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Background: Women with polycystic ovary syndrome (PCOS) are generally insulin- resistant and are consequently often treated with metformin. We investigated the effect of metformin and AICAR on the AMP-activated protein kinase (AMPK) pathway. Methods: We evaluated the effects of 5-amino-imidazole-4-carboxyamide-1- beta-D-ribofuranoside (AICAR) and metformin on tumor necrosis factor (TNF)-alpha- stimulated chemokine production in human granulosa cells. The phosphorylations of AMPK, I-kappaB, 4E-BP-1, p70S6K were analyzed by western immunoblotting. Results: AICAR and metformin markedly reduced the IL-8 and GROalpha production induced by TNF-alpha. AICAR and metformin also reduced the TNF-alpha-induced phosphorylation of I-kappaB. The phosphorylations of I-kappaB, 4EBP-1, p70S6K were inhibited via an AMPK-dependent signal transduction. Conclusions: These results suggest that metformin promotes granulosa cell function by reducing a TNF-alpha- and chemokine-mediated inflammatory reaction through an AMPK-dependent pathway. These finding may have implications for metformin's actions during the treatment of PCOS with metformin. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to investigate the role of vascular endothelial growth factor (VEGF) and hepatocyte growth factor (HGF) in folliculogenesis, and to evaluate the effect of these substances concerning oocyte maturation Methods Follicular fluids (FFs) were aspirated from the women undergoing in IVF-ET. Serum were collected from women in IVF-ET and normal menstrual cycles with informed consents. VEGF and HGF in FFs and serum were measured by ELISA. VEGF and HGF mRNA expression in the follicles were analyzed by reverse transcription and polymerase chain reaction (RT-PCR) Results: The concentrations of VEGF in FFs were higher than those in serum [VEGF; 1909 pg/ml, 516 pg/ml (P < 0.001), HGF; 74.6 ng/ml, 0.83 ng/ml (P < 0.0001)] The levels of HGF in FF were increased correlated with oocyte maturation[immature; 62.9 ng/ml, mature 80.3 ng/ml (P < 0.05)] The levels of VEGF in FF including mature oocytes under 39-yearold-women were significantly decreased compared with these more than 40-year-old-women [less than 39 yrs; 1386.3 pg/ml, more than 40 yrs; 2682.7 pg/ml (P < 0.05)] Conclusion Our data suggest that VEGF and HGF as angiogenic factors may play an important role of follicular growth and development in human preovulatory processes. It is suggested that VEGF and HGF production might be available biochemical markers for oocyte maturation. [ABSTRACT FROM AUTHOR]

Minimally invasive surgery (MIS) is performed for various human cancers, among which robot-assisted surgery is widely used in the United States, Europe, and other countries. Presently, the total number of robot-assisted surgeries in gynecology exceeds that in urology and any other clinical department. Our group began using robot-assisted surgery for early-stage uterine corpus cancer as from November 2017 and has already performed 40 robot-assisted operations. For this study, we examined the cases of 35 patients, excluding 3 in whom lymphadenectomy was not performed and 2 who underwent additional vaginal wall plasty. Compared with the first 20 cases, the latter 15 had reduced bleeding and shorter operation times. No serious complications were observed in the whole cohort, but infections, including urinary tract infections and peritonitis, were common among the first 20 patients. Although robot-assisted surgery is considered more advantageous for obese patients than laparoscopic and open surgery, we found no significant differences in bleeding, surgical time, or the number of resected lymph nodes between obese patients (Body Mass Index (BMI) ≥30) and other patients in this present study. Robot-assisted surgery is expected to be more widely used, and further technical improvements are needed. [ABSTRACT FROM AUTHOR]

The incidence of ectopic pregnancy is approximately 1.3~2% of all pregnancies, and more than 90% of ectopic pregnancies are detected in the ampulla of the fallopian tube. Ectopic pregnancy occurring in tubal stump after tubectomy is extremely rare, and the frequency of tubal stump pregnancy is approximately 0.4% of all pregnancies. We report one of these rare cases of ectopic pregnancy in a 26-year-old Japanese woman, gravida 4, parity 1. She had undergone laparoscopic tubectomy because of a tubal pregnancy two years ago. She was presented to our hospital with a positive pregnancy test, but no gestational sac was detected in the uterus by echography, even though the level of human chorionic gonadotropin (hCG) in the blood was elevated to 8,900 mIU/mL. Laparoscopic surgery for ectopic pregnancy was performed. During surgery, the position of the pregnancy was found to be in the tubal stump, where tubectomy had already been performed, and the gestational sac was successfully removed. After the surgery, the condition of the patient uneventfully improved and she was discharged from the hospital three days after the surgery. The diagnosis of tubal stump pregnancy is more difficult than that of the more common positions of an ectopic pregnancy in the fallopian tube, and so it is more important to carefully examine the patients with suspected ectopic pregnancy. Laparoscopic surgery is one of the options for tubal stump pregnancy if diagnosed early and if the condition of the patient is stable. [ABSTRACT FROM AUTHOR]

Objective IL-8 and GRO-α have been demonstrated to be important modulators of neutrophil-chemotaxis in the inflammation-like mechanism of human ovulation. In this study, we investigated the possible effects of TGF-α and EGF on IL-8 and GRO-α secretion by granulosa cells Methods We used immortalized granulosa cells and granulosalutein cells with informed consents. Confluent cells were placed in serum-free media and treated with the above-mentioned growth factors for 8 hrs. IL-8 and GRO-α were measured in the culture media using an ELISA Results Treatment of immortalized granulosa cells with 10 nM of TGF-α and EGF produced higher levels of IL-8 than untreated cells by 8 hrs (241.8 ± 21.8, 261.4 ± 19.4 pg/ml; control = 125 ± 15 pg/ml; P < 0.0001). On the other hand, the same treatment produced slightly higher levels of GRO-α than untreated cells by 8 hrs. Treatment of granulosa-lutein cells with 1 nM of TGF-α and EGF produced higher levels of IL-8 than untreated cells by 8 h (980.1 ± 51.5, 1134.6 ± 76.2 pg/ml; control = 593.9 ± 30.2 pg/ml; P < 0.0001). Furthermore, the same treatment produced higher level of GRO-α than untreated cells after 8 h (P < 0.0005) Conclusion Given the significant effects of both TGF-α and EGF on IL-8 and GRO-α secretion by granulosa-lutein cells, our data suggest that TGF-α and EGF might play a role in the inflammatory mechanism of human ovulation. [ABSTRACT FROM AUTHOR]

Objective To clarify the role of platelet-activating factor (PAF) in parturition, we have investigated the effect of sex-steroids on the PAF metabolism in the decidua. Methods The decidual macrophages were obtained from human decidua by enzymic digestion, followed by Ficoll-Paque centrifugation. The effects of estrone (E[sub 1]), estradiol (E[sub 2]), estriol (E[sub 3]), progesterone (P[sub 4]), and medroxy progesterone acetate (MPA) on the secretion of a PAF-inactivating enzyme, PAFacetylhydrolase (PAF-AH), by these cells were examined. The enzyme activity was assayed by the method of Miwa et al. This study was approved by our ethical committee. Results E[sub 2] inhibited PAF-AH secretion by decidual macrophages in a dose-dependent manner (IC50:82 ± 7 nM, n = 6). E[sub 3] also inhibited PAF-AH secretion (IC50:4153 ± 297 nM, n = 6); however, the effect was seen only at 50 time's higher concentrations than required for E[sub 2]-induced inhibition (P < 0.001). In contrast to E[sub 2] and E[sub 3], P[sub 4] and MPA increased the PAF-AH secretion by the decidual macrophages (SC50:206 ± 32 nM, 47 ± 3 nM, respectively, n = 6). E1 had no effect on the enzyme secretion. Conclusion Sex-steroids may modulate the concentration of PAF in the decidua via their inhibitory or stimulatory effect on the PAF-AH secretion by decidual macrophages, contributing to the regulation of PAF concentration at the maternal-fetal interface during parturition. [ABSTRACT FROM AUTHOR]