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   Table of Contents - Current issue
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April-June 2018
Volume 2 | Issue 2
Page Nos. 65-127

Online since Thursday, October 4, 2018

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ORIGINAL ARTICLES  

Gene Expression Pattern of Histone Acetylation Enzymes Changed in the Hypothalamus of Middle-Aged Female Rats: A Putative Mechanism for Female Reproductive Aging p. 65
Wen Xu, Na Zhang, Li-Sha Li, Yan Wang, Lin Wang, Mei-Rong Du, Da-Jin Li, Yan Sun
DOI:10.4103/2096-2924.242756  
Objective: Female reproductive aging is characterized by reduced responsiveness of the hypothalamus to E2-positive feedback, which can result in alterations of gene expression and luteinizing hormone (LH) surge dysfunction. We hypothesize that age-related changes in E2-responsive gene expression are due to altered histone acetylation by histone deacetylases (HDACs) or estrogen receptor-alpha (ERα) coactivators with histone acetyltransferase (HAT) activity. Methods: In the present study, young and middle-aged female rats were ovariectomized (OVX) and treated with E2 or oil once per day for 2 days. At the time of the expected LH surge, the anterior and posterior hypothalami were dissected, and gene expression of 11 HDACs and 4 ERα coactivators with HAT activity was measured using real-time polymerase chain reaction. Results: In the anterior hypothalamus, age affected the gene expression of 3 HDACs (Hdac3, Hdac5, and Hdac11) and 2 ERα coactivators (Src2 and Crebbp). E2 treatment significantly decreased mRNA levels of 4 HDACs (Hdac4, Hdac5, Hdac10, and Hdac11) and 2 ERα coactivators (Src2 and Crebbp) in young females (3–4 months). However, none of the genes responded to E2 in the middle-aged females (9–11 months), except Hdac10. In the posterior hypothalamus, age influenced Hdac5 and Src1 mRNA expression. E2 treatment increased Hdac4 and Crebbp mRNA levels in the young but not middle-aged females. Conclusions: These data suggest that E2 regulates HDACs and ERα coactivators with HAT activity in an age- and E2-dependent manner, which may contribute to the age-related gene expression changes on the day of LH surge in female reproductive aging.
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Vitamin K3 Regulates Reactive Oxygen Species and Extracellular-Regulated Protein Kinase in Differentiated PC-12 Cells within a Safe Dose Range p. 74
Jing Yang, Jun-Ya Ke, Yu-Ling Lian, Yang Zhang, Jin-Feng Huang, Li Wang
DOI:10.4103/2096-2924.242757  
Objective: Acupuncture can relieve pain by acting on the mitogen-activated protein kinase (MAPK) signal pathway, which plays a critical role in the balance between hyperalgesia and inflammation. Our previous studies have suggested that acupoint injection of Vitamin K3 (Vit K3) had an intensive analgesic effect on primary dyspareunia. However, the mechanism by which Vit K3 worked on nerve cells has not been elucidated. Methods: Cell apoptosis, mitochondrial membrane potential (MMP), and reactive oxygen species (ROS) changes of PC-12 cells with Vit K3 treatment, for which the concentration gradient was 0, 5, 10, 20, 40, and 60 μmol/L, were quantified by flow cytometry. The expression and phosphorylation of c-Jun N-terminal kinase, p38, and extracellular-regulated protein kinase (ERK), the three critical molecules of the MAPK pathway, were further assessed using Western blotting. Results: The level of ROS first decreased and then increased with Vit K3 at 20 μmol/L, but no change in neither apoptosis nor MMP was evident. In addition, only ERK level decreased at 20 μmol/L and the relative phosphorylation level increased. Changes in ROS were negatively correlated with the expression of ERK. Conclusions: The rapid analgesic effect of Vit K3 acupoint injection may be through the reduction of ROS in nerve cells with a small dose of Vit K3 or by influencing the expression of ERK but without damaging the nerve cells themselves.
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Association of Thr307Ala and Asn680Ser of Follicle-Stimulating Hormone Receptor Gene Polymorphisms with Gonadotropin Administration during Controlled Ovarian Hyperstimulation p. 81
Qing-Xia Meng, Dan Song, Hong Li, Wei Wang, Jian Ou, Yong-Le Xu, Ai-Yan Zheng
DOI:10.4103/2096-2924.242750  
Objective: This study is to investigate the effect of different single-nucleotide polymorphisms of follicle-stimulating hormone receptor (FSHR) gene on gonadotropin (Gn) administration dosage during controlled ovarian hyperstimulation (COH) protocol of in vitro fertilization and embryo transfer. Methods: This retrospective study included 184 Chinese infertile women in Center for Reproduction and Genetics of Suzhou Municipal Hospital from June 2012 to 2014. All of the enrolled patients were homogeneous in some basal characteristics, and they all met the eligibility criteria. Blood tests were conducted on day 3 of menstrual cycle or the day of human chorionic gonadotropin administration for hormonal profile analysis and DNA extraction. DNA sequencing was performed for polymorphism analysis. The participants were classified into threonine (Thr)/Thr, Thr/alanine (Ala), and Ala/Ala groups according to genotype at position 307, and asparagine/asparagine (Asn/Asn), Asn/serine (Ser), and Ser/Ser groups according to genotype at position 680. Logistic regression and correlation analyses were performed to identify the effect of these two polymorphisms on Gn consumption. Results: The frequency of Thr307Ala and Asn680Ser distribution was consistent with Hardy–Weinberg equilibrium (P > 0.05). No significant difference was found in age, basal hormone levels for different genotype groups. Logistic regression analysis results revealed that patients with Ser680Ser genotype have a higher risk of requiring a high dose of Gn compared with patients with Asn680Asn genotype, while polymorphism of Thr307 Ala has no such effect. Conclusion: This study suggested that FSHR genotype Asn680Ser would be helpful in determining the dosage of Gn in COH; patients with Ser680Ser genotype may require higher dose of Gn.
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Comparison of Five Treatment Strategies for Cesarean Scar Pregnancy p. 88
Feng-Yi Xiao, Xiao-Hong Xue, Xin Lu
DOI:10.4103/2096-2924.242751  
Objective: To explore appropriate treatment strategy for cesarean scar pregnancy (CSP) in the first and second trimester. Methods: Clinical characteristics and treatment strategies in 182 patients with CSP were retrospectively analyzed. Treatment strategies were as follows: Group A (n = 102), uterine artery chemoembolization (UACE) followed by dilation and curettage (D&C); Group B (n = 63), D&C; Group C (n = 6), hysteroscopy; Group D (n = 6), laparotomy; and Group E (n = 5), laparoscopy. The basic clinical findings were collected and analyzed, along with the curative effects. Results: The preoperative serum beta-human chorionic gonadotropin (β-HCG) level was in the order of Group D, A>B, C>E (P = 0.001); the size of gestational sac (GS) was in the order of Group D, E>A, C>B (P = 0.000); and the thickness of the anterior myometrium was in the order of Group B>A, C>D, E (P = 0.000). Three cases in the second trimester were all in Group D; two cases were treated with UACE before laparotomy with moderate blood loss (100 and 200 mL, respectively) and the third case was initially treated with D&C and had severe hemorrhage. Conclusions: The diameter of GS, thickness of the anterior myometrium, and preoperative β-HCG level are important factors for the choice of treatment. UACE combined with D&C is a useful measure for most Type 2 CSP cases in the first trimester. For Type 2 CSP cases in the second trimester, UACE before laparotomy could be a reasonable choice.
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Clinical Outcomes of Transfer Vitrified-Thawed Day 4, 8-Cell Embryos into Endometrium Prepared for Day 3 Embryos p. 95
Ji-Qiang Si, Hannah Ya-Ning Chang, Yan-Ping Kuang, Qi-Feng Lyu
DOI:10.4103/2096-2924.242752  
Objective: To determine the clinical outcomes of transfer of day 3, 8-cell embryos into endometrium prepared for day 3 embryos. Methods: This study performed a retrospective analysis of 1,190 retarded embryos. These embryos underwent extended culture in vitro to select and vitrify day 4, 8-cell embryos, followed by 176 frozen embryo transfer cycles (study group), matching 660 transfer cycles with single frozen day 3, 8-cell embryos as the control (control group). Results: The study group achieved successful implantation rates, clinical pregnancy rate, and live-birth rates (20.45%, 15.91%, 14.20%, respectively), although these were lower than that in the control group (30.45%, 27.42%, and 20.91%; P = 0.009, 0.002, and 0.046, respectively). The miscarriage rate was similar to that in the control group (4.55% vs. 3.33%, P > 0.05), and the mean birth weight of the study group was higher than that in the control group (3,556 ± 381 g vs. 3,311 ± 570 g, P = 0.012). Conclusions: Transfer of frozen day 4, 8-cell embryos into endometrial prepared for day 3 embryos can be a new and safe alternative for patients with delayed embryos.
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Clinical Results of In Vitro Fertilization or Intracytoplasmic Sperm Injection Treatments in Women Aged 40 Years and above p. 100
Ting-Yu Zhang, Qin-Zhi Bu, Chun-Ying Su
DOI:10.4103/2096-2924.242754  
Objective: The study was designed to estimate the live birth rate (LBR) and cumulative LBR (CLBR) in patients aged ≥40 years undergoing in vitro fertilization or intracytoplasmic sperm injection treatments during their first and multiple ovarian stimulation cycle(s). Methods: A total of 697 advanced women underwent 1,293 treatment cycles, and 973 fresh embryo transfers were performed. The LBR and CLBR were analyzed with respect to an increase in the maternal age by every year. Results: A declining trend in LBR and CLBR of the first cycle was seen with an increase in maternal age. The LBR in women aged 40 years was significantly higher than that in women aged ≥44 years (18.39% and 4.39%, respectively); the CLBR in women aged 40 years was also significantly higher than that in women aged 42, 43, and ≥44 years (22.40%, 9.09%, 9.09%, and 4.80%, respectively). However, there was no significant difference (P > 0.05) in the rate of miscarriage among all groups. For those who underwent multiple cycles, the number of live-born babies decreased rapidly after three ovarian stimulation cycles; the LBR in patients aged 40 years was significantly higher than that in patients aged 42 years and ≥44 years (15.24%, 5.20%, and 4.49%, respectively), and the CLBR in patients aged 40–41 years was significantly higher than that in patients aged ≥42 years. The CLBR in all groups gradually plateaued after three cycles; women aged 40–41 years achieved relatively reasonable CLBR, while the CLBR was <10% in women aged ≥42 years. Conclusions: Women aged 40–41 years had a low but acceptable outcome in the first three ovarian stimulation cycles. The success rate quickly decreased, and for women aged ≥42 years, the decision to continue after three ovarian stimulation cycles should be made cautiously.
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Logistic Regression Analysis of Risk Factors Associated with Spontaneous Abortion after In Vitro Fertilization/Intracytoplasmic Sperm Injection-Embryo Transfer in Polycystic Ovary Syndrome Patients p. 105
Xiao-Lan Li, Rui Huang, Cong Fang, Yan-Fang Wang, Xiao-Yan Liang
DOI:10.4103/2096-2924.242758  
Objective: To analyze spontaneous abortion rate and its associated risk factors in patients with polycystic ovary syndrome (PCOS) after in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET). Methods: This was a retrospective cohort study on 2,231 PCOS patients undergoing IVF/ICSI treatment. For comparison, we enrolled another 2,231 patients with tubular factors in control group. Spontaneous abortion rate and chromosomal abnormality rate were compared between the two groups. Furthermore, clinical data were compared between the patients with spontaneous abortion and those with ongoing pregnancy using univariate and multivariate analysis for risk factors of spontaneous abortion in PCOS patients. Results: Patients in the PCOS group had significantly higher spontaneous abortion rate (24.15%) than that in the control group (12.75%, P < 0.001). Chromosomal abnormality rate was significantly lower in the PCOS group (36.05%, 31/86) than in the control group (55.56%, 50/90, P = 0.009). In the PCOS group, patients with spontaneous abortion had significantly elder age, higher body mass index (BMI), and homeostasis model assessment for insulin resistance (HOMA-IR) than those with ongoing pregnancy. The logistic regression analysis confirmed that the age, BMI, and HOMA-IR were the risk factors of spontaneous abortion in the PCOS patients. There were no significant differences between groups in the type of cycles, the quality of embryos transferred, the number of embryos transferred, fasting blood glucose, fasting insulin, and so on. Conclusions: Compared with non-PCOS patients, PCOS patients had higher spontaneous abortion rate, but the chromosomal abnormality was not a major factor for the high spontaneous abortion rate in the PCOS patients. Age, BMI, and HOMA-IR were risk factors for spontaneous abortion after IVF/ICSI-ET in PCOS patients.
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The Association between Interpersonal Relationship and Erectile Dysfunction of Middle-Aged and Elderly Men in a Rural Area of Zhejiang, China p. 111
Qun-Feng Liang, Xiao-Hua Yu, Shu-Cheng Zhang, Jian-Hui Li, Jing Zhao, Jun-Biao Zheng, Yi-Hua Gu, Wei-Jin Zhou, Guo-Qing Liang, Qian-Xi Zhu
DOI:10.4103/2096-2924.242753  
Objective: To explore the association between interpersonal relationship and erectile dysfunction (ED) of middle-aged and elderly men. Methods: A population-based cross-sectional research was conducted in the rural area of Jiashan County, Zhejiang Province, in 2016. Middle-aged and elderly men (aged 40–80) were selected as study participants. The face-to-face questionnaire was collected, including basic information, lifestyles, interpersonal relationship, and sexual function. The interpersonal relationship was evaluated based on marital relationship, neighborhood relationship, and relatives/friends relationship. According to the International index of erectile function, the study participants were divided into ED group (mild ED, moderate-to-severe ED), and non-ED group. Correlations were evaluated between interpersonal relationship indices and the prevalence or the severity of ED. Potential confounders were adjusted by the logistical regression model. Results: There were 674 study participants with average age of 60.4 ± 8.5 years, and 489 ED patients with prevalence of 72.6%. With age increasing, the prevalence and the severity of ED increased significantly. The men who could get help from spouse when an emergency occurred or who were more cared about by their neighbors had lower ED risk, and odds ratios (ORs) (95% confidence intervals [CIs]) were 0.23 (0.13–0.42) and 0.58 (0.46–0.75), respectively. After the adjustment of the covariates (age, education degree, household income, smoking, and drinking), the ORs (95% CIs) were 0.29 (0.14–0.60) and 0.54 (0.39–0.74), respectively. Good marital relationship and good neighborhood relationship were associated with a less severity of ED. Conclusions: The risk of ED was negatively correlated with marital relationship and neighborhood relationship.
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Correlations of Sperm Mitochondrial Membrane Potential with Semen Parameters and Male Obesity p. 116
Ying Yang, Yong Fan, Yan-Ping Kuang, Qi-Feng Lyu
DOI:10.4103/2096-2924.242759  
Background: To investigate the correlations of sperm mitochondrial membrane potential (MMP) with semen parameters and body mass index (BMI) in males with obesity. Methods: Semen samples were obtained by masturbation after 3–7 days of sexual abstinence from males who visited semen collect room of Shanghai Ninth People's Hospital. Conventional semen analyses were performed by computer-aided sperm analysis (CASA), and sperm morphology was analyzed by modified Papanicolaou staining. Spermatozoa were stained by JC-1 to evaluate MMP through flow cytometry. Results: Sperm MMP of asthenozoospermia group (41.24% ± 9.71%) was significantly lower than that in control group (56.68% ± 11.13%). MMP was negatively correlated with BMI (r = −0.25, P < 0.01), but positively correlated with total sperm motility (r = 0.63, P < 0.01), motility of progressive sperm (r = 0.64, P < 0.01), and normal sperm morphology rate (r = 0.37, P < 0.01). In addition, MMP showed no significant correlations with age, volume of semen, sperm concentration, sperm count, and other indexes. Conclusions: Sperm MMP is an important index in the evaluation of sperm function, and detection of MMP may provide references for the diagnosis and treatment of male infertility.
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REVIEW ARTICLE Top

A Retrospective Review of 10 Cases of Villoglandular Papillary Adenocarcinoma of the Uterine Cervix Including One with Successful Pregnancy p. 120
Chun-Yan Wei, Yu-Qing Qu, Yin-Yan He, Qing Wang, Xiao-Yong Zhu, Jun Shao
DOI:10.4103/2096-2924.242755  
Objective: Villoglandular papillary adenocarcinoma (VGPA) of the uterine cervix is a subtype of cervical adenocarcinoma. In the present study, we summarized the clinical features of VGPA of the uterine cervix and discussed the potential indications for a conservative treatment. Methods: A retrospective review of clinical characteristics and treatment aspects of 10 patients with VGPA at the Obstetrics and Gynecology Hospital of Fudan University was conducted between January 2007 and December 2016. Almost all of the existing 40 English papers on “villoglandular papillary adenocarcinoma [title/abstract]” identified from PubMed were obtained. Clinical data from these papers were analyzed in terms of age, International Federation of Gynecology and Obstetrics (FIGO) stage, recurrence rate, mortality, and conservation treatment aspects. Results: The median age of 10 patients with VGPA was 40 years. All cases had Stage IB 1 disease. Seven patients underwent human papillomavirus examinations, which revealed 6 positive and 1 negative case(s) of infection. Six patients underwent ThinPrep cytologic tests, which revealed 4 patients with atypical glandular cells, 1 with a high-grade squamous intraepithelial lesion, and 1 who tested negative for intraepithelial malignancy. None of the patients had lymph node metastases. During the 6–114 months of follow-up, no disease recurrence or death occurred. Of note, one patient who received conservative treatment successfully became pregnant. Conclusions: VGPA can be detected at an early FIGO stage with excellent prognosis. For young patients who do not exhibit poor prognosis factors, conservative treatment may be the first treatment choice based on overall assessment of clinical conditions.
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