简介：AbstractBackground:Endometrial cancer is one of the most common malignancies of the reproductive system. Effective and cost-effective screening method for populations at high risk is not available. This study aimed to investigate specimen adequacy and the influencing factors in microscale endometrial sampling biopsy and to evaluate the diagnostic accuracy and medical cost of biopsy in endometrial cancer and atypical hyperplasia screenings in comparison with hysteroscopic endometrial biopsy.Methods:A total of 1551 patients at high risk for endometrial lesions who required hysteroscopic endometrial biopsy from November 2017 to August 2018 were included. Microscale endometrial sampling biopsy was performed, followed by hysteroscopic endometrial biopsy. We evaluated the specimen adequacy and influencing factors of microscale endometrial sampling. Diagnostic consistency between microscale endometrial sampling biopsy and hysteroscopic endometrial biopsy was evaluated. The sensitivity, specificity, positive predictive value, and negative predictive value of microscale endometrial sampling biopsy in screening for endometrial cancer and atypical hyperplasia were analyzed, and the medical costs of the two procedures were compared.Results:The specimen adequacy was 81.2%. Patient age, menopausal status, endometrial thickness, and endometrial lesion type were correlated with specimen adequacy. There was good consistency in distinguishing benign and malignant endometrial diseases between microscale endometrial sampling biopsy and hysteroscopic biopsy (kappa 0.950, 95% CI 0.925-0.975). The sensitivity, specificity, positive predictive value, and negative predictive value of microscale endometrial sampling biopsy were 91.7%, 100.0%, 100.0%, and 99.3% for endometrial cancer screening, respectively, and 82.0%, 100.0%, 100.0%, and 99.4% for atypical hyperplasia screening. The medical cost of endometrial sampling biopsy was only 22.1% of the cost of hysteroscopic biopsy.Conclusions:Microscale endometrial sampling biopsy is a minimally invasive alternative technique for obtaining adequate endometrial specimens for histopathological examination. It has the potential to be used in detecting endometrial cancer and atypical hyperplasia with high efficiency and low cost.

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简介：AbstractObjective:This study aimed to investigate the differentiation of human adipose-derived stem cells (hASCs) into endometrial epithelial cells (EECs) under certain induction conditions and to a further step provide a promising approach for ASCs in clinical practice to the treatment of severe intrauterine adhesion.Methods:Four groups of hASCs were separately cultured as follows: in Group 1, hASCs were cultured in a control medium (5% fetal bovine serum [FBS] + α-minimum Eagle’s medium [α-MEM]); in Group 2, hASCs were cultured in an induction medium (5% FBS + α-MEM + [1 × 10-7 mol/L 17β-estradiol] + 10 ng/mL transforming growth factor β1 [TGF-β1] + 10 ng/mL epidermal growth factor [EGF] + 10 ng/mL platelet-derived growth factor BB [PDGF-BB]); in Group 3, hASCs and human endometrium cells (hEMCs) were cocultured in the control medium; and in Group 4, hASCs and hEMCs were cocultured in the induction medium.Results:When cocultured with hEMCs, the morphology of hASCs became similar with EECs, and the addition of factors such as EGF, TGFβ, PDGF-BB, and 17β-estradiol promoted differentiation. This study, for the first time, demonstrated estrogen receptor (ER)α and ERβ expression in hASCs and preliminarily explored changes in ERα, ERβ, β-catenin, and H19 mRNA expression during hASC differentiation. Furthermore, we concluded that H19 mRNA expression was negatively correlated with differentiation, which is seemingly related to the estrogen signaling pathway.Conclusions:hASCs revealed the potential for differentiating to EECs when cocultured with hEMCs.

简介：对在中间风险、高风险的子宫内膜的癌症的辅助治疗的实践和结果的现在的模式客观。有从1999～2006的中间风险、高风险的子宫内膜的癌症的224个女人上的方法回顾的数据被考察。所有病人经历了外科的阶段。辅助治疗的模式，加化疗由骨盆的放射疗法，化疗，和放射疗法组成，被估计。3年、5年的疾病特定的幸存(决策支持系统)率用Kaplan-Meier方法被计算。结果处于5年的决策支持系统率的差别在辅助的组和非辅助的组之间是统计上重要的(80.65%对63.80%，P=0.040)。在经历了辅助治疗的110个高风险的病人，两5年的决策支持系统率和周期性的率独自与放射疗法相比在联合放射疗法和化疗组是显著地不同的，化疗独自组织(决策支持系统率，P=0.049；周期性的率，P=0.047)。在经历了辅助治疗的83个中间风险的女人，在联合放射疗法之中处于5年的决策支持系统率和复发率没有重要差别，化疗，独自一个的放射疗法和化疗独自组织(决策支持系统率，P=0.776；周期性的率，P=0.937)。加化疗的结论辅助放射疗法在高风险的子宫内膜的癌症病人独自与独自一个的放射疗法和化疗相比与更高5年的决策支持系统率和更低的复发率被联系。有中间风险的子宫内膜的癌症的病人可能不是可能的得益于辅助联合放射疗法和化疗。

简介：Objective:Despiteevidencethatestrogensandinsulinareinvolvedinthedevelopmentandprogressionofmanycancers,theirsynergisticroleinendometrialcarcinoma(EC)hasnotbeenanalyzedyet.Methods:Here,weinvestigatedhowestrogensactsynergisticallywithinsulintopromoteECprogression.Cellgrowthinvitroandinvivo,effectsofestradiolandinsulinonapoptosisandcellcycledistribution,andexpressionandactivationofestrogenreceptor(ER),insulinreceptor(InsR),andkeyproteinsinthePI3KandMAPKpathwayswereexaminedaftercombinedstimulationwithestradiolandinsulin.Results:ComparedtoECcellstreatedwithestradiolorinsulinalone,thosetreatedwithbothestradiolandinsulinexhibitedstrongerstimulation.EstradiolsignificantlyinducedphosphorylationofInsR-βandIRS-1,whereasinsulinsignificantlyinducedphosphorylationofER-α.Inaddition,treatmentwithbothinsulinandestradioltogethersignificantlyincreasedtheexpressionandphosphorylationofAkt,MAPK,andERK.Notably,InsR-βinhibitionhadalimitedeffectonestradiol-dependentproliferation,cellcycle,andapoptosis,whereasER-αinhibitionhadalimitedinsulin-dependenteffect,inECcelllines.InsulinandestradiolindividuallyandsynergisticallypromotedECxenograftgrowthinmice.Conclusions:EstrogenandinsulinplaysynergisticrolesinECcarcinogenesisandprogressionbyactivatingInsR-βandER-α,promotingacrosstalkbetweenthem,andtherebyresultingintheactivationofdownstreamPI3K/AktandMAPK/ERKsignalingpathways.

简介：AbstractBackground:Recent studies identifying methylenetetrahydrofolate reductase (MTHFR) polymorphisms associated with breast cancer (BC), ovarian cancer (OC), cervical cancer, and endometrial cancer (EC) have reported conflicting results and been underpowered. To clarify the correlation between MTHFR mutations and these common female malignancies, we conducted a comprehensive meta-analysis incorporating all eligible publications.Methods:Relevant reports published before January 20, 2020, were retrieved from PubMed, Embase, the Cochrane Library, and the China National Knowledge Infrastructure databases. The odds ratio and 95% confidence interval summaries for the MTHFR 677C/T and 1298A/C polymorphisms in BC, OC, cervical cancer, and EC were estimated.Results:A total of 171 studies comprising 56,675 cancer cases and 67,559 controls were included. The results showed a markedly elevated risk of cancer susceptibility related to MTHFR 677C/T based on all genetic models. Similarly, we identified a significant correlation between 1298A/C mutation and cancer risk based on overall comparisons among all models, except the heterozygous model. Moreover, subgroup analysis by cancer type revealed a significantly increased risk of BC associated with 677C/T in the five models and of cervical cancer associated with 1298A/C in some models. Based on ethnicity, significant associations were observed between Asian, African, and mixed populations for 677C/T and the Asian population for 1298A/C. With regard to the sample type used for analysis, we detected a positive association between using blood as the DNA source and cancer risk for 677C/T in all genetic models and for 1298A/C in some genetic models. Further stratification of the results revealed that a notably increased risk was associated with the use of polymerase chain reaction-restriction fragment-length polymorphism or TaqMan as the genotyping method, as well as with the use of population-or hospital-based groups as the controls for 677C/T and 1298A/C, respectively.Conclusion:This meta-analysis suggests that MTHFR 677C/T and 1298A/C polymorphisms correlate with the risk of common gynecological cancers, with these findings potentially applicable for overall comparisons of related data.

简介：AbstractBackgroundEndometrial cancer (EC) has been one of the most general cancers with respect to gynecological malignancies; however, there are debates on clinical strategies concerning treatments especially for patients with grade 3 (G3) endometroid endometrial cancer (EEC). Present study aimed to evaluate the lymphatic metastasis (LM) related factors and figure out the necessity of lymphadenectomy for G3 EEC patients.MethodsFrom January 2009 to April 2019, 3751 EC patients were admitted to Obstetrics and Gynecology Hospital of Fudan University. Clinical characteristics include age, grade, stage, and clinical pathological features. A total of 1235 EEC patients were involved in the multivariable analysis. Three hundred and eighty-one patients were involved in the survival analysis and the data attributed to sufficient follow-up information. Kaplan-Meier curve and log-rank test were utilized to analyze the survival rate.ResultsAmong the 1235 EEC patients, 181 (14.7%) were categorized as G3 and 1054 (85.3%) were grade 1 to grade 2 (G1-2). Multivariate analysis demonstrated that lymphovascular space invasion, adnexal involvement, and cervical stroma involvement were independent risk factors of LM in G3 cohort with odds ratio 3.4, 5.8, and 8.9; 95% confidence interval 1.1-10.6, 1.5-22.4, and 2.8-28.0, respectively. LM rates increased from 3.3% (3/92) to 75% (9/12) for G3 EEC cohort as related factor numbers increased from one to three. There were no differences between G3 and G1-2 EEC in overall survival and progression free survival. Additionally, no survival advantage was observed for G3 EEC patients at early stage with different plans of adjuvant treatment.ConclusionsFor G3 EEC patients without other pathological positive factor, the LM rate is lower than those with other pathological positive factor. Survival analysis showed no difference between G3 cohort and G1-2 cohort. Also, different adjuvant treatments had no impact on the overall survival for G3 EEC patients.

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简介：AbstractObjective:To investigate the effects of endometrial stimulation timings and techniques on pregnancy outcomes in patients without prior embryo transfer (ET).Methods:We included a total of 10 studies related to the impact of endometrial stimulation on the pregnancy outcome of infertile patients with the first ET from 2010 to 2019. These studies were found by searching databases including China Science and Technology Journal Database (VIP), Chinese Biological Med (CBM), Chinese Medical Current Content (CMCC), China National Knowledge Internet (CNKI), WanFang Med Online, Cochrane Library, Web of Science, PubMed, Medline, ScienceDirect, and EMBASE. A total of 1,983 cycles were included, of which 725 were cycles with endometrial stimulation. Clinical outcomes included clinical pregnancy, implantation, abortion, multiple pregnancy, and live birth rate.Results:The implantation rate (IR) was higher in the fresh cycle endometrial stimulation group than in the control group (relative risk [RR] = 1.21, 95% confidence interval [CI] = 1.03-1.42; P = 0.02), but there were no significant between-group differences in the live birth rate (LBR) and abortion rate (AR). Subgroup analysis showed that whether follicular or luteal endometrial stimulation was performed before the ET cycle had no effect on the clinical pregnancy outcome, and endometrial stimulation on the day of oocyte retrieval reduced the clinical pregnancy rate (CPR) (RR = 0.37, 95% CI= 0.19-0.75; P = 0.005). Whether the technique involved the use of a curette or catheter, there was no significant between-group difference in CPR.Conclusions:Fresh cycle endometrial stimulation can improve the embryo IR in patients without prior ET, but it cannot increase CPR, LBR, or AR. Subgroup analysis showed that different endometrial stimulation timings and techniques did not significantly improve CPR and that endometrial stimulation on the day of oocyte retrieval reduced CPR.

简介：LRP16以前在乳癌房间作为导致雌激素的基因被识别。到在子宫内膜的癌症(EC)的雌激素和它的功能的效果的LRP16的应答的海角房间仍然是不清楚的。这里，我们证明LRP16基因的信使rna水平和倡导者活动被17beta-estradiol(E2)显著地在雌激素受体高山增加哈(嗯高山哈)-positiveIshikawa人EC房间。尽管Ishikawa细胞的生长率没被LRP16的宫外的表示显然影响，Transwell试金的结果显示出LRP16-overexpressing细胞的侵略能力的近似one-thirdincrease。由于分子的屏蔽，我们观察到E-cadherin的表示，与肿瘤转移联系的一个必要粘附分子，被LRP16镇压。进一步的倡导者分析以一种剂量依赖者方式表明了那LRP16inhibitedE-cadherintransactivation。然而，抑制被雌激素剥夺废除，显示由LRP16requires的E-cadherin抄写的down规定嗯高山哈调停。染色质免疫降水分析表明到E-cadherin倡导者的ERalpha的绑定被LRP16反对，建议那LRP16能防碍嗯调停alpha的抄写。这些结果建议起来由雌激素的LRP16的规定能被在人的EC调整E-cadherin的down涉及侵略生长。