“STUDY OF ENDOMETRIAL PATHOLOGY IN ABNORMAL UTERINE BLEEDING”

CONTEXT - Histopathological analysis of endometrial samples in various forms of abnormal uterine bleeding in adjunction with clinical history of patient to identify underlying cause of bleeding. This also helps in early diagnosis of premalignant and malignant lesions leading to their proper follow up and improved prognosis. AIMS - Histopathological analysis of causes of abnormal uterine bleeding with their clinical correlation. SETTINGS AND DESIGN -A prospective observational study MATERIAL AND METHODS - This study was done in department of pathology, GSVM medical college, Kanpur. This was a prospective study from year 2017-2018. A total of 300 cases were studied. Specimen received were xed in 10% formalin, processed and sections of 3-4 micron were prepared, stained with H and E. Histopathological examination was done. RESULTS - It was observed that the highest number of patients were between 41-50 years of age. (44.33%). Menorrhagia is the most common symptom accounting for 135 (45%) patients followed by metrorrhagia accounting for 135 (45%) patients and hypomenoorhea is the least common complaint. It was observed that there were signicantly higher number of patients with proliferative phase – 68 (22.67%) and in endometrial hyperplasia 35 (33.66%) patients. The least common cause were endometrial polyp, seen in 4 (1.33%) patients, gestational endometrium and gestational trophoblastic tumor accounted for 2 ( 0.67%) patients. In patients who presented with metrorrhagia, secretory phase endometrium was the most common histopathological nding accounting for 34.62% followed by proliferative phase. In cases of endometrial hyperplasia, 28 (80%) cases were simple cystic type, 5 ( 14.29%) cases were of simple endometrial hyperplasia with atypia and complex endometrial hyperplasia with atypia was found in 2(5.71%) cases. Among cases of endometrial hyperplasia, 28 (80%) cases were simple cystic type, 5 ( 14.29%) cases were of simple endometrial hyperplasia with atypia and complex endometrial hyperplasia with atypia was found in 2(5.71%) cases. Endometrial carcinoma is commonest complain in 51-60 years and >60 years age group. CONCLUSION - Histopathological analysis of AUB causes helps in identifying the cause and early diagnosis of premalignant and malignant cases.

Evaluation of Blood Pressure and Heart Rate Variability during Different Phases of Menstrual Cycle

Introduction: Every month, between puberty and menopause, a woman’s body goes through a number of changes to get it ready for a possible pregnancy. This series of hormone-driven events is called the menstrual cycle. A woman’s menstrual cycle is divided into three phases- proliferative phase, secretory phase and menstrual phase. The hormonal surge during each phase causes profound effects on the cardiovascular system as well. However, previous research reported conflicting results in this concept. Thus the controversial statements associating blood pressure and heart rate variability with menstrual cycle promoted this research. Objective: The aim of this study is to evaluate the blood pressure and heart rate variability during different phases of the menstrual cycle. Materials and Methods: 20 healthy women belonging to the proliferative, secretory and menstrual phase of the menstrual cycle were analyzed for autonomic functions tests using systolic blood pressure, diastolic blood pressure, pulse rate and heart rate variability. Results: It showed that there was a statistically significant increase in systolic blood pressure, diastolic blood pressure, and pulse rate during the secretory phase. There was an increase in heart rate variability during the menstrual phase but this was statistically insignificant. Conclusion: The study concluded that there were significant changes in blood pressure during the secretory phase and pulse rate and insignificant increase in heart rate variability during the menstrual phase. Thus, the study also concluded that sympathetic nervous activity in the secretory phase is significantly greater than in the proliferative phase, whereas parasympathetic nervous activity is predominant in the proliferative phase.

Myringoplasty with Morphological Rationale of Application of Xenoperitoneum Decellularized Matrix in Experiment

AIM: The aim of the study is to create a myringoplasty technique with decellularized matrix of xenoperitoneum in an experiment on rabbits with morphological rationale of a new biological material application. METHODS: Sixty rabbits were included in research. The animals were randomly divided in two groups for use the bioimplant – decellularized matrix of xenoperitoneum and control. Each subgroup corresponded to the observation period and the removal of the animal from the experiment. Observation period was: 7 days, 21 days and 30 days after myringoplasty. RESULT: The maturation of connective tissue in both groups was completed by the 30th day. But the change in the exudative phase into the proliferative phase occurred faster and the dynamics of reparative processes after myringoplasty were better in experimental group. CONCLUSION: The use the decellularized matrix of xenoperitoneum had better reparative properties

Body Composition Results of Caucasian Young Normal Body Mass Women in the Follicular Proliferative Phase, Measured for the Different Positions of Limbs

The bioelectrical impedance analysis (BIA) became a standardized technique for assessing body composition, but many factors affect the reproducibility of measurement, including body and limbs position. In spite of the fact that it is recommended for patient to be in a supine position, with arms abducted at least 30° and legs abducted at approximately 45°, a lot of authors conduct their measurements with arms and legs of patients separated to not touch the body but not strictly following the recommendations. Taking this into account, the aim of the study was to analyze the body composition results of Caucasian young normal body mass women in the follicular proliferative phase, measured for the different positions of limbs in order to compare the results obtained in the recommended position (with arms abducted at least 30° and legs abducted at approximately 45°) and in the commonly used position (not following strictly the recommendations). The study was conducted in a homogenous group of 100 adult females under the age of 30 years using BIA 101/ASE with the Bodygram Pro software and its equations by Akern Srl, Firenze, Italy, based on the measurement recommendations. The measurements were conducted (1) in a recommended position of arms abducted at least 30° and legs abducted at approximately 45° and (2) with arms spread and legs separated to not touch the body to compare the body composition assessment (fat mass, fat-free mass, body cell mass, muscle mass, water content, extracellular water content, and intracellular water content). It was stated that the results obtained for various positions of limbs were positively correlated (p < 0.0001; R > 0.5). At the same time, the statistically significant differences dependent on the position were observed for the calculated results of body cell mass (lower results for the recommended position for the results observed in kg and % of body mass; p = 0.0165 and p = 0.0075, respectively) and muscle mass (lower results for the recommended position for the results observed in kg and % of body mass; p = 0.0025 and p = 0.0011, respectively), as well as extracellular and intracellular water (higher % of total body water for the extracellular water and lower for intracellular water; p = 0.0049 and p = 0.0115, respectively), resulting from the measured resistance and reactance values. For all listed comparisons of significantly differing variables, weighted κ statistics indicated moderate agreement (values of 0.41–0.60), and the Bland–Altman plot analysis indicated no agreement (Bland–Altman index of >5%). While compared with the reference values, the major differences were observed for extracellular/intracellular water content, as, while applying a method with arms and legs separated to not touch the body (not recommended position), the extracellular water content was underestimated for 31% and intracellular water content was overestimated for 28% of participants. It may be concluded that the recommended body position of arms abducted at least 30° and legs abducted at approximately 45° should be chosen to ensure the reliability of the BIA measurements, as, while the recommendations of a body position are not followed, the results obtained may be misleading and may not reflect the actual body composition.

Effectivity of Camellia sinensis Extract with Nanochitosan to Fibroblast Amounts of Wistar Rats Gingival Wound Healing Process

Green tea (Camellia sinensis) has high level of flavonoids which are proven to have anti-inflammatory activity. Effect of flavonoids can be enhanced by nano-chitosan capsulation as drug carrier. Chitosan is polysaccharide derived from crustacean shells that mostly used as matrix of various drugs and plant extracts. The aim of this study was to determine the effectivity of flavonoids in green tea extract in nanochitosan capsulation towards the number of fibroblasts on proliferative phase of gingival wound healing process. Green tea was extracted, encapsulated with nano-chitosan and then made into gel. Gingiva labial of 24 male white 3-month-old Wistar rats were wounded by punch biopsy (2 mm diameter), then were treated two times a day, and were divided randomly into four groups of topical gel applications: green tea extract gel encapsulated nano-chitosan, green tea extract gel, base gel as negative control, and NSAIDs gel as positive control, starting at 0 day until 7th day. At 5th and 7th day, three rats from each group were decapitated and the mandibular gingiva was taken in order to make histology slides with hematoxylin eosin staining. Under microscope, the number of fibroblasts were examined. The data were analysed using ANOVA test with 95% confidence level. The results showed that the number of fibroblasts on proliferative phase was significantly higher than control negative (p < 0.05) and has no significant differences (p > 0.05) with control positive. In conclusion, topical application of green tea extract gel encapsulated nano-chitosan was effective to accelerate rats gingival wound healing process by increasing the fibroblasts.

Participation of Selected Soluble BMP-2 and BMP-7 Bone Morphogenetic Proteins and Their Soluble Type I ALK-1 and Type II BMPR2 Receptors in Formation and Development of Endometriosis

Angiogenesis is considered to be one of the key stages in the development of endometriosis. Recent studies indicate that bone morphogenetic proteins (BMPs) and their receptors (BMPR) may play an important role in the angiogenesis process. In the literature, however, there is a lack of publications concerning binding BMPs and their receptors with the pathogenesis of endometriosis. The aim of the study was to determine the role of soluble bone morphogenetic proteins, BMP-2 and BMP-7, and their receptors, ALK-1 and BMPR2, in the process of the formation and development of endometriosis. Peritoneal fluid was collected in the proliferative phase of the menstrual cycle, from 80 women aged 21–49 years (mean age 31.3 ± 6.7 years) undergoing laparoscopy to determine the causes of primary infertility. The study involved 60 women in the I, II, III, and IV stages of the disease. The reference group consisted of 20 women who did not have endometriosis or other lesions in the pelvic area. The concentration in the peritoneal fluid of women with endometriosis was compared to the concentration of this parameter in the reference group, and a statistically significant reduction in the concentration of the BMP-2 molecule was found, as well as increasing concentrations of BMP-7, ALK-1, and BMPR2. BMP-2 and BMP-7 and their soluble receptors, ALK-1 and BMPR2, are involved in the formation of endometriosis. The changes in the concentrations of most of the tested parameters demonstrated in the study, especially in the early stages of the disease, may indicate the more effective formation of new blood vessels in this period.

Mifepristone inhibited the expression of B7-H2, B7-H3, B7-H4 and PD-L2 in adenomyosis

Background The immune mechanism was shown to be involved in the development of adenomyosis. The aim of the current study was to evaluate the expression of the immune checkpoints B7-H2, B7-H3, B7-H4 and PD-L2 in adenomyosis and to explore the effect of mifepristone on the expression of these immune checkpoints. Methods The expression of B7-H2, B7-H3, B7-H4 and PD-L2 in normal endometria and adenomyosis patient samples treated with or without mifepristone was determined by immunohistochemistry analysis. Results In adenomyosis patient samples, the expression of B7-H2, B7-H3 and B7-H4 was increased in the eutopic and ectopic endometria compared with normal endometria, both in the proliferative and secretory phases. Moreover, the expression of B7-H2 and B7-H3 was higher in adenomyotic lesions than in the corresponding eutopic endometria, both in the proliferative and secretory phases. The expression of PD-L2 was higher in adenomyotic lesions than in normal endometria in both the proliferative and secretory phases. In the secretory phase but not the proliferative phase, the expression of B7-H4 and PD-L2 in adenomyotic lesions was significantly higher than that in the corresponding eutopic endometria. In normal endometria and eutopic endometria, the expression of B7-H4 was elevated in the proliferative phase compared with that in the secretory phase, while in the ectopic endometria, B7-H4 expression was decreased in the proliferative phase compared with the secretory phase. In addition, the expression of B7-H2, B7-H3, B7-H4 and PD-L2 was significantly decreased in adenomyosis tissues after treatment with mifepristone. Conclusions The expression of the immune checkpoint proteins B7-H2, B7-H3, B7-H4 and PD-L2 is upregulated in adenomyosis tissues and is downregulated with mifepristone treatment. The data suggest that B7 immunomodulatory molecules are involved in the pathophysiology of adenomyosis.