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uterine Artery Embolization for Management of Primary Postpartum Hemorrhage Associated with Placenta Accreta

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Chinese Medical Sciences Journal 2016年第4期31卷 228-232页

作者： Zhi-wei Wang Xiao-guang Li Jie Pan Xiao-bo Zhang Hai-feng Shi Ning Yang Zheng-yu Jin Department of Radiology Peking Union Medical College HospitalChinese Academy of Medical Sciences & Peking Union Medical College

Objective To evaluate the efficacy and safety of uterine artery embolization(UAE) in the management of primary postpartum hemorrhage associated with placenta accreta. Methods We retrospectively reviewed the medical records of patients with placenta accreta between January 2010 and August 2014. Totally 18 women(mean age 30.8±4.2 years) of primary massive postpartum hemorrhage with diagnosis of placenta accrete received treatment of UAE after delivery. Images of DSA and medical records were reviewed. Technical success was defined as control of bleeding after embolization. The complications, control of hemorrhage and recurrent bleeding of the placenta left inside the uterus were retrospectively collected for assessment. Results All patients underwent transcatheter embolization of bilateral uterine arteries. The technical success rate of embolization was 100%. Bleeding was controlled in 17 of 18 patients(94%) during follow-up period(median 18 months, 3-31months) without further bleeding recurred. One patient with placenta percreta undertook an emergent hysterectomy along with surgical bladder repair after UAE because of persistent uterine bleeding. Eight patients had postembolization syndrome and no other complications occurred. Conclusion uterine artery embolization is an effective and safe treatment for the management of primary postpartum massive hemorrhage associated with placenta accreta.

关键词： uterine artery embolization postpartum hemorrhage placenta accrete

The use of contrast-enhanced ultrasound in uterine leiomyomas

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Chinese Medical Journal 2010年第21期123卷 3095-3099页

作者： ZHANG Xin-ling ZHENG Rong-qin YANG Yue-bo HUANG Dong-mei SONG Qian MAO Yong-jiang LI Yu-hua ZHENG Zhi-juan Department of Ultrasound Third Affiliated Hospital Sun Yat-sen University Guangzhou Guangdong 510630 China Department of Gynecology Third Affiliated Hospital Sun Yat-sen University Guangzhou Guangdong 510630 China

Background Ultrasound （US） is a popular method in the diagnosis and treatment of uterine leiomyomas, but the lack of accuracy greatly limits its application. Recently, microbubble enhancement technique affords direct depiction of tumor neovascularity and establishes a more precise vascular map of the tumor. This study was undertaken to describe the distribution patterns of SonoVue, a second-generation contrast agent, in the micrecirculation of uterine leiomyomas, and to investigate the potential use of contrast-enhanced ultrasound （CEUS） in the characterization and treatment of uterine leiomyomas.Methods Ninety-six patients with uterine leiomyomas were enrolled in this study. The CEUS was performed using cadence pulse sequencing technique （CPS） and SonoVue. Enhancement patterns of different lesions were observed.The diagnostic accuracy of CEUS was compared with that of conventional ultrasound.Results After contrast injection, vessels of macro- and micro-circulation of the myoma first appeared, followed by the normal myometrium and finally the endometrium. During the washout phase, the myoma exhibited homogeneous enhancement followed by apparent hypoenhancement. The margin of the tumor was depicted clearly. There was no agent perfusion in the benign degenerative or necrotic area. However in sarcomas degeneration, the feeding vessels appeared markedly earlier than those in myometrium. In addition, the tumor exhibited heterogeneous hyperenhancment with no agent perfusion in the center and no membraniform sign was observed in the late phase. In subserous andsubmucous leiomyomas, the feeding arteries in the pedicle arising from the uterine could be seen. In this study, the diagnostic accuracy of CEUS and conventional US for uterine leiomyomas was 96.7% （160/165） and 82.4% （136/165）respectively.Conclusions CEUS can provide a precise description of the leiomyomas vascularization. The specific enhancement pattern may be helpful for the characterization, treatment choice and therapeutic monitoring of leiomyomas.

关键词： ultrasound contrast leiomyomas uterine pathology

Role of uterine natural killer cells in angiogenesis of human decidua of the first-trimester pregnancy

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Science China(Life Sciences) 2008年第2期51卷 111-119页

作者： LI GuoHua1, HUANG Wei1, XIA QingJie2, YANG KaiXuan3, LIU RaoFang1, ZHU HuiLi1 & JIANG Wei4 1 Department of Reproductive Endocrinology, West China Second University Hospital, Sichuan University, Chengdu 610041, China 2 West China Research Laboratory of Molecular Genetics, Sichuan University, Chengdu 610041, China 3 Department of Pathology, West China Second University Hospital, Sichuan University, Chengdu 610041, China 4 Department of Pathology, West China Hospital, Sichuan University, Chengdu 610041, China Department of Reproductive Endocrinology West China Second University Hospital Sichuan University Chengdu China West China Research Laboratory of Molecular Genetics Sichuan University Chengdu China Department of Pathology West China Second University Hospital Sichuan University Chengdu China Department of Pathology West China Hospital Sichuan University Chengdu China

Decidualization is accompanied by extensive angiogenesis, which is an essential step in the maturation of new blood vessels in mammalian pregnancy. The purpose of this study was to determine a distribution of uNK cells (CD56+ uNK or CD56bright cells) in human decidua of the first-trimester pregnancy, and investigate whether uNK cells in human decidua could express vascular endothelial growth factor (VEGF-A) and/or angiopoietin2 (Ang2). Our immunohistochemical staining results demonstrated that a great amount of uNK (CD56+) cells scattered throughout the decidual stroma and near endometrial gland and spiral vessels in human decidua. The protein expression of VEGF-A and Ang2 was detected in decidual stroma cells, capillary endothelial cells and glandular cells in tissue specimens. There was a positive correlation between microvessel density (MVD) and the number of the CD56-positive uNK cells in decidual stroma, and also between the number of the CD56-positive uNK cells and VEGF-A protein expression in the tissue. In addition, we found that uNK cells in human decidua could express VEGF-A mRNA, but not Ang2 mRNA, in isolated uNK cells in human decidua of the first-trimester gestation by combination of LCM and Nested-PCR. Our study indicated that uNK cells, through expressing VEGF-A, may play an important role in the angiogenic response at the time of human decidualization and early placenta development.

关键词： uterine natural killer cells decidua angiogenesis VEGF Ang2

Superselective uterine arterial embolization with pingyangmycin-lipiodol emulsion for management of symptomatic uterine leiomyoma

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Chinese Medical Journal 2004年第1期117卷 75-78页

作者：单鸿黄明声关守海姜在波朱康顺李征然 Department of Radiology Third Affiliated HospitalSun Yat-sen University

Background uterine arterial embolization (UAE) is a safe and effective therapy for symptomatic uterine leiomyoma. This study was to assess the effectiveness and the feasibility of pingyangmycin-lipiodol emulsion (PLE) for the management of symptomatic uterine leiomyoma. Methods One hundred consecutive patients (aged 21-53 years,with 38 in average) with symptomatic uterine leiomyoma underwent superselective UAE with PLE. Clinical symptoms of the patients (including menorrhagia,bulk-related symptoms,and postprocedure-related abdominal pain) and the changes in uterine volume and tumor size after the embolization were analyzed. The patients were followed up for 8-21 months (mean,15 months). Results Ninety-nine patients (99%,99/100) were interviewed in their first menses circle after embolization,showing improvements in their abnormal bleeding and bulk-related symptoms to some extent. Imagiological results during follow-up showed a mean of 48% reduction in uterine volume at 6 months and a mean of 75% reduction in tumor size at 9 months. Eighty-three percent of the patients reported complete resolution of postprocedure pain within 7 days. Conclusions PLE is effective in the management of uterine leiomyoma,having superiority in alleviating postprocedure-related pain.

关键词： leiomyoma uterine pingyangmycin

Comparison on serum biomarkers for anovulatory and ovulatory dysfunctional uterine bleeding in Lizu females

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Asian Pacific Journal of Tropical Medicine 2014年第2期7卷 149-152页

作者： Shan Bao Shu-Ying Yang Zhuo-Ri Li Ge-Bo Wen Department of Endocrinology.The First Affiliated Hospital University of South China Department of Gynecology and Obstetrics.Hainan Provincial People's Hospital Department of Surgery Hainan Provincial People's Hospital

Objective:To screen,identify,and compare the serum biomarkers between anovulatory dysfunctional uterine bleeding(ADUB)and ovulatory dysfunctional uterine bleeding(ODUB)in Lizu females.Methods:The subjects included 128 ADLB patients,63 ODUB patients,and 93controls.The serum and supernate of the subjects'mense were collected and stored at-80°C until use.Differential proteins in the sera of three groups were screened using surface-enhaneed laser desorption ionization time-of-flight mass spectrometry.The screened proteins were then identified by tricine-SDS-PAGE gel and spectrometry.Protein expression levels in the menses of ADUB,ODUB,and control subjects were determined using ELISA,RT-PCR,and Western blotting.SPSS 14.1 was used for statistical analysis and chart drawing(a=0.05),Results:Three differentia)protein peaks with peak values of 11.80,13.59,and 14.68 km/z were,screened and identified as serum amyploid protein A(SAA),vascular endothelial growth factor,and vitamin K epoxide reductase,respectively.The SAA was highly expressed in the menses of ADUB and ODUB patients but poorly expressed in the controls.The vascular endothelial growth factor was highly expressed in the menses of ODUB and controls but poorly expressed in ADUB patients.Meanwhile,the vitamin K epoxide reductase was highly expressed in the menses of ADUB and control subjects but poorly expressed in ODUB patients.Conclusions:The SAA is the common serum biomarker of ADUB and ODUB.ADUB may be related to angiogenesis impairment,whereas ODUB may be associated with blood coagulation disruption.

关键词： Anovulatory dysfunctional uterine bleeding Biomarker Serum amyploid protein A Vascular endothelia growth factor Vitamin K epoxide reductase

Role of epidermal growth factor in pathogenesis of uterine leiomyomas

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Asian Pacific Journal of Tropical Medicine 2015年第5期8卷 378-381页

作者： Chun Su Mei Fan Lin Lu Pei Li Department of Gynaecology and Obstetrics The Fifth Affiliated Hospital of Zhengzhou University Department of Ultrasound The First Affiliated Hospital of Zhengzhou University Department of Ultrasound The Third Affiliated Hospital of Zhengzhou University Department of Pathophysiology Zhengzhou University

Objective:To investigate the role of epidermal growth factor(EGF) in the pathogenesis of uterine leiomyomas.Methods:Human myometrial smooth muscle cells(HM-SMCs) and smooth muscle cells of human uterine leiomyomas(HL-SMCs) were separated from patients' specimens and cultured.After processed by EGF or PD98059(inhibitor of MKK/MEK) +EGF,the proliferation rate of both SMCs was detected by BrdU method and the phosphorylation level of p44/42 mitogen-activated protein kinase(MAPK) was determined by Western-blot.After different processing time by EGF,the phosphorylation levels of p44/42 MAPK and AKT and p27 expression level in both SMCs were detected by Western-blot.Results:EGF could significantly promote HL-SMCs proliferation and PD98059 could inhibit this effect(P<0.05);besides,PD98059 could inhibit the increase of the phosphorylation level of p44/42 MAPK in both SMCs induced by EGF.When the processing time by EGF was over 15 min,the phosphorylation levels of p44/42 MAPK and AKT in both SMCs decreased sharply and were close to zero:p27 expression in HM-SMCs raised significantly while the upregulation in HL-SMCs was little.Conclusions:EGF could not cause activation of EGFR because of the dephosphorylation of p44/42 MAPK and AKT in HL-SMCs,which caused p27 expression insufficiently and cell cycle dysregulation.

关键词： HL-SMCs HM-SMCs Epidermal growth factor uterine leiomyoma

Antidiastole Value of Three-dimensional Ultrasonography and Power Doppler between uterine Parenchyma Lumps and Endometrial Cancer:A Retrospective Study

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Current Medical Science 2019年第5期39卷 816-819页

作者： Yan ZHANG Jing CHEN Zeng ZHEN Xiao-yan XU Department of Obstetrics and Gynecology Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030China

Sometimes endometrial polyps,submucosal myomas,and endometrial cancer show similar findings under ultrasonography.The aim of this study was to assess the antidiastole value of blood flow parameters using three-dimensional(3D)power Doppler ultrasonography angiography(PDA)between endometrial cancer and uterine parenchyma lumps.The data of the blood flow indices in 3D-PDA including the vascularization index(VI),flow index(FI),and vascularization flow index(VFI)in 40 patients with endometrial cancer and 41 patients with uterine parenchyma lumps(endometrial polyps and submucosal myomas)were retrospectively analysed and compared utilizing Virtual Organ Computer-aided AnaLysis(VOCAL)software.The results showed that all the blood flow parameters(VI,FI,VFI)were significantly higher in women with endometrial cancer than in those with uterine parenchyma lumps(Puterine parenchyma lumps to assist clinicians in properly diagnosing patients.

关键词： power Doppler three-dimensional ultrasound uterine parenchyma lump endometrial carcinoma blood flow signal parameter

Peripheral maternal leukocytes are activated in response to cytokines secreted by uterine tissues of pregnant women

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Cellular & Molecular Immunology 2017年第7期14卷 635-638页

作者： Tali Farine Stephen Lye Oksana Shynlova Lunenfeld-Tanenbaum Research Institute Mount Sinai HospitalTorontoOntario M5G 1X5Canada Department of Physiology University of TorontoTorontoOntario M5S 1A1Canada Department of Obstetrics&Gynecology University of TorontoOntarioM5S 1A1Canada

The infiltration of leukocytes into uterine tissue is an essential step in parturition.This phenomenon,described as physiologic sterile inflammation,has been demonstrated over the past decade through the observation of multiple leukocyte subpopulations(monocytes,granulocytes and lymphocytes)migrating into various reproductive tissues such as the cervix.

关键词： uterine inflammation cytokines

Current status of the adjuvant therapy in uterine sarcoma: A literature review

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World Journal of Clinical Cases 2019年第14期7卷 1753-1763页

作者： Alessandro Rizzo Maria Abbondanza Pantaleo Maristella Saponara Margherita Nannini Department of Experimental Diagnostic and Specialty Medicine University of Bologna

uterine sarcomas (US) are rare mesenchymal tumours accounting approximately for 3%–7% of all uterine cancers. Histologically, US are classified into mesenchymal tumours or mixed epithelial and mesenchymal tumours. The group of mesenchymal tumours includes uterine leiomyosarcoma (uLMS, 65% of cases), endometrial stromal sarcoma (ESS, 21%)– traditionally divided into low grade (LG-ESS) and high grade–undifferentiated uterine sarcoma (5%) and other rare subtypes such as alveolar or embryonal rhabdomyosarcoma. Despite the fact that several drugs demonstrated clinical activity in advanced or metastatic settings, the role of postoperative therapy in US remains controversial. In this review, we have summarised the current state of the art, including the chief trials on adjuvant treatment modalities in US, especially focusing on uLMS, LG-ESS and other rare histotypes.

关键词： uterine sarcoma uterine leiomyosarcoma Endometrial stromal sarcoma Adenosarcoma Adjuvant therapy Chemotherapy Radiotherapy