Magnetic resonance imaging-guided focused ultrasound surgery for uterine fibroids: Initial experience in Korea / 대한산부인과학회지

OBJECTIVE: The purpose of this report is to review the safety and short-term efficacy of non-invasive magnetic resonance imaging-guided focused ultrasound surgery (MRgFUS) on uterine myomas in Korean women. METHODS: A total of 29 outpatient Korean women, whose mean age was 39.1+/-5.8 years, were treated using the MRgFUS system for their symptomatic uterine myomas. Patients??symptoms were recorded using a validated symptom-specific questionnaire on treatment day, and at follow-up visits, 3 and 6 months post treatment. Data on adverse events was recorded on each follow up period. RESULTS: Symptom improvement was experienced by 83% of the patients at the three months follow-up, and 90% of the patients reported on improved quality of life by the six months follow-up. There were no serious adverse events during the treatments or the follow-up period. CONCLUSION: MRgFUS appears to be a safe and effective treatment for symptoms relief of uterine fibroids. Additional reports on longer follow up should verify long-term durability.

Expressions of Leukemia Inhibitory Factor (LIF): Comparison of Normal Pregnancy and Recurrent Abortion / 대한산부인과학회잡지

OBJECTIVE: Successful implantation depends on a complex interaction between the developing blastocyst and the endometrium. Among the steroid hormones, growth factors, and cytokines which participate in preparing the uterus for implantation, leukemia inhibitory factor (LIF) plays an essential role in implantation. We compared the expression of LIF in normal pregnancies to that of recurrent abortions in placenta to elucidate whether spontaneous abortion and expression of LIF has correlation. METHODS: Placental tissues from normal pregnancies and recurrent abortions were fixed and embedded in paraffin. Standard immunohistochemical staining was used to identify LIF. RESULTS: LIF expressions on cytotrophoblast of recurrent abortion were lower than those of normal pregnancy. There were no expressions on syncytiotrophoblast and stroma in the both groups. In the decidua and gland, LIF was expressed in mild degree and there were no differences in LIF expression between normal pregnancy and recurrent abortion. CONCLUSION: LIF expression on cytotrophoblast of recurrent abortion was lower than that of normal pregnancy. LIF may provide paracrine and autocrine signals to both embryonic tissues and uterine epithelium during implantation. The dysfunction of LIF production may be a cause of the unexplained recurrent abortions.

The Effect of Leukemia Inhibitory Factor in Decidualizing Human Endometrial Stromal Cells / 대한산부인과학회잡지

OBJECTIVE: Decidualization of endometrial stromal cells is essential for a successful implantation of the embryo. The process of decidualization can be modulated by sex steroids, growth factors and cytokines. Leukemia inhibitory factor (LIF) is a pleiotropic cytokine of the interleukin-6 family and has different biological actions in various tissue systems. Recently, LIF has been reported as an important factor for adequate decidualization of endometrium. However, the effect on production of prolactin (PRL), known as the decidualization marker, are not clearly understood. The objective of this study was to determine whether LIF is capable of modulating prolactin production during 8-bromo (Br)-cAMP induced decidualization in vitro. METHODS: Human endometrial stromal cells were cultured and decidualization was induced by 0.5 mM 8-Br-cAMP. Phase contrast microscopy was used to verify morphological changes associated with differentiation in vitro in response to 8-Br-cAMP. Both stromal cells exposed to 8-Br-cAMP and cells not exposed to 8-Br-cAMP were also incubated with LIF (10 ng/mL). PRL levels in each supernatant were measured by a commercial PRL ELISA kit. Immunostaining and reverse transcription-polymerase chain reaction (RT-PCR) for PRL were performed. RESULTS: The concentration of PRL in the supernatant increased significantly in the cells treated with 8-Br-cAMP plus LIF (10 ng/mL) at culture day 6 compared with the others. The results of immunohistochemical staining reflected that of immunoassay. The PRL genes are expressed in the decidualized stromal cells treated with 8-Br-cAMP. No PRL mRNA was detectable in the absence of the 8-Br-cAMP. The intensity of the PCR band measured by densitometry is stronger in the cells treated with 8-Br-cAMP plus LIF than that with the others. CONCLUSION: These results suggested that LIF increased the production of PRL in decidualizing human endometrial stromal cells and may play a role in preparing the human endometrium for implantation through the promotion of PRL production.

The effect of telomerase expression on the escape from M2 crisis in virus-transformed human retinal pigment epithelial cells

Integrins are heterodimeric glycoproteins that have been found to undergo dynamic temporal and spatial changes in the endometrium during the menstrual cycle and in early pregnancy. Specificity of integrins is known to be different in human endometrial stromal cells and decidual cells. These shifts of integrins suggested to play an important role in embryo implantation and can be modulated by progesterone, cAMP derivatives, and cytokines. The mechanisms of decidualization and its precise physiological role are still not clearly understood and in vitro systems could provide an alternative that overcomes limitations of studying such complex biological phenomena in vivo at the time of implantation. This study was undertaken to establish an in vitro model system for human decidualization using 8-bromo-cAMP and to investigate the characteristics of stromal integrin expression in vitro by 8-Br-cAMP. Endometrial stromal cells were isolated and cultured, and then were induced to decidualize by 0.5 mM 8-Br-cAMP for 15 days. Immunofluorescence staining and flow cytometric analyses of the integrin subunits (alpha1, alpha4, alpha5, alpha6, beta1 and alpha v beta3) were performed at day 9. In the presence of 8-Br-cAMP, the staining intensity of alpha v beta3 was significantly higher than control and measurements for alpha1, alpha4, alpha5, alpha6, and beta1 were similar. Immunofluorescent localization of the integrins reflected the differences obtained from the flow cytometric analyses described above. In summary, the expression of alpha;avbeta;b3 integrin increased in stromal cells in vitro decidualized by 8-Br-cAMP and this up-regulation of alpha v beta3 integrin expression during decidualization might influence on human implantation.

Expression of Transforming Growth Factor-1, 2 in the Decidua of the Early Pregnancy: Comparison of Decidua Basalis and Decidua Parietalis / 대한산부인과학회잡지

OBJECTIVES: Implantation is a complex process between developing embryo and maternal endometrium, especially decidua. Decidua is a specialized endometrium during pregnancy and decidua basalis is the real implantation site infiltrated directly by trophoblast cells. The decidua parietalis lines the uterine cavity away from the implantation site, not real implantation site. TGF-beta1 and TGF-beta2 have known as multipotential cytokines and expression of TGF-beta1 and TGF-beta2 increased in decidua during pregnancy than secretory phase of endometrium. However, there is little known about their expression in decidua parietalis, compared with decidua basalis. The purpose of this study was to compare the expression of TGF-beta1 and TGF-beta2 in the decidua basalis and decidua parietalis during early pregnancy. METHODS: The early pregnant 26 samples were obtained at hysterectomy, which underwent surgery for cervical carcinoma, ovarian cancer, etc. Immunohistochemical staining of TGF-beta1 and TGF-beta2 was performed and staining intensity was semiquantified by using HSCORE. RESULTS: TGF-beta1 was slightly expressed in the decidua basalis and decidua parietalis and there were no differences among them. But the expressions of TGF-beta2 of stroma and glandular cells were higher in the decidua basalis than parietalis (p < 0.005). And the expressions of TGF-beta2 were stronger than that of TGF-beta1 in the both decidua of early pregnancy (p < 0.005). CONCLUSION: In decidua basalis, especially stromal cells, the expression of TGF-beta2 was increased than in the decidua parietalis. This suggests that TGF-beta2 may play an important role in decidua basalis that is directly invasion site by embryo and can be regulated by embryonic derived local factor. TGF-beta2, compared with TGF-beta1, was increased in both implantation site and suggest it may regulate implantation process during early pregnancy.

Expression of Transforming Growth Factor-beta1, beta2 by ImmunohistochemicalStaining METHOD: Comparison in Normal Pregnancy, Extopic Pregnancy, and Missed Abortion / 대한산부인과학회잡지

OBJECTIVES: This study have demonstrated that transforming growth factor TGF-beta s(TGF-beta 1 and TGF beta 2) may play an important role in implantation and also to determinethe defferences of in the decidua and placenta between normal pregnancy, ectopic pregnancy, and missedabortion. METHODS: We have studied the expression of TGF-beta 1 and TGF-beta 2 byimmunohistochemical staining method in the decidua trophoblasts of normal early pregnancy, ectopicpregnancy, and missed abortion. RESULTS: In the epithelial cells and decidua, TFG-beta 1 was moderately expressed in thenormal pregnancy and weakly expressed in the ectopic pregnancy. But TGF-beta 1 was notexpressed in missed abortion. In contrast, the epithelial expression of TGF-beta 2 was moderatelyin all groups and there are no differences among the groups. And in the decidua, TFG-beta 2 wasmoderately expressed in the normal pregnancy and missed abortion and was weakly expressed in theectopic pregnancy. In the trophoblasts, TFG-beta 1 was weakly expressed in all groups andTGF-beta 2 was moderately expressed in all groups that are no differences among the groups. CONCLUSIONS: These findings suggest that TGF-beta 2 may have an important role in deciduaduring pregnancy, especially normal pregnancy. These could indicate that the presence oftroplablast and/or hormonal milieu of normal pregnancy resulted in the expression of TGF-beta s,particularly TGF-beta 1.

Expression of Transforming Growth Factor-beta1 , beta2 by Immunohistochemical Staining method: In Human Endometrium through the Menstrual Cycle / 대한산부인과학회잡지

OBJECTIVES: The purpose of this study was to determine the differences of expression of TGF-betaS(TGF-beta1 and TGF-beta2) in the human proliferative endometrium, secretory endometrium, and the decidua during early pregnancy. And we also have studied the endometrial expression of TGF-beta1 and TGF-beta2 in the menopause and compared that to the expression in the endometrium and decidua. METHODS: We have studied the expression of TGF-beta1 and TGF-beta2 by immunohistochemical staining method in the proliferative endometrium, secretory endometrium, decidua during early pregnancy, and menopausal endometrium. RESULTS: In the epithelial cells, TGF-beta1 was moderately expressed in the secretory phase and was weakly expressed in the proliferative phase and menopause. In the stromal cells, TGF-beta1 was not expressed in the whole menstrual phase and menopause. And in the epithelial cells, TGF-beta2 was moderately expressed in the proliferative phase, secretory phase, and menopause. In the stromal cells, TGF-beta2 was not expressed in the whole menstrual phase and menopause. Especially, TGF-beta1 and TGF-beta2 were markedly expressed in the decidua during early pregnancy compared to the expression in the proliferative, secretory endometrium, and menopausal endometrium. CONCLUSIONS: These findings suggest that TGF-beta1 may have an important role in the epithelial cells during the secretory phase, not stromal cells. And TGF-beta1 and TGF-beta2 may have a paracrine and autocrine role in the decidua/trophoblast interaction during pregnancy , especially in the normal pregnancy.

Study on Pregnancy Outcomes after Transabdominal Cervico-Isthmic Cerclage during Pregnancy / 대한산부인과학회잡지

OBJECTIVE: Transabdominal cervico-isthmic cerclage(TCIC) may increase the fetal salvage rate and pregnancy outcome in selected women when poor obstetric outcome is related to previously failed transvaginal cervical cerclage and an anatomically defective cervix. Our purpose was to evaluate the outcomes after transabdominal cervicoisthmic cerclage during pregnancy. STUDY DESIGN: A retrospective review was done from patients who had been received transabdominal cervicoisthmic cerclage during pregnancy at Hanyang University Medical Center from October, 1989 to April 1997. The fetal salvage rate before and after post-conceptional transabdominal cervicoisthmic cerclage were compared and analysed. RESULTS: The seventy-eight patients had 95 successful pregnancies out of a total of 97. Thus the fetal salvage rate of TCIC during in pregnancy was 97.9 %. Of 78 patients, nineteen patients had the second succesful pregnancies and repeat cesarean deliveries after TCIC. CONCLUSION: We conclude that the transabdominal cervicoisthmic cerclage during pregnancy offers a high fetal salvage rate with a minimal complications in patients with extremely poor obstertric histories as a result of cervical incompetence, where vaginal cerclage is not warranted.