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ABSTRACT: PURPOSE: Cesarean scar pregnancy (CSP) is one of the rarest forms of ectopic pregnancy. A delay in treatment can lead to massive bleeding, uterine rupture, and life-threatening maternal morbidity. We present a conservative method for the management of CSP at a single tertiary centre over a 6-year period. METHODS: Eleven patients with unruptured CSPs who were treated by transvaginal aspiration of the gestational sac followed by a local methotrexate injection were evaluated. RESULTS: Gestational age at diagnosis ranged from 5 + 2 weeks to 7 + 4 weeks. Seven of the patients had undergone two prior Caesarean sections (63.6 %). The levels of β-hCG at the time of diagnosis ranged from 1,290 to 81,586 mIu/ml. The mean time of the procedure was 8.2 ± 1.6 min. During follow up, 54.5 % of the patients may need an additional systemic MTX injection due to an elevation of β-hCG. Estimated blood loss of the procedure was <50 ml and no blood transfusion is needed. This method has a shorter operative time, less blood loss and no hospitalization is needed for CSPs. All patients had their uterus successfully preserved without maternal morbidity or mortality. CONCLUSIONS: Transvaginal sono-guided sac aspiration concurrent with a local MTX injection is an effective management option for preserving the fertility of women with an unruptured CSP. However, additional systemic MTX injection may be needed if β-hCG levels >20,000 mIU/ml at diagnosis.
Archives of Gynecology 02/2013; · 0.91 Impact Factor
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ABSTRACT: Background: Aquaglyceroporin-7 (AQP7) is an adipose glycerol channel protein that has been suggested to be involved in whole-body glucose homeostasis and insulin sensitivity. The aim of this study was to investigate the expression of AQP7 in visceral adipose tissues from women with the polycystic ovary syndrome (PCOS). Methods: AQP7 mRNA and protein levels were measured in omental adipose tissue from 5 women with the PCOS and 4 healthy controls matched for body mass index and age; this was done by the real-time polymerase chain reaction (PCR) and Western blotting. Results: The women with the PCOS had significantly higher homeostasis model insulin resistance indices (HOMA(IR)) and their quantitative insulin sensitivity check indices were significantly lower compared to the controls (p < 0.05). No significant difference was noted between the two groups for the plasma glycerol concentration. AQP7 mRNA expression and protein levels in omental adipose tissue from women with the PCOS were significantly higher than those of the controls (p = 0.007). AQP7 expression showed a positive correlation with fasting insulin levels, insulin levels at 2 h after glucose loading and HOMA(IR) in women with the PCOS. Conclusion: AQP7 overexpression may be related to insulin sensitivity and glucose homeostasis in women with the PCOS.
Gynecologic and Obstetric Investigation 12/2012; · 1.28 Impact Factor
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ABSTRACT: The objective of this study was to measure levels of mRNAs for inflammatory markers and resistin in human peripheral blood mononuclear cells (PBMCs) in young and nonobese women with polycystic ovary syndrome (PCOS).
Fifteen young, nonobese women with PCOS and 10 age-matched controls were enrolled in this study. Levels of mRNAs for resistin and the inflammatory markers interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), monocyte chemoattractant protein-1 (MCP-1), intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) in human PBMCs were measured using real-time PCR.
The mean age and BMI of the women with PCOS were 27.54 ± 6.3 years and 27.4 ± 5.7, respectively. The women with PCOS had significantly higher fasting and 2-hour insulin levels, homeostasis model assessment of insulin resistance index (HOMA(IR)) and total cholesterol levels than the controls. VCAM-1 and ICAM-1 mRNA levels were significantly higher in women with PCOS than in controls, whereas no differences in resistin, IL-6, TNF-α and MCP-1 mRNA levels were observed between the groups. After adjusting for the BMI, only VCAM-1 mRNA levels were significantly higher in women with PCOS than in controls and correlated with the HOMA(IR) and total cholesterol.
Elevated VCAM-1 in human PBMCs in young, nonobese women with PCOS is associated with insulin resistance, independent of the BMI.
Gynecologic and Obstetric Investigation 03/2012; 73(3):236-41. · 1.28 Impact Factor
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Journal of the Chinese Medical Association 03/2012; 75(3):93-4. · 0.79 Impact Factor
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ABSTRACT: Visfatin, which is secreted predominantly from visceral adipose tissue, has an insulin-mimetic action and may play a role in the regulation of insulin sensitivity in humans. Peripheral blood mononuclear cells (PBMCs) from venous blood samples are the most accessible tissue for the analysis of gene expression. The aims of the study were to compare the expression of visfatin in PBMCs with that in omental adipose tissue in women with polycystic ovary syndrome (PCOS).
Visfatin mRNA was measured in omental adipose tissue and PBMCs from 10 women with PCOS and 10 healthy controls, matched for BMI and age, using the real-time polymerase chain reaction (PCR).
The expression of visfatin mRNA in both omental adipose tissue and PBMCs from the women with PCOS was significantly higher (P = 0.01 and P = 0.05, respectively) than that in the controls. This finding indicated that mononuclear cells are a potential source of visfatin in women with PCOS. However, only the expression of visfatin mRNA in adipose tissue, not that in PBMCs, showed a significant positive correlation with insulin levels 2h after glucose loading (P = 0.044, r(2) = 0.45), and with homeostasis model assessment-insulin resistance (HOMA(IR); P = 0.035, r(2) = 0.47). In addition, the expression of visfatin mRNA in PBMCs did not correlate with the expression of visfatin mRNA in omental adipose tissue.
PCOS is associated with increased visfatin mRNA concentrations in PBMCs and in omental adipose tissue. However, only visfatin mRNA concentration in omental adipose tissue is closely correlated with BMI and insulin resistance.
Human Reproduction 08/2011; 26(10):2869-73. · 4.47 Impact Factor
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ABSTRACT: Haem oxygenase (HO)-1, an enzyme that degrades haem, plays a key role in the regulation of the inflammatory response and insulin resistance. The aim of this study was to evaluate the role of HO-1 in the regulation of insulin resistance and glucose tolerance in women with polycystic ovary syndrome (PCOS).
Omental adipose tissue and human peripheral blood mononuclear cells (PBMCs) from seven women with PCOS and five healthy controls, matched for BMI and age, were analysed using western blotting and the real-time PCR.
Women with PCOS were found to have significantly higher fasting and 2-h insulin levels, a significantly higher homeostasis model assessment insulin resistance index and a lower fasting glucose-to-insulin ratio (G(0)/I(0)) than the controls. The level of HO-1 protein in omental fat (P = 0.002), and the expression of HO-1 mRNA in omental fat and PBMCs from the women with PCOS were significantly lower (P = 0.002 and 0.05, respectively) than those of the controls. The expression of adiponectin mRNA in omental fat was also significantly lower (P = 0.02) in the women with PCOS than in the controls. However, there were no significant differences in the expression of tumour necrosis factor-α or interleukin-6 between the two groups. The level of HO-1 protein showed a significant positive correlation with the expression of HO-1 mRNA (r(2) = 0.786, P = 0.037) and adiponectin mRNA (r(2) = 0.7276, P <0.05). Serum insulin and glucose levels and BMI showed a significant negative correlation with the level of HO-1 (P< 0.05).
Our results suggest that the HO-1-adiponectin axis may be associated with the regulation of insulin resistance and glucose intolerance in women with PCOS.
Human Reproduction 02/2011; 26(2):431-7. · 4.47 Impact Factor
