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Caetano IM, da Silva AL, Lamaita RM, Maia BA, Barroso EST, Candido EB. Preoperative promestriene for hysteroscopy: a randomized clinical trial. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20231559. [PMID: 39045953 PMCID: PMC11288270 DOI: 10.1590/1806-9282.20231559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 03/02/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVE Intraoperative complications of hysteroscopy, such as the creation of a false passage, cervix dilatation failure, and uterine perforation, may require suspension of the procedure. Some patients refuse a new procedure, which delays the diagnosis of a possible serious uterine pathology. For this reason, it is essential to develop strategies to increase the success rate of hysteroscopy. Some authors suggest preoperative use of topical estrogen for postmenopausal patients. This strategy is common in clinical practice, but studies demonstrating its effectiveness are scarce. The aim of this study was to evaluate the effect of cervical preparation with promestriene on the incidence of complications in postmenopausal women undergoing surgical hysteroscopy. METHODS This is a double-blind clinical trial involving 37 postmenopausal patients undergoing surgical hysteroscopy. Participants used promestriene or placebo vaginally daily for 2 weeks and then twice a week for another 2 weeks until surgery. RESULTS There were 2 out of 14 (14.3%) participants with complications in the promestriene group and 4 out of 23 (17.4%) participants in the placebo group (p=0.593). The complications were difficult cervical dilation, cervical laceration, and vaginal laceration. CONCLUSION Cervical preparation with promestriene did not reduce intraoperative complications in postmenopausal patients undergoing surgical hysteroscopy.
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Affiliation(s)
- Isabela Maciel Caetano
- Universidade Federal de Minas Gerais, Hospital das Clínicas, Woman's Health Department – Belo Horizonte (MG), Brazil
| | - Agnaldo Lopes da Silva
- Universidade Federal de Minas Gerais, Department of Gynecology and Obstetrics – Belo Horizonte (MG), Brazil
| | - Rivia Mara Lamaita
- Universidade Federal de Minas Gerais, Department of Gynecology and Obstetrics – Belo Horizonte (MG), Brazil
| | | | | | - Eduardo Batista Candido
- Universidade Federal de Minas Gerais, Department of Gynecology and Obstetrics – Belo Horizonte (MG), Brazil
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Jiang M, Huang L, Wang Y, Wang Y, Kang Q, Chen C, Hu Y, Li J, Wang T. Yueliang Yin Ameliorates Endometrial Receptivity in Mice with Embryo Implantation Failure by Reducing Pyroptosis and Activating BDNF/TrkB Pathway. Mol Nutr Food Res 2023; 67:e2300339. [PMID: 37797178 DOI: 10.1002/mnfr.202300339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/16/2023] [Indexed: 10/07/2023]
Abstract
SCOPE Endometrial receptivity plays a vital role in embryonic implantation. Yueliang Yin is a marketed solid drink in China, also known as Bushen Cuyun Recipe (BCR), that is, assumed to have a therapeutic effect on infertility by improving endometrial receptivity. This study investigates the effects and mechanisms of BCR in protecting the endometrium. METHODS AND RESULTS Mice with mifepristone-induced embryo implantation failure that exhibited a decreased implantation sites number, thinner endometrium, reduced endometrial glands number, and poor pinopode expression levels are treated with BCR, and these mentioned conditions significantly improves afterward. Molecular docking shows that the main active components kaempferol, quercetin, and hesperetin of BCR stably bound to gasdermin D (GSDMD). Experimental results demonstrate that levels of GSDMD, cleaved caspase-1 and leucine-rich repeat, and pyrin domain-containing 3 and IL-1β levels in model mice are significantly decreased and expressions of brain-derived neurotrophic factor (BDNF) and tyrosine protein kinase B (TrkB) expression levels are significantly elevated after BCR treatments, and that the DNA damage is significantly reversed in BCR-treated mice. CONCLUSIONS BCR is potent and effective in ameliorating endometrial receptivity. The potential mechanisms of BCR on endometrial receptivity may mediate by activating BDNF/TrkB pathway activation and protecting endometrial cells' protection against pyroptosis.
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Affiliation(s)
- Mei Jiang
- Beijing Research Institute of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Ling Huang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Yuxi Wang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Yao Wang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, 100029, China
- National Key Laboratory of Efficacy and Mechanism on Chinese Medicine for Metabolic Diseases, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Qianjun Kang
- Beijing Research Institute of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Cong Chen
- Beijing Research Institute of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Yujie Hu
- Ziqiang Vocational School of Shaanxi Province, Shaanxi Province, 721000, China
| | - Jialin Li
- Beijing Research Institute of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Ting Wang
- Beijing Research Institute of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China
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Hota T, Abuzeid OM, Raju R, Holmes J, Hebert J, Abuzeid MI. Management of false passage complication during operative hysteroscopy. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2022. [DOI: 10.1186/s43043-022-00102-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
False passage is a possible complication during operative hysteroscopy and can lead to termination of the intended procedure. The aim of this study is to describe two techniques to overcome the complication of false passage during operative hysteroscopy.
Results
This is a retrospective case series of 9 patients who had a false passage during operative hysteroscopy for Müllerian anomaly or endometrial polyps. The diagnosis was immediately made by visualization of a lattice network of myometrial fibers without normal landmarks of the endometrial cavity and tubal ostia. Once a false passage was suspected, an attempt was made to overcome this complication and complete the intended operative hysteroscopy. The hysteroscope was slowly withdrawn to identify both the false passage and the opening towards the internal cervical os. The hysteroscope was tilted towards the opening to the internal cervical os, and it was carefully advanced under direct vision into the endometrial cavity. In two patients, this technique failed because the opening to the internal cervical os was small, so the bridge of tissue between the internal os and false passage was partially divided using hysteroscopic scissors or a straight resectoscope loop, allowing for entry into the endometrial cavity. The intended procedures were completed successfully in all patients. No intraoperative or postoperative complications occurred as a result of the two techniques.
Conclusions
The techniques described in this study, to overcome false passage during operative hysteroscopy, appear to be safe, effective, and easy to perform. They enable the surgeon to complete the intended procedure.
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Zheng Y, Zhu Y, Zhuge T, Li B, Gu C. Metabolomics Analysis Discovers Estrogen Altering Cell Proliferation via the Pentose Phosphate Pathway in Infertility Patient Endometria. Front Endocrinol (Lausanne) 2021; 12:791174. [PMID: 34867831 PMCID: PMC8636142 DOI: 10.3389/fendo.2021.791174] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 10/22/2021] [Indexed: 12/21/2022] Open
Abstract
Estrogen therapy is widely used as a supplementary treatment after hysteroscopy for female infertility patients owing to its protective function that improves endometrial regeneration and menstruation, inhibits recurrent adhesions, and improves subsequent conception rate. The endometrial protective function of such estrogen administration pre-surgery is still controversial. In the current study, 12 infertility patients were enrolled, who were treated with estrogen before hysteroscopy surgery. Using cutting-edge metabolomic analysis, we observed alterations in the pentose phosphate pathway (PPP) intermediates of the patient's endometrial tissues. Furthermore, using Ishikawa endometrial cells, we validated our clinical discovery and identified estrogen-ESR-G6PD-PPP axial function, which promotes estrogen-induced cell proliferation.
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Affiliation(s)
- Yingxin Zheng
- Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Yuemeng Zhu
- Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Ting Zhuge
- Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Bin Li
- Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- *Correspondence: Chao Gu, ; Bin Li,
| | - Chao Gu
- Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- *Correspondence: Chao Gu, ; Bin Li,
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Chang Y, Duan H, Shen X, Wang S, Guo Z, Chen S. Controversy in the management of oestrogen therapy before hysteroscopic adhesiolysis: a systematic review and meta-analysis. Reprod Biomed Online 2020; 41:715-723. [DOI: 10.1016/j.rbmo.2020.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/27/2020] [Accepted: 06/16/2020] [Indexed: 01/18/2023]
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Xiao B, Zhu Y, Huang J, Wang T, Wang F, Sun S. Exosomal transfer of bone marrow mesenchymal stem cell-derived miR-340 attenuates endometrial fibrosis. Biol Open 2019; 8:bio.039958. [PMID: 30890521 PMCID: PMC6550064 DOI: 10.1242/bio.039958] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Bone marrow mesenchymal stem cells (BMSCs) have potential therapeutic benefits for the treatment of endometrial diseases and injury. BMSCs interact with uterus parenchymal cells by direct contact or indirect secretion of growth factors to promote functional recovery. In this study, we found that BMSC treatment in rats subjected to mechanical damage (MD) significantly increased microRNA-340 (miR-340) levels in the regenerated endometrium. Then we employed knockin and knockdown technologies to upregulate or downregulate the miR-340 level in BMSCs (miR-340+ BMSCs or miR-340− BMSCs) and their corresponding exosomes, respectively, to test whether exosomes from BMSCs mediate miR-340 transfer. We found that the exosomes released from the primitive BMSCs or miR-340+ BMSCs but not miR-340− BMSCs increased the miR-340 levels in primary cultured endometrial stromal cells (ESCs) compared with control. Further verification of this exosome-mediated intercellular communication was performed using exosomal inhibitor GW4869. Tagging exosomes with red fluorescent protein demonstrated that exosomes were released from BMSCs and transferred to adjacent ESCs. Compared with controls, rats receiving primitive BMSC treatment significantly improved functional recovery and downregulated collagen 1α1, α-SMA and transforming growth factor (TGF)-β1 at day 14 after MD. The outcomes were significantly enhanced by miR-340+ BMSC treatment, and were significantly weakened by miR-340− BMSC treatment, compared with primitive BMSC treatment. In vitro studies reveal that miR-340 transferred from BMSCs suppresses the upregulated expression of fibrotic genes in ESCs induced by TGF-β1. These data suggest that the effective antifibrotic function of BMSCs is able to transfer miR-340 to ESCs by exosomes, and that enhancing the transfer of BMSC-derived miR-340 is an alternative modality in preventing intrauterine adhesion. Summary: miR-340 in the exosomes released from BMSCs are transferred to endometrial cells, which regulate gene expression, repress endometrial fibrosis and promote functional recovery in rats subjected to mechanical damage.
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Affiliation(s)
- Bang Xiao
- Department of Medical Genetics, Second Military Medical University, Shanghai 200433, China
| | - Yiqing Zhu
- Department of Medical Genetics, Second Military Medical University, Shanghai 200433, China
| | - Jinfeng Huang
- Department of Medical Genetics, Second Military Medical University, Shanghai 200433, China
| | - Tiantian Wang
- Department of Medical Genetics, Second Military Medical University, Shanghai 200433, China
| | - Fang Wang
- Department of Medical Genetics, Second Military Medical University, Shanghai 200433, China
| | - Shuhan Sun
- Department of Medical Genetics, Second Military Medical University, Shanghai 200433, China
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Chen L, Zhang H, Wang Q, Xie F, Gao S, Song Y, Dong J, Feng H, Xie K, Sui L. Reproductive Outcomes in Patients With Intrauterine Adhesions Following Hysteroscopic Adhesiolysis: Experience From the Largest Women's Hospital in China. J Minim Invasive Gynecol 2017; 24:299-304. [DOI: 10.1016/j.jmig.2016.10.018] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 10/11/2016] [Accepted: 10/14/2016] [Indexed: 12/31/2022]
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