not be associated with RSA in Chinese population.     

Could interleukin-33 and its suppressor of tumorigenicity 2 (ST2) receptor have a role in cervical human papillomavirus (HPV) infections?

Why most women can clear human papillomavirus (HPV) infections while others can develop permanent infections. The stimulation of immunotolerance of the immune system of the host by the persistent HPV infection may be the answer to this question. Interleukin-33 (IL-33) may play a role in the pathogenesis of HPV infection, this hypothesis was thought to be due to the rapid release of IL-33 from damaged cells following tissue damage, necrosis, and activation of the inflammasome. Thus, in this study, the role of IL-33/suppressor of tumorigenicity 2 (ST2) was emphasized in HPV positive and HPV negative cervical tissues. A total of 80 were assessed. The reduced levels of IL-33 and ST2 are associated with cervical HPV infections. There was a statistically significant 42% positive correlation between IL-33 and ST2 in the HPV-positive group. Surprisingly, our data showed no significant difference between the expression levels of IL-33 or ST2 and working status, type of delivery, pre- and post-operative pathology, cigarette, educational status, locality, birth control method, gynecological, and colposcopic findings. We found that as a result of our study; low IL-33 and ST2 levels were associated with HPV infections     

Aromatase inhibitors and cyclooxygenase-2 (COX-2) inhibitors in endometriosis: New questions—old answers?

The medical treatment of endometriosis needs to be optimized. Therapeutic management strategies for endometriosis-associated pain or recurrent disease are primarily aimed at downregulating ovarian function or antagonizing the effect of estrogen in ectopic endometrial implants. In this context, basic research is providing important results for the development of new, specific treatment modalities. Aromatase overexpression has recently been detected in endometriotic tissue. Aromatase (p450arom) is responsible for converting C19 androgens into estrogen in several types of human tissue. Aromatase activity causes local estrogen biosynthesis, which, in turn, stimulates prostaglandin E2 production by upregulating cyclooxygenase-2 (COX-2). Thus, a positive feedback cycle develops between the two systems. Another abnormality in endometriosis, the deficient 17beta-hydroxysteroiddehydrogenase type II (17beta-HSD-Type-II) expression, impairs the inactivation of estradiol to estrone. In contrast to the eutopic endometrium, these molecular aberrations increase the amount of local estradiol and prostaglandin E2 in endometriosis. In several human cell lines, prostaglandin and estrogen concentrations are associated with proliferation, migration, angiogenesis, apoptosis resistance and even invasiveness. Consequently, aromatase and COX-2 are thought to be promising new therapeutic targets. Thus, specific aromatase inhibitors (e.g. Letrozol/Femara, Anastrozol/Arimidex or Exemestan/Aromasin) or selective COX-2 inhibitors (e.g. Celecoxib/Celebrex, Rofecoxib/Vioxx, Valdecoxib/Bextra) are of great interest and should be studied in clinical trials in premenopausal woman with endometriosis to expand the spectrum of currently available treatment options.     

Changes of nuclear factor kappa B (NF-κB), cyclooxygenase-2 (COX-2) and matrix metalloproteinase-9 (MMP-9) in human myometrium before and during term labor

Objective

To investigate the changes of nuclear factor kappa B (NF-κB), cyclooxygenase-2 (COX-2) and matrix metalloproteinase-9 (MMP-9) in human term myometrium before and during term labor.

Study design

Myometrium was obtained from women undergoing cesarean delivery at term before (n = 16) and after labor (n = 12). Immunostaining of NF-κB subunits (p65/p50) and Western blot analysis of NF-κB subunits, MMP-9 and COX-2 proteins were compared. Human term myocyte cultures were stimulated with IL-1β. Activation of NF-κB was assessed by evaluating changes in the inhibitory protein IκB; regulation of COX-2 and MMP-9 levels was studied using Western blot analysis and gelatin zymography.

Results

In contrast to a significant increase in the level of COX-2 and MMP-9 proteins, p65 and p50 decreased significantly in the after-labor group compared to the before-labor group. After treatment with IL-1β, IκB was degraded by almost 90% within 5 min and became undetectable by 15 min. IL-1β stimulation increased the levels of COX-2 protein and the gelatinolytic activities of MMP-9, both of which were inhibited by NF-κB inhibitors.

Conclusions

Human term labor is associated with changes in NF-κB and increased expression of COX-2 and MMP-9 in the myometrium. NF-κB pathway activation and subsequent increments of COX-2 and MMP-9 were observed in human term myocyte cultures.     

Small antral follicle count (2–5 mm) and ovarian volume for prediction of pregnancy in in vitro fertilization cycles

Aims.?To assess the value of antral follicle count (AFC) and other parameters as predictors of pregnancy in in vitro fertilization (IVF).

Methods.?In a cohort study, unselected consecutive women in IVF treatment were evaluated. Pretreatment parameters included AFC (subpopulations of small (2–5?mm) and large (5–10?mm) AFC), ovarian volume, and ovarian stroma Doppler indices.

Results.?The study included 115 women of whom 38 (33%) were pregnant. Total AFC was significantly higher in the pregnant than in the non-pregnant group (13.7?±?5.8 vs. 11.3?±?5.3, p?=?0.034). On receiver operator characteristic (ROC) curve analysis, the pretreatment variables that were significantly associated with pregnancy were small AFC (2–5?mm), total AFC, and ovarian volume/AFC ratio. Women with a positive score (total AFC >15; small AFC (2–5?mm) >10; ovarian volume in mm³/AFC, <1400), had a significantly higher number of retrieved oocytes and a higher pregnancy rate than women with a negative score (12.1?±?5.1 vs. 8.7?±?5.0, p?=?0.027 and 58.3% vs. 30.1%, p?=?0.049, respectively). On multivariate logistic regression analysis, total AFC was the only significant and independent predictor of pregnancy (p?=?0.034).

Conclusion.?Pretreatment small AFC and ovarian volume may identify women with a higher probability to achieve pregnancy in IVF.     

Narbenfreies Operieren (NOTES) in der Gynäkologie

The latest development in the field of minimally invasive surgery is NOTES (natural orifice transluminal endoscopic surgery), which uses endoscopic accesses through the gastrointestinal tract or the vagina. In contrast to classic laparoscopic surgery, this technique offers the opportunity of surgery without visible scars. This technique has been integrated into our surgical procedures especially for adnexectomy. Through a transvaginal approach a flexible endoscope (Fa. Storz) is inserted intraperitoneally. Via integrated working canals, both adnexectomies as well as hysterectomies are performed. Thus the NOTES technique is a new and promising development in minimally invasive surgery, which can reduce the invasiveness even further as compared to classic laparoscopic surgery.     

孕37~( 2)周自觉胎动消失2天

患者,29岁,护士．因停经37＋’周,自觉胎动消失2天．于1999年5月2日下午3时50分急诊入院。GZPI,曾于1993年12月因43”‘周孕,剖宫产娩出一活女婴;新生儿因呼吸道感染到我校儿童医院诊治。婴儿于9”月时因“白血病”住他院抢救无效死亡。本次妊娠本次月经（LMP）：1998年8月15日,预产期（EDC）：1999年5月22日。孕广月出现恶心、呕吐等早孕反应,孕扩月感股动,无阴道出血及液体分泌病史。孕6月有轻微腹部倡痒,无黄殖。孕期7次产前检查未发现明显异常。因自觉胎动消失2天到我院门诊就诊．检查：胎心14o次／分．B超未发现胎动,…     

Validation of the modified Glasgow Prognostic Score (mGPS) in recurrent ovarian cancer (ROC) – Analysis of patients enrolled in the GCIG Symptom Benefit Study (SBS)

Background

Modified Glasgow Prognostic Score (mGPS) is predictive of survival in many advanced cancers, but has not been evaluated in recurrent ovarian cancer (ROC). The aim was to determine validity of mGPS in ROC, investigate its associations with health related quality of life (HRQL) and ECOG performance status (PS).

Reduction in multiple pregnancy rate in donor oocyte–recipient gestational carrier (GC) in vitro fertilization (IVF) cycles in the USA with single-embryo transfer and preimplantation genetic testing

Purpose

To evaluate the utilization of single-embryo transfer (SET) and preimplantation genetic testing (PGT) in gestational carrier IVF cycles in the USA with donor oocyte and examine the impact on live birth and multiple gestation.

Methods

Retrospective cohort study using the Society of Assisted Reproductive Technology (SART) clinic database of 4776 donor oocyte–recipient IVF cycles in which a GC was used. The cycles were separated into 4 groups by use of PGT and number of embryos transferred as follows: (1) PGT and single-embryo transfer (PGT-SET); (2) PGT and multiple embryo transfer (PGT-MET); (3) no PGT and SET (NoPGT-SET); (4) no PGT and MET (NoPGT-MET). Primary outcomes were live birth rate (LBR) and multiple pregnancy rate (MPR).

Results

More than one blastocyst was transferred in 48.7% (2323/4774) of the cycles. When ≥1 blastocyst was transferred, with or without the use of PGT, the MPR was 45.5% and 42.0%, respectively. In comparison, in the PGT-SET and NoPGT-SET groups, the MPR was 1.4% (8/579) and 3.3% (29/883), respectively. Live birth rates increased with the use of PGT-A and with MET.

Conclusion

This study shows that SET, with or without PGT, is associated with a significantly reduced MPR in donor oocyte–recipient GC IVF cycles while maintaining high LBR. It also demonstrates that many infertility centers in the USA are not adhering to ASRM embryo transfer guidelines. Our findings highlight an opportunity to increase GC safety, which ultimately may lead to widened access to this increasingly restricted service outside the USA.

     

术前介入化疗对Ⅰ_(B2)～Ⅱ_(A2)期宫颈癌的意义

目的:探讨术前介入化疗对ⅠB2～ⅡA2期宫颈癌的意义。方法:回顾分析2006年1月～2008年1月收治的早期巨块型宫颈鳞癌90例的临床资料,患者分为两组,研究组45例术前行介入化疗栓塞术,术后根据瘤体形态学变化,评价介入治疗的近期疗效,并于术后14天行宫颈癌根治术;对照组45例行单纯性宫颈癌根治术。用3年时间随访90例患者的肿瘤复发率及生存率;用χ2检验分析统计患者资料。结果:研究组介入术后肿瘤体积均缩小,部分完全缓解,短期介入治疗总有效率达82.22%。术后病理结果:研究组盆腔淋巴结转移、宫旁浸润、脉管侵犯、宫颈深肌层侵犯明显低于对照组(P<0.05)。术后随访3年期间,研究组肿瘤复发率及远处转移率低于对照组(P<0.05),3年生存率两组则无统计学差异(P>0.05)。结论:治疗早期巨块型宫颈癌术前行导管动脉化疗栓塞术为一种有效的治疗措施;提高手术安全性和病变组织的切除率,降低术后复发率,是疗效较肯定的治疗手段之一。     

前列腺素F_(2α)用于葡萄胎引产

作者自1971年12月至1972年10月观察6例葡萄胎应用静脉滴注前列腺素F_(2α)引产,以后许多临床报道对足月妊娠,特别对早期及中期妊娠用前列腺素引产也有效。例1:24岁初孕妇,妊娠21周合并妊娠中毒症,子宫约妊娠29周大小,少量阴道出血,无胎动,12小时绒毛促性腺激素(HCG)排出量为10,000,000—12,000,000单位,超声波呈典型葡萄胎波型,确诊为葡萄胎。前列腺素F_(2α)溶于1毫升生理盐水中,开始50微克/分静滴4 1/2小时,继之100微克/分再静滴8小时。注射开始后30分钟出现有规     

Low-dose (2.5 mg/day) finasteride treatment in hirsutism

This study was performed to confirm the therapeutic effects of low-dose (2.5?mg/day) finasteride in hirsute women. Our study was a non-randomized prospective clinical trial. Twenty-nine patients with hirsutism were included in the study. The patients received 2.5?mg finasteride once a day over a period of 12 months. Follicle stimulating hormone, luteinizing hormone, sex hormone binding globulin, 17α-hydroxyprogesterone, estradiol, androstenedione, total and free testosterone, dehydroepiandrosterone sulfate levels and hirsutism scores were determined in all patients before treatment and at every 6 months during the therapy. The hirsutism score decreased from a mean of 18.4?±?4.6 to 8.4?±?4.2 during the study. The per cent reduction in hirsutism score (mean?±?SD) at 6 and 12 months was 29.2?±?14.5 and 55.7?±?14.9%, respectively. There were no significant differences in any of the hormone levels and no serious side-effects were observed during the treatment. In conclusion, low-dose finasteride (2.5?mg/day) is a cost-effective, well-tolerated therapeutic agent without significant abnormal biochemical findings and can be used in place of high-dose (5?mg/day) finasteride in the treatment of hirsutism.     

前列腺素E_2及F_(2α)的抗生育作用

作者报道用家兔作试验考察前列腺素E_2及F_(2α)的事后避孕作用。肌注;母兔交配后24小时,皮下注射3毫克/公斤的药物,14天后处死,记录黄体数、着床数、存活及退化胚胎数。5只注射PGE_2的母兔,有18个存活胚胎。根据观察到的黄体数汁算。有25%的卵未着床,11%的胚胎退化。6只注射PGF_(2α)的母兔,有8个存活胚胎,61%的卵未着床,17%的胚胎退化。5只对照母免有29个着床,12%的卵本着床。静注:母兔支配后4天静注2毫克/公斤剂量     

Das humane Papillomavirus (HPV) in der Gyn?koonkologie

Knowledge concerning the human papillomavirus in the development of cervical cancer and other genital cancers has led to a rethinking and therefore renewal of primary prevention. In addition to the annually offered cytological check for preventing cervical cancer, a vaccination has also been developed which targets adolescent girls. Current results of clinical trials are positive but long-term follow-up results are still awaited. The second pillar of the prevention of cervical cancer is the annual cytological check up. Unfortunately, only the minority of women in Germany undergo this check. Therefore it remains questionable whether the new vaccination strategy is able to close this gap and reduce the incidence of cervical cancer.     

如何避免不必要的二次手术(2)

如何避免不必要的二次手术（２）胡家骆３．术前应根据医院的技术水平、设备条件认真制定手术方案．充分估计手术中可能发生的困难及应该采取的相应措施，决不能草率上台，一旦碰到困难束手无策，无法完成手术或手术不彻底。例３，２９岁，因下腹疼痛伴自带增多，腥臭３月...     

Retrieving oocytes from small non-stimulated follicles in polycystic ovary syndrome (PCOS): in vitro maturation (IVM) is not indicated in the new GnRH antagonist era

It has been two decades since pregnancies have been obtained through in?vitro maturation (IVM) of germinal vesicle-stage oocytes retrieved from non-stimulated ovaries. This technique first offered in PCOS cannot be recommended today in this indication because the results do not match those of regular ART, and new GnRH antagonist and agonist-trigger protocols reliably prevent OHSS.     

静脉滴注合成前列腺素F_(2α)终止妊娠

应用前列腺素E_2或F_(2α)引产及人工流产已有广泛报道。不论何种给药途径,其成功率稍低于100％,但其副作用发生率均很高。希望合成前列腺素F_(2α)有较好引产效果,同时并能降低其副作用。