Clinical analysis of intravenous leiomyomatosis:report of 9 cases / 中国实用妇科与产科杂志

OBJECTIVE: To investigate the clinical characteristics,diagnosis and treatment of intravenous leiomyomatosis(IVL).METHODS: The clinical data of 9 IVL treated at Women's Hospital,Zhejiang University School of Medicine from January 2013 to December 2017 were analyzed retrospectively. All the cases were followed up.RESULTS: Out of 8702 patients with uterine leiomyoma,9 patients were diagnosed with IVL. Most patients complained of pelvic mass,and 6 patients had enlarged uterus. Preoperative imaging examination demonstrated parametrial mass in 5 cases. All nine cases were confined to the pelvic cavity except for one who had lung metastasis. Two cases had myomectomy,and seven underwent hysterectomy. The lesions were dendritic,dumbbell-shaped,elliptical or elongate in four cases. Nine cases had a mean follow-up of 28.2 months,and recurrence occurred in two cases.CONCLUSION: The obvious enlargement of uterus and parametrial mass are important features of IVL. It is difficult to diagnose preoperatively. Identifying the morphological features of lesions during operation can improve the diagnostic accuracy. Total hysterectomy is the first choice of treatment and long-term follow-up is also needed.

Relation between coagulation parameters and pelvic adhesions in endometriosis / 中国实用妇科与产科杂志

OBJECTIVE: To investigate the correlation between coagulation parameters and pelvic adhesions in endometriosis.METHODS: The clinical data of 408 patients with endometriosis who underwent surgery in Women's Hospital School of Medicine Zhejiang University from June 2016 to February 2018 were retrospectively analyzed to evaluate the correlation between coagulation parameters and the severity of pelvic adhesions.RESULTS: In endometriosis cases,the levels of plasma fibrinogen(FIB)in patients with pelvic adhesions were significantly shorter than those without pelvic adhesions[median:3.1 g/L(range:2.7-4.5 g/L)vs. 2.8 g/L(range:2.6-3.2 g/L),respectively;P0.05). FIB was positively correlated with pelvic adhesion scores(r=0.248,P<0.01).In the judgment of pelvic adhesion,the area under the curve(AUC)of FIB was 0.630,and the cut-off value was 2.87 g/L.The incidence of adhesions in patients with FIB greater than 2.87 g/L increased(χ2=15.4,P<0.01).CONCLUSION: Coagulation parameters was correlated with the pelvic adhesions in endometriosis,especially fibrinogen,which may help to judge the severity of pelvic adhesions caused by endometriosis.

Clinical manifestation and classification of adenomyosis / 中国实用妇科与产科杂志

Dysmenorrhea,menorrhagia and infertility are the main clinical manifestations of adenomyosis.Although there is controversy about the classification of adenomyosis at present,several types of adenomyosis typing associated with its clinical and pathological characteristics are still valuable for its clinical diagnosis and treatment.Therefore,this article only introduces several types of adenomyosis typing related to the clinical and pathological features of adenomyosis.

Role of mast cells in estrogen-mediated experimental endometriosis in rats / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate the role of mast cells in the pathogenesis of estrogen-mediated experimental endometriosis in rats.</p><p><b>METHODS</b>Endometriosis model was established by transplanting autologous fragments of uterus to the inner surface of the abdominal wall in 24 un-pregnant female Sprague Dawley rats. The rats were divided randomly into three groups (n=8 in each group), and were injected with different doses of estrogen: high-dose group (200 μg·kg⁻¹·d⁻¹), low-dose group (100 μg·kg⁻¹·d⁻¹) and the control group (0 μg·kg⁻¹·d⁻¹). The ovaries were surgically removed in high-dose and low-dose groups. Four rats were sacrificed in each group at 2 and 4 weeks after surgery. Their serum estradiol levels, size of lesions, total number of mast cells and degranulations, serum TNF-α levels, expression of tryptase and NGF in tissues were analyzed and compared among groups.</p><p><b>RESULTS</b>The mean levels of serum estradiol 2 weeks and 4 weeks after model established and serum TNF-α at 4 weeks in estrogen-treated groups were significantly higher than those in control group (all P<0.05). The mean size of endometriotic lesions in the estrogen-treated groups was also significantly larger than that in the control group 2 weeks and 4 weeks after model established (all P<0.05). Meanwhile, both at week 2 and week 4, the mean ratio of degranulation/total number of mast cells by toluidine blue staining in low-dose estrogen group was significantly higher than that in the control group (P<0.05). The expression of NGF in high-dose estrogen group was significantly higher than that in the control group at week 4(P<0.05).</p><p><b>CONCLUSION</b>Estrogen can promote the growth of endometriotic lesions and may mediate the pathogenesis of endometriosis by activating mast cells, which may be associated with increasing TNF-α and NGF levels.</p>

Sodium cromoglycate attenuates experimental endometriosis in rats by regulating mast cells / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate the effect of sodium cromoglycate on experimental endometriosis in rats.</p><p><b>METHODS</b>Endometriosis model was established in 36 unpregnant female SD rats by transplanting autologous fragments of endometrium to the inner surface of the abdominal wall. The endometriotic lesions were measured by a second laparotomy 2 weeks after surgery. Then the rats were randomly divided into four groups (n=8 in each group) to receive intraperitoneal injection of different doses of sodium cromoglycate for 2 weeks: high-dose group (20 mg·kg⁻¹·d⁻¹); low-dose group (10 mg·kg⁻¹·d⁻¹); the negative control group and the blank control group. The animals were sacrificed and the size of the lesions were measured. The endometriosis model of SD rats was identified by HE staining and immunohistochemical staining of keratin and vimentin. The total number of mast cells and their degranulation were measured by Toluidine blue staining; the concentrations of TNF-α in serum were measured by enzyme linked immunosorbent assay; the concentrations of estradiol in serum were measured by enzyme immunoassay; the expression of tryptase and nerve growth factor (NGF) were measured by immunohistochemical staining.</p><p><b>RESULTS</b>The number of activated mast cells (MC) by Toluidine blue staining in high-dose group was significantly lower than that in negative control group (P<0.05), and its ratio of degranulation/total number of MC was significantly lower than that in negative control group or blank control group (P<0.05). The serum TNF-α levels and tryptase expression in tissues in high-dose group were significantly lower than those in negative control group or blank control group (P<0.05). However, no significant difference in the size of endometriotic lesions and expression of NGF was found among groups (P>0.05).</p><p><b>CONCLUSION</b>Sodium cromoglycate can stabilize mast cells from degranulation, which may relieve the clinical symptoms of endometriosis by reducing TNF-α and tryptase levels.</p>

Overt gastrointestinal bleeding because of hookworm infection

Hookworm infection is a relatively common cause of anemia in endemic areas. The most common hookworm species are Ancylostoma duodenale and Necator americanus. In this report we present a case of overt gastrointestinal bleeding because of hookworm infection. Capsule endoscopy revealed many hookworms in the lumen of proximal jejunum where active bleeding was seen. The patient was successfully treated with Albendazole.

Diagnosis and treatment of complicated interstitial pregnancy / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To review the diagnosis and treatment of interstitial pregnancy.</p><p><b>METHODS</b>Four cases with complicated interstitial pregnancy were diagnosed and treated from January, 2004 to June, 2007 at the Affiliated Obstetrics and Gynecology Hospital, College of Medicine, Zhejiang University. The clinical data and follow-up records were analyzed retrospectively.</p><p><b>RESULTS</b>All 4 nulliparous patients were misdiagnosed before operation. The median age was 30 years (25-34 years), and the median duration of amenorrhea was 48 days (37-58 days). The median concentrations of serum beta-hCG were 3245.5 IU/L (282-30729 IU/L). Two patients with interstitial pregnancy had high levels of beta-hCG, and were diagnosed and treated under laparoscopy. Among them one patient was underwent transcervical curettage under laparoscopic guidance,and another underwent laparoscopic salpingotomy. The remained two patients had low levels of beta-hCG, and were diagnosed and treated under hysteroscopy, 50 mg methorexate(MTX)was injected into the implanted sites under hysteroscopic guidance. The levels of serum beta-hCG in 4 patients dropped down quickly, reaching undetected levels at a mean duration of 13 days after operation. Three months postoperatively, ultrasonic examination revealed the normal contour of uterus.</p><p><b>CONCLUSIONS</b>Endoscopic examination is helpful to make a correct diagnosis, and transcervical curettage (or transcatheter chemotherapy) under laparoscopic guidance (or under hysteroscopic guidance) may be a promising approach for young or nulliparous women with interstitial pregnancy who want to maintain future fertility.</p>

Research on relationship between gene polymorphisms of interleukin-1 family and endometriosis / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate whether interleukin-1 beta (IL-1beta ) and interleukin-1 receptor antagonist (IL-1RA) gene polymorphisms are associated with endometriosis (EMs) in Chinese women.</p><p><b>METHODS</b>One hundred and thirty-eight patients with EMs and 100 women without EMs were enrolled in the study. Polymorphisms for IL-1 beta-511 promoter, IL-1 beta exon 5, and IL-1RA were detected by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP).</p><p><b>RESULT</b>There were no significant differences about the distribution of the genotypes and alleles of IL-1 beta -511 promoter and IL-1 beta exon 5 in two groups (P > 0.05). The frequencies of A1/A1, A1/A2, A1/A4 and A2/A2 of IL-1RA gene were 84.1 %, 12.3 %, 2.9 % and 0.7 % in EMs and 95 % , 4 % ,1 % and 0 % in controls, respectively (P=0.042). The A1, A2 and A4 alleles were 91.7 % , 6.9 % and 1.4 % in EMs and 97.5 % , 2 % and 0.5 % in controls (P=0.019). In comparison with the reference genotype, the wild A1/A1 homozygote, the odds ratio for A1/A2 was 3.48 (95 % CI: 1.13 - 10.69). Compared with the A1 allele, the odds ratio for the A2 allele was 3.66 (95 % CI: 1.23 - 10.94).</p><p><b>CONCLUSION</b>Association between the IL-1 beta-511 promoter,IL-1 beta exon 5 polymorphisms and EMs in China is not found. However, the A2 allele of IL-1RA gene may be one of the risk factors for the Chinese women in Zhejiang Province to suffer EMs.</p>

Determination of interleukine-16 levels in peritoneal fluid and serum of women with endometriosis / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate the role of interleukine-16 (IL-16) in the pathogenesis of endometriosis.</p><p><b>METHODS</b>Enzyme-linked immunosorbent assay (ELISA) was used to determine the levels of IL-16 in peritoneal fluid and serum specimens of 22 women with different stage endometriosis and 22 controls.</p><p><b>RESULTS</b>The median levels of IL-16 in peritoneal fluid and serum were 290.5 pg/ml and 539.4 pg/ml in women with endometriosis, and 296.6 pg/ml and 778.1 pg/ml in controls, respectively; there was no significant difference between two groups (P>0.05). However, the IL-16 levels in peritoneal fluid and serum of patients with minimal/mild stage endometriosis and controls were all significantly higher than those of patients with moderate/severe endometriosis (P<0.01, <0.05). In addition, there was no statistical correlation of peritoneal IL-16 levels with those in serum (P>0.05).</p><p><b>CONCLUSION</b>Reduced levels of IL-16 in peritoneal fluid and serum of women with advanced stage endometriosis may imply a role of IL-16 in the development and progression of endometriosis.</p>

Sequence analysis and genotypes of glutamate rich protein of Plasmodium falciparum isolates from different malaria endemic areas in China / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To sequence the gene encoding glutamate rich protein (GLURP) and identify the genotypes of geographically different Plasmodium falciparum (P. f) isolates from China.</p><p><b>METHODS</b>The gene of R2 repeat region of GLURP was amplified by nested polymerase chain reaction and cloned into T-vector. The nucleotide sequence of GLURP gene was determined by automatic sequencer (Dideoxy termination method) and analyzed by DNA Star software.</p><p><b>RESULTS</b>At least 7 different GLURP genotypes ranging from 600 bp to 1,500 bp were found in Yunnan and Hainan provinces. R2 region of GLURP gene consisted of several repeat units. Each repeat unit was composed of 19-20 residues which were shown to be highly conserved. GLURP gene was also size polymorphic due to differences in the number of repeat units, whereas the repeat sequence was conserved. Sequence analysis showed that DNA sequences and deduced amino acid sequences were highly homologous among the geographically dispersed isolates or various isolates from the same geographical region. No obvious differences were found in the GLURP gene sequences among geographically different isolates.</p><p><b>CONCLUSION</b>GLURP gene is highly structure conserved and size polymorphic, and so is useful in searching for malaria vaccine candidate antigen and developing a genotyping method for malaria research.</p>