Association of IL-18 genotype with impaired glucose regulation in Korean women with polycystic ovary syndrome

Objective

Polycystic ovary syndrome (PCOS) is a common endocrine disorder among women of reproductive age. The pro-inflammatory cytokine, interleukin (IL)-18, is associated with metabolic syndrome, and elevated serum IL-18 levels are related to obesity and insulin resistance in PCOS patients. However, the role of IL-18 in the PCOS remains unclear. So we examined whether or not two functional polymorphisms in the IL-18 gene, −137G > C and +183A > G, are associated with PCOS itself or glucose intolerance in Korean women with PCOS.

Study design

The IL-18 genotypes of 126 women with PCOS and 113 controls were determined and their serum levels of lipid and hormone profiles measured. The insulin resistance index was calculated from the glucose and insulin concentrations obtained by oral glucose tolerance tests.

Results

There were no statistically significant differences in the distribution of −137 G > C polymorphisms among the women classified according to presence or absence of PCOS and obesity. However, the −137G/G allele was more frequent in the PCOS + impaired glucose regulation (IGR) group than PCOS + normal glucose tolerance group (X² = 7.637, p_Bonf = 0.022). The PCOS group with only the −137G allele had a significantly increased risk of IGR compared to the PCOS group with the −137C allele (92 vs. 8%, odds ratio = 6.325, 95% confidence interval = 1.403–28.519). In the PCOS patients, the mean fasting and 2-h post-prandial plasma glucose level of patients with only the −137G allele was significantly higher than those of the patients with the −137C allele (88.87 ± 9.49 vs. 84.37 ± 6.19, p = 0.002 and 120.07 ± 34.53 vs. 107.54 ± 27.13, p = 0.038). Only one woman was heterozygous for the +183A > G polymorphism and the other 224 subjects were homozygous for the polymorphism (A/A).

Conclusion

The IL-18 −137G allele could play a role in the predisposition to glucose intolerance in Korean women with PCOS, and the +183G allele of IL-18 is not associated with the Korean population.     

Association between endometriosis and polymorphisms in insulin-like growth factor binding protein genes in Korean women

Objective

Genetic factors are known to be associated with the development and progression of endometriosis, but the genes related to endometriosis have not been defined. Insulin-like growth factor binding proteins (IGFBPs) are believed to be involved in the proliferation and apoptosis of cells that play an important role in the pathophysiologic mechanism of endometriosis. This study aimed to determine the association between endometriosis and polymorphisms of the IGFBP genes in Korean women.

Study design

In a case–control study, the rs1995051, rs1065780 and c.759A > G single nucleotide polymorphisms (SNPs) in the IGFBP1 gene and the −672A > G, −202A > C and c.95C > G SNPs in the IGFBP3 gene were analyzed in 128 women with endometriosis and 108 normal control women.

Results

The haplotype genotype composed of a combination of three IGFBP1 gene polymorphisms was not related to endometriosis, while the haplotype genotype of the IGFBP3 gene had a significant association with endometriosis. Women not carrying the AAG (−672A/−202A/c.95G) haplotype allele of three IGFBP3 gene polymorphisms have a 3.19-times higher risk of endometriosis compared with women with AAG homozygotes, and this trend was found in women with advanced endometriosis but not in women with early endometriosis.

Conclusions

The AAG haplotype allele of the −672A > G, −202A > C and c.95C > G polymorphisms in the IGFBP3 gene may be associated with advanced endometriosis in Korean women.     

Association between TGF-β1-509C/T polymorphism and endometriosis: a systematic review and meta-analysis

Objective

To evaluate the association between the transforming growth factor β1 gene-509C/T (TGF-β1-509C/T) polymorphism and the risk of endometriosis.

Study design

Relevant studies published before October 2011 were identified by searching PubMed and Embase. Studies were selected using prior defined criteria. The strength of the relationship between the TGF-β1-509C/T polymorphism and endometriosis risk was assessed by Odds Ratios (ORs). Fixed- or random-effects model was calculated according to study heterogeneity. Stratification analysis and sensitivity analysis were also conducted. Possible publication bias was tested by funnel plots and Egger's test.

Results

Of 49 potentially relevant studies, six case–control studies were identified in this meta-analysis. The integrated result showed that the TGF-β1-509C/T polymorphism was not associated with the endometriosis risk for the allele contrast (T vs. C: OR = 1.57, 95%CI = 0.88–2.79), the additive genetic model (T/T vs. C/C: OR = 2.96, 95%CI = 0.97–9.10), the dominant genetic model (T/T + T/C vs. C/C: OR = 1.80, 95%CI = 0.80–4.07) and the recessive genetic model (T/T vs. C/C + T/C: OR = 1.91, 95%CI = 0.89–4.12). In the stratified analysis by ethnicity, genotyping method and source of control, no significantly association was found. Publication bias was not detected in the included studies.

Conclusions

Meta-analyses of the available data showed that the association between TGF-β1-509C/T polymorphism and susceptibility of endometriosis was not significant. More studies are needed to elucidate its role in endometriosis.     

Polymorphic variants of DNMT3A and the risk of endometriosis

Objective

Overexpression of DNA methyltransferase 3A (DNMT3A) and aberrant methylation of various genes in eutopic endometrium have been demonstrated in women with endometriosis. We aimed to study whether DNMT3A polymorphisms could be a genetic risk factor for endometriosis and endometriosis-related infertility.

Study design

We studied 5 SNPs (rs2289195, rs7590760, rs13401241, rs749131 and rs1550117) located in the DNMT3A gene in 357 women with endometriosis and 640 controls.

Results

We did not observe significant differences between genotype and allele frequencies of rs2289195, rs7590760, rs13401241, rs749131 and rs1550117 SNPs in women with endometriosis, endometriosis-related infertility, and controls. The lowest p values of the trend test were observed for DNMT3A rs1550117 in endometriosis and endometriosis-related infertility (p_trend = 0.049 and p_trend = 0.055, respectively).

Conclusions

Our results did not supply evidence for the contribution of SNPs located in DNMT3A to either endometriosis or endometriosis-related infertility.     

Vascular endothelial growth factor −2578 A/C, −460 T/C and +405 G/C polymorphisms in polycystic ovary syndrome

Objective

Vascular endothelial growth factor (VEGF) may be involved in the physiological regulation of ovarian angiogenesis and pathogenesis of polycystic ovary syndrome (PCOS). VEGF −2578 A/C, −460 T/C and +405 G/C single nucleotide polymorphisms (SNPs) are known to be related to VEGF production.

Study design

In order to investigate the possible association between VEGF gene and PCOS susceptibility, we analyzed genotype and allele distributions of above mentioned SNPs in 137 patients with PCOS and 155 healthy women. Differences in genotype distributions and allele frequencies in the cases and controls were compared for statistical significance using the χ²-test. Haplotype frequencies were estimated using a contingency χ²-test. Mann–Whitney U test was used for the statistics of the clinical and biochemical parameters.

Results

No significant association between PCOS and the variant alleles of VEGF −2578 (OR: 0.91, 95% CI = 0.65–1.26), −460 (OR: 0.78, 95% CI = 0.56–1.08), and +405 (OR: 1.25, 95% CI = 0.81–1.93) was observed. However, haplotype analysis demonstrated that the frequency of CTG haplotype, was higher among PCOS compared with controls (p = 0.019) and that there is a strong linkage disequilibrium (D′ = 0.873, r² = 0.752) between −2578 and −460 polymorphisms.

Conclusions

These preliminary results suggest that the −2578, −460 and +405 SNPs of VEGF gene are not significant risk factors for PCOS development alone. However, because of the high VEGF producer CTG haplotype was more frequent among the PCOS, we suppose that investigated polymorphisms – interacting with other genetic and environmental factors – could play a role in the development of PCOS.     

Interleukin-12 p40 gene (IL12B) polymorphisms and the risk of cervical caner in Korean women

Objective

The aim of this study was to investigate whether IL12B polymorphisms might be associated with increased risk and invasiveness of cervical cancer in Korean women.

Study design

Peripheral blood samples from patients with invasive cervical cancer (n = 154) and non-cancer controls (n = 191) were used to detect three biallelic IL12B polymorphisms at IVS2 −912, IVS4 +314, 3′UTR +1188 sites by performing SNaPshot assay. Allelic frequencies, genotype distributions, and haplotype patterns in the case group were compared with those in the control group. The relationships between these polymorphisms and cancer invasiveness were also evaluated by collating the clinicopathologic parameters including FIGO stage, lymph node status, histologic type, and parametrial invasion. The used analytic methods are chi-square test and logistic regression analysis.

Results

Allelic frequencies of cases (G, 0.853; A, 0.147) were not significantly different from controls (G, 0.796; A, 0.204) in IVS2 −912G/A SNP (P = 0.054). GG genotype of IVS2 −912G/A SNP showed increased risk for cervical cancer compared with AA genotype (P = 0.040). The IVS2 −912G:IVS4 + 314A haplotype, IVS2 −912G:IVS4 +314A:3′UTR +1188A haplotype, and IVS2 −912G:IVS4 +314A:3′UTR +1188C haplotype were also significantly associated with increased risk for cervical cancer. A subgroup analysis of the clinicopathologic parameters in cancer group also showed that there is no significant association between IL12B polymorphisms and cervical cancer invasiveness.

Conclusions

This study suggests that IVS2 −912GG genotype and IVS2 −912G:IVS4 +314A haplotype of IL12B gene are associated with increased risk for cervical cancer in Korean women.     

Is preeclampsia associated with higher frequency of HSP70 gene polymorphisms?

Aim

To evaluate the possible association of three different HSP70 gene polymorphisms with preeclampsia.

Study design

HSPA1A G(190)C, HSPA1B A(1267)G and HSPA1L T(2437)C polymorphisms were analyzed from blood samples of 72 women with preeclampsia and of 70 healthy pregnant women as controls by PCR-RFLP method.

Results

HSPA1B (1267)GG and HSPA1L (2437)CC genotypes occurred more frequently in preeclamptic patients compared to healthy controls (p < 0.002 [RR: 4.38, 95% CI: 1.56–12.28]) and (p < 0.03 [RR: 1.31, 95% CI: 1.03–1.67]), respectively. Significant difference was found in the distribution of HSPA1B A(1267)G genotype between the preeclamptic and control group (p < 0.004 [RR: 0.67, 95% CI: 0.51–0.88]). Distribution of HSPA1A G(190)C was similar in the preeclamptic and control group. In controls, genotype distribution of HSPA1A G(190)C and HSPA1L T(2437)C was in Hardy–Weinberg equilibrium, while this criterion was not fulfilled for HSPA1B A(1267)G.

Conclusion

We concluded that HSPA1B (1267)GG and HSPA1L (2437)CC genotypes were more frequent among preeclamptic than control patients, suggesting that these genotypes may play a role in the susceptibility for preeclampsia.     

Recurrent hydatidiform mole: detection of two novel mutations in the NLRP7 gene in two Egyptian families

Objectives

To explore the effects of progressive muscle relaxation (PMR) training on anxiety, depression and quality of life (QOL) of endometriosis patients under gonadotrophin-releasing hormone (GnRH) agonist therapy.

Study design

This was a controlled, randomized, open-label study. One hundred consecutive Han Chinese endometriosis patients, aged 18–48 years, were randomly assigned to a PMR group (n = 50) and a control group (n = 50). In a study of 12 weeks’ duration, both groups received one dose of depot leuprolide, 11.25 mg IM. In addition to the GnRH agonist therapy, the PMR group received 12 weeks of PMR training. Anxiety level was measured using the state-trait anxiety inventory (STAI). Depression was assessed using subscale D of the hospital anxiety and depression scale (HADS-D). Health-related QOL was measured with SF-36 instrument. The patients were evaluated with STAI, HADS-D and SF-36 before and after the PMR intervention.

Results

The control group and the PMR group were comparable at baseline. After 12 weeks of intervention, both groups showed significant improvement in overall QOL (P < 0.05). The PMR group, but not the control group, showed significant improvement in state anxiety, trait anxiety and depression after intervention (P < 0.05). Moreover, the PMR group showed significant improvement in all QOL domains after intervention; by contrast, the control group showed significant improvement in all physical health domains and only two mental health domains after intervention. Between-group comparisons of the improvement in scores after intervention showed that the PMR group had significantly better improvement in the scores of anxiety, depression and overall/domain QOL than the control group (P < 0.05). Repeated measures ANOVA revealed that both PMR intervention and time had significant individual as well as interactive effects on state anxiety, trait anxiety depression and overall QOL (P < 0.05).

Conclusions

This study suggests that PMR training is effective in improving anxiety, depression and QOL of endometriosis patients under GnRH agonist therapy. This is the first study to explore the effects of psychosomatic therapy on emotional status and QOL of endometriosis patients, and may serve as an important reference for future psychosomatic interventions on endometriosis.     

Reproductive outcome after laparoscopic treatment of endometriosis in an infertile population

Objectives

To evaluate fertility outcome after laparoscopic management of endometriosis in an infertile population.

Materials and methods

A retrospective analysis of 64 patients presenting more than one year infertility and a pregnancy-wish associated with minimal to severe endometriotic lesions (stage I to IV according to the revised American Fertility Society (rAFS) classification), treated using laparoscopic surgery in order to remove the entire lesions. We excluded women under 20 years and over 40, as well as those with other infertility factors (tubal non endometriosis-related, hormonal or sperm). Fertility of the remaining 34 patients was studied in relation to endometriosis stage and to pregnancy's mode (spontaneous or induced).

Results

Pregnant women percentage was 65% (22 patients) within a 8.5 months (quartiles: 3; 15.5) [range: 1; 52] post-surgical time, and 86.5% pregnancies issued with a delivery. The rate of pregnant women depended on stage of endometriosis (89% for stages I–II, and 56% for stages III–IV). Sixty percent pregnancies were spontaneous within a 5 months (3; 9) [1; 52] post-surgical time to pregnancy average. When pregnancies were obtained with assisted reproductive techniques, the median post-surgical time to pregnancy was 12 months (9; 22) [2; 31]. Among women with stages I–II endometriosis, the median post-surgical time to pregnancy was 2 months when spontaneous and 20.5 months when induced (P = 0.007). In case of stages III–IV endometriosis, pregnancy's delay was 8 and 12 months respectively (P = 0.79). Among the 21% women who had had an induced pregnancy failure before surgery, 71% became pregnant and 80% spontaneously. Eighteen patients (53%) had an ovarian endometrioma and 50% of them became pregnant. Among the 4 patients who had colorectal endometriosis requiring colorectal resection, 1 pregnancy was obtained.

Conclusions

These findings suggest that in a context of more than one year infertility only related to endometriosis, it is reasonable to offer these patients a complete operative laparoscopic treatment of their lesions, which enables 65% of them to be pregnant within a 8.5 months post-surgical median time to pregnancy and spontaneously in 60%. In case of stages I–II endometriosis we suggest a spontaneous pregnancy try during 8 to 12 months before starting induced pregnancy therapeutics instead of stages III–IV endometriosis where induced methods should be used after only 6 or 8 months.     

Diameter of dominant leiomyoma is a possible determinant to predict coexistent endometriosis

Objective

To identify the frequency and assess risk factors for unexpected discovery of peritoneal endometriotic implants in patients who underwent myomectomy or hysterectomy for symptomatic uterine leiomyomas.

Study design

We retrospectively collected medical records of 829 patients with symptomatic leiomyomas in The University of Tokyo Hospital. All the patients underwent abdominal or laparoscopic surgeries between January 2001 and December 2010 and the presence or absence of endometriosis during surgery was analyzed. Possible determinant to predict coexistent endometriosis was statistically investigated.

Results

In total, 105 leiomyoma cases (12.7% in 829 patients) were diagnosed with endometriosis. Patients with small dominant leiomyomas were significantly complicated by peritoneal endometriotic implants (small leiomyomas were classified as <8 cm). The patients with both diagnoses were more likely to be infertile and at age 39 years or younger than those with leiomyoma alone.

Conclusions

Women undergoing myomectomy or hysterectomy with both endometriosis and leiomyomas have several different clinical features compared with women with only leiomyomas. The size of largest leiomyoma may provide an important clue for coexistent endometriosis. Women with substantial infertility despite a smaller leiomyomas burden may be more likely to have a surgical indication for concomitant endometriosis.     

Risk factors of surgical failure following transvaginal mesh repair for the treatment of pelvic organ prolapse

Objective

To identify the factors associated with pelvic organ prolapse (POP) recurrence after transvaginal mesh (TVM) repair.

Study design

One hundred and thirteen women with symptomatic POP stage II to IV were scheduled for TVM procedures. All subjects underwent urinalyses and pelvic examination using the POP quantification (POP-Q) staging system before and after surgery.

Results

Seven (6.2%) of 113 women reported POP recurrence after a mean follow-up time of 30 months. We performed a univariate analysis of patients’ characteristics to identify the predictors of surgical failure after TVM. There was no difference between two groups as to body mass index, POP stage, mesh type, and preoperative urinary symptoms and urodynamic parameters (P > 0.05). However, we found that uterine prolapse (P = 0.016) and surgical experience (P = 0.043) were two significant predictors of surgical failure. Multivariate logistic regression showed similar results.

Conclusion

Advanced uterine prolapse and lack of surgical experience were two significant predictors of failure following TVM. POP recurrence after mesh repair appears to be unlikely beyond the learning curve.     

Interleukin-1 beta gene polymorphisms and preterm birth

Objective

To investigate the association between two genetic variations in the Interleukin-1 beta (IL1B) gene and preterm birth.

Study design

In this case-control study we tested the allelic distribution of two of its common polymorphisms (IL1B +3953C>T [rs1143634], IL1B −511C>T [rs16944]) in one hundred women with preterm birth and one hundred healthy women with at least one uncomplicated full term pregnancy and no history of preterm birth.

Results

A significant association was found between the presence of the IL1B +3953C>T polymorphism and preterm birth (p = 0.049, OR 0.6 [0.3–1.0]). No significant association was found between the IL1B −511C>T polymorphism and preterm birth (p = 0.471, OR 1.3 [0.7–2.3]).

Conclusion

Our findings suggest that the IL1B +3953C>T polymorphism is associated with a risk reduction for preterm birth in Caucasian women, possibly by altering the inflammatory response during pregnancy.     

Is there any relation between IL-6 gene −174 G>C polymorphism and postmenopausal osteoporosis?

Objective

IL-6 gene single nucleotide polymorphisms (SNPs) have been reported to have a protective effect against bone resorption. We aimed to investigate the association between bone mineral density and IL-6 promoter region −174 G>C SNP.

Study design

This study included 356 postmenopausal Turkish women, of whom 201 were osteoporotic (lumbar spine T score < −2.5 SD) and 155 non-osteoporotic (lumbar spine T score > −1.5 SD). Bone mineral density (BMD) measures were obtained using dual-energy X-ray absorptiometry. SNP of the IL-6 gene (−174 G>C) was examined by polymerase chain reaction-restriction fragment length polymorphism.

Results

The frequencies of the variant C allele (24% vs. 30%, p = 0.074) and mutant CC genotype (12% vs. 20%, p = 0.094) were higher in non-osteoporotic women. Lumbar spine and total hip BMD values were lowest among women with the G/G genotype, intermediate in the heterozygotes, and highest in women with the C/C genotype. The GG (p = 0.022) and GC (p = 0.037) genotypes were covariates which approached statistical significance in the regression model fitting of BMD.

Conclusion

IL-6 promoter region SNP showed an association with BMD in this postmenopausal Turkish population and these data suggest that the wild GG genotype influences the phenotype.     

Recurrence rate of endometrioma after laparoscopic cystectomy: A comparative randomized trial between post-operative hormonal suppression treatment or dietary therapy vs. placebo

Objective(s)

To assess the recurrence rate of endometrioma after laparoscopic cystectomy plus hormonal suppression treatment or plus dietary therapy compared to post-operative placebo.

Study design

A randomized comparative trial was conducted on 259 consecutive women who underwent laparoscopic unilateral/bilateral cystectomy for endometrioma. Seven days after surgery, the patients were randomly allocated on the basis of a computer-generated randomization sequence, to one of four post-operative management arms as follows: placebo (n = 65) or gonadotrophin-releasing hormone analogue (tryptorelin or leuprorelin, 3.75 mg every 28 days) (n = 65) or continuous low-dose monophasic oral contraceptives (ethynilestradiol, 0.03 mg plus gestoden, 0.75 mg) (n = 64) or dietary therapy (vitamins, minerals salts, lactic ferments, fish oil) (n = 65) for 6 months. At 18 months’ follow-up after surgery, all patients were monitored with a clinical gynecologic examination, and a transvaginal ultrasonography for possible evidence of endometrioma recurrence.

Result(s)

At 18 months’ transvaginal ultrasonographic follow-up after surgery, no significant recurrence rate of endometrioma was detected in women who received a postoperative course of hormonal suppression treatment or dietary therapy when compared with placebo (placebo vs. GnRH-a P = 0.316, placebo vs. estroprogestin P = 0.803, placebo vs. dietary therapy P = 0.544). Second-look laparoscopy was performed on a clinical basis and confirmed the ultrasonographic suspicion of recurrence of endometrioma in all cases: 10 (16.6%) in the post-operative placebo group vs. 6 (10.3%) in the post-operative GnRH-a group vs. 9 (15.0%) in the post-operative continuous estroprogestin group vs. 11 (17.8%) in the post-operative dietary therapy group. Of 36 patients with recurrent ovarian endometriosis, 8 had recurrence on the treated ovary, 20 on the contralateral ovary that appeared to be normal at the time of the first-line surgery, and 8 on both the treated and untreated ovaries. Endometrioma recurrences were associated with moderate-to-severe painful symptoms in 14/36 patients (38.8%), while the remaining 22 (61.1%) patients were asymptomatic.

Conclusion(s)

A 6-month course of hormonal suppression treatment or dietary therapy after laparoscopic cystectomy had no significant effect on the recurrence rate of ovarian endometriosis when compared with surgery plus placebo. So, treatment of endometrioma can be carried out exclusively by laparoscopic cystectomy without post-operative therapy, if a complete excision of ovarian endometriosis has been assured.     

Peritoneal tuberculosis mimicking ovarian cancer

Objective

To evaluate the clinical and urodynamic outcomes of transvaginal mesh repair (TVM) for the treatment of pelvic organ prolapse (POP).

Study design

One hundred and twenty-four women with POP stage II to IV were scheduled for a TVM procedure. Preoperative and postoperative assessments included pelvic examination, urodynamic testing, and a personal interview about urinary symptoms using a standard questionnaire.

Results

We found a significant improvement at points Aa, Ba, C, Ap, and Bp (P < 0.001) except for total vaginal length (P = 0.08), and the overall success rate was 93.5% (116/124). Various urinary symptoms improved significantly following TVM (P < 0.01). In addition, residual urine, functional urethral length, and the rate of detrusor overactivity, improved significantly after surgery (P < 0.05). Apart from vaginal erosion (14/124; 11.3%), the rates of other surgical complications were acceptably low.

Conclusion

TVM is an effective procedure for the treatment of POP and urinary symptoms, this being possibly related to postoperative release of urethral obstruction. Vaginal erosion is less likely to occur beyond the learning curve.     

Serum C-reactive protein in the differential diagnosis of ovarian masses

Objective

A number of serum tumor markers have been investigated to aid clinicians in the differential diagnosis of ovarian masses. Serum C-reactive protein (CRP) is a widely used biomarker of inflammation and has been previously shown to be a promising biomarker in patients with ovarian cancer.

Study design

In a retrospective single-center study, we evaluated serum CRP in 576 patients with benign and in 242 patients with malignant (ovarian tumors of low malignant potential [LMP]: n = 44, epithelial ovarian cancer [EOC]: n = 198) ovarian masses. Results were correlated to clinical data.

Results

Median (25th, 75th percentiles) serum CRP in patients with benign ovarian tumors, with ovarian tumors of LMP, and with EOC were 0.5 (0.5, 0.6) mg/dL, 0.5 (0.5, 0.9) mg/dL, and 1.36 (0.5, 4.9) mg/dL, respectively (p < 0.001). In the subgroup of patients with EOC, serum CRP significantly correlated with FIGO stage (p < 0.001), residual tumor mass (p < 0.001), and patients’ age (p = 0.04), but not with tumor grade (p = 0.2) and histologic type (p = 0.4). In univariable and multivariable models including serum CRP, serum CA 125, and patients’ age, serum CRP independently predicted the presence of malignant ovarian masses (p < 0.0001; Odds Ratio [OR] 5.3, 95% Confidence Interval [CI] 3.8–7.4). Serum CRP had a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for identifying malignant ovarian masses of 49.8%, 84.1%, 57.1%, and 79.8%, respectively.

Conclusion

Serum CRP is associated with the presence of malignant ovarian tumors independent of serum CA 125 and patients’ age and can therefore be used as additional diagnostic marker in the differential diagnosis of ovarian masses.     

Comparison of active and expectant management on the duration of the third stage of labour and the amount of blood loss during the third and fourth stages of labour: a randomised controlled trial

Background

Postpartum haemorrhage is one of the most important causes of maternal death.

Objectives

To evaluate the effect of active management of the third stage of labour on the amount of blood loss in the third and fourth stages of labour, and the duration of the third stage of labour.

Methods

A randomised controlled trial was completed on 200 women who gave birth at a maternity unit in Iran. In the intervention group (n=100), 10 IU of oxytocin was injected intramuscularly into the mother following birth of the anterior shoulder of the baby. After clamping and cutting the umbilical cord, the uterus was pushed upwards and posterior, while the cord was pulled down with constant and intermittent traction until the placenta was delivered. In the control group (n=100), on observing signs of placental separation, the placenta was expulsed by maternal force. In both groups of women, blood loss was measured at birth using collecting devices, and drapes and sheets were weighed to estimate blood loss.

Findings

Mean blood loss during the third stage of labour was 216.93±165.16 ml and 232.12±150.35 ml in the intervention and control groups, respectively; the difference was not significant (p=0.49). In contrast, mean blood loss during the fourth stage of labour differed significantly (422.62±324.7 ml and 327.27±255.99 ml in the intervention and control groups, respectively; p=0.02). The mean duration of the third stage of labour was less in the intervention group than in the control group (4.69±5.51 mins and 6.34±5.03 mins; p=0.028).

Conclusions

Active management did not decrease blood loss during the third stage of labour, but did decrease the duration of this stage. Active management was associated with increased blood loss during the fourth stage of labour. Due to conflicting results between studies, further research should be undertaken to determine the optimal method by which to manage the third stage of labour.     

Association between endometriosis and polymorphisms in insulin-like growth factors (IGFs) and IGF-I receptor genes in Korean women

Objectives

To evaluate the relationship between endometriosis and polymorphisms in insulin-like growth factors (IGFs) and IGF-I receptor genes.

Study design

In a case-control study, 128 women with endometriosis and 108 control women were recruited at the Department of Obstetrics and Gynecology in Seoul National University Hospital. Determinations of −969(CA) block, −603A>T, and −553T>C single nucleotide polymorphism (SNP)s in the IGF-I gene, c.517C>T, c.540G>T and 820G>A SNPs in the IGF-II gene, and c.3129G>A SNP in the IGF-I receptor gene were performed to evaluate the prevalence of IGFs and IGF-I receptor genotypes or alleles.

Results

Among studied SNPs, the IGF-II 820G>A polymorphism was associated with endometriosis. Women with endometriosis were observed 1.99 times more frequently in the GG genotype of the IGF-II 820G>A polymorphism compared with non-GG genotype (95% confidence level: 1.18-3.35). The similar finding was observed only in early stage endometriosis (stages I and II).

Conclusions

The IGF-II 820G>A polymorphism is a genetic factor which may be associated with the development of endometriosis in Korean women.     

Learning curve analysis of laparoscopic radical hysterectomy and lymph node dissection in early cervical cancer

Objective

Locally advanced bulky cervical cancer (LABCC) is characterized by poor local control. The objective of this study was to identify the clinicopathologic variables associated with one-year central-only recurrence, which will serve as criteria for adjuvant hysterectomy after radiation (AHR) in patients with LABCC.

Study design

Between January 2000 and August 2007, we retrospectively evaluated outcomes in 225 patients with LABCC who were initially treated with radiation or chemoradiation.

Results

Among the 225 patients with LABCC, there were 41 recurrences within one year after treatment (8 central-only and 33 pelvis and/or distant site recurrences). Age, stage, and treatment type were not associated with the one-year central-only recurrences, but tumor size ≥8 cm had a statistically significant association based on multivariate analysis (OR, 5.39; 95% CI, 1.15–25.31; p = 0.03). The combination of non-squamous cell (non-SCC) type and tumor size ≥8 cm had a significantly higher rate of recurrence within one year (OR, 43.0; 95% CI, 4.78–386.68; p < 0.01).

Conclusions

Of patients with LABCC, those with non-SCC tumors ≥8 cm in size were at high risk for early central-only recurrence after cisplatin-based chemoradiation, and represent the subset of patients for whom AHR is beneficial.     

Relationship of serum adipocyte-derived proteins with insulin sensitivity and reproductive features in pre-pubertal and pubertal daughters of polycystic ovary syndrome women

Objective

To evaluate in a cross-sectional study adiponectin and leptin levels in prepubertal and pubertal daughters of women with PCOS and their relationship to insulin sensitivity and reproductive features.

Study design

We studied 92 daughters of PCOS women (PCOSd) and 76 daughters of control women (Cd) matched by age and body mass index SD scores and distributed according to breast Tanner stage: prepuberty (Tanner 1), early puberty (Tanner 2–3) or late puberty (Tanner 4–5). In all girls an oral glucose tolerance test was performed. Leptin, adiponectin, sex steroids, SHBG, glucose, insulin and lipid profile were determined. Leptin–adiponectin ratio, free androgen index and insulin sensitivity (HOMA-IR and ISI composite) were then calculated.

Results

Prepubertal PCOSd showed lower serum adiponectin compared to Cd (p = 0.028), whereas during puberty no differences were observed between the groups. Leptin concentrations were similar in both groups in all Tanner stages. In addition, in PCOSd during early puberty, adiponectin showed a negative correlation with testosterone and leptin showed a negative correlation with ISI composite, which were independent of BMI SDS (r = −0.39; p = 0.02 and r = −0.42; p = 0.01).

Conclusion

These observations suggest that during the prepubertal period PCOSd exhibit abnormal adiponectin levels, independently of BMI. Moreover, leptin and adiponectin may be related to metabolic and reproductive abnormalities observed in PCOSd during the early stages of sexual development.