Meng Hsing Wu

Detection of congenital Müllerian duct anomalies using three-dimensional ultrasound

The purpose of this study was to assess the value of 3‐dimensional sonography in the diagnosis of congenital müllerian duct anomalies, which cause infertility, preterm labor, and first trimester abortion.

The perception of menopause among women in Taiwan

OBJECTIVES Hormone replacement therapy (HRT) has become a popular topic and the subject of many newspaper and magazine health articles in the last 5 years in Taiwan, so a great deal of knowledge about the menopause has been introduced to Taiwanese women. With this massive change, we wanted to know the current perception of the menopause among women in Taiwan and also evaluate the prevalence of various acute menopausal symptoms and womens attitudes toward receiving hormone replacement therapy. METHODS We designed a cross-sectional study, using structured questionnaires, targeting women who attended the health information seminar on the menopause and HRT, held in an urban area in Taiwan. The audience was asked to fill out the questionnaire before the seminar began. More than 2000 questionnaires were collected, but only 386 women completed all items of the questionnaire and were included in this study. Among them, 161 women were postmenopausal and their answers to questions regarding acute menopausal symptoms were collected for statistical analysis. The other 225 women were non-menopausal and their perception of menopausal symptoms was also collected for analysis. Qualitative data, in the form of transcripts, were interpreted using text-based content analysis. RESULTS Among these women, 375/386 (97%) had previously heard of the menopause, but only 207/386 (53%) knew the definition of the term. The most commonly indicated source of knowledge on the menopause was reading material, such as newspapers and magazines 283/386 (43%); less common sources of information were friends 141/386 (22%), medical personnel 114/386 (18%) and family members 49/386 (8%). Among these women, 276 (71%) thought they should receive therapy. The most common acute menopausal symptoms in postmenopausal women and perception of menopausal symptoms in non-menopausal women, respectively, were insomnia 68/161 (42%); 111/225 (49%), hot flushes 61/161 (38%); 115/225 (51%), heart palpitation 55/161 (34%); 103/225 (46%), an irritable temper 54/161 (34%); 138/225 (61%), dyspareunia 52/161 (32%); 100/225 (44%), headaches or dizziness 45/161 (28%); 74/225 (33%), a lack of energy 42/161 (26%); 73/225 (32%), depression 32/161 (20%); 114/225 (51%), night sweating 29/161 (18%); 61/225 (27%), and loss of bladder control 26/161 (16%); 37/225 (16%). CONCLUSIONS According to this study, Taiwanese women have a much higher percentage of awareness of the menopause than other Asian women, as reported previously and a greater willingness to receive treatment. We also found that most of their knowledge of the menopause was obtained from reading material (43%) or friends (22%). Furthermore, the percentage of recognition of menopausal symptoms, especially of vasomotor symptoms, is lower than that of Western women and higher than that of women in Hong Kong and Southern China.

Enhanced interleukin-4 expression in patients with endometriosis

OBJECTIVE To investigate the expression of cytokines by T-helper cells type 1 (interleukin [IL]-2 and interferon-gamma [IFN-gamma]) and type 2 (IL-4 and IL-10) in peripheral blood monocytes and peritoneal fluid (PF) cells from patients with endometriosis. DESIGN Peripheral blood (PB) monocytes and PF cells from patients with endometriosis were isolated and the expression of cytokines investigated. SETTING Institute for the treatment of endometriosis and research institute in university-based medical center. PATIENT(S) The study included 7 women with normal pelvic structure, 36 patients with endometriosis, and 7 women with pelvic adhesion but without apparent endometriotic lesion. The existence and severity of endometriosis was determined by laparoscopic examination. INTERVENTION(S) All patients received laparoscopic operation to identify the existence and stages of endometriosis. Danazol (200 mg, twice daily) was prescribed for those with endometriosis. MAIN OUTCOME MEASURE(S) Transcription of cytokines were directly analyzed using the reverse transcriptase-polymerase chain reaction method. The concentrations of cytokines in peritoneal fluids and sera were analyzed by the ELISA. RESULT(S) Levels of IL-4 messenger RNA (mRNA) and protein in the PB and peritoneal cells of patients with endometriosis were higher than those of normal patients, whereas levels of IFN-gamma mRNA and protein were suppressed. There were no significant changes in the mRNA or protein levels of IL-2 or IL-10 in both peritoneal fluids and sera. The level of IL-4 was reduced to normal after combined treatment with laparoscopic surgery and danazol. The secretion of IFN-gamma was elevated after treatment. CONCLUSION(S) Cytokine secretion by T-helper cells type 1 and type 2 is altered in women with endometriosis, suggesting that these T-helper subsets play a role in the immunologic responses to endometriosis.

Fibroblast Growth Factor-9 Is an Endometrial Stromal Growth Factor

Fibroblast growth factor-9 (FGF-9) is an autocrine/paracrine growth factor considered to be important for the growth and survival of motorneurons and prostate. In this study, we found that FGF-9 was expressed at high levels in normal uterine endometrium, especially during the late proliferative phase, which is coincident with the rise of estradiol and the time of uterine endometrial proliferation. Using quantitative RT-PCR analysis, we found that FGF-9 mRNA was expressed primarily by endometrial stromal cells. High affinity receptors of FGF-9 were detected in both epithelial and stromal cells but with distinct patterns. FGFR2IIIc and FGFR3IIIc are abundant in endometrial stromal cell. FGFR2IIIb is mostly expressed in endometrial epithelial cells, whereas FGFR3IIIb is found in both epithelial and stromal cells. Treatment with FGF-9 induces endometrial stromal proliferation in a dose-dependent manner. Expression of FGF-9 in stromal cells was induced by 17β-estradiol but not by progesterone. Furthermore, the...

Prostaglandin E2: the master of endometriosis?

Endometriosis is the primary cause of infertility in women, with a prevalence rate ranging from 5% to 10%. Women with endometriosis suffer from symptoms such as chronic pelvic pain, dysmenorrhea and dyspareunia, which significantly reduce the quality of life. Endometriosis is a polygenic disease with a complex, multifactorial etiology. The mechanism responsible for the initiation and development of this disease remains largely unknown. Prostaglandin E2 (PGE2), a versatile eicosanoid that exerts numerous physiological and pathological functions, has been implicated to play critical roles in the development of endometriosis. A growing body of evidence demonstrates that PGE2 regulates many pathophysiological processes including cell proliferation, antiapoptosis, immune suppression and angiogenesis during the development of endometriosis. This review focuses on recent advances in cellular and molecular mechanisms triggered by PGE2 that contribute to the pathological processes of endometriosis.

Endometriosis: disease pathophysiology and the role of prostaglandins.

Endometriosis is considered to be a polygenic disease with a complex, multifactorial aetiology that affects about 10% of women in the reproductive age. Women with endometriosis have symptoms that include chronic pelvic pain, dysmenorrhoea and dyspareunia, significantly reducing their quality of life. Endometriosis is also the primary cause of infertility in women, with the prevalence rate ranging from 20% to 50%. The high prevalence and severe outcomes of this disease have made it a major public health concern in modern society. Currently, the mechanism(s) responsible for the initiation and promotion of this disease remains obscure. In this review, we focus on the expression, regulation and action of prostaglandins in the cellular and molecular mechanisms that contribute to the development and/or maintenance of endometriosis.

Suppression of Matrix Metalloproteinase-9 by Prostaglandin E2 in Peritoneal Macrophage Is Associated with Severity of Endometriosis

Decreased phagocytotic ability of macrophages has been reported to be associated with the severity of endometriosis, although the underlying mechanism remains uncharacterized. Expression and secretion of matrix metalloproteinase (MMP)-9 by macrophages is a means to degrade the extracellular matrix of cells that are designated for phagocytosis. Here, we describe the regulation of MMP-9 expression and activity in peritoneal macrophages of women with endometriosis. Results demonstrated that peritoneal macrophages isolated from women with endometriosis have decreased levels of protein and enzyme activity of MMP-9. Treatment of macrophages with peritoneal fluid obtained from patients with severe endometriosis inhibited MMP-9 expression and gelatinase activity. Further investigation identified prostaglandin (PG) E(2) as the major factor in the peritoneal fluid that inhibited MMP-9 activity. The inhibitory effect of PGE(2) was mediated via the EP2/EP4-dependent PKA pathway. Furthermore, expression of tissue inhibitor of metalloproteinase-1, tissue inhibitor of metalloproteinase-2, and RECK in macrophages was not affected by treatment with PGE(2), indicating the effect of PGE(2) on suppressing MMP-9 activity was not mediated by up-regulation of its inhibitor. Our results suggest that decreased phagocytotic capability of peritoneal macrophage in patients with endometriosis may be caused by PGE(2)-mediated decreases in MMP-9 expression.

The role of three-dimensional ultrasonographic images in ovarian measurement

OBJECTIVE To determine whether three-dimensional ultrasonography can increase the ability to evaluate the ovary and follicles, especially in women with polycystic ovary disease (PCOD). DESIGN Prospective clinical study. SETTING University hospital endocrine and infertility center. PATIENT(S) Sixty-six patients undergoing routine gynecologic evaluation were divided into two groups: the normal control group consisted of 22 patients, and there were 44 patients with PCOD. INTERVENTION(S) Three-dimensional ultrasonography was performed to store and document whole volumes of the ovaries for evaluation. MAIN OUTCOME MEASURE(S) Three perpendicular planes of bilateral ovaries are rotatable to obtain the largest dimensions. The three-dimensional volume was measured using the trapezoid formula. RESULT(S) The ovaries of the patients with PCOD were larger in size, area, and volume than those of normal controls. CONCLUSION(S) Stroma and volume determinations can be obtained more accurately by three-dimensional images than by traditional ultrasonography. Three-dimensional ultrasonography not only facilitates noninvasive evaluation and volume calculation but also completes the examination in a short time without increasing patient discomfort.

Phthalate exposure in girls during early puberty

The aim of this study was to determine the levels of phthalate ester metabolites in girls in early puberty, and the associated environmental factors for phthalate exposure. A case-control study was conducted in which we recruited girls in early puberty, including 30 girls with premature thelarche (PT) and 26 with central precocious puberty (CPP), and 33 normal controls. The mean urine levels of monomethyl phthalate (MMP) were significantly higher in the PT group (96.5 +/- 134.0 ng/ml) than in the control group (26.4 +/- 30.0 ng/ml; p = 0.005). The levels of monobutyl phthalate (MBuP) correlated with the intake of seafood, drink and the use of plastic cups. The levels of mono-(2-ethylhexyl) phthalate (MEHP) correlated with the intake of seafood and meat and exposure plastic handi-wrap. Significantly higher MMP in the PT girls revealed that phthalate may be one of the environmental causes of early puberty in Taiwanese girls.

Inhibition of CD36-dependent phagocytosis by prostaglandin E2 contributes to the development of endometriosis

Dysfunction in macrophage-mediated phagocytosis of aberrant cells that undergo retrograde transport to the peritoneal cavity is considered an important factor in the development of endometriosis. However, the mechanisms responsible for the loss of function of macrophages remain largely unknown. Herein, we report that prostaglandin (PG) E(2), via the EP2 receptor-dependent signaling pathway, inhibits the expression of CD36 in peritoneal macrophages, resulting in reduced phagocytic ability. PGE(2)-mediated inhibition of macrophage phagocytic capability was restored by ectopic expression of CD36. Treatment with PGE(2) inhibited CD36-dependent phagocytosis of peritoneal macrophages and increased the number and size of endometriotic lesions in mice. In contrast, blockade of PGE(2) production by cyclooxygenase inhibitors enhanced the phagocytic ability of peritoneal macrophages and reduced endometriotic lesion formation. Taken together, our findings reveal a potential mechanism of immune dysfunction during endometriosis development and may contribute to the design of an effective prevention/treatment regimen.