An evaluation of hamster,rat, and mouse sperm-cell motility in media formulated with water of different qualities

The in vitro motility of caudal epididymal spermatozoa from four hamsters, four rats, and four mice was compared in modified Tyrode's medium (TLP-PVA) prepared with water of three qualities: (1) Sigma tissue culture water, 18 m, high quality (HQ); (2) deionized distilled water, 4,5 m prior to distillation, intermediate quality (IQ); and (3) tap water, low quality (LQ). The objective was to evaluate the in vitro bioassay potential of spermatozoa from these species, in terms of relative sensitivities to toxins in different qualities of water. An average sperm motility index (SMI) was calculated per treatment at 2, 4, and 6 hr, where SMI=fpm²×% motility. Hamster SMI could be used to discriminate between HQ and IQ media at 4 and 6 hr (P<0.001), while rat SMI could be used to discriminate between HQ and IQ media at 6 hr (P<0.05). Mouse SMI did not differ between HQ and IQ media. The ability to discriminate between extremes in quality, HQ or IQ vs LQ, was equal between species (P<0.001). These results suggest that hamster spermatozoa provide the more sensitive in vitro bioassay model, while rat and mouse spermatozoa may be used for assay of extremes in water quality.     

Elevated serum progesterone values at the time of ovulation induction in luteal leuprolide acetate-down-regulated GIFT cycles are associated with decreased clinical pregnancy rates

Purpose: The effects of premature luteinization of ovarian follicles as detected by elevated progesterone values on the day of human chorionic gonadotropin induction of ovulation were evaluated in 38 consecutive gamete intrafallopian transfer (GIFT) retrieval cycles. Materials and Methods: All patients received leuprolide acetate beginning in the midluteal phase of their prior menstrual cycle, followed by gonadotropin stimulation of folliculogenesis. At least four oocytes were transferred in each cycle. Results: No significant differences in gonadotropin dosage, total number of days of gonadotropins, age, number of prior pregnancies, years of infertility since last pregnancy, total number of eggs retrieved, mature residual oocytes, fertilization of mature residual oocytes, or primary etiology of infertility were observed between groups; however, estradiol concentrations were significantly higher in the group with elevated progesterone values (2573±216 pg/ml) compared to the lower progesterone group (1925±202 pg/ml,P=0.035) and the total number of oocytes transferred was greater in the high progesterone group (7.5±0.5) vs the low progesterone group (6.3±0.3,P<0.038).P ₄ concentrations 0.8 ng/ml were associated with significantly higher pregnancy rates (11/19; 57.9%) compared to progesterone concentrations >0.8 ng/ml (5/19, 26.3%;P=0.050). Conclusions: Premature luteinization may occur in luteal leuprolide acetate-down-regulated patients and progesterone values >0.8 ng/ml are associated with significantly lower pregnancy rates in GIFT cycles.     

Pregnancy complications,obstetric risks,and neonatal outcome in singleton and twin pregnancies after GIFT and IVF

Purpose In vitro fertilization (IVF) and to a lower extent gamete intra-fallopian transfer (GIFT) have become routine infertility treatments in industrialized countries. Our purpose is to compare the obstetric and neonatal characteristics of singleton and twin pregnancies after GIFT and IVF with those conceived spontaneously.Methods This case-control study was conducted in a tertiary care medical center. The 322 singleton and 78 twin pregnancies after GIFT or IVF from 1991 through 1996 were evaluated and compared with each other, and with a control group that conceived spontaneously and matched for parity, maternal and gestational age. Statistical significance of differences was assessed by ² test or two-tailed Fisher exact test. Continuous variables were compared by the paired t-test.Results Pregnancy-induced hypertension (PIH) and vaginal bleeding were significantly more frequent maternal complications in the GIFT/IVF singleton groups compared to controls. In twin pregnancies the rate of cesarean sections, vaginal bleeding and preterm labor were more common after GIFT/IVF but did not reach statistical significance. Assisted reproduction was associated with low birth weight only in twin pregnancies when controlled for confounding variables, however perinatal outcome was comparable. There was no significant difference in the outcome measures between GIFT and IVF pregnancies.Conclusion After controlling for parity, maternal and gestational age, singleton pregnancies conceived by GIFT/IVF are at increased obstetrical risk, however the perinatal outcome is comparable despite a lower average birth weight.     

The limitations of in vitro fertilization from males with severe oligospermia and abnormal sperm morphology

Thirty-one patients whose infertility was attributed to oligospermia were included for treatment by in vitro fertilization and embryo transfer. Three subgroups were defined: severe oligospermia (5 million motile sperm/ml), moderate oligospermia (6 to <12 million motile sperm/ml), and abnormal sperm morphology (>60% atypical). The fertilization rates were compared to those of a normospermic group managed concurrently. A modified overlay technique of sperm preparation is described for oligospermic samples so that the number of motile spermatozoa inseminated into each tube or culture dish containing a mature preovulatory oocyte was similar in each category, within the range 0.5 to 2×10⁵/ml. Significantly fewer oocytes were fertilized in the severe oligospermic group (P<0.001), suggesting a reduced capacity for fertilization by spermatozoa from severely oligospermic males. The fertilization rate of oocytes was normal in the moderate oligospermic group and those with abnormal morphology, although in the latter there was a significant delay noted in reaching the pronuclear stage (P<0.001), and the embryos were at a less advanced stage of cleavage at the time of transfer (0.001<P<0.01). Pregnancies were achieved in both the severe and the moderate oligospermic groups, with healthy infants delivered from each.     

Endocrine and ovarian parameters at various frequencies of ovulation in adolescents

Summary We assessed ovarian and endocrine function in 86 adolescents over a six month, period. Postmenstrual Estrone (E₁) and Estradiol-17 (E₂) levels, premenstrual FSH levels and pre-and postmenstrual LH, Testosterone (T) and Androstenedione (A) levels decreased as the frequency of ovulation increased, while premenstrual E₂, Progesterone (P) and 17-hydroxyprogesterone levels increased. Both right and left ovarian volume and the per cent of multifollicular ovaries decreased with an increase in the frequency of ovulation. In the premenstrual phase P values correlated significantly with frequency of ovulation for FSH (r=–0.43:P<0.001), LH (r=–0.36:P<0.01), T (r=–0.31:P<0.05) and A (r=–0.26:P<0.05). Our data suggest that in the postmenarcheal period the progressive loss of immature endocrine and ovarian characteristics (high LH, FSH, and androgen levels and enlarged, multifollicular ovaries) is linked to an increasing number of ovulations. Progesterone plays a major role in the development of cyclic function characteristic of adult maturity.     

Analysis of human spermatozoa before and after processing for in vitro fertilization

Washed incubated spermatozoa processed for in vitro fertilization were compared to the spermatozoa from the same unprocessed ejaculate in 31 randomly selected normal males (Group 1) and 7 subfertile moles (Group 2). In Group I there was a significant increase in motility (P=0.001) as well as a significant increase in normal morphology (P=0.001). All categories of morphologically abnormal sperm decreased, with a significant decrease in those exhibiting small heads (P=0.01), tapered heads (P=0.01), cytoplasmic droplets (P=0.001), bent midpieces (P=0.01), or coiled tails (P=0.02). There was also a significant decrease in immature germ cells (P=0.001) as well as white blood cells (P=0.02). Group 2 also showed a significant increase in motility (P=0.01). and a significant increase in normal morphology (P=0.01). There was a decrease in various categories of abnormal sperm, with a significant decrease in sperm with cytoplasmic droplets (P=0.02).     

Characteristics of Nigerian women taking sulfadoxine/pyrimethamine twice during pregnancy for the prevention of malaria

Objective

To investigate the characteristics of women in Nigeria who are likely to take sulfadoxine/pyrimethamine (SP) as recommended for the prevention of malaria in pregnancy to reduce maternal and child mortality rates.

Methods

A cross-sectional survey of 1380 women was conducted using a structured questionnaire. The women had given birth within 6 months prior to the survey and were drawn from 6 local government areas in Nigeria.

Results

Several demographic factors—older age bracket, ever attended school, currently living with a partner, ever married, and wealth—were significantly associated with compliance. Compliance was higher among respondents who had ever been married than among those who had never been married (χ² = 6.733; P = 0.006). Compliance was also higher among those in paid employment (χ² = 17.110; P < 0.001) and those in a higher wealth quintile (χ² = 34.861; P < 0.001). Knowledge of malaria, which included prevention of malaria in pregnancy through use of IPTp with 2 doses of SP, showed a positive association with compliance. Compliance with 2 doses of SP among those with good knowledge was higher (63.9%) than among those with poor knowledge (46.9%) (χ² = 26.981; P < 0.001).

Conclusion

The present findings could help in targeting health education programs to specific subgroups of women to increase compliance with the recommended 2 doses of SP for the prevention of malaria in pregnancy.     

The measurement of SUVmax of the primary tumor is predictive of prognosis for patients with endometrial cancer

Objective

The purpose of this study was to evaluate if preoperative measurements of the maximum standardized uptake valve (SUVmax) on positron emission tomography/computed tomography (PET/CT) and tumor marker CA125 are correlated with clinical characteristics and prognosis in patients with endometrial cancer.

Methods

The distribution of cases that scored positive for each of the biological parameters examined and the correlations with the SUVmax of the primary tumor and the serum tumor marker CA125 were examined for 106 patients with preoperative assessment of primary endometrial cancer.

Results

There were significant correlations between the SUVmax of the primary tumor and the FIGO stage (P = 0.030), histology (P = 0.025), depth of myometrial invasion (P = 0.031) and tumor maximum size (P < 0.001). The serum CA125 level was significantly associated with the FIGO stage (P = 0.050). The disease-free survival (DFS) and overall survival (OS) rates of patients exhibiting a high SUVmax of the primary tumor were significantly lower than those of patients exhibiting a low SUVmax of the primary tumor (P = 0.049, and P = 0.039, respectively). Furthermore, the DFS and OS rates of patients exhibiting a high SUVmax of the primary tumor were significantly lower than those of patients exhibiting a low SUVmax of the primary tumor at advanced stages (stages III–IV) (P = 0.032 and P = 0.023, respectively). In particular, the SUVmax of the primary tumor was an independent prognostic factor for OS by a multivariate analysis (P = 0.025).

Conclusions

The present findings indicate that for patients with endometrial cancer, a high preoperative SUVmax of the primary tumor is an important predictive factor for identifying endometrial cancer patients with a poor prognosis.     

Clinicopathologic significance of DNA mismatch repair protein defects and endometrial cancer in women 40years of age and younger

Background

The hereditary basis of endometrial cancer is apparent in young women with endometrial cancer. The objective of this study was to examine risk factors and outcomes in patients 40 years of age and younger with endometrial cancer.

Methods

We performed a retrospective cohort study of patients aged 40 years or less who were diagnosed with endometrial carcinoma between 1/93 and 5/08. Clinical and pathologic data were extracted from medical records. Paraffin-embedded slides from hysterectomy specimens were obtained and DNA mismatch repair (MMR) immunohistochemistry was performed. Cases were analyzed according to the presence of DNA MMR protein defects. Standard two-sided statistical tests were performed.

Results

Of the 56 identified patients, the median age was 36 years (range, 24–40). The majority of the endometrial carcinomas were of endometrioid histology (91%), stage I (71%), and FIGO grade 1 (59%). Abnormal DNA MMR was found in 9 cases (16%). Cases with abnormal DNA MMR had lower body mass index (BMI) (P = 0.05), and had a family history suggestive of Lynch syndrome (P = 0.001). Tumors were more likely to have advanced stage disease (P < 0.001), be high grade (P < 0.001), have deep myometrial invasion (P < 0.001), and have lymphovascular invasion (P = 0.002). Cases with abnormal DNA MMR had significantly worse overall survival (P = 0.028) and progression-free survival (P = 0.042).

Conclusions

Endometrial cancer is rare in women aged 40 years or less. In this group of patients, loss of DNA MMR was associated with lower BMI, worse clinicopathologic factors, and worse outcome. These results may have implications when young women diagnosed with endometrial cancer are counseled regarding prognosis.     

Vers une simplification de la technique de césarienne : suture péritonéale ou non ?

Objectives

To assess the postoperative morbidity of a technique for caesarean section without closing the visceral and parietal peritoneum.

Patients and methods

We conducted a prospective cohort study randomized 252 patients over a period of four months (from March 1 to June 30, 2009). We studied the early postoperative morbidity.

Results

Among the 252 patients, 137 were included in the group “with peritonisation” and 115 in the group “without peritonisation”. Clinical and hematology maternal characteristics were comparable in both groups. The duration of intervention was reduced significantly in the absence of peritonisation (31.1 instead of 41.4 minutes; P < 0.001). The postoperative pain was less but not significant between h0 and h12, however it is significant at h18, h24and h30 in the absence of peritonisation (respectively 2.37 versus 2.81; P = 0.030; 1.98 versus 2.37; P < 0.001 and 1.38 versus 1.72; P = 0.018). Resumption of transit was significantly faster “without peritonisation” (24.3 versus 24.7 hours; P < 0.001). However, there is no significant difference between the two groups as regards the immediate postoperative complications.

Conclusion

The absence of visceral and parietal peritoneum shortens the operative time and favors an earlier resumption of transit. It also decreases pain symptoms. We therefore recommend not to suture the parietal and visceral peritoneum during cesarean section.     

Identification of TP53 Gene Mutations in Uterine Corpus Cancer with Short Follow-up

The involvement of the TP53 tumor suppressor gene in uterine corpus cancer was investigated by single-stranded conformation polymorphism and sequence analysis of its exons 4 to 10. Mutations were found in 12 (18.5%) of 65 cases. Ten of these 12 were single-base substitutions (8 missense and 2 nonsense mutations), whereas 2 were frame-shifting mutations. TP53 gene mutations correlated significantly with advanced surgical stage of disease (P= 0.006) and unfavorable tumor histology types (P= 0.003), whereas the association to myometrial wall invasion did not reach statistical significance (P= 0.054). TP53 gene mutations also correlated significantly with allelic loss at TP53 locus (P= 0.024), absence of estrogen (P= 0.045) and progesterone receptors (P= 0.001), DNA nondiploidy (P= 0.002), and high S-phase fraction values (P= 0.002). Our results suggest that inactivation of the TP53 checkpoint function is associated with disease transition into a stage of rapid progression and spread.     

Emergency peripartum hysterectomy in a tertiary London hospital

Objective The objective was to review all emergency peripartum hysterectomies performed at a tertiary hospital in London, UK, and to identify the risk factors for emergency peripartum hysterectomy.Method A retrospective case control study. The cases consisted of all women who had emergency peripartum hysterectomy between 1 January 1993 and 31 December 2003. Controls were women who delivered immediately before and after the indexed case. Demographic data, medical and surgical histories, pregnancy, intrapartum and postpartum data were collected. Differences between cases and controls were compared with ², Fisher exact and Student t tests. Multiple logistic regression analysis was performed to identify independent risk factors for emergency peripartum hysterectomy.Results There were 15 cases of emergency peripartum hysterectomy in 31,079 deliveries, giving a rate of 0.48 per 1,000. Women who had emergency peripartum hysterectomy were significantly older (mean age 37 years vs. 29 years, P<0.001) and multiparous (P=0.02). More of the cases had a history of uterine surgery (67 vs. 30%, P=0.01), placenta praevia (60 vs. 3%, P<0.0001) and were delivered by caesarean section (86.7 vs. 30%, P=0.003). Eighty percent of the hysterectomies were performed in the daytime and all were done by consultants. Haemorrhage due to placenta praevia was the main indication for emergency peripartum hysterectomy (47%). Independent risk factors for emergency peripartum hysterectomy were older age (odds ratios [OR] 1.2, 95% confidence interval [95% CI] 1.2–1.6), multiparity (OR 2.6, 95% CI 1.3–10.2), history of previous caesarean section (OR 13.5, 95% CI 2.7–65.4), caesarean delivery in index pregnancy (OR 11.6, 95% CI 2.1–68.6) and caesarean delivery in index pregnancy for placenta praevia (OR 18, 95% CI 3.6–69).Conclusion Caesarean deliveries, especially repeat caesareans in women with placenta praevia, significantly increase the risk of emergency peripartum hysterectomy.     

Effect of the bone marrow derived-mononuclear stem cells transplantation in the growth, VEGF-R and TNF-alpha expression of endometrial implants in Wistar rats

Objective

To study the effect of bone marrow derived-mononuclear stem cells transplantation in the growth, VEGF-R and TNF-alpha expression of surgically induced endometriosis in an experimental model.

Study design

This is an experimental study conducted in the Center for Health and Biological Sciences at the Pontifical Catholic University of Parana, Brazil. Endometriotic implants were surgically induced in 120 female Wistar rats. The animals with viable endometrial implant (larger than 25 mm²) were randomically divided into 3 groups to receive an intraperitoneal injection of 0.2 cc of saline solution (C group; n = 30), a subcutaneous injection of 1 mg/kg of leuprolide (L group; n = 34), or an intraperitoneal injection of 5 × 10⁶ bone marrow derived-mononuclear stem cells (SC group; n = 36). They were sacrificed after 21 days to assess the implants’ size and the tissue expression of vascular endothelial growth factor receptor (VEGF-R) and tumor necrosis factor-alpha (TNF-alpha).

Results

Treatment with leuprolide decreased the surface area of the endometriotic implant compared to the SC group and the C group. The absolute reduction in the surface area of the implant was 16.5 mm, 0 mm, and 0 mm (p = 0.007), respectively, and the percent reduction was 40.2%, 0%, and 0% (p = 0.001). VEGF-R expression in the endometriotic implant decreased after treatment in the L and SC groups compared to the C group (409.6 μm² vs. 465 μm² vs. 920.9 μm², respectively; p = 0.021). TNF-alpha expression also reduced in the L and SC groups compared to the C group (585.7 μm² vs. 549.3 μm² vs. 2402.1 μm², respectively; p < 0.001).

Conclusion

Bone marrow derived-mononuclear stem cells transplantation decreased the expression of VEGF-R and TNF-alpha in the endometriotic implant but did not reduce the surface area of the lesion.     

Predictive value of intra-amniotic and serum markers for inflammatory lesions of preterm placenta

Objective

To compare the relative predictive values of amniotic fluid (AF) matrix metalloproteinase-9 (MMP-9), interleukin-6 (IL-6), and serum C-reactive protein (CRP) for histologic chorioamnionitis and intra-amniotic infection in women with preterm labor or preterm premature rupture of membranes (PROM).

Study design

This retrospective cohort study included 99 consecutive women with preterm labor or preterm PROM (21–35 weeks’ gestation) who delivered within 72 h of transabdominal amniocentesis. The AF was cultured for aerobic and anaerobic bacteria and for genital mycoplasmas and was assayed for MMP-9 and IL-6 levels. Maternal serum CRP was measured immediately after amniocentesis. The placentas were examined histologically.

Main outcome measures

histologic chorioamnionitis and intra-amniotic infection.

Results

The prevalence of histologic chorioamnionitis and a positive AF culture was 44% (44/99) and 28% (28/99), respectively. In predicting intra-amniotic infection, AF MMP-9 had a significantly higher area under the curve (AUC: 0.94 [95% CI, 0.87–0.98]) than AF IL-6 (0.87 [95% CI, 0.78–0.84]; P < 0.05) and serum CRP (0.76 [95% CI, 0.66–0.84]; P < 0.001) and a higher sensitivity and specificity than serum CRP (P < 0.01, respectively). However, in predicting histologic chorioamnionitis, there were no significant differences in AUCs among the three tests (AF MMP-9: 0.78 [95% CI, 0.68–0.85]; AF IL-6: 0.76 [95% CI, 0.66–0.84]; serum CRP: 0.76 [95% CI, 0.66–0.84]). In a sub-analysis of 71 women without intra-amniotic infection, histologic chorioamnionitis was associated with an elevated serum CRP level (P < 0.05), but not with the level of AF IL-6 or MMP-9 (P = 0.232 and P = 0.402, respectively).

Conclusions

The AF MMP-9 has a better overall diagnostic performance than the AF IL-6 and maternal serum CRP in predicting intra-amniotic infection. However, the serum CRP level obtained up to 72 h before delivery appears to be an important marker for early identification of histologic chorioamnionitis in women without intra-amniotic infection.     

Total laparoscopic hysterectomy versus total abdominal hysterectomy in the treatment of benign gynaecological disease: a retrospective review over 5 years

Hysterectomy remains one of the most common gynaecological procedures performed in the UK. However, unlike other parts of Europe and America, where laparoscopic hysterectomy (LH) rates have significantly increased, in the UK, abdominal hysterectomy (AH) rates remain high and often the first choice for many surgeons. The minimal access route offers significant patient benefits over open surgery, and the purpose of this study was to evaluate the role of total laparoscopic hysterectomy (TLH) versus total abdominal hysterectomy (TAH) in the management of benign gynaecological conditions. This retrospective study was carried out over a 5-year period, and 296 procedures were included. Outcome measures included operating time, estimated blood loss (EBL), intraoperative and postoperative complications, postoperative analgesia requirements and length of hospital stay. TLH was associated with a significantly lower mean operating time (63.4 versus 75.3 min, P = <0.001) and reduced EBL (145.1 versus 277.0 ml, P = <0.001). Intraoperative complications were significantly less in the TLH group (1.9 versus 7.0 %, P = 0.029) with no ureteric injuries noted. Postoperative complications were also lower (6.8 versus 15.6 %, P = 0.016). TLH was also associated with significantly less analgesia requirements, with fewer requiring breakthrough analgesia (6.2 versus 26.6 %, P = <0.001), and a significantly shorter inpatient hospital stay (1.7 versus 3.0 days, P = <0.001). The results from our study highlight that TLH is superior to TAH in all operative outcome measures. With adequate training and experience, TLH is a safe, reproducible technique that should be offered to all women requiring a hysterectomy for a normal sized uterus in the absence of significant adhesions.     

Serum inhibin B correlates with successful ovulation in infertile women

Purpose : To investigate whether inhibin B and activin A serum and follicular fluid levels in infertile women undergoing induction of superovulation correlate with successful ovulation. Methods : Infertile women (n = 16) (30–43 years of age) undergoing induction of superovulation for assisted reproduction were studied. A blood sample was collected before and days 3, 8, and 12 during the induction of superovulation. A follicular fluid sample at the time of ovarian pick up was also collected. Serum and follicular fluid were assayed for inhibin B, activin A, and estradiol. Results : According to the successful follicular development women were divided in two groups: (A) responders (n = 10) and (B) poor responders (n = 6). Women of group A showed mean follicular fluid inhibin B levels higher than in group B (P = 0.001), while no significant difference for activin A levels was found. During induction of superovulation serum activin A levels did not change in both groups of women, while inhibin B and estradiol levels significantly increase only in responder women (P < 0.001). Serum inhibin B and estradiol levels correlated with follicles developed 10 mm (P = 0.000). Conclusions : Serum inhibin B is an effective marker of follicular development in infertile women undergoing induction of superovulation, and may represent a further marker for ovarian follicular capacity.     

A 5-day educational program for teaching cervical cancer screening using visual inspection with acetic acid in low-resource settings

Objective

To assess the effectiveness of an educational program in visual inspection with acetic acid (VIA) for cervical cancer screening among healthcare providers in 2 low-resource countries.

Methods

A cohort of multidisciplinary healthcare workers in Uganda and El Salvador were recruited to the study. A pretest was administered before the intervention of a 5-day educational program on VIA. A posttest was performed immediately after the educational program and again at a 6-month follow-up visit to assess retention of knowledge.

Results

In total, 42 (93%) of the healthcare workers who participated in the educational program completed the initial posttest evaluation, and 18 (40%) healthcare workers completed the 6-month follow-up evaluation. Mean test scores increased after participation in the training session (62% versus 81%; P < 0.001). The self-reported comfort level for identifying cellular abnormalities also increased (2.1 versus 3.3; P < 0.001). At 6-month follow-up, the mean test score remained higher than pretest scores (79% versus 57%; P < 0.001). There was no significant difference in the initial and 6-month posttest scores (80% versus 79%; P = 0.20).

Conclusion

The educational program in VIA provided healthcare workers with the tools potentially to decrease the morbidity and mortality of cervical cancer in the 2 low-resource countries.     

Comparison of the effect between pioglitazone and metformin in treating patients with PCOS:a meta-analysis

Background

Pioglitazone was used to treat patients of PCOS in many researches, but the treatment has not been recognized by public or recommended by all the guidelines.

Method

We conducted a meta-analysis of the related literatures to objectively evaluate the clinical effectiveness and safety by comparing pioglitazone with metformin administrated by PCOS patients. Searches were performed in Cochrane Library, EMBASE and PubMed (last updated December 2016).

Results

Eleven studies among 486 related articles were identified through searches. Fixed effects and random effects models were used to calculate the overall risk estimates. The results of the meta-analysis suggest that improvement of the menstrual cycle and ovulation in pioglitazone treatment group was better than metformin group [OR = 2.31, 95% CI (1.37, 3.91), P < 0.001, I ² = 41.8%]. Improvement of the F-G scores in metformin treatment group was better than pioglitazone group [SMD = 0.29, 95% CI (0.0, 0.59), P = 0.048, I ² = 0.0%]. BMI was more elevated in pioglitazone group than in metformin group [SMD = 0.83, 95% CI (0.24, 1.41), P = 0.006, I ² = 82.8%]. There were no significant differences of the other data between the two groups.

Conclusions

This meta-analysis indicated that pioglitazone ameliorated menstrual cycle and ovulation better than metformin and metformin ameliorated BMI and F-G scores better than pioglitazone in treating patients with PCOS. Pioglitazone might be a good choice for the patients with PCOS who were intolerant or invalid to metformin for the treatment.

     

Immunohistochemical expression of inhibin-alpha in human endometrium and the in vitro secretion of inhibin,estradiol and cortisol in cultured human endometrial glandular cells

Background Inhibins are multipotent dimeric glycoproteins, composed of an -subunit and one of two possible -subunits (_A or _B). Aims of this study were (a): the immunohistochemical characterisation of normal human endometrium for the inhibin- subunit; (b) the assessment of the secretion and metabolism of inhibin, E₂ and cortisol; (c) the evaluation of any relationship between these three substances in cell culture medium of isolated and cultivated normal human endometrial glandular cells.Materials and methods Samples of human endometrium were obtained from 34 premenopausal patients. Nineteen endometrial specimen (proliferative [PP] n=8; early secretory [ES] n=7; late secretory phase [LS] n=4) were brought into cell culture. Fifteen endometrial specimen (PP n=5; ES n=5; LS n=5) were paraffin-fixed and used for the immunohistochemical analysis for inhibin-. Stromal and epithelial cells were separated by collagenase digestions, filtrations, sedimentations and Ficoll-gradient centrifugation. E₂ and cortisol were measured with radioimmunoassay (RIA) and inhibin with enzyme-immunoassay (EIA). Statistical analysis was performed with the non-parametric Mann-Whitney rank-sum test and linear regression analysis.Results Inhibin- showed a weak (positive) expression during proliferative phase, which increased significantly as the menstrual cycle continued. In secretory glands the mean inhibin concentration was higher than that from proliferative samples. A significant correlation was observed between inhibin and E₂ (p<0.001) as well as cortisol and inhibin (p<0.0001) in glands from proliferative phase. Between inhibin and E₂ (p<0.05) as well as inhibin and cortisol (p<0.002) a significant correlation in early secretory glands was also noted. In late secretory phase inhibin and E₂ (r²=0.78650; p<0.0001), inhibin and cortisol (r²=0.58326; p<0.001) and E₂ and cortisol (r²=0.52880; p<0.001) showed a significant correlation.Discussion In conclusion, we found a cyclical expression of inhibin- subunit in the endometrium demonstrated by immunohistochemical means. A higher in vitro secretion of inhibin from secretory glands was also observed. In addition, a significant correlation between inhibin with E₂ and cortisol in PP and ES glands and a significant correlation between inhibin, E₂ and cortisol in LS glands could also be demonstrated. We conclude that inhibin can be associated with E₂ and cortisol metabolism, playing an important role in paracrine/autocrine mechanisms in the endometrium and possibly exerting its function through cortisol and E₂. The cortisol concentration also correlates with E₂, suggesting a link between these steroids in the endometrial function. The correlation of inhibin, E₂ and cortisol suggest complex autocrine/ paracrine mechanisms in human endometrial glands, modulated and controlled by all these three substances.I. Mylonas and U. Jeschke contributed equally to this work     

The relationship between maternal serum prenatal screening combined with epidemiological study and early onset preeclampsia

Objective

To explore the major risk factors and early prediction methods in the pathogenesis of early onset preeclampsia through combining prenatal screening markers and epidemiological characteristics.

Methods

Prenatal screening was performed in second trimester using enzyme-linked immunosorbent assay in 1,011 gravidas and epidemiological correlation factors were got by telephone with prospective cohort study. Predictive model of early onset preeclampsia was established and evaluated by single and multiple factor logistic analysis in 30 cases of preeclampsia and 867 cases of normal gravidas.

Results

As compared with the control group, the maternal serum level of human chorionic gonadotropin (hCG) in second trimester of patients with early onset preeclampsia elevated significantly (P < 0.001). Pregestational BMI ≥ 24 kg/m² (OR = 3.649, 95 % CI 1.600–8.321, P = 0.002), history of hypertension, diabetes and nephritis (OR = 55.724, 95 % CI 8.223–377.614, P < 0.001), family history of hypertension (OR = 6.777, 95 % CI 2.917–15.742, P < 0.001), and risk coefficient for trisomy 21 (OR = 3.688, 95 % CI 1.013–13.429, P = 0.048) were major risk factors of early onset preeclampsia. The sensitivity and specificity of predictive model were 70.0 and 75.1 %, when cutoff point was 0.249. The diagnostic accuracy of the logistic model was better than hCG.

Conclusions

In order to early prevent the onset and development of EOPE, it is necessary to strengthen pregestational and prenatal care for women in these aspects including pregestational BMI ≥?24 kg/m², history of hypertension, diabetes, nephritis, family history of hypertension, and high risk for trisomy 21 syndrom.