OBJECTIVE: This study aimed to investigate the effect of a new clomiphene citrate (CC) regimen on preventing thin endometrial lining in polycystic ovary syndrome (PCOS) patients receiving CC plus gonadotropin treatment with a timed intercourse cycle. METHODS: A total of 114 women with PCOS were included in this trial. Patients were divided into two groups and treated in accordance with the controlled ovarian stimulation (COS) protocol. In group A, 104 COS cycles in 67 patients were included, and in each cycle 150 mg CC was given for three days, starting from day 3. In group B, 69 COS cycles in 47 patients were included, in which 100 mg CC was given for five days, starting from day 3. The thickness of the endometrium was measured on the day of human chorionic gonadotropin (hCG) injection. Timed intercourse was recommended at 24 and 48 hours after the hCG injection. RESULTS: Additional doses of human menopausal gonadotropin and the number of days of hCG administration were not significantly different between the two groups. Endometrial thickness on the day of hCG administration was significantly larger in group A than group B (9.4+/-2.1 mm vs. 8.5+/-1.7 mm, p=0.004). The pregnancy rate was significantly higher in group A than in group B (38.4% vs. 21.7%, p=0.030). CONCLUSION: Three-day CC treatment resulted in a significantly higher pregnancy rate than the standard five-day CC treatment in a timed intercourse cycle in PCOS patients. Facilitating adequate endometrial growth via the early discontinuation of CC might be a crucial factor in achieving a higher pregnancy rate.
Chorionic Gonadotropin ; Clomiphene* ; Endometrium ; Female ; Gonadotropins* ; Humans ; Ovulation Induction ; Polycystic Ovary Syndrome* ; Pregnancy ; Pregnancy Rate

Disseminated intravascular coagulation (DIC) is usually developed after infection, metastatic cancer or complicated pregnancy. We experienced a case of infertile woman with adenomyosis, who had not been predisposed any common risk factors but had acute DIC during menstruation after controlled ovarian stimulation. The patient received anticoagulation therapy with supplementation of coagulation factors, followed by surgical removal of uterus 3 months later. We assumed that DIC resulted from rapidly aggravated lesion during controlled ovarian stimulation and massive intramuscular hemorrhage during menstruation. So, we report the case with brief review of literatures.
Adenomyosis ; Blood Coagulation Factors ; Dacarbazine ; Disseminated Intravascular Coagulation ; Female ; Hemorrhage ; Humans ; Infertility ; Menstruation ; Ovulation Induction ; Pregnancy ; Risk Factors ; Uterus

To identify the relation between simple reaction time and height and arm length, simple reaction time was performed to medical students with measurement of height, and arm length. Participants should answer questions about Smoking, drinking, sleep deprivation, history of diseaseand drug, whether to use computer or hot Mean height of men(n=98) was 173.0+/-4.79 cm, that of women (n-22) 161.7+/-4.33 cm. Mean arm length of men was 73.5+/-3.09 cm, and that of women 68.0+/-2.93 cm respectively. Height and arm length were statistically significantly different between-men and women (plt;0.01). Mean simple reaction time of men was 265.4+/-25.03 msec, that of women 286.8+/-28.48 msec. Mean simple reaction time was also statistically significantly different(p<0.01). As a result of correlation analysis, for men. None was significant. However, for women, height and arm length showed statistically significant, correlation with mean reaction time. Correlation coefficient of height and arm length were 0.45 (p<0.05) and 10.57 (p<0.05) respectively.
Arm* ; Drinking ; Female ; Humans ; Male ; Reaction Time* ; Sleep Deprivation ; Smoke ; Smoking ; Students, Medical

OBJECTIVE: Homeostasis of the extracellular matrix (ECM) is maintained by the action of a specific system of proteolytic enzymes known as matrix metalloproteinases (MMP) and tissue inhibitors of metalloproteinases (TIMP). The MMP/TIMP system regulates the composition and turnover of ECM to control the site and extent of connective tissue remodeling. In pathologic conditions, MMP play a key role in degradation of basement membrane and extracellular matrix, and is responsible for cancer invasion, progression and metastasis. The aim of this study is to evaluate the correlation between expressions of MMP/TIMP and clinicopathologic factors in endometrial cancer. METHODS: Expressions of MMP-2, MMP-9, TIMP-1, and TIMP-2 were assessed by immunohistochemistry in a total of 55 endometrial cancers and were analyzed by the correlation between expressions of MMP/TIMP and clinicopathologic factors in endometrial cancer. RESULTS: Expression rates of MMP-2,-9, TIMP-1, and TIMP-2 were 71.7%, 54.9%, 41.2%, and 76.5% respectively. Expression of MMP-2 was correlated with the group of positive lymph node metastasis in endometrial cancer (p=0.04). Specially, coexpression of MMP-2 and TIMP-2 was significantly more frequent in the group of positive lymph node metastasis (p<0.01) and the group of positive peritoneal CONCLUSION: The expressions of MMP and TIMP were not a significant difference in survival analysis, but this study was recognized that the coexpression MMP-2 and TIMP-2 is correlated with lymph node metastasis and positive peritoneal cytology.
Basement Membrane ; Connective Tissue ; Endometrial Neoplasms ; Extracellular Matrix ; Female ; Homeostasis ; Immunohistochemistry ; Lymph Nodes ; Matrix Metalloproteinases ; Metalloproteases ; Neoplasm Metastasis ; Peptide Hydrolases ; Tissue Inhibitor of Metalloproteinase-1 ; Tissue Inhibitor of Metalloproteinase-2

Gallbladder (GB) cancer is relatively rare and has a poor prognosis, with a median survival time of less than 3 months. It is resistant to chemotherapy. Therefore, the role of systemic chemotherapy is limited. However, administering the anticancer agent directly into the hepatic artery can result in a higher drug concentration in the cancer tissue. In this paper, we report a case of advanced GB cancer treated with hepatic arterial infusion chemotherapy (HAIC) using the port system. The patient received six cycles of HAIC with 5-fluorouracil (750 mg/m²) and cisplatin (25 mg/m²); each cycle lasted for 4 days every month. The tumor showed objective response during HAIC, and the patient survived for 15 months from the first therapy. HAIC using the port system might be a promising therapeutic modality for treating locally advanced GB cancer.
Cisplatin ; Drug Therapy ; Fluorouracil ; Gallbladder Neoplasms ; Gallbladder ; Hepatic Artery ; Humans ; Prognosis

Gallbladder (GB) cancer is relatively rare and has a poor prognosis, with a median survival time of less than 3 months. It is resistant to chemotherapy. Therefore, the role of systemic chemotherapy is limited. However, administering the anticancer agent directly into the hepatic artery can result in a higher drug concentration in the cancer tissue. In this paper, we report a case of advanced GB cancer treated with hepatic arterial infusion chemotherapy (HAIC) using the port system. The patient received six cycles of HAIC with 5-fluorouracil (750 mg/m²) and cisplatin (25 mg/m²); each cycle lasted for 4 days every month. The tumor showed objective response during HAIC, and the patient survived for 15 months from the first therapy. HAIC using the port system might be a promising therapeutic modality for treating locally advanced GB cancer.

BACKGROUND/AIMS: Midazolam is utilized as a premedication for uppoer gastrointestinal endoscopy. Midazolam has a more rapid onset of reaction than that of diazepam and its duration is shorter. But the Consciousness of premedicated patients has not been regained sooner. The Purpose of this study was to examine the effectiveness of flumazenil against midazolam as premedication for upper gastrointesinal endoscopy. METHODS: Sixty patients underwent upper gastrointestinal endoscopy. These patients were divided to three groups: Group I included twenty patients without premedication; Group II Included twenty patients with premedication of midazolam and then were not given an antisedative agent excluign of normal saline; and Group III included the others with midazolam and flumazenil as an antisedative agent. RESULTS: There was no change in vital signs after midazolam and flumazenil as an antisedative agent. RESULTS: There was no change in vital signs after midazolam injection, compared with presedation value. Modified Steward Coma Scale showed a significant increase after flumazenil injection as an antagonist of midazolam. The assessment of the endoscopist and the comfort of patients were satisfactory. When the 40 patients were asked about their willingness to undergo the same procedure in the future, thirty-four patients responded favorably. CONCLUSION: Midazolam was safe and effective for sedation for upper gastrointestinal endoscopy. There was rapid regaining of consciousness with flumazenil indection after midazolam, so the use of flumazenil against midazolam injection also appeared to be effective.
Coma ; Consciousness ; Diazepam ; Endoscopy ; Endoscopy, Gastrointestinal* ; Flumazenil* ; Humans ; Midazolam* ; Premedication* ; Vital Signs

OBJECTIVE: To compare the hatching rates of the vitrified and the fresh mouse blastocysts co-cultured with decidualized or non decdualized human endometrial cells and to confirm the necessity of assisted hatching in the vitrified mouse blastocyst. METHODS: Stromal and epitherial cells isolated from human endometrial tissue were co-cultured and decidualized with TGF-beta 1 and progesterone. The vitrified and the fresh mouse blastocysts were co-cultured with human decidualized or non-decidualized endometrial cells, respectively and the hatching rates were investigated. RESULTS: Epithelial and stromal cells isolated from endometrial tissue were cultured seperately for 24 hours and stained by immunohistochemical staining for cytokeratin (epithelial cells) or vimentin (stromal cells). The immunohistochemical study was positive for cytokeratin or vimentin and confirmed that epithelial and stromal cells were isolated from endometrial tissue successfully. The co-cultured human stromal and epitherial cells were decidualized by administration of TGF-beta 1 and progesterone. The hatching rates of the fresh and the vitrified mouse blastocysts co-cultured with decidualized human endometrial cells were 89% and 31%, respectively. The hatching rates of the fresh and the vitrified mouse blastocysts co-cultured with non-decidualized human endometrial cells were 82% and 27%, respectively. The hatching rates were significantly higher in fresh mouse blastocysts than in vitrified mouse blastocysts regardless of decidualization of human endometrial cells (P<0.05). CONCLUSION: The hatching rate was significantly higher in fresh mouse blastocysts than in vitrified mouse blastocysts. This results showed that the cryopreservation procedure caused the zona hardening of mouse blastocyst and the decidualization of endometrial cells did not affect to hatching rate of the vitrified mouse blastocysts. We confirmed that assisted hatching was necessary for improving the hatching rate of cryopreserved mouse blastocysts.
Animals ; Blastocyst ; Coculture Techniques ; Cryopreservation ; Herpes Zoster ; Humans ; Keratins ; Mice ; Progesterone ; Stromal Cells ; Transforming Growth Factor beta ; Vimentin

PURPOSE: This study was to observe whether the apoptotic function of tumor-infiltrating lymphocytes (TIL) is induced in human gastric epithelial dysplasia and gastric adenocarcinoma according to the role of FasL expression. MATENRIALS AND METHODS: A total of 56 gastric epithelial dysplasia and gastric adenocarcinoma patients were enrolled in this study: 9 cases of gastric epithelial dysplasia, 18 cases of early gastric carcinomas (EGC) and 29 cases of advanced gastric carcinomas (AGC). Immunohistochemical staining was performed for FasL and CD45, and the terminal deoxynucleotidyl transferase mediated dUTP nick end labelling (TUNEL) method was used to detect cell death in tumor-infiltrating lymphocytes. RESULTS: 1) Positive reactions of FasL to neoplastic cells were 88.9% (8/9) in gastric epithelial dysplasia, 83.3% (15/18) in EGC, and 75.9% (22/29) in AGC. 2) Expression of TIL was decreased in the FasL positive region and was increased in the FasL negative region, and significant expression of TIL was observed in the AGC group (P=0.001). 3) Expression of apoptotic TIL was very similar to the FasL expression, and 100% expression was observed in gastric epithelial dysplasia group. 4) Expression of apoptotic TIL was increased in the FasL positive region and decreased in the FasL negative region, and significant apoptotic expression was observed in the gastric epithelial dysplasia and EGC groups (P=0.0420, P=0.0263, respectively). CONCLUSION: These results suggest that FasL is a prevalent mediator of immune privilege in epithelial dysplasia and cancer of the stomach.
Adenocarcinoma* ; Apoptosis* ; Cell Death ; DNA Nucleotidylexotransferase ; Humans ; Lymphocytes, Tumor-Infiltrating ; Stomach Neoplasms

OBJECTIVE: Recently it has been proposed that stem cells may be associated with the pathogenesis of endometriosis. The purposes of this study are to investigate whether the eutopic endometrial cells of women with or without endometriosis show the characteristics of stem cells in vitro and have a difference of the expressions of the undifferentiated stem cell markers as OCT-4 and CXCR4. METHODS: A total of 6 women with advanced endometriosis and a total of 10 women without endometriosis, adenomyosis or leiomyoma were included in this study. The eutopic endometrial cells, which were obtained from the menstrual blood at menstrual cycle day 2 to 4, were cultured in vitro for approximately 2 weeks, subsequently the putative very small stem cells were separated by Percoll density gradient method and were cultured. The expressions of OCT-4 and CXCR4 were analyzed by real time RT-PCR. RESULTS: The eutopic endometrial cells of the group of endometriosis compared with the control group showed the different morphological characteristics in vitro; more commonly heterogeneous supportive cells, very small round cells less than 3 micrometer and 5~15 micrometer sized hyperchromatic round cells. After the separation of very small round cells by Percoll density gradient method, these cells showed the several characteristics of stem cells; self-renewal, asymmetric cell division, colony formation and embryoid body-like formation. Also These cells showed the similar characteristics of very small embryonic-like stem cells; the mobile cells smaller than erythrocyte, the cell migration or adhesion to supportive cells, the sphere formation by cell aggregation and the formation of new differentiated cell by cell fusion. The expressions of OCT-4 and CXCR4 in the group of endometriosis are respectively 5.66 times and 17.69 times as high as the control group (P<0.05). CONCLUSION: The very small round cells less than 3 micrometer and 5~15 micrometer sized hyperchromatic round cells, which showed the several characteristics of stem cells in vitro, were more common in eutopic endometrial cells of patients with endometriosis and the expressions of OCT-4 and CXCR4 were significantly higher. This study suggests that stem cells might play a key role in the pathogenesis of endometriosis and OCT-4 and CXCR4 might be used as a tool for diagnosis or follow-up.
Adenomyosis ; Asymmetric Cell Division ; Cell Aggregation ; Cell Fusion ; Cell Movement ; Endometriosis ; Endometrium ; Erythrocytes ; Female ; Humans ; Leiomyoma ; Menstrual Cycle ; Povidone ; Silicon Dioxide ; Stem Cells