SUCCESSFUL HYSTEROSCOPY GUIDED SUCTION & EVACUATION OF PRODUCT OF CONCEPTION ALONG WITH REMOVAL OF UTERINE SEPTUM IN SAME SITTING

Objective To report a case of early pregnancy loss with septate uterus, successfully managed by hysteroscopy guided suction & evacuation of product of conception along with removal of uterine septum in same sitting. Case report. Tertiary care hospital. One woman with early pregnancy loss with septate Design Setting Patient uterus. Hysteroscopy guided suction & evacuation of product of conception along with removal of uterine septum Intervention in same sitting. Hysteroscopy guided suction & evacuation of product of conception followed by septum removal with Result hysteroscopic scissor was performed, with minimal blood loss, in same sitting. Products of conception were sent for pathologic examination. There were no intra-operative or postoperative complications. Even though the role of septum as a Conclusion contributing factor to miscarriage in not certain, early pregnancy loss may be seen in patients with septate uterus. Blind removal of POCs with dilatation & curettage, may be complicated with retained products of conception (RPOC) or intrauterine adhesion formation, which can lead to adverse fertility outcomes in the future. Also removal of septum, which may or may not be the cause, is often performed before further pregnancy. This requires another admission & exposure to anaesthesia, along with added cost. Hysteroscopy guided resection of POC with septum removal in same sitting has been associated with complete tissue removal under vision, less damage to surrounding endometrium, cost effective combination of two surgical procedures & earlier time to conception compared with 2 sitting procedure (dilation and curettage than septum removal). Thus, hysteroscopy guided suction & evacuation of POC & septum removal in same sitting can be considered as an alternative surgical technique for management of early pregnancy loss in patients diagnosed with septate uterus. This case report demonstrates the successful application of hysteroscopic procedure in a case of early pregnancy loss with septate uterus.

Effects of different induced abortions on women's menstrual re-fluid time, vaginal bleeding time and the incidence of postoperative intrauterine adhesion / 中国基层医药

Objective:To investigate the effects of different induced abortions on women's menstrual re-fluid time, vaginal bleeding time and the incidence of postoperative intrauterine adhesion.Methods:A total of 260 women who underwent painless abortion under ultrasound surveillance in The Second Hospital of Jiaxing from January 2019 to January 2021 were included in the ultrasound group. An additional 260 women who underwent minimally invasive endoscopic visual abortion were included in the endoscopy group. Operation-related indexes were compared between the two groups. Menstrual re-fluid time, vaginal bleeding time, postoperative abdominal pain and the incidence of postoperative intrauterine adhesion were compared between the two groups.Results:Operative time in the endoscopy group was significantly shorter than that in the ultrasound group [(3.37 ± 0.84) minutes vs. (6.59 ± 2.03) minutes, t = 23.68, P < 0.001]. The amount of intraoperative blood loss in the endoscopy group was significantly less than that in the ultrasound group [(15.87 ± 5.65) mL vs. (33.04 ± 10.44) mL, t = 23.33, P < 0.001]. Postoperative vaginal bleeding time and menstrual re-fluid time in the endoscopy group were (3.16 ± 1.58) days and (30.37 ± 6.13) days, respectively, which were significantly shorter than those in the ultrasound group [(4.23 ± 1.83) days, (32.07 ± 4.25) days, t = 7.10, 3.69, P < 0.001]. There were no significant differences in the severity and duration of postoperative abdominal pain between the two groups (both P > 0.05). Complete abortion rate in the endoscopy group was significantly higher than that in the ultrasound group [98.85% vs. 96.15%, χ2 = 3.86, P < 0.05]. The incidence of complications in the endoscopy group was significantly lower than that in the ultrasound group (2.31% vs. 5.77%, χ2 = 4.01, P < 0.05). There was no significant difference in the incidence of postoperative intrauterine adhesion between the endoscopy and ultrasound groups (1.15% vs. 3.46%, P > 0.05). Conclusion:Both minimally invasive endoscopic visual abortion and B-ultrasound-guided painless abortion have painless effects. Minimally invasive endoscopic visual abortion produces less postoperative impact, leads to better postoperative recovery, and is safer than B-ultrasound-guided painless abortion.

Construction and evaluation of a nomogram prediction model for the intrauterine adhesions risk factor after hysteroscopic surgery for subumcosal myoma of uterus / 中国医师进修杂志

Objective:To analyze the risk factors of intrauterine adhesions in patients after hysteroscopic surgery for subumcosal myoma of uterus, and to construct and evaluate a nomogram prediction model.Methods:The clinical data of 322 patients underwent hysteroscopic surgery for subumcosal myoma of uterus in Dongguan Maternal and Child Health Hospital from January 2017 to December 2020 were collected. The univariate analysis and multivariate Logistic regression were used to analyze the factors affecting the occurrence of intrauterine adhesions, according to the analysis results, R software was used to construct a nomogram prediction model that affected the occurrence of intrauterine adhesions after hysteroscopic surgery for subumcosal myoma of uterus, and the H-L fit curve and the area under the curve were used to evaluate the effectiveness and discrimination of the model.Results:Through a 1-year follow-up, it was found that 47 patients had intrauterine adhesions (adhesions group), accounting for 14.60%; another 275 patients was enrolled in non-adhesions group. The results of univariate analysis showed that combined pelvic inflammatory disease, pregnancy times, history of curettage, combined uterine fibroids, and serumtransforming growth factor (TGF)-β1 level were risk factors that affected the occurrence of intrauterine adhesions ( P<0.05). The results of multivariate Logistic regression analysis showed that serum TGF-β1 level, pelvic inflammatory disease, history of curettage and uterine fibroids were independent risk factors that affected the occurrence of intrauterine adhesions ( P<0.05). The nomogram prediction model was established with the results of multivariate Logistic regression analysis, and the discrimination of the nomogram model was evaluated, the results showed that the area under the curve was 0.854, and the sensitivity and specificity were 91.50% and 70.50%, respectively. The validity of the model (H-L fit curve) was evaluated and the results showed that χ2 = 7.12, P = 0.413. Conclusions:Serum TGF-β1 level, combined with pelvic inflammatory disease, history of curettage, combined with uterine fibroids are independent risk factors that affect the occurrence of uterine adhesions after hysteroscopic surgery for subumcosal myoma of uterus. The constructed nomogram prediction model has relatively good effectiveness and discrimination. It can be used as an effective predictive tool for early clinical intervention.

Development and Evaluation of Vaginal Suppository Containing Althaea officinalis L. Polysaccharide Extract

Abstract Intrauterine adhesions cause several gynecological problems. Althaea officinalis L. roots known as marshmallows contain polysaccharides (M.P.) which possess anti-inflammatory and anti-ulcerogenic activities also can form a bio-adhesive layer on damaged epithelial membranes prompting healing processes. Vaginal formulations of herbal origin are commonly applied to relieve cervico-uterine inflammation. Herein, we aim to develop and evaluate vaginal suppositories containing polysaccharides isolated from the A. officinalis root. Six formulations (four P.E.G.-based and two lipid-based suppositories containing 25% and 50% M.P.) met standard requirements, which were then subjected to qualitative and quantitative evaluation. All suppositories exhibited acceptable weights, hardness, content uniformity, melting point, and disintegration time, which fall within the acceptable recommended limits. Higher concentrations of M.P. in PEG-bases moderately increased the hardness (p<0.05). PEG-formulations showed content uniformity>90% of the average content while it was 75-83% for suppocire formulations. All formulations disintegrated in<30minutes. In-vitro release test revealed that M.P. release from 25%-MP formulations was higher than that of 50%-M.P. suppositories. Overall, results revealed the feasibility of preparing P.E.G.-or lipid-based suppositories containing M.P., which met the B.P. quality requirement

Severity of intrauterine adhesions and pregnancy success rates after treatment: Comparison of adhesions obtained from open myomectomy versus uterine curettage

Intrauterine adhesions (IUA) are rare. A retrospective comparative study was conducted between January 1, 2015, and December 31, 2018. Group A comprised 117 women who developed IUAs after open myomectomy, while Group B comprised 113 women who developed IUAs following uterine trauma caused by uterine instrumentation after a termination of pregnancy (TOP) or spontaneous miscarriage. The IUA grade and pregnancy rates and outcomes were compared using the March classification system. All patients underwent hysteroscopic adhesiolysis. The adhesions tended to be more severe (45/117, 38.5%) in Group A than in Group B (29/113, 25.7%); however, this difference was not statistically significant (Chi-Suare 5.047; p = .080). The period of observation was 24 months from the last hysteroscopy. The pregnancy rate in Group A (26, 22.2%) was significantly lower than in Group B (46, 40.7%) (OR: 2.403, 95% CI: 1.352­4.271; p = .003). Open myomectomy was the preceding aetiological factor in a greater proportion of women with IUA in our study. In cases where pregnancy is desired after open myomectomy, especially where the endometrial cavity is breached, postoperative hysteroscopy to exclude IUAs is recommended.

A randomized controlled study on an integrated approach to prevent and treat re-adhesion after transcervical resection of moderate-to-severe intrauterine adhesions

OBJECTIVES: This study aims to compare the clinical efficacy of an integrated approach to prevent and treat the recurrence of moderate-to-severe intrauterine adhesions (IUA) after hysteroscopic transcervical resection of adhesion (TCRA). METHODS: The study included a total of 70 patients with moderate-to-severe IUAs who underwent TCRA. Patients were randomly divided into two groups: treatment group (n=35) and control group n=35). In the treatment group, patients underwent balloon uterine stent placement and artificial cycle as well as received intrauterine perfusion of Danshen injection and oral Chinese medicine. In the control group, patients underwent balloon uterine stent placement and artificial cycle as well as received hyaluronic acid sodium and intrauterine device (IUD). Follow-up was performed after treatment of uterine cavity, menstruation and pregnancy. RESULTS: After 3 months of treatment, we observed a significantly lower rate of intrauterine re-adhesion (45.71% versus 77.14%, p=0.044) and significantly higher clinical efficiency (82.86% versus 77.14%, p=0.025) in the treatment group than those in the control group. After 6 months of treatment, we observed a significantly higher clinical efficiency in the treatment group than that in the control group (88.57% versus 68.57%, p=0.039). During the follow-up period, the pregnancy rate was 45.71% and 37.14% in the treatment group and control group, respectively, although the difference was not statistically significant (p=0.628). CONCLUSIONS: After surgical management of IUA, the integrated treatment combining a uterus stent placement and artificial cycle with Danshen injection and oral Chinese medicine can improve the condition of menstruation, and prevent and treat recurrence of IUA.

Research progress on the role of the Wnt signaling pathway in the development of intrauterine adhesions and its significance in treatment / 中华老年医学杂志

The Wnt signaling pathway also plays a role in fibrotic diseases of various tissues and organs, such as pulmonary fibrosis, liver fibrosis, renal fibrosis and skin fibrosis.Activation of the Wnt signaling pathway is related to the fibrosis of the endometrium and ectopic endometrial tissue, and it is a key component of the potential mechanisms for the development intrauterine adhesions.It could also be a target for treatment via promoting endometrial proliferation and angiogenesis and enhancing colony formation and self-renewal ability of endometrial stem cells.Wnt signaling pathways may regulate the complicated cross-talking networks and balance the dynamic processes of fibrogenesis and repair in intrauterine adhesions, thus potentially providing a new route for studying the pathological mechanisms of intrauterine adhesions and finding therapeutic targets.

Efficacy of severe intrauterine adhesions / 医学研究生学报

ObjectiveTo investigate the effect of COOK balloon placement time on the efficacy of severe intrauterine adhesions.Methods150 patients with severe IUA were prospectively enrolled and randomized divided into three short-term group, medium-term group and long-term group, with respectively balloon placement time 1 week, 1 month and 2 months. All subjects underwent transcervical resection of adhesion (TCRA). Re-adhesion and pregnancy rate after treatment, the relevant infection indicators, uterine cavity recovery, AFS score improvement rate, menstrual improvement, and endometrial thickness were analyzed.ResultsAll patients underwent transcervical resection of adhesion (TCRA) and COOK balloon placement successfully. Improvement of pregnancy rate and first pregnancy time were observed in group B and C than group A (P0.05).ConclusionPlacement of the uterine COOK balloon for more than 1 month may improve uterine cavity, pregnancy rate, AFS score, menstruation and endometrial thickness. However, the risk of infection increased at the second month after COOK balloon placement.

Efficacy of severe intrauterine adhesions / 医学研究生学报

ObjectiveTo investigate the effect of COOK balloon placement time on the efficacy of severe intrauterine adhesions.Methods150 patients with severe IUA were prospectively enrolled and randomized divided into three short-term group, medium-term group and long-term group, with respectively balloon placement time 1 week, 1 month and 2 months. All subjects underwent transcervical resection of adhesion (TCRA). Re-adhesion and pregnancy rate after treatment, the relevant infection indicators, uterine cavity recovery, AFS score improvement rate, menstrual improvement, and endometrial thickness were analyzed.ResultsAll patients underwent transcervical resection of adhesion (TCRA) and COOK balloon placement successfully. Improvement of pregnancy rate and first pregnancy time were observed in group B and C than group A (P0.05).ConclusionPlacement of the uterine COOK balloon for more than 1 month may improve uterine cavity, pregnancy rate, AFS score, menstruation and endometrial thickness. However, the risk of infection increased at the second month after COOK balloon placement.

Role of hysterolaparoscopy in unexplained infertility

Background: Infertility, as defined by World Health Organization (WHO), is failure to achieve pregnancy during 1 year of regular unprotected intercourse. The objective of this study was to determine the incidence of unsuspected pathology at hysterolaparoscopy in presumed unexplained infertility, the incidence of intervention done for correcting pathology and its outcome and the importance of hysterolaparoscopy in the evaluation and treatment of infertile couples.Methods: This prospective observational study was carried out at IVF and Endoscopy centre, Department of obstetrics and gynecology at the Ruby Hall clinic, Pune from 1st November 2014 to 30th July 2016, after obtaining institutional ethical clearance and who met the inclusion and exclusion criteria. A detailed clinical history and physical examination and bimanual pelvic examination were done, following which all the patients were subjected to baseline blood investigation, 3D pelvis (TVS) and semen analysis. Day care hysterolaparoscopy was performed and systematic analysis were done.Results: The mean duration of infertility was 2 to 4 years. In our study out of 75 women 62 (82.67%) showed normal hysteroscopic findings, remaining 13 women (17.67%) showed abnormal hysteroscopic findings like cornaul blockage, intrauterine adhesions and tuberculosis endometrium. Abnormal laparoscopic findings were reported in 29.33% of which the most common pathology was endomertiosis (21.33%).Conclusions: Diagnostic Hysterolaproscopy is a safe, effective, minimally invasive, cost effective, daycare comprehensive procedure in evaluation of unexplained infertility. Apart from routine diagnostic protocol missed pathologies can be detected and this tool can be used for diagnostic as well as therapeutic intervention.

The role of KDR in intrauterine adhesions may involve the TGF-ß1/Smads signaling pathway

The aim of this study was to investigate the role of kinase-insert domain-containing receptor (KDR) in intrauterine adhesions (IUA) and its mechanism. The Case group consisted of 92 patients diagnosed with IUA, and the Control group included 86 patients with uterine septum who had normal endometrium verified with an uteroscope. In addition, 50 rats were randomly assigned into Control, Sham, Model, NC-siRNA, and KDR-siRNA groups. Rats in the Model, NC-siRNA, and KDR-siRNA groups were induced by uterine curettage and lipopolysaccharide (LPS) treatment to establish the IUA model. Then, immunohistochemistry was applied for detection of VEGF and KDR expression, HE staining was used for observation of the endometrial morphology and gland counting, Masson staining for measurement of the degree of endometrial fibrosis, and qRT-PCR and western blot for the expression of KDR, VEGF, MMP-9, as well as TGF-β1/Smads pathway-related proteins. Compared with the Control group, the mRNA and protein expressions of KDR were significantly higher in IUA endometrial tissues, and the expression of KDR was positively correlated to the severity of IUA. In addition, the injection of si-KDR increased the number of endometrial glands, reduced the area of fibrosis, inhibited mRNA and protein expression of KDR and VEGF, up-regulated the expression of MMP-9 and Smad7, and decreased the expression level of TGF-β1, p-Smad2, p-Smad3, and Smad4 in rats with IUA. Highly-expressed KDR was related to patients' severity of IUA, and silencing KDR may prevent the occurrence and development of IUA via TGF-β1/Smads signaling pathway and up-regulating the expression of MMP-9.

Improvement effect of estradiol valerate combined with aspirin on intrauterine adhesion in rats / 吉林大学学报(医学版)

Objective:To investigate the improvement effect of estradiol valerate combined with aspirin on the intrauterine adhesion (IUA) in the rats, and to elucidate the therapeutic mechanism of estradiol valerate combined with aspirin. Methods:Fifty healthy female SD rats were randomly divided into control group, model group, estradiol valerate group, aspirin group,and estradiol valerate combined with aspirin group (combination group)(n=10);the rats in the other groups except control group were used to establish the IUA models with double injury method of uterine curettage and infection. The serum and uterine tissue were taken from the rats in each group 24 h after continuous administration, the estradiol levels in serum of the rats were observed by ELISA, and the pathological changes and the number of glands in the uterine cavity of the rats in various groups were observed by HE staining, and the ratio of endometrial fibrosis are a was observed by Masson staining. The expression levels of transforming growth factor-β1 (TGF-β1), plasminogen activator inhibitor type-1 (PAI-1) and matrix metalloproteinase-9 (MMP-9) in the endometrium of the rats were detected by immunohistochemistry. Results:The results of ELISA indicated that the estrodiol level in serum of the rats in model group was significantly lower than that in control group(P<0.05);compared with model group,the estrodiol levels in serum of the rats in estradiol valerate group, aspirin group, and combination group were significantly increased (P<0.05). The results of HE and Masson staining showed that compared with control group, uterine cavity adhesion and enlargement, fluid accumulation in the cavity, disorganized arrangement of the cells of uterine cavity wall, significant infiltration of inflammatory cells, endometrial stroma fibrosis,and disordered collagenous fibers were found in model group; the number of endometrial glands in the rats was significantly decreased(P<0.05),and the fibrosis area ratio was significantly increased (P<0.05). Compared with model gorup,the adhesion and effuson in uterine cavity,inflammatory cell infiltration and endometrial stroma fibrosis were alleviated,the cells of uterine cavity wall were arranged neatly,and there was little collagenous fibers in estradiol valerate group,aspirin group,and combination group;the number of endometrial glands was increased(P<0.05),and the fibrosis area ratios were significantlhy decreased(P<0.01).Compared with aspirin group,the number of endometrial glands in combination group was significantly increased(P<0.05),and the fibrosis area ratio was significantly decreased(P<0.05).Compared with model group, the expression levels of TGF-β1 and PAI-1 proteins in the endometrium tissue of the rats in estradiol valerate group, aspirin group, and combination group were significantly decreased (P<0.05 or P<0.01), and the expression levels of MMP-9 protein in the endometrium tissue were significantly increased (P<0.05).The expression levels of TGF-β1 and PAI-1 proteins in the endometrium tissue of the rats in combination group were significantly lower than those in aspirin group (P<0.05), and the expression level of MMP-9 in the endometrium tissue was significantly higher than that in aspirin group (P<0.05). Conclusion:Estradiol valerate combined with aspirin can decrease the expression levels of TGF-β1 and PAI-1 in the endometrium tissue and increase the expression level of NMP-9, which can improve the IUA of the rats.

Effect of metformin on TGF-β1-induced fibrosis in human endometrial stromal cells / 解放军医学杂志

[Abstract] Objective To explore the effect of metformin on the fibrosis of human endometrial stromal cells (HESCs) induced by transforming growth factor-β1 (TGF-β1). Methods The in vitro model of endometrial fibrosis was established using TGF-β1 treated HESCs, and then treated with TGF-β1 in presence or absence of metformin at different concentrations (10, 50, 200 μmol/L). There set 5 experimental groups: normal control group, model group, 10 μmol/L metformin intervention group, 50 μmol/L metformin intervention group, and 200 μmol/L metformin intervention group. The mRNA and protein expression levels of α-smooth muscle actin (α-SMA), collagen type 1 alpha 1 (Col1α1) and fibronectin were detected by qPCR and Western blotting. The cell proliferation was detected by CCK-8 and EdU staining. Results The mRNA expression levels of α-SMA in the 5 groups were 1.003±0.108, 4.329±0.342, 3.383±0.342, 2.310±0.263 and 1.566±0.205; of Col1α1 were 1.002±0.299, 3.462±0.695, 2.342±0.531, 1.970±0.336 and 1.450±0.233; and of fibronectin were 1.000±0.225, 4.455±0.524, 3.164±0.317, 2.728±0.311 and 2.145±0.218; the differences between groups were statistically significant (P0.05). The OD values of the 5 groups were 0.313±0.091, 1.497±0.081, 1.095±0.059, 0.895±0.046 and 0.560±0.082, and the positive rate of EdU cells were 12.665±3.146, 47.650±4.656, 37.568±2.549, 32.050±3.652 and 26.050±3.453, showing statistically significant differences between the groups (P<0.001). Compared with normal control group, the proliferation capacity of model group increased significantly (P<0.01). Compared with model group, the proliferation capacity of 10, 50 and 200 μmol/L metformin intervention group reduced significantly in a dose-dependent manner (P<0.01). Conclusion Metformin may play an anti-fibrosis effect via inhibiting TGF-β1-induced myofibroblast differentiation as well as ECM synthesis and proliferation in HESCs.

Three-dimensional power Doppler ultrasound in evaluation of endometrial receptivity in patients with intrauterine adhesions / 中国医学影像技术

Objective To explore the value of transvaginal three-dimensional power Doppler ultrasound in evaluation of endometrial receptivity in patients with intrauterine adhesions.Methods Totally 43 patients with intrauterine adhesions confirmed by hysteroscopy were enrolled in this study.According to the hysteroscopy,the patients were divided into mild adhesion group (n=17),moderate adhesion group (n=18) and severe adhesion group (n=8).All the patients were examined with transvaginal three-dimensional power Doppler ultrasonography on the day of ovulation.Endometrial thickness (ED),endometrial volume (EV),endometrial vascular index (VI),endometrial flow index (FI) and endometrial vascular flow index (VFI) were compared among three groups.Results There was significant difference in EV among three groups (P＜0.001).ED,VI and VFI were significantly different between the mild and severe adhesion groups,as well as between moderate and severe adhesion groups (all P＜0.05).Conclusion Transvaginal three-dimensional power Doppler ultrasound provides a safe and noninvasive approach to assess endometrial receptivity of patients with intrauterine adhesions.EV has good predictive value on endometrial receptivity.

In vivo tracing of human amniotic mesenchymal stem cells labeled with PKH26 in rat intrauterine adhesions model / 生物工程学报

To observe the migration of human amniotic mesenchymal stem cells (hAMSCs) labeled with PKH26 in the endometrium of rats intrauterine adhesion. hAMSCs were isolated, identified and labeled with PKH26 to detect the biological characteristics of the cells. Rat intrauterine adhesion models were established using mechanical and infective method and PKH26-labeled hAMSCs were transplanted through the tail vein. The distribution of PKH26 labeled hAMSCs in the endometrium of rats were observed with the fluorescence confocal microscope. The results showed that PKH26 stain had no significant effect on cell activity, cycle, apoptosis and so on. PKH26-labeled positive cells were mainly distributed in injured endometrium of rats. It shows that the PKH26 labeling technique is a safe and effective method for tracing the human amniotic mesenchymal stem cells in the treatment of intrauterine adhesions.

Efficacy of Foley balloon combining with uterine adhesions to prevent the recurrence of intrauterine adhesions after resection of intrauterine adhesions / 中国内镜杂志

Objective To observe the efficacy of Foley balloon combining with uterine adhesions to prevent the recurrence of intrauterine adhesions after resection of intrauterine adhesions.Methods Patients underwent resection of intrauterine adhesions were randomized into two groups. 30 patients in control group underwent the therapy of uterine adhesions to prevent the relapse intrauterine. On the other hand, the study group with 30 patients were placed Foley balloon for 5 ~ 7 days and combined with the therapy of uterine adhesions to intervention for 1 ~ 2 weeks. All patients were followed-up for 1 ~ 2 months, and the result of the intrauterine adhesion were assessed by hysteroscopy.Results The rate of the relapse in control group was 3.33%; the study group had the same result (the rate was 3.33%). There was no difference between these two groups.Conclusions The rate of recurrent intrauterine adhesions is no different between the control group of only use therapy of uterine adhesions and replacement of Foley balloon combining with therapy of uterine adhesions as intervention.

Effects of estrogen on the fibrosis process of intrauterine adhesions and the expression of forkhead box F2 / 解放军医学杂志

Objective To investigate the effect of estrogen on the fibrosis process of intrauterine adhesions and the expression of forkhead box F2 (FoxF2).Methods Primary human endometrial stromal cells (HESCs) were obtained by separation with 0.2％ collagenase Ⅰ digestion-mesh filtration-differential adherence,and identified by immunocytochemistry.HESCs affected with 10ng/ml transforming growth factor β1 (TGF-β1) for 48 hours.HESCs in model group were affected with 0,10-6,10-8,10-10 and 10-12mol/L estrogen,the expressions of smooth muscle actin alpha (α-SMA),Collagen I (COL Ⅰ) and FoxF2 were detected by quantitative PCR (qPCR) and Western blotting.Results HESCs with high purity and good activity were obtained by using 0.2％ collagenase Ⅰ digestion-mesh filtration-differential adherence separation method.Immunocytochemistry showed positive vimentin and negative cytokeratin 18 in HESCs.The results of qPCR and Western blotting showed that the mRNA and protein expression levels of α-SMA,COL Ⅰ and FoxF2 were higher in model group than in control group (P＜0.05),the model was built successfully.qPCR revealed that the mRNA expression levels ofα-SMA,COL Ⅰ and FoxF2 were significantly lower in 10-6,10-8 and 10-10mol/L estrogen groups than in model group (P＞0.05 in 10-10mol/L estrogen group,P＜0.05 in other groups),while in 10-12mol/L estradiol group,the expression levels of FoxF2 mRNA significantly decreased (P＜0.05),and of α-SMA and COL Ⅰ mRNA increased,but no significant difference were found (P＞0.05).Compared with the model group,the protein expression levels of α-SMA,COL Ⅰ and FoxF2 in 10-6,10-8 and 10 10mol/L estrogen groups decreased,but no significant difference was found (P＜0.05),while in 10-12mol/L estradiol group,the expression levels ofα-SMA protein increased (P＞0.05),and of COL Ⅰ and FoxF2 proteins decreased (P＜0.05).Conclusions The expression of FoxF2 in intrauterine adhesions is increased.Estrogen can reverse the fibrosis process of intrauterine adhesions in a certain range and inhibit the expression of FoxF2.

Efficacy of Shure Granule Combined with Estradiol Valerate in Prevention of Intrauterine Adhesions After Induced Abortion / 中国药师

Objective: To investigate the clinical efficacy and safety of Shure granule combined with estradiol valerate in the prevention of intrauterine adhesions in induced abortion.Methods: Selected 240 cases of artificial abortion were divided into observation group and control group according to the order of admission, 120 cases each.Patients in the control group were treated with estradiol valerate.The observation group was treated with Shure granules on the basis of the control group;The treatment time was 3 weeks.The time of vaginal bleeding and the amount of bleeding, menstruation, retidal and adverse drug reactions of the two groups were observed;The levels of serum fibronectin (FN), human laminin (LN) and vascular endothelial growth factor (VEGF) were compared between the two groups before and after the operation.The adhesion of the 12 cases in the two cases was compared.Results: The time of vaginal bleeding and the amount of bleeding in the observation group were significantly better than those in the control group (P＜0.05), and the normal rate of menstrual volume was higher than that of the control group (P＜0.05).The serum levels of FN, LN and VEGF in the observation group were significantly lower than those in the control group 2 weeks after the operation (P＜0.05).After 12 months, the incidence of intrauterine adhesions in the observation group was significantly lower than that in the control group (P＜0.05).There was no significant difference in the incidence of adverse drug reactions between the two groups (P＞0.05).Conclusion: The efficacy of Shure granule combined with estradiol valerate in preventing intrauterine adhesions in induced abortion is superior to estradiol valerate alone.

Effects of aspirin on the endometrium of patients with severe intrauterine adhesions after electrical resection / 中国生化药物杂志

Objective To investigate the effect of aspirin on the endometrium of patients with severe intrauterine adhesions after electrical resection.Methods 130 patients with severe intrauterine adhesions after electrical resection from August 2013 to August 2015 in our hospital were selected and randomly divided into the observation group and the control group ( 65 cases in each group ); The control group were given progestogen sequential therapy, while the observation group were given aspirin for treatment on basis of the control group; All the two groups were treated for three menstrual cycles; Before and after treatment indexes including uterine endometrial thickness, ovulation of the uterine artery blood flow index artery pulsatility index in ultrasound (PI), resistance index (RI), endometrial blood flow parameters[vascular index (VI), flow index (FI) and vascular blood flow index (VFI)] were recorded and compared, as well as menstruation and uterine cavity shape 3 menstrual cycles after treatment;All the two groups were followed up for one year, and one year pregnancy rates in the two groups were recorded.Results After treatment, the total efficiency in the observation group was 92.3% significantly higher than 69.2% in the control group ( P <0.05 ) .After treatment, in the two groups endometrial thickness, PI, RI, VI, FI and VFI were significantly improved compared with before treatment (P<0.05), but the observation group improved more obviously (P<0.05).Within one years in the observation group the pregnancy rate was 57.1%higher than that in the control group 26.5%(P<0.05) .Conlcusions Application of aspirin can significantly improve the endometrial thickness on the basis of estrogen and progesterone sequential therapy , increase the endometrial blood flow and improve the pregnancy rate, which mechanism may be related to promoting endometrial repair and improving blood perfusion of the uterus.

Expression and significance of ArhGAP29 and E-cadherin in intrauterine adhesions of endometrium / 临床与实验病理学杂志

Purpose To investigate the expression and significance of ArhGAP29 and E-cadherin in endometrial tissue of intrauterine adhesions (IUAs) and to explore their roles in the pathogenesis of IUAs.Methods The expression of ArhGAP29 and E-cadherin was detected by immunohistochemical PV 9000 two-step method.The correlation between ArhGAP29 and E-cadherin expression and clinical features was analyzed.Results (1) The immunoreactive score (IRS) of ArhGAP29 and E-cadherin in normal endometrial tissue were higher than those in IUAs endometrial tissue (P =0.017,P =0.004).(2) IRS of ArhGAP 29 and E-cadherin in moderate IUAs patients were higher than that in severe IUAs patients (P =0.020,P =0.026).In IUAs patients without amenorrhea,the IRS of ArhGAP29 and Ecadherin were higher (P =0.019,P =0.031) than that in IUAs patients with amenorrhea.(3) The decrease of ArhGAP29 expression had a significantly parallel relationship with the negative expression of E-cadherin (r =0.725,P ＜ 0.001).Conclusion The expression of ArhGAP29 and E-cadherin decreases in endometrial tissue of IUAs patients,which is related with degree of IUAs severity.ArhGAP29 and E-cadherin may participate in the IUAs formation.