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   Table of Contents - Current issue
April-June 2019
Volume 3 | Issue 2
Page Nos. 63-127

Online since Tuesday, July 9, 2019

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Preconception care of patients with recurrent spontaneous abortion p. 63
Jie Qiao
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Activated platelets induce hypoxia-inducible factor-1α expression likely through transforming growth factor-β1 in human endometrial stromal cells p. 69
Qiu-Ming Qi, Sun-Wei Guo, Xi-Shi Liu
Objective: Endometriosis is a common gynecological disease with an enigmatic pathogenesis. Recent studies suggest that the behavior of normal endometrial stromal cells can dramatically change under hypoxic conditions, which effectively turns them into endometriotic stromal cells. Because menstrual debris is not only hypoxic but may also contain platelet aggregates, at present, we aimed to approve that activated platelets could induce hypoxia-inducible factor-1α (HIF-1α) expression in endometrial stromal cells, signaling the presence of hypoxia. Methods: We evaluated the gene and protein expression levels of HIF-1α and its target gene erythropoietin (EPO) in both human endometriotic stromal cells (HESCs) and a human endometrial stromal cell line (ESCL) cocultured with or without activated platelets for 48 h. Results: We found that the gene and protein expression levels of HIF-1α and EPO in both HESC and ESCL were significantly increased after coculture with activated platelets. We also found that neutralization of transforming growth factor-β1 completely abolishes this induction. Conclusions: Platelets can induce a hypoxic state in endometrial and endometriotic stromal cells, resulting in increased angiogenesis, as well as enhanced survival and proliferation. In conjunction with other roles that platelets play in the development of endometriosis, our findings further highlight the important roles of platelets in the development and initiation of endometriosis, shedding new light into the etiology of endometriosis.
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Development and validation of a nomogram for predicting the probability of live birth in infertile women p. 77
Meng Zhang, Hai-Qing Tian, Tao Bu, Xia Li, Xiao-Hui Wan, Duo-Lao Wang, Hua Xu, Xin-Min Mao, Qing-Li Wang, Xiao-Lin La
Objective: To develop a nomogram to predict the probability of live birth on the basis of the association of patient characteristics in subfertile individuals or couples. Methods: A retrospective study was conducted from January 2014 to December 2015. A nomogram was built from a training cohort and tested on an independent validation cohort. A total of 2,257 patients who had undergone their first nondonor cycle of in vitro fertilization (IVF) (including intracytoplasmic sperm injection) were randomly split 2:1 into training (n = 1,527) and validation (n = 730) cohorts. Results: There were no statistically significant differences in the patients' baseline and cycle characteristics between the training and validation cohorts. On multiple logistic regression analysis, female age, antral follicle count, tubal factor, anovulation, ethnicity, unexplained fertility, and male factor were significantly associated with live birth. The nomogram had a C-index of 0.700 (95% confidence interval [CI]: 0.698–0.701) in the training cohort and 0.684 (95% CI: 0.681–0.687) in the validation cohort. Conclusions: Our nomogram can predict the probability of live birth for infertile women and can be used to guide clinicians and couples to decide on an IVF treatment option.
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Expression of target genes in cumulus cells derived from human oocytes with and without blastocyst formation p. 84
Tuan-Ping Zhou, Di Zhang, Ling-Bo Cai, Yi-Xin Xu, Li Shao, Kai-Lu Liu, Jia-Yin Liu, Yu-Gui Cui, Ling Wang, Ri-Cheng Chian
Objective: The transcriptional profile of cumulus cells (CCs) during oocyte maturation provides information for predicting oocyte developmental competence. Our previous study using a mouse model indicated that there were nine different genes related to oocyte development potential expressed in CCs during oocyte maturation. The purpose of this study was to elucidate whether gene expression levels of CCs during oocyte maturation are associated with oocyte developmental competence. Methods: The human CCs collected from each oocyte were divided into two groups after tracking depending on whether or not they developed to the blastocyst stage: (1) the oocytes were developed to blastocyst stage after fertilization (B+) and (2) the oocytes were not developed to blastocyst stage after fertilization (B−). The expression levels of the nine selected genes (ARRB1, ATP2C1, CDH5, CNTNAP1, LGR4, MKLN1, RHOBTB1, SIX2, and SMC2) were examined. CCs were obtained from 29 women who were undergoing intracytoplasmic sperm injection treatment cycles. Quantitative reverse transcriptase-polymerase chain reaction analysis was performed on cumulus masses collected before insemination. Each sample was run three times. Statistically significant differences in mRNA expression of the target genes in independent samples were evaluated by two-tailed Student's t-test, and P < 0.05 was considered significantly different. Results: There were significant differences in the mRNA expression levels of ARRB1 (P = 0.016), LGR4 (P = 0.025), and SMC2 (P = 0.013) between the groups B+ and B−. Gene expression of ARRB1, LGR4, and SMC2 in CCs is related to blastocyst development. Conclusions: Analysis of expression of ARRB1, LGR4, and SMC2 genes in CCs as biomarkers may provide predictive information on oocyte developmental competence before insemination and fertilization.
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Effects of Luteinizing Hormone Supplementation on Ovarian Response and Assisted Reproductive Technology Outcomes in Antagonist In vitro Fertilization/Intracytoplasmic Sperm Injection Cycles: A Meta-analysis p. 89
Lei Chen, Cai-Rong Chen, Xue-Jian Kong, Cheng-Ran Qiu
Objective: The study objective was to investigate the effects of luteinizing hormone (LH) supplementation on ovarian response and assisted reproductive technology (ART) outcomes in in vitro fertilization/intracytoplasmic sperm injection cycles with a gonadotropin (Gn)-releasing hormone antagonist protocol. Methods: This is a meta-analysis, and nine published randomized controlled trials (1,685 patients) were included. Continuous data were extracted in the form of mean ± standard deviation and population size, whereas dichotomous data were extracted in the form of odds ratio. Results: The total amount of follicle-stimulating hormone (FSH) used, the duration of stimulation (DOS), the number of eggs in MII stage, the total number of formed embryos, the clinical pregnancy rate, and live birth rates were similar between groups, but the estrogen level on the day of human chorionic Gn (hCG) administration was slightly higher in the LH supplementation group. On subgroup analysis, it was reported that the addition of LH could significantly increase estrogen levels on the day of hCG administration in patients older than 35 years, and LH supplementation starting on the day of FSH administration may slightly extend the DOS. Moreover, regardless of the timing of LH supplementation, an increase in estrogen levels was found on the day of hCG administration. Conclusions: LH supplementation of an antagonist protocol increases estrogen levels on the day of hCG administration, but does not increase the number of mature oocytes retrieved, and also fails to improve ART outcomes.
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Analysis of clinicopathologic classification features of hydatidiform mole misdiagnosed as missed abortion preoperatively p. 97
Yun-Hui Tang, Yi-Hua Sun, Jin Zhu, Xiao-Ying Yao
Objective: To analyze clinicopathologic classification features of the cases that were diagnosed as missed abortion preoperatively but turn out to be hydatidiform mole (HM) postoperatively. Methods: A retrospective analysis was conducted on the patients who had a missed abortion in our hospital from 2017 to 2018. Clinical and pathological characteristics of different types of HMs were observed. Diagnostic value of karyotype in HM was discussed based on the karyotype analysis of villi chromosome. Results: A total of 278 (11.2%) HM patients were misdiagnosed as missed abortion. Naked-eye detection rate of HM was 26.61%, and sensitivity of transvaginal ultrasound on HM was 7.91%. One hundred and forty-seven (52.88%) HM cases could not be genotyped via pathological hematoxylin and eosin (HE) staining. 70 HM patients underwent P57 immunohistochemistry, which had guiding significance to the classification. In addition, the karyotype diagnosis of the tissues from 15 cases basically matched their P57 classifications. Conclusions: P57 should be listed as a routine test in hydatidiform pathological examination at the same time of HE staining, and what's more, P57 expression is consistent with genotyping, which should be recommended for the patients with HM if observed by naked eye.
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Characteristics of and risk factors associated with self-reported sexual repression among internal migrants in China: A large-scale cross-sectional study p. 102
Rui Zhao, Yi-Ran Li, Yan Gao, Jun-Guo Zhang, Yu-Yan Li, Ying Zhou, Jun-Qing Wu
Objective: This large-scale cross-sectional study aims to identify the characteristics of and risk factors associated with sexual repression among internal migrants in China. Methods: Between August 2013 and August 2015, a total of 8,669 internal migrants from four major cities in China (Beijing, Shanghai, Chengdu, and Chongqing) voluntarily participated in our study. They were interviewed, and the data on their demographic information, occupation, and sexual activities were collected. The Chi-square test and multiple logistic regressions were conducted to identify significant associations. A stepwise method was adopted for the selection of variables. Results: There were 3,597 (41.49%) males and 5,072 (58.51%) females in total. A higher percentage of males reported that they felt sexual repression compared to females (14.43% vs. 9.21%). After adjusting for other covariates, the consequence was showed that male migrants working for more than 5 days were more likely to report sexual repression (odds ratio [OR] = 1.40, P < 0.05). Living in a collective dormitory with others was also a risk factor for male migrants. The longer males spent with their partners, the less sexual repression occurred (OR= 0.94, P < 0.05). Similarly, agricultural household registration status and working for more than 5 days increased the risk for sexual repression among female migrants (OR= 1.41 and OR = 1.46, respectively, P < 0.05). Frequent and constructive communication also protected females against sexual repression (P < 0.05). Well-educated females experienced relatively less sexual repression when compared to their counterparts with less education (P < 0.05). Conclusions: Sexual repression was significantly associated with a few demographic, occupational, and sexual risk factors. Meaningful differences have been identified between male and female migrants. More effective intervention programs such as safeguard measures and welfare policies should be designed and implemented for a majority of female migrants and for those with agricultural household registration status.
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Indoleamine 2,3-dioxygenase in endometriosis p. 110
Hui-Li Yang, Ming-Qing Li
Endometriosis (EMS) is a chronic inflammatory and estrogen-dependent gynecological disease characterized by the presence of endometrial tissue outside the uterine cavity. Although it is a benign disease, EMS is tumor-like in several aspects, which include unrestrained growth, decreased apoptosis, and aggressive invasion. EMS involves endocrine disorders and immunological factors. Indoleamine 2,3-dioxygenase (IDO) is an intracellular enzyme that catalyzes the initial and rate-limiting step of the metabolism of tryptophan. IDO is a potential candidate facilitating EMS development. Increased IDO expression in both eutopic and ectopic endometria of women with EMS is biologically important in aspects, which include regulation of endometrial stromal cell function and modulation of adjacent local immunocytes to generate a supportive microenvironment. In turn, the expression of IDO can be regulated by the complex endocrine-immune microenvironment networks in endometrial lesions. Here, we systematically review the roles of IDO in EMS to explore its pathological implications and treatment potential.
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Roles of regulatory T Cells in pathogenesis of endometriosis p. 117
Xin-Xin Hou, Xiao-Qiu Wang, Da-Jin Li
Numerous studies have shown aberrant immune cell function in endometriosis, including T cells, B cells, natural killer cells, and macrophages (Mφ). These alterations are thought to be induced by various mechanisms that promote the disease. Regulatory T cells (Tregs) may account for a decreased ability of newly recruited leukocytes to initiate effective immune responses against viable endometrial fragments, permitting their survival. Tregs differentiate during the development of endometriosis, which confer immunosuppression or play other roles in disease progression. In this review, we provide an overview of the regulation and roles of Tregs in endometriosis. These data provide further scientific evidence for the altered immune response in endometriosis, which could be a potential target in the treatment of endometriosis. This review could create new diagnostic strategies and effective immune-targeted therapies for this highly prevalent disease. Recent progress in the field indicates that these goals may be achieved in the future.
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47,XYY,dup(13q12.11),t(4;9)(q21.1;q22.3),r(21)(p12q22.3) with azoospermia and low intelligence p. 124
Chao Lou, Han-Zhi Wu, Cui-Yun Qin, Shu-Wen Xin, Qiu-Hua Wu, Hong-Min Yan, Rong Qiang
A 27-year-old patient with azoospermia and low intelligence was reported having a rare karyotype 47,XYY,dup(13q12.11),t(4;9)(q21.1;q22.3),r(21)(p12q22.3). Clinical genetic tests, including next-generation sequencing (NGS), karyotyping, fluorescence in situ hybridization (FISH), and azoospermia factor (AZF) microdeletions, were conducted. The results showed that (1) one copy of chromosome 21 lost a short arm and appeared as a marker, but subsequent detection confirmed that it was a ring 21; (2) there was a reciprocal translocation between chromosome 4 and chromosome 9; (3) NGS revealed a duplication of 0.3 Mb on 13q12.11 and two Y chromosomes; (4) the Y chromosome showed no AZF microdeletions; and (5) FISH confirmed the two Y chromosomes. To our knowledge, this is the first reported case with rare karyotype, combined with four abnormal chromosomal changes simultaneously. Because no Online Mendelian Inheritance in Man genes were found in duplication fragment on 13q12.11, this duplication is not associated with low intelligence.
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