Hysterosalpingo-Contrast Sonography With a Saline-Air Device Is Equivalent to Hysterosalpingography Only in the Presence of Tubal Patency

OBJECTIVES

To compare hysterosalpingo-contrast sonography with a saline-air device to hysterosalpingography for evaluating tubal patency.

METHODS

Eighty women undergoing infertility evaluations were recruited for this prospective cohort study. All patients underwent both office-based hysterosalpingo-contrast sonography with a saline-air device and hysterosalpingography as the reference standard, and the fallopian tubes were individually assessed for tubal patency in each procedure. The Cohen κ coefficient was used to assess agreement between each procedure, and the Student t test and χ(2) test were used to compare differences in time, pain, and procedural preference.

RESULTS

In total, 75 patients with 148 fallopian tubes were evaluated. Tubal patency on hysterosalpingo-contrast sonography with the saline-air device was noted in 85.8% (n = 127) of tubes compared to 92.5% (n = 137) on hysterosalpingography, with a positive predictive value of 95.2%. Tubal occlusion was noted in 21 tubes (14.2%) on hysterosalpingo-contrast sonography compared to 11 (7.4%) on hysterosalpingography, with a negative predictive value of 23.8% (24 of 28). Overall, hysterosalpingo-contrast sonography agreed with hysterosalpingography in 126 of 148 fallopian tubes (85.1%; κ = 0.47; P < .001). The procedural time and pain scores were significantly greater for hysterosalpingo-contrast sonography compared to hysterosalpingography.

CONCLUSIONS

There was a significant degree of agreement between hysterosalpingo-contrast sonography with a saline-air device and hysterosalpingography when the fallopian tube was patent but not when it was occluded. In the absence of patency, further evaluations with hysterosalpingography may be indicated to avoid false-positive results. Although the procedure time and degree of pain appear to be greater, avoidance of radiation exposure by using hysterosalpingo-contrast sonography with a saline-air device may outweigh the drawbacks.

Overexpression of cyclin D3 improves decidualization defects in Hoxa-10(-/-) mice

Uterine decidualization, a crucial process for implantation, is a tightly regulated process encompassing proliferation, differentiation, and polyploidization of uterine stromal cells. Hoxa (Homeobox A)-10, a homeobox transcription factor, is highly expressed in decidualizing stromal cells. Targeted gene deletion experiments have demonstrated marked infertility resulting from severely compromised decidualization in Hoxa-10(-/-) mice. However, the underlying mechanism by which Hoxa-10 regulates stromal cell differentiation remains poorly understood. Cyclin D3, a G(1) phase cell-cycle regulatory protein involved in stromal cell proliferation and decidualization, is significantly reduced in Hoxa-10(-/-) mice. The expression of cyclin D3 in the pregnant mouse uterus parallels stromal cell decidualization. Here, we show that adenovirus-driven cyclin D3 replacement in Hoxa-10(-/-) mice improves stromal cell decidualization. To address our question of whether cyclin D3 replacement in Hoxa-10(-/-) mice can improve decidualization, both in vitro and in vivo studies were completed after the addition of cyclin D3 or empty (control) viral vectors. Immunostaining demonstrated increased proliferation and decidualization in both in vitro and in vivo studies, and in situ hybridization confirmed increased expression of decidualization markers in vivo. Placentation was demonstrated as well in vivo in the cyclin D3-replaced animals. However, fertility was not restored in Hoxa-10(-/-) mice after d 10 of pregnancy. Finally, we identified several downstream targets of cyclin D3 during decidualization in vitro via proteomics experiments, and these were confirmed using in situ hybridization in vivo. Collectively, these results demonstrate that cyclin D3 expression influences a host of genes involved in decidualization and can improve decidualization in Hoxa-10(-/-) mice.

Developmental regulation of decidual cell polyploidy at the site of implantation

Polyploidy has been reported in several animal cells, as well as within humans; however the mechanism of developmental regulation of this process remains poorly understood. Polyploidy occurs in normal biologic processes as well as in pathologic states. Decidual polyploid cells are terminally differentiated cells with a critical role in continued uterine development during embryo implantation and growth. Here we review the mechanisms involved in polyploidy cell formation in normal developmental processes, with focus on known regulatory aspects in decidual cells.

Decidual cell polyploidization necessitates mitochondrial activity

Cellular polyploidy has been widely reported in nature, yet its developmental mechanism and function remain poorly understood. In the present study, to better define the aspects of decidual cell polyploidy, we isolated pure polyploid and non-polyploid decidual cell populations from the in vivo decidual bed. Three independent RNA pools prepared for each population were then subjected to the Affymetrix gene chip analysis for the whole mouse genome transcripts. Our data revealed up-regulation of 1015 genes and down-regulation of 1207 genes in the polyploid populations, as compared to the non-polyploid group. Comparative RT-PCR and in situ hybridization results indeed confirmed differential expressional regulation of several genes between the two populations. Based on functional enrichment analyses, up-regulated polyploidy genes appeared to implicate several functions, which primarily include cell/nuclear division, ATP binding, metabolic process, and mitochondrial activity, whereas that of down-regulated genes primarily included apoptosis and immune processes. Further analyses of genes that are related to mitochondria and bi-nucleation showed differential and regional expression within the decidual bed, consistent with the pattern of polyploidy. Consistently, studies revealed a marked induction of mitochondrial mass and ATP production in polyploid cells. The inhibition of mitochondrial activity by various pharmacological inhibitors, as well as by gene-specific targeting using siRNA-mediated technology showed a dramatic attenuation of polyploidy and bi-nucleation development during in vitro stromal cell decidualization, suggesting mitochondria play a major role in positive regulation of decidual cell polyploidization. Collectively, analyses of unique polyploidy markers and molecular signaling networks may be useful to further characterize functional aspects of decidual cell polyploidy at the site of implantation.

Rats and mice exhibit distinct inflammatory reactions after spinal cord injury

Spinal contusion pathology in rats and mice is distinct. Cystic cavities form at the impact site in rats while a dense connective tissue matrix occupies the injury site in mice. Because inflammatory cells coordinate mechanisms of tissue injury and repair, we evaluated whether the unique anatomical presentation in spinally injured rats and mice is associated with a species-specific inflammatory response. Immunohistochemistry was used to compare the leukocytic infiltrate between rats and mice. Microglia/macrophage reactions were similar between species; however, the onset and magnitude of lymphocyte and dendritic cell (DC) infiltration were markedly different. In rats, T-cell numbers were highest between 3 and 7 days postinjury and declined by 50% over the next 3 weeks. In mice, significant T-cell entry was not evident until 14 days postinjury, with T-cell numbers doubling between 2 and 6 weeks. Dendritic cell influx paralleled T-cell infiltration in rats but was absent in mouse spinal cord. De novo expression of major histocompatability class II molecules was increased in both species but to a greater extent in mice. Unique to mice were cells that resembled lymphocytes but did not express lymphocyte-specific markers. These cells extended from blood vessels within the fibrotic tissue matrix and expressed fibronectin, collagen I, CD11b, CD34, CD13, and CD45. This phenotype is characteristic of fibrocytes, specialized blood-borne cells involved in wound healing and immunity. Thus, species-specific neuroinflammation may contribute to the formation of distinct tissue environments at the site of spinal cord injury in mice and rats.