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Objective To investigate the clinical factors affecting live birth rate in patients who underwent hysteroscopic adhesiolysis and subsequent embryo transfer.Methods A total of 643 patients who had undergone hysteroscopic surgery to remove various degrees of intrauterine adhesion(IUA)and subsequently received embryo transfer between January 2018 and December 2020 were retrospectively analyzed.Postoperative treatment regimens and pregnancy outcomes after embryo transfer were collected.The primary endpoint was live birth rate.A multivariate logistic regression analysis was performed to further investigate the factors affecting pregnancy outcomes.Results Among the 643 IUA patients,20.5%(132/643)patients were diagnosed as having mild IUA,63.6%(409/643)patients moderate IUA,and15.9%(102/643)patients severe IUA.The median time from hysteroscopy to the first cycle of embryo transfer was 126(73,225)d.The clinical pregnancy rate was 32.7%(210/643)and the live birth rate was 24.7%(159/643).Logistic regression analysis found that age(OR =0.926,95%CI:0.880-0.974,P =0.003)and endometrial thickness on the day of transplantation(OR =1.188,95%CI:1.030-1.370,P =0.018)were prognostic factors of live birth.The live birth rate significantly decreased with age in the mild and moderate adhesion groups(P =0.004 and 0.018),while in the severe adhesion group,the live birth rate decreased with age,but the difference was not significant(P =0.526).Postoperative estrogen dosage,number of artificial cycles,interval between hysteroscopy and transplantation,fresh or frozen-thawed embryo transfer,and type of embryo transferred had no significant impact on live birth.Conclusions Maternal age and endometrial thickness on the day of transplantation are the most important predictors of live birth in patients undergoing embryo transfer after hysteroscopic adhesiolysis.Fresh or frozen-thawed embryo transfer after surgery and the interval between hysteroscopy and transplantation do not affect the live birth rate.
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Objective To compare the efficacy of three different methods in the prevention of adhesion after the HEOS system for different degrees of intrauterine adhesions.Methods 284 patients with mild,moderate and severe intrauterine adhesions,who were treated with the HEOS system,were divided into three groups,the intrauterine device with sodium hyaluronate gel was placed in Group A,Foley water capsule tube with sodium hyaluronate gel was placed in Group B,and sodium hyaluronate gel was placed in Group C only.The recovery of uterine adhesion,improvement of menstruation,endometrial thickness,and adverse reactions were compared among the three groups.Results The mild intrauterine adhesions group showed statistical differences among the three groups(P<0.05).Group A had a higher menstrual improvement rate than Group C(P<0.017),and there was no significant difference in other therapeutic indicators(P>0.017).However,the adverse reaction rate in Group A was also higher than that in Group C(P<0.017).In the moderate intrauterine group,there was a significant difference in the improvement rate of intrauterine adhesions between Group B and the other two groups(P<0.017).Group A and B were higher than Group C in terms of menstrual status,endometrial thickness,and adverse reactions(P<0.017).In severe intrauterine adhesions,Group A had higher efficacy indicators than other groups(P<0.017).Conclusions The curative effect index and adverse reaction rate were analyzed,after operation.For the light,moderate,and severe intrauterine adhesions,sodium hyaluronate gel,Foley water capsule tube with sodium hyaluronate gel,and intrauterine device with sodium hyaluronate gel were the best choice for adhesion.Individual and hierarchical management can achieve good clinical effects,which is worth popularizing.
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BACKGROUND:The key to preventing the recurrence of intrauterine adhesions is to reconstruct the endometrium with normal function.The latest breakthrough in the treatment of recurrent intrauterine adhesions in and outside China is the use of degradable materials to prepare hydrogels to prevent the recurrence of adhesions. OBJECTIVE:To review the research advance in hydrogel-promoted endometrial repair in intrauterine adhesions. METHODS:PubMed,Web of Science,China National Knowledge Infrastructure(CNKI),and WanFang databases were searched systematically,with the keywords"intrauterine adhesions,endometrial injury,endometrium regeneration,hydrogel"in Chinese and English.Relevant articles published in each database from January 1990 to March 2023 were collected. RESULTS AND CONCLUSION:In recent years,research on hydrogel-promoted endometrial repair in uterine adhesions in and outside China has made some progress and plays an important role in the prevention and treatment of intrauterine adhesions and the promotion of endometrial repair:(1)As an important carrier in tissue engineering,hydrogel itself has excellent biocompatibility,biodegradability and three-dimensional network structure,which can be better applied in the treatment of intrauterine adhesions.(2)The hydrogel-based carrier system can promote the proliferation and differentiation of endometrial epithelial cells by transporting drugs/biologics/stem cells,and restore normal uterine morphology to prevent adhesion recurrence.(3)Hyaluronic acid hydrogels can not only meet good biocompatibility,but also promote the proliferation and differentiation of endometrial epithelial cells,and will be hydrolyzed by corresponding enzymes in utero,without affecting the normal metabolism of the body.They are currently commonly used uterine anti-adhesion agents in the clinic and are also the most commonly used hydrogel carriers in tissue engineering research.(4)Poloxamer hydrogel with excellent temperature-sensitive properties can rapidly gelate into the body,quickly form a physical barrier,and can play a slow-release effect on carrying substances and provide a platform for cell growth/adhesion.(5)There are broad prospects for the preparation of therapeutic hydrogels using materials with different characteristics,such as temperature-sensitive hydrogels,pH-responsive hydrogels and photosensitive hydrogels,but there are still many problems to be solved,such as the safety of the hydrogel system,whether the degradation products cause immune reactions,and whether they have an impact on the normal body's menstrual period.A large number of animal experiments and clinical trials are needed to verify its safety and efficacy,and continuously improve the treatment strategy.
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[Objective]To explore the application and effect of traditional Chinese medicine(TCM)clinical decision-making system in the treatment of moderate or severe intrauterine adhesion(IUA).[Methods]A prospective randomized controlled trial was conducted.Patients with moderate or severe IUA who underwent hysteroscopic uterine adhesiolysis in a tertiary hospital of TCM in Hangzhou from January 2022 to December 2022 were selected.The patients were divided into control group(51 cases),decision system group(53 cases)and clinician group(54 cases)according to whether they were treated by TCM dominant disease clinical decision-making system.The improvement of menstrual volume,American Fertility Society(AFS)score,endometrial thickness,endometrial blood flow parameters and the efficacy of TCM accompanying symptoms were compared among the three groups before and after treatment.[Results]Compared with control group,the menstrual volume of decision system group and clinician group were significantly improved(P＜0.05),but there was no significant difference between decision system group and clinician group(P＞0.05).Compared with control group,the AFS scores of uterine cavity in decision system group and clinician group were significantly decreased(P＜0.01),and there was no significant difference between decision system group and clinician group(P＞0.05).The endometrial thickness was significantly increased and the endometrial blood flow parameters were significantly decreased in the three groups after treatment,and the differences were statistically significant(P＜0.01),but there was no significant difference among the three groups before and after treatment(P＞0.05).Compared with control group and decision system group,the clinical physician group had significantly improved efficacy of TCM accompanying symptoms(P＜0.05),and there was no significant difference between control group and decision system group(P＞0.05).[Conclusion]TCM clinical decision system for IUA can significantly improve the menstrual volume of patients with moderate or severe IUA,reduce postoperative AFS score and prevent the recurrence of adhesion.
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ObjectiveTo observe the effectivenss and safety of Yiqi Huoxue Formula （益气活血方） combined with surgery and sequential therapy of estrogen and progesterone for the treatment of intrauterine adhesion with syndrome of qi deficiency and blood stasis. MethodsSixty-four patients with intrauterine adhesions were recruited in Guang'anmen Hospital， China Academy of Chinese Medical Sciences during 1st June 2021 to 31st December 2022， and they were randomly divided into two groups， with 32 patients in each group， all receiving transcervical resection of adhesions （TCRA）. The control group was treated with sequential therapy of estrogen and progesterone after surgery， taking 1 tablet orally daily， estradiol tablets for the first 14 days， and estradiol dydrogesterone tablets for the last 14 days. In the treatment group， the postoperative treatment was combined with Yiqi Huoxue Formula on the basis of the treatment in the control group， and 1 dose was taken daily. The treatment course of both groups was 3 months. We observed the clinical effectiveness， syndrome scores of traditional Chinese Medicine （TCM）， endometrial thickness， uterine adhesion score， menstrual flow points， and the re-adhesion rate and pregnancy rate 3 months after the end of treatment of the two groups， and conducted evaluation on safety. ResultsThe total clinical effectiveness rates of the treatment group and the control group were 90.63% and 75.00%， respectively， significantly better in the treatment group （P＜0.05）. The endometrial thickness and menstrual flow of patients in both groups increased after treatment， and the scores of uterine adhesion and TCM syndrome scores decreased significantly （P＜0.05 or P＜0.01）. After treatment， the uterine adhesion score and TCM syndrome scores of the treatment group decreased significantly compared with the control group （P＜0.05）. The 6-month postoperative pregnancy rate in the treatment group was 37.50%， higher than the 12.50% in the control group （P＜0.05）. The re-adhesion rate was 3.13% in the treatment group and 9.38% in the control group， and the difference between the two groups was not statistically significant （P＞0.05）. No adverse events occurred in both groups. ConclusionYiqi Huoxue Formula combined with surgery and sequential therapy of estrogen and progesterone for treating intrauterine adhesion patients with syndrome of qi deficiency and blood stasis can promote endometrial recovery， increase menstrual flow， improve patients' clinical symptoms， and improve pregnancy rate， showing certain clinical effectiveness and safety.
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Objective @#To explore the mechanism of mesenchymal epithelial transformation ( EMT) mediated by Wnt/β-catenin signaling pathway in the inhibition of endometrial fibrosis by endometrial mesenchymal stem cells (eMSCs) . @*Methods @#Eighteen female SD rats were randomly divided into Sham group , Model group and eMSCs group , with 6 rats in each group . Rats in Sham group merely had laparotomy without any treatment. A rat model of intrauterine adhesion (IUA) was established in the Model group and eMSCs group . In eMSCs group , the total a- mount of eMSCs cell suspension transplanted immediately after model injury was 0. 05 ml(2 ×107 cells/ml) per u- terus for treatment. Three weeks later , the uterus with unilateral injury was collected for hematoxylin-eosin (HE) staining and Masson staining. Endometrial fibrosis , EMT , Wnt/β-catenin pathway protein expression were analyzed by protein blot. @*Results @#In the Model group , the structure of the uterine cavity was destroyed and the number of glands were significantly reduced with a large number of blue collagen fibers were accumulated . However , after eM- SCs treatment, the number of endometrial glands increased, and the fibrotic area decreased significantly. Compared with Sham group , the expression levels of type I collagen and α-SMA protein in Model group increased significantly (P < 0. 05) , but decreased significantly in eMSCs group (P < 0. 05) . In the Model group , the expressions of N- cadherin , vimentin and ZEB1 increased significantly , while the expression of E-cadherin decreased . However , in eMSCs group , the changes of protein of the above molecules were completely opposite . Compared with Sham group , the expression of β-catenin and C-myc increased in Model group (P < 0. 05) . Compared with the Model group , the expressions of CyclinE , β-catenin and C-myc increased in eMSCs group ( P < 0. 05) .@*Conclusion @#eMSCs can promote endometrial repair in IUA rats by inhibiting EMT and endometrial fibrosis , which is partly achieved by ac- tivating Wnt/β-catenin signaling pathway.
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Background Endometrial fibrosis, a significant characteristic of intrauterine adhesion (IUA), is caused by the excessive differentiation and activation of endometrial stromal cells (ESCs). Glutaminolysis is the metabolic process of glutamine (Gln), which has been implicated in multiple types of organ fibrosis. So far, little is known about whether glutaminolysis plays a role in endometrial fibrosis. Methods The activation model of ESCs was constructed by TGF-β1, followed by RNA-sequencing analysis. Changes in glutaminase1 (GLS1) expression at RNA and protein levels in activated ESCs were verified experimentally. Human IUA samples were collected to verify GLS1 expression in endometrial fibrosis. GLS1 inhibitor and glutamine deprivation were applied to ESCs models to investigate the biological functions and mechanisms of glutaminolysis in ESCs activation. The IUA mice model was established to explore the effect of glutaminolysis inhibition on endometrial fibrosis. Results We found that GLS1 expression was significantly increased in activated ESCs models and fibrotic endometrium. Glutaminolysis inhibition by GLS1 inhibitor bis-2-(5-phenylacetamido-1,2,4-thiadiazol-2-yl) ethyl sulfide (BPTES or glutamine deprivation treatment suppressed the expression of two fibrotic markers, α-SMA and collagen I, as well as the mitochondrial function and mTORC1 signaling in ESCs. Furthermore, inhibition of the mTORC1 signaling pathway by rapamycin suppressed ESCs activation. In IUA mice models, BPTES treatment significantly ameliorated endometrial fibrosis and improved pregnancy outcomes. Conclusion Glutaminolysis and glutaminolysis-associated mTOR signaling play a role in the activation of ESCs and the pathogenesis of endometrial fibrosis through regulating mitochondrial function. Glutaminolysis inhibition suppresses the activation of ESCs, which might be a novel therapeutic strategy for IUA.
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Objective:To explore the similarities and differences of China Society of Gynecology Endoscopy (CSGE) and American Fertility Society (AFS) intrauterine adhesion (IUA) scoring criteria on IUA grading and their predictive value of reproductive prognosis.Methods:From January 2016 to January 2019, a total of 1 249 patients were diagnosed with IUA by hysteroscopy at Beijing Obstetrics and Gynecology Hospital. Totally, 378 patients with complete clinical data were enrolled, and the results diagnosed by CSGT and AFS scoring criteria were compared and analyzed.And follow-up for 2 years, the pregnancy rate and live birth rate were statistical analysis.Results:(1) The grade of IUA according to AFS and CSGE scoring criteria was less consistent ( κ=0.295, P<0.001). Compared with AFS, the proportion of severe IUA cases diagnosed by CSGE was significantly lower [45.8% (173/378) vs 15.1% (57/378); RR=0.22, 95% CI: 0.15-0.30, P<0.01); the proportions of both mild and moderate IUA cases were significantly higher ( RR=4.16, 95% CI: 2.38-7.14; RR=2.38, 95% CI: 1.75-3.23; both P<0.01). (2) The pregnancy rates of mild, moderate and severe IUA diagnosed according to CSGE were 11/13, 64.5% (147/228), 31.8% (7/22), live birth rates were 11/13, 54.8% (125/228) and 22.7% (5/22), respectively; there were statistically significant differences between the groups (all P<0.01). The pregnancy rates of mild, moderate and severe IUA diagnosed based on AFS were 3/3, 66.9% (97/145) and 56.5% (65/115), respectively, with no statistically significant difference between the groups ( P>0.05). (3) IUA grades based on both CSGE and AFS criteria were significantly negatively correlated with pregnancy rates and live birth rates (CSGE: r=-0.210, r=-0.226; AFS: r=-0.130, r=-0.147; all P<0.05). Univariate logistic regression analysis showed that CSGE had higher OR for both pregnancy rates and live birth rates compared to AFS (3.889 vs 1.657, 3.983 vs 1.554, respectrvely). Conclusions:Compared with AFS, the IUA grade based on CSGE is better related with reproductive prognosis, suggesting that the CSGE standard might be more objective and comprehensive and has better predictive value for reproductive prognosis, thus avoiding overdiagnosis and overtreatment.
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Objective:Uterine adhesion is mainly caused by endometrial injury,leading to poor postoperative pregnancy outcome.Therefore,preoperative evaluation on uterine cavity,especially endometrial condition,is very necessary.This study aims to explore the correlation between preoperative three-dimensional transvaginal ultrasound(3D-TVS)imaging characteristics and postoperative pregnancy outcomes after hysteroscopic adhesiolysis(HA). Methods:A total of 401 patients,who underwent HA surgery from February 22,2018 to October 31,2018 at the Third Xiangya Hospital of Central South University or Changsha Jiangwan Hospital,were enrolled,and we collected data regarding the preoperative 3D-TVS imaging characteristics and followed up their postoperative pregnancy outcomes.Correlation analysis and univariate and multivariate logistic regression analysis were performed between imaging features and pregnancy outcomes(live and non-live birth outcomes)in patients with intrauterine adhesion. Results:The results of correlation analysis showed that endometrial thickness,endometrial echo,visible tubal openings,endometrial blood flow,intercornual distance,and endometrial peristalsis were correlated with the live birth rate(all P<0.05).Logistic regression analysis revealed that in the HA patients with the live birth,the endometrial thickness was thicker(P<0.001),endometrial echo was more homogeneous(P<0.001),the number of tubal openings was more(P<0.001),the intercornual distance was wider(P<0.05),the endometrial blood flow,and irregular cases of endometrial peristaltic waves were more and cases of deficiency were fewer(both P<0.01)than those in the non-live birth group. Conclusion:Preoperative 3D-TVS imaging performance is closely related to pregnancy outcomes of HA patients,and preoperative 3D-TVS can be used to predict pregnancy outcomes after HA.
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ObjectiveTo investigate the pharmacological effect and metabolic mechanism of Linderae Radix on the intrauterine adhesion （IUA） rat model. MethodAn IUA rat model was induced by mechanical injury and infection. Molecular biology and pharmacology techniques were employed to evaluate the inhibitory effect of Linderae Radix extract （LAE） on fibrosis in IUA. Serum metabolomics analysis based on gas chromatography-mass spectrometry （GC-MS） was conducted to explore the metabolic regulation mechanism of LAE. ResultAnimal experiments showed that LAE significantly improved the morphology and structural damage of uterine tissue cells in the IUA rat model， promoted endometrial proliferation， vascular regeneration， and morphological recovery， inhibited the mRNA expression of transforming growth factor-β1 （TGF-β1）， Smad2， and Smad3， and increased the expression of Smad7 mRNA to suppress fibrosis. Additionally， LAE significantly suppressed the levels of estrogen （E2）， follicle-stimulating hormone （FSH）， luteinizing hormone （LH）， and tumor necrosis factor-α （TNF-α） expression （P<0.01）， thereby improving the uterine microenvironment. Metabolomics analysis revealed significant metabolic abnormalities in the serum of IUA rats compared with the results in the normal group， and nine differential metabolites were identified. LAE effectively ameliorated these metabolic abnormalities， primarily by influencing six differential metabolites， including five shared metabolites among the nine identified markers： L-aspartic acid， L-pyroglutamic acid， L-serine， glucose， and L-norvaline. Pathway enrichment analysis indicated that the aminoacyl-tRNA biosynthesis pathway was the main affecting mechanism. ConclusionIn combination with the pharmacological research results， LAE effectively improved uterine damage and inhibited fibrosis in the IUA rat model. Its mechanism may involve the inhibition of the aminoacyl-tRNA biosynthesis pathway and the improvement of the microenvironment.
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Although estrogen has crucial functions for endometrium growth, the specific dose and underlying molecular mechanism in intrauterine adhesion (IUA) remain unclear. In this study, we aimed to investigate the effects of estrogen on epithelial-mesenchymal transition (EMT) in normal and fibrotic endometrium, and the role of estrogen and Wnt/β-catenin signaling in the formation of endometrial fibrosis. CCK-8 and immunofluorescence assay were performed to access the proliferation of different concentrations of estrogen on normal human endometrial epithelial cells (hEECs). qRT-PCR and western blot assay were utilized to explore the effect of estrogen on EMT in normal and fibrotic endometrium, and main components of Wnt/β-catenin signaling pathway in vitro. Hematoxylin and eosin and Masson staining were used to evaluate the effect of estrogen on endometrial morphology and fibrosis in vivo. Our results indicated that the proliferation of normal hEECs was inhibited by estrogen at a concentration of 30 nM accompanied by upregulation of mesenchymal markers and downregulation of epithelial markers. Interestingly, in the model of transforming growth factor β1 (TGF-β1)-induced endometrial fibrosis, the same concentration of estrogen inhibited the process of EMT, which might be partially mediated by regulation of the Wnt/β-catenin pathway. In addition, relatively high doses of estrogen efficiently increased the number of endometrial glands and reduced the area of fibrosis as determined by the reduction of EMT in IUA animal models. Taken together, our results demonstrated that an appropriate concentration of estrogen may prevent the occurrence and development of IUA by inhibiting the TGF-β1-induced EMT and activating the Wnt/β-catenin pathway.
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Humans , Animals , Female , Uterine Diseases , Transforming Growth Factor beta1 , Epithelial-Mesenchymal Transition , Estrogens , Wnt Signaling PathwayABSTRACT
Objective: To observe the effect of thermosensitive hydroxybutyl chitosan (HBC) hydrogel in the prevention of intrauterine adhesion in New Zealand white rabbits. Methods: Eighteen female New Zealand rabbits were randomly divided into 3 groups, i. e., normal control group, model group and HBC group. Normal control group underwent sham operation. The models of intrauterine adhesion were constructed by both mechanical damage and infection in model group and HBC group. In HBC group, 2 mL 1.5% thermosensitive HBC hydrogel was injected into the uterine cavity immediately after injury. Two rabbits were killed in each group 1 week, 2 weeks and 4 weeks after operation, respectively. The bilateral uterine tissues were collected. The endometrial morphology and quantity of glands were observed by hematoxylin-eosin staining. The area of fibrosis in endometrium was measured by Masson staining. Results: One week after operation, compared with normal control group, the columnar epithelial cells of endometrium gradually disappeared and the ratio of endometrial fibrosis area increased significantly in the other two groups. The number of glands also decreased. After 2 weeks, intrauterine adhesion was observed in model group, and the ratio of endometrial fibrosis area continued increasing, and the number of glands decreased further. However, in HBC group, there was no residual hydrogel in the uterine cavity, and the ratio of endometrial fibrosis area decreased and the number of glands increased. After 4 weeks, there was a recovery of columnar epithelium cells, the ratio of endometrial fibrosis area, and the number of glands in HBC group, which returned to the normal level. Conclusion: Thermosensitive HBC hydrogel can effectively prevent intrauterine adhesion in New Zealand white rabbits.
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Objective To compare the analgesic effect and adverse reactions of oxycodone versus morphine after transcervical resection of adhesions (TCRA). Methods Sixty patients undergoing hysteroscopic TCRA under general anesthesia in Dalian Municipal Woman and Children′s Medical Center were randomly assigned to the test group or control group with 30 patients in each group; the test group received oxycodone 0.1 mg/kg (Q group), and the control group received morphine 0.1 mg/kg (M group). Both group was followed by propofol 2—3 mg/kg, as well as laryngeal mask airway (LMA) insertion after loss of consciousness to maintain ventilation. Propofol 6—10 mg/kg/h and remifentanil 0.1—0.2 μg/kg min were administered intraoperatively to maintain anesthesia. The visual analogue scale (VAS) score, sedation score and number of rescue medications were recorded immediately and 1 h, 2 h after the patient was sent to postoperative recovery room. The incidences of body movement, nausea and vomiting and pruritus after LMA insertion were recorded. Results There were no statistically significant differences between the two groups in VAS score, sedation score ,nausea and vomiting, itchy skin or the number of rescue medications at any post-recovery time point (P > 0.05); the incidence of body movements during LMA insertion was lower in M group: 13.3%(4/30) vs 36.7%(11/30), with statistically significant difference (P < 0.05). Conclusions Oxycodone could provide favorable postoperative analgesia for patients with intrauterine adhesion, with low incidence of adverse reactions.
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Objective To build a rat model of intrauterine adhesion (IUA) by whole layer removal of endometrium in order to provide a suitable animal model for the treatment and experimental study of endometrial lesions and IUA.Methods According to different scopes of endometrial excision,105 female SD rats were divided into group A (2.5 cm × 0.5 cm),group B (2.5 cm × 0.25 cm) and group C (sham operation group) with 35 rats in each group.Uterine tissues of rats were collected 3,7,15 and 30 days after surgery.The ratio of uterine cavity narrow and congestion was recorded,the number of glands in the endometrium and the ratio of endometrial fibrosis area was counted,microvascular density (MVD) was measured,and pregnancy rate of rats in each group were observed to compare the two excision methods.Results The ratio of fibrosis area in group A and group B (0.892 ± 0.068,0.562 ± 0.027) were higher than that in group C (0.374 ± 0.074).Uterus patency scores in group A and group B (1.87 ± 0.16,1.20 ± 0.17) were both significantly higher than that in group C (0.68 ±0.098).The differences were statistically significant (P ＜ 0.001).The numbers of glands in the endometrium 30 days after surgery in group A,B and C were 7.35 ± 2.19,14.5 ± 2.43 and 15.56 ± 2.63,respectively,significantly less in group A than that in group B and C (both P＜0.001),while there was no statistical difference between group B and C (P =0.054).The MVD in group A,B and C were 16.06 ± 2.11,24.6 ± 2.34 and 26.37 ± 5.09,respectively,significantly less in group A than that in group B and C (both P＜0.001),while there was no statistical differences between group B and C (P=0.303).The rates of pregnancy in group A,B and C were 20％,33.3％ and 100％,respectively,obviously lower in group A than that in group B and C (P＜0.05).Conclusions The method of whole layer removal of endometriun had a high success rate in establishing a stable and effective rat model of IUA.
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The pathogenesis and therapeutic treatment of intrauterine adhesions (IUAs) remain unsolved, highlighting the need for stable and effective experimental animal models. In this study, uterine electrocoagulation of twenty-one female New Zealand White rabbits was carried out to establish an IUA model. As rabbits have two completely separate uterine horns, each rabbit had its own internal control: one uterine horn was given an electrothermal injury (Group A, n=21), and the contralateral uterine horn received no treatment and served as the control (Group B, n=21). The endometrial morphology, number of endometrial glands, area of endometrial fibrosis, and number of implanted fetuses were compared between the two groups. In Group A, the numbers of endometrial glands on Days 7 and 14 and the number of implanted fetuses were significantly lower than those in Group B (P<0.05, P<0.05, and P<0.01, respectively), while the ratio of the area with endometrial stromal fibrosis to the total endometrial area was significantly increased (P<0.01). These results suggest that this method of electrothermal injury is effective for the establishment of a rabbit IUA model between 7 and 14 d after surgery.
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Animals , Female , Pregnancy , Rabbits , Disease Models, Animal , Electrocoagulation , Endometrium , Pathology , Tissue Adhesions , Pathology , Therapeutics , Uterine DiseasesABSTRACT
To explore the possibility of periodic treatment of high dose asteroidal valerate (E2V) after hysteroscopy surgery on serious intrauterine adhesion. Methods The post-operative effects of periodic high-dose E2V treatment was compared with retrospective analysis on 62 cases of serious intrauterine adhesion and their clinical files. The cases were divided to 3 groups: immediate high-dose periodic treatment of E2V after hysteroscopy electric resection + contraceptive ring fitting (experiment group I), low-dose periodic treatment of E2V (experiment group II), and Irregular use of hormone treatment (control group). Results The effective rate of menstruation recovery of experiment group I and that of experiment group II are higher than control group (P＜0. 05);experiment group I is higher than experiment group II (P＜0. 05). The effective rate of Intrauterine recovery of experiment group I is higher than experiment group II and control group(P＜0. 05); the curative effect of experiment group I is higher than experiment group II (P＜0. 05). The endometrium of experiment group I is thicker than experiment group II and control group (P＜0. 05). Conclusion The use of high dose asteroidal valerate after hysteroscopy surgery on serious intrauterine adhesion, which improves the treatment effectively, is reliable and safe.
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Despite the sharply development of reproductive science,the treatment for infertility has arrived at its bottle neck. Being a common cause of preganancy failure,intrauterine adhension(IUA)is getting widespread attention.A new treatment for IUA has brought into being when the stem cell theory of endometrial regeneration was presented.This paper summarizes the research progress of both treatment and etiology of IUA.
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Objective To compare Masson staining,van Gieson staining,and Sirius red staining for evaluation of an intrauterine adhesion(IUA)model in rats. Methods In total,24 female adult Sprague-Dawley rats were selected and bilateral uteri exposed. To establish an IUA rat model, the left uterus was cut and the endometrium scraped using a scalpel. The right uterus was used as a control. Fourteen days after surgery, all uteri were collected for histological evaluation of IUA by hematoxylin and eosin(HE)staining,Masson staining,van Gieson staining,and Sirius red staining. Results HE staining showed that the endometrial epithelial layer of the uterus was absent, with a smaller number of endometrial glands than the control uterus(P < 0.01). Collagen fibers were clearly visible using all special staining method. The fibrotic area rate of uteri by Masson staining(using toluidine blue)was higher than Masson staining(using light green),van Gieson staining,and Sirius red staining(P< 0.01). Under polarized light,type I and type III collagen fibers were clearly distinguished by Sirius red staining,but not using Masson and van Gieson staining. Conclusions Sirius red staining is a superior method than Masson and van Gieson staining for evaluation of fibrosis in IUA and can also differentiate collagen fiber types.
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OBJECTIVE:To study the clinical effects of curettage under hysteroscopy combined with estrogen and progesterone in preventing intrauterine adhesion after missed abortion.METHODS:A total of 120 patients receiving missed abortion selected from gynecology department of our hospital during Jun.2014-Jun.2016 were randomly divided into observation group (60 cases) and control group (60 cases) according to seguential coding.Observation group was given estradiol valerate 3 mg,qd,for 5 d in total,received curettage under hysteroscope,and was given Estradiol valerate tablet/Estmdiol valerate cyproterone tablet one tablet,qd after surgery,for 21 d.Control group received routine curettage and didn't take estrogen and progesterone during the perioperative period.The time of vaginal bleeding,endometrial thickness 14 d after surgery,the amout of vaginal bleeding with in 3 months after surgery,intrauterine adhesion,the occurrence of ADR were observed in 2 groups.RESULTS:In observation group,57 cases completed the study except that 2 cases withdrew from the study due to the amount of vaginal bleeding as much as menstrual volume and 1 case withdrew from the study due to pregnancy tissue self-discharge.The duration of postoperative vaginal bleeding was (3.2 ±1.1) d in observation group and (5.4 ± 1.9) d in control group.The endometrial thickness of observation group was (8.04 ± 1.52)mm and that of control group was (5.27 ± 2.36) mm;the incidence of intrauterine adhesion was 3.5％ in observation group (2/57)and 15％ in control group (9/60).Above indexes of observation group were better than those of control group (P＜0.05).CONCLUSIONS:Curettage under hysteroscope combined with estrogen and progesterone helps to reduce post-curettage vaginal bleeding,promote endometrial repair and prevent intrauterine adhesion so as to protect women's reproductive ability.
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[Objective]Sum up the academic thought and clinical experience of Professor CHEN Xia syndrome differentiation of intrauterine adhesion [Methods]By learning from CHEN Xia and studying the medical record of intrauterine adhesion, sum up the clinical experience of Professor CHEN Xia from etiology and pathogenesis, therapeutic methods, administered medical herbs and prescription ,and features of the clinical treatment. [Results]For intrauterine adhesions caused by artificial abortions, Professor CHEN considered that this disease took deficiency of kidney as original cause and blood stasis as the superficial cause.And in accordance with the pathogenesis,Professor Chen pointed out that the basic big law of treatment was tonifying kidney to nourish the endometrium and removing blood stasis to anti-inflammatory reaction,and developed a prescription named"Bushen Huayu formula".What's more, Professor CHEN is deft at staging treatment and tonifying kidney and regulating menstrual cycle. In the menstrual period, Professor CHEN emphasizes the points that it is better to clear heat and activate blood; In the non-menstrual period, she attaches importance to tonify kidney. Meanwhile, Professor CHEN proposes to integrate Chinese and western medicine therapy and combine with psychotherapy. [Conclusion]Professor CHEN 's rich experience in clinical medicine is worth clinical promotion.