Fallopian tubal infertility: the result of Chlamydia trachomatis-induced fallopian tubal fibrosis

Molecular and Cellular Biochemistry - Chlamydia trachomatis is one of the most common pathogens of sexually transmitted diseases, and its incidence in genital tract infections is now 4.7% in south...     

输卵管性不孕症孕妇女生殖道微生物群落研究

目的分析输卵管性不孕症妇女阴道微生物群落,研究阴道微生物菌落在输卵管性不孕症中的作用。方法选择2016年4月-2018年4月在本院就诊的女性246例,其中符合输卵管性不孕症诊断标准女性126例,设为不孕组;其余120例患者,设为对照组。对患者阴道微生物菌群分布,菌群密集度,菌群多样性,优势菌和炎症情况检测。结果两组间患者的年龄分组(P=0.916,0.564,0.734,0.423)、文化程度分布(P=0.937,0.488,0.522)、月经周期(P=0.839)、月经周期是否规律(P=0.943)、Nugent评分(P=0.614,0.089,0.108)等差异无统计学意义。对照组和不孕组患者阴道微生态各指标相比差异无统计学意义。不孕组患者解脲支原体阳性率明显高于对照组(P=0.000),沙眼衣原体阳性率明显高于对照组(P=0.005),阴道毛滴虫、线索细胞、假丝酵母菌等阳性率与对照组比较差异无统计学意义(Ps0.05)。结论阴道解脲支原体、沙眼衣原体感染与女性输卵管性不孕症有关,可能是引起女性不孕的主要因素之一。     

Cytologic diagnosis of primary tubal cancer

A study was made of the 128 cases of primary tubal cancer reported to date in Japan, especially of the 61 cases with a preoperative cytologic examination, which was positive for malignancy in 28 cases (45.9%). A positive cytologic diagnosis was made on the cervicovaginal smear in 37.9% of the 58 cases so examined and on the endometrial smear in 80.0% of the 15 cases so examined. Of the 12 cases with positive endocervical smear cytologies, 11 were without endometrial invasion and 4 had no cancer cells in the cervicovaginal smear. Histologic examination of endometrial curettage specimens was positive for cancer in 8 (23.5%) of 34 cases so examined. Endometrial invasion by cancer cells was seen in 11.1% of the surgically extirpated endometrial specimens. The results of this study suggest that cytologic diagnosis is one of the most reliable methods for detecting primary tubal cancer before a surgical operation is undertaken. Its efficacy might be improved by more careful sampling and study in patients suspected of having primary tubal cancer.     

QF-PCR在染色体异常男性不育症诊断中的应用

为评估定量荧光PCR(QF-PCR)方法在男性不育遗传学诊断中的应用价值,文章对78例非梗阻性男性不育患者,采用精液常规检测精子情况,并检测患者性激素水平;采用QF-PCR方法对患者性染色体多态性STR位点及特异性位点进行检测;采用常规染色体G显带方法进行核型分析;PCR检测AZF微缺失。结果显示78例非梗阻性男性不育患者中发现无精子症患者18例,少精子症患者20例,总检出率为48.72%。采用QF-PCR方法检出3例47,XXY患者,2例46,XX(SRY+)性反转患者,1例AZFc区微缺失患者,与细胞培养染色体分析和AZF微缺失PCR检测结果相符。与传统方法相比,QF-PCR技术能更迅速、直接、可靠地检测到男性不育患者的染色体异常区域,及早发现染色体细微结构异常,有助于染色体异常造成的男性不育症的鉴别诊断。     

Transvaginal echography in the diagnosis of endometrioid cysts of the ovaries]

Research into the value of transvaginal echography in the diagnosis of endometrioid ovarian cysts has shown that this pathology is characterized by the presence of a round or oblong formation, filled with small-dotted suspension of mean or high echogeneity, by a dense hyperechogenic component of small sizes and wall thickening up to 0.2-0.3 cm. The accuracy of diagnosis of endometrioid ovarian cysts was 92.3%.     

经输卵管注药介入治疗慢性盆腔炎性疼痛及阻塞性不孕的路径探讨和疗效观察

目的为探索治疗慢性盆腔痛及不孕的理想方法,本文尝试通过输卵管注药介入治疗盆腔炎性后遗症等疼痛疾病及输卵管阻塞性不孕,观察其疗效并对输卵管这条自身路径进一步拓宽利用进行实践论证。方法应用NCI—I型数字化输卵管通液诊断治疗仪对56例盆腔炎性等疼痛、伴有不孕或计划妊娠的患者结合超声监测通液诊断,根据输卵管通畅程度分别给予盆腔注药或输卵管疏通后介入治疗。结果56例盆腔疼痛患者仅有19例输卵管通畅,37例输卵管阻塞（不全阻塞25例,11例不通）,占66．1％。治疗后通畅组盆腔疼痛消失16例,治愈率为84．2％;不全阻塞组疼痛减轻20例,好转率为76．9％,其中14例患者输卵管得以疏通;不通组45．5％（5／11）病情好转,输卵管疏通率为63。6％（7／11）;通畅组疼痛治愈率明显高于不全阻塞和不通组（P〈0．05）。盆腔炎性疼痛治愈率和输卵管疏通率分别为45．5％和82．4％,内异症等疼痛组为13．0％和65.0％,后者虽不及前者理想（P〈0．05）,但确有60．9％患者疼痛好转。本文输卵管阻塞疏通率为72．9％,慢性盆腔疼痛治疗有效率达87．5％。结论输卵管是一条与生俱来的自身生理通道,可拓宽利用诊治盆腔疾病。NCI—I型数字化输卵管通液诊断治疗仪盆腔注药介入治疗是一种准确易行、安全无创、科学有效的诊治盆腔炎性等疾病的方法。实践证明,疏通这条路径不仅在阻塞性输卵管不孕方面起到了至关重要的临床作用,对治疗盆腔炎性后遗症等慢性盆腔疼痛疾病也有较高的研究价值,值得进一步探索和应用,并有广阔的前景和发展空间。     

Correlation of infertility with altered tubal morphology and function in mice with salpingitis induced by a human genital-tract isolate of Chlamydia trachomatis

Progesterone-treated C3H mice were inoculated into the uterus or ovarian bursa with a human genital tract isolate of C. trachomatis (serovar E), or with control medium alone. The mice were then observed at various times up to 260 days after inoculation. Before being killed the mice were given pituitary gonadotrophins to induce ovulation. Eggs were sought in the oviducts and ciliary activity in the fimbrial and ampullary sections of the oviducts was determined by light microscopy, before detailed examination by scanning electron microscopy. Eggs were visible in all control oviducts and both mucosal ultrastructure and ciliary activity appeared normal. By contrast, eggs were not recovered from the inoculated oviducts of mice infected intrabursally, nor was ciliary activity observed up to 28 days after inoculation. After this, ciliary activity reappeared but eggs were still not transported to the oviduct. Ultrastructural studies suggested that severe mucus congestion accompanied by tubal oedema and loss of ciliated epithelia play a major role in the aetiology of chlamydial-induced tubal damage. Infertility following chlamydial salpingitis could be associated with failure of egg transportation to the oviduct. Egg transport was still impaired even when luminal ciliary activity, ultrastructural integrity and patency had recovered. Our results suggest that chlamydial salpingitis in this mouse model closely resembles the human disease in its pathology and consequences for fertility, making the model particularly relevant for research on chlamydial vaccine development.     

Expectations of assisted conception for infertility.

OBJECTIVE--To provide reliable prognostic information for couples seeking assisted conception. DESIGN--Analysis of four years'' practice (1988-91). SETTING--Private university service linked with NHS reproductive medicine services. PATIENTS--804 couples with various causes of subfertility, median duration five years, median age of women 34 years. INTERVENTIONS--1280 completed cycles: 950 in vitro fertilisation, 144 gamete intrafallopian transfer, and 186 intrauterine insemination and superovulation. MAIN OUTCOME MEASURES--Pregnancy and birth rates per cycle and cumulative pregnancy and take home baby rates per couple. RESULTS--In women under 40 years and men with normal sperm, whatever the cause of infertility, results with in vitro fertilisation improved steadily reaching a pregnancy rate per cycle of 30% (95% confidence interval 26% to 35%) during 1990-1 and birth rate per cycle of 29% (23% to 35%) in 1990. Pregnancy and birth rates for gamete intrafallopian transfer were 36% (28% to 44%) and 26% (17% to 37%) and for intrauterine insemination 18% (12% to 24%) and 16% (10% to 22%). After six cycles cumulative probability of pregnancy was 82% and cumulative take home baby rate 70%. Considering only in vitro fertilisation and gamete intrafallopian transfer after four cycles the pregnancy rate was 78% (66% to 91%). CONCLUSIONS--Conception is less likely in women over 40 and men with sperm dysfunction. For other couples the prognosis for a live birth is at least as good as for fertile couples if they persist with treatment.     

阴道彩超对宫角妊娠的诊断运用评价

目的：探究阴道彩超对宫角妊娠的诊断价值,为宫角妊娠的临床诊断提出有效方法。方法：对我院2010年4月～2013年4月收治的80例初诊宫角妊娠患者进行回顾性分析,对比其经腹彩超和经阴道彩超的的诊断结果与术后病理确诊差异。结果：阴道彩超下宫角妊娠共分三种表现,包括胚囊型、包块型和破裂型;阴道彩超显示,所有初诊宫角妊娠患者均可见孕囊与子宫内膜相连,其肌层厚度在7．5-11.3mm间,平均（10．5±1．7）mm;二次检查中,经腹超声确诊59例宫角妊娠,经阴道超声确诊51例,病理诊断共确诊宫角妊娠48例。经腹超声诊断准确率为81．4％,明显低于经阴道超声的94．1％,两组数据对比存在显著统计学差异。经腹超声两次检查符合率为73．8％,显著低于经阴道超声的96．2％,两组数据对比存在显著统计学差异。结论：阴道彩超较经腹彩超对宫角妊娠具有更高的诊断准确率,通过图像判断,能够有效对宫角妊娠、输卵菅间质部妊娠进行有效鉴别诊断,可作为指导临床早期干预方案、制定跟踪随访措施的关键依据。     

Metabolomic profile as a noninvasive adjunct tool for the diagnosis of Grades III and IV endometriosis‐related infertility

The aim of the present case‐control study was to develop a noninvasive adjuvant tool for the diagnosis of endometriosis. Serum samples from 100 patients undergoing intracytoplasmic sperm injection were split into two groups according to the cause of infertility: an endometriosis group (n = 50), consisting of samples derived from patients with Grade III and IV endometriosis, and a control group (n = 50), comprising samples derived from patients with isolated male factor infertility. The metabolomic profile of each sample was obtained, through mass spectrometry. Partial least squares discriminant analysis was able to clearly classify the endometriosis and control groups. Ten potential biomarkers were selected based on their importance for model prediction. These ions were used to build the receiver‐operating characteristic curve, which presented an area under the curve of 0.904 (95% confidence interval: 0.796–0.985). To validate the model, 30 other samples from infertile women without any evidence of endometriosis were tested. Considering these ions as possible biomarkers, the model was able to correctly classify 84% of the patients. Finally, a similar prediction potential was observed in the model validated set, when samples from the disease‐free group were tested. Serum metabolomics may be useful as a noninvasive adjunct tool for the selection of patients who must undergo laparoscopy for definitive endometriosis diagnosis.