Premature progesterone rise in ART-cycles

Premature rise of progesterone during the late follicular phase in stimulated IVF cycles is a frequent event and its effect on the endometrial receptivity and on the ART (Assisted Reproductive Technique) – outcome has become a matter of intense debate and research. An emerging body of evidence demonstrates that premature progesterone rise does have a negative impact on the outcome of the ART-success. Until now, the exact cause of progesterone elevation is not fully clear, however lately published studies points to the fact, that premature progesterone elevation might be caused by enhanced FSH stimulation. The impact of elevated peripheral progesterone levels seems to be mainly on the endometrium and the window of implantation, leading to an asynchrony between the endometrium and the developing embryo. Hence, new data show additional an influence on the embryo quality. This review aims to summarize the up-to-date knowledge on the causes of premature progesterone rise during hormonal stimulation, on its influence on endometrial receptivity and embryo quality, on the impact on pregnancy and live birth rates as well as on the possible strategies to prevent this event or to deal with premature progesterone elevation in case it could not be avoided.     

Upregulation of miR-582-5p regulates cell proliferation and apoptosis by targeting AKT3 in human endometrial carcinoma

The human endometrial carcinoma is one of the most common female malignancies, and there is an urgent requirement to explore new therapeutic strategies. There is accumulating evidence that microRNAs (miRNAs) can serve as potential diagnostic and prognostic biomarkers for various types of cancer, but the significance of miR-582-5p still remains largely unknown in the endometrial carcinoma. The aims of this study were to understand and identify the influence of miR-582-5p on the proliferation and apoptosis of human endometrial carcinoma and its relevant mechanism. First, quantitative real-time PCR (qRT-PCR) was used to detect miR-582-5p and AKT3 expression in human tissue samples and cells. Then, CyQuant assay and 2D colony assay were employed to evaluate cell proliferation. Western blotting was used to determine protein expression. Subsequently, the luciferase reporter assay was used to identify the target of miR-582-5p. Finally, Annexin V assay was used to detect cell apoptosis. We found that miR-582-5p expression was significantly decreased in human endometrial carcinoma tissues, and miR-582-5p upregulation in human endometrial carcinoma cells inhibit cell proliferation and promote apoptosis. Moreover, AKT3 was validated as a target of miR-582-5p and AKT3 expression was inversely correlated with miR-582-5p expression. Besides, AKT3 upregulation efficiently abrogates the effect of miR-582-5p on the cells. These results demonstrated that miR-582-5p regulates cell proliferation and apoptosis in human endometrial carcinoma via AKT3. Thus, miR-582-5p represents a potential therapeutic target in human endometrial carcinoma meriting further investigation.     

CXCR4和NF-κB在子宫内膜癌中的表达及其临床意义

目的:检测CXCR4和NF-κB在子宫内膜癌中的表达并探讨其在肿瘤发生发展中的作用机制。方法:用免疫组织化学SP法测定不同子宫内膜组织中CXCR4和NF-κB的蛋白质表达情况,并分析两者表达的相关性,所选标本包括20例正常子宫内膜蜡块、30例子宫内膜不典型增生石蜡标本、60例子宫内膜癌。结果:CXCR4的阳性表达率在子宫内膜癌中为73.33%、在不典型增生子宫内膜中为43.33%,在正常子宫内膜中为25.00%;NF-κB在子宫内膜癌、不典型增生子宫内膜和正常子宫内膜的阳性表达率依次为:63.33%、36.67%、15.00%,差异均具有统计学意义(P0.05)。CXCR4和NF-κB两个因子与淋巴结有无转移、年龄、肌层浸润情况无相关性,但与癌组织分化级别相关。两个因子在子宫内膜癌中的表达具有明显的相关性(r=0.341,P=0.008)。结论:CXCR4和NF-κB在子宫内膜癌组中的阳性表达率明显升高,且两者成正相关,两个因子在诱发子宫内膜癌的发生中可能起协同作用。     

经阴道超声与宫腔镜对子宫内膜病变患者的诊断价值比较研究

目的:探讨经阴道超声与宫腔镜检查诊断子宫内膜病变的临床价值,为临床诊断子宫内膜病变提供理论依据。方法:选取2011年3月-2014年3月间我院收治的158例疑似子宫内膜病变患者,分别采用经阴道超声和宫腔镜进行检查,并以病理诊断结果为"金标准",比较两种检查方法的诊断价值。结果:病理检查结果中,143例患者被确诊为子宫内膜病变,其中子宫内膜增生23例(16.08%),子宫内膜息肉31例(21.68%),子宫粘膜下肌瘤24例(16.78%),子宫内膜癌19例(13.29%),慢性非特异性子宫内膜炎46例(32.17%)。宫腔镜对子宫内膜病变诊断的准确率为94.41%,高于阴道超声的81.12%,差异有统计学意义(P0.05),其中阴道超声和宫腔镜对子宫粘膜下肌瘤、子宫内膜癌诊断的准确率比较差异无统计学意义(P0.05),阴道超声对子宫内膜增生、子宫内膜息肉及慢性非特异性子宫内膜炎的诊断准确率均较宫腔镜降低,差异有统计学意义(P0.05)。阴道超声对子宫内膜病变诊断的特异度较宫腔镜更低(P0.05),但两者灵敏度、AUC比较差异无统计学意义(P0.05)。结论:经阴道超声诊断子宫内膜病变简单、有效,而宫腔镜诊断子宫内膜病变具有准确率以及特异度较高的特点。     

肝癌乙型肝炎病毒感染患者术后恩替卡韦抗病毒治疗的临床疗效及安全性评价

目的:探讨肝癌乙型肝炎病毒(HBV)感染患者根治性切除术后采用恩替卡韦抗病毒治疗的临床疗效及安全性。方法:收集2015年1月-2017年8月在我院行根治性切除术的肝癌HBV感染患者279例为研究对象,以血清HBV-DNA载量10~5 copies/ml为界限,分为高病毒复制组128例,低病毒复制组151例,按照随机数字表法将高病毒复制组分为高-治疗组64例、高-对照组64例,将低病毒复制组分为低-治疗组76例、低-对照组75例。高-治疗组和低-治疗组术后给予恩替卡韦0.5 mg/d,高-对照组和低-对照组未行抗病毒治疗。比较手术前、术后7 d各组的血清HBV-DNA水平,血清白蛋白(ALB)、谷丙转氨酶(ALT)、前白蛋白(PA),以及术后并发症的发生情况。结果:高-治疗组、高-对照组、低-治疗组、低-对照组术后血清ALB、PA均较治疗前降低,血清ALT均较治疗前升高,且高-治疗组或低-治疗组术后血清ALB、PA均高于高-对照组或低-对照组,血清ALT水平均低于高-对照组或低-对照组,差异均有统计学意义(P0.05);高-治疗组或低-治疗组术后血清HBV-DNA水平均低于治疗前,且均低于同期高-对照组或低-对照组,差异均有统计学意义(P0.05)。高-治疗组与高-对照组、低-治疗组与低-对照组患者术后并发症发生率均无统计学差异(P0.05)。结论:恩替卡韦能显著改善肝癌HBV感染患者术后的血清HBV-DNA载量水平和肝功能,安全性高,值得临床推广。     

HALS与LAP用于直肠癌根治术患者的临床疗效及其对血清炎性因子水平的影响

目的:探讨手辅助腹腔镜手术(hand-assisted laparoscopic surgery,HALS)与全腹腔镜手术(laparoscopic surgery,LAP)用于直肠癌根治术患者的临床疗效及其对血清炎性因子水平的影响。方法:选取2013年3月～2018年3月在我院行直肠癌根治术的患者61例进行回顾性分析,按照手术方式不同分为手辅助腹腔镜手术组(HALS组)和全腹腔镜手术组(LAP组)。比较两组患者的手术相关指标、术后恢复指标和治疗前后血清炎性因子水平的变化。结果:HALS组的手术时间、术中出血量和副损伤显著低于LAP组(P0.05),两组中转开腹率相比无统计学差异(P0.05);两组患者术后肠功能恢复时间、进食时间、下床时间和住院时间比较均无显著性差异(P0.05);两组患者术后1 h和术后1 d血清白细胞介素-10(interleukin-10, IL-10)、C-反应蛋白(C reactive protein,CRP)和α肿瘤坏死因子(Tumor Necrosis Factor-α,TNF-α)水平均较术前显著升高,且HALS组显著低于LAP组(P0.05),术后1 w血清IL-10、CRP和TNF-α水平与术前相比无统计学差异(P0.05)。结论:HALS直肠癌根治术对患者的手术创伤小,炎性反应轻,且不影响患者的预后,利于患者的康复。     

宫腔镜下子宫内膜电切术联合刮宫术治疗多发性子宫内膜息肉的效果探讨

目的:探讨宫腔镜下采取子宫内膜电切术联合刮宫术对于治疗多发性子宫内膜息肉(EMP)患者的临床效果。方法:选取2012年6月至2014年3月在我院确诊为EMP的患者100例,随机平均分为两组,研究组采取宫腔镜下子宫内膜电切术联合刮宫术治疗,对照组单纯采取宫腔镜下子宫内膜电切术治疗。观察两组患者术中出血量、手术时间、一年内子宫息肉的复发率及子宫异常出血的发病率。结果:两组术中出血量、手术时间及子宫息肉复发率比较差异无统计学意义(P0.05)。研究组子宫异常出血发病率低于对照组,差异有统计学意义(P0.05)。结论:宫腔镜下电切术联合刮宫术对于治疗EMP的效果更佳,可降低子宫异常出血发病率,安全有效,值得临床进一步推广。     

Activation of estrogen receptor-beta by a special extract of Rheum rhaponticum (ERr 731), its aglycones and structurally related compounds

The special extract ERr 731^® from the roots of Rheum rhaponticum is the major constituent of Phytoestrol^® N which is used for the treatment of climacteric symptoms in menopausal women. However, the molecular mode of action of ERr 731^® was unknown. For the first time, ERr 731^® and its aglycones trans-rhapontigenin and desoxyrhapontigenin were investigated with regard to the activation of the estrogen receptor- or estrogen receptor-β (ER, ERβ). The related hydroxystilbenes cis-rhapontigenin, resveratrol and piceatannol were studied as comparators. As controls, 17β-estradiol or the selective ER-(propylpyrazoltriol) or ERβ-agonists (diarylpropionitril) were used. Neither in ER-expressing yeast cells, in the ER-responsive Ishikawa cells, nor in human endometrial HEC-1B cells transiently transfected with the ER an activation of ER by ERr 731^® or the other single compounds was detected. Furthermore, an antiestrogenic effect was not observed. In contrast in human endometrial HEC-1B cells transiently transfected with the ERβ, 100 ng/ml ERr 731^® and the single compounds significantly induced the ERβ-coupled luciferase activity in a range comparable to 10⁻⁸ M 17β-estradiol. All effects were abolished with the pure ER antagonist ICI 182780, indicating an ER-specific effect. The ERβ agonistic activity by ERr 731^® could be of importance for its clinical use, as central functions relevant to climacteric complaints are proposed to be mediated via ERβ activation.     

Adenovirus mediated homozygous endometrial epithelial Pten deletion results in aggressive endometrial carcinoma

Pten is the most frequently mutated gene in uterine endometriod carcinoma (UEC) and its precursor complex atypical hyperplasia (CAH). Because the mutation frequency is similar in CAH and UEC, Pten mutations are thought to occur relatively early in endometrial tumorigenesis. Previous work from our laboratory using the Pten^+/− mouse model has demonstrated somatic inactivation of the wild type allele of Pten in both CAH and UEC. In the present study, we injected adenoviruses expressing Cre into the uterine lumen of adult Pten floxed mice in an attempt to somatically delete both alleles of Pten specifically in the endometrium. Our results demonstrate that biallelic inactivation of Pten results in an increased incidence of carcinoma as compared to the Pten^+/− mouse model. In addition, the carcinomas were more aggressive with extension beyond the uterus into adjacent tissues and were associated with decreased expression of nuclear ERα as compared to associated CAH. Primary cultures of epithelial and stromal cells were prepared from uteri of Pten floxed mice and Pten was deleted in vitro using Cre expressing adenovirus. Pten deletion was evident in both the epithelial and stromal cells and the treatment of the primary cultures with estrogen had different effects on Akt activation as well as Cyclin D3 expression in the two purified components. This study demonstrates that somatic biallelic inactivation of Pten in endometrial epithelium in vivo results in an increased incidence and aggressiveness of endometrial carcinoma compared to mice carrying a germline deletion of one allele and provides an important in vivo and in vitro model system for understanding the genetic underpinnings of endometrial carcinoma.