Impaired Gremlin 1 (GREM1) expression in cumulus cells in young women with diminished ovarian reserve (DOR)

Purpose  

A symbiotic relationship between ovarian granulosa cells (GC) and the developing oocyte is critical. Genetic modulations in GC’s can lead to reproductive insufficiency, highlighting the role of GC’s in reproductive competence. Utilizing gene expression analyses in cumulus GC’s, we attempt to enhance our understanding of mechanisms that may contribute to poor reproductive capacity in young women with diminished ovarian reserve (DOR).     

Changes in Sexual Function of Women with Refractory Interstitial Cystitis/Bladder Pain Syndrome after Intravesical Therapy with a Hyaluronic Acid Solution

IntroductionIntravesical instillation with a hyaluronic acid (HA) solution is an effective treatment for interstitial cystitis/bladder pain syndrome (IC/BPS), but its impact on sexual functioning of patients is not known.AimThe aim of this study was to evaluate the changes in sexual function of women with refractory IC/BPS who underwent a second‐line intravesical HA therapy.MethodsA total of 103 women diagnosed with refractory IC/BPS were enrolled in this prospective, multicenter study. Sexual function was evaluated using the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ‐9). Bladder‐related symptoms and bother were assessed by the Interstitial Cystitis Symptom Index (ICSI) and Interstitial Cystitis Problem Index (ICPI), and a pain visual analog scale (VAS), respectively. Data were analyzed with univariate methods or multivariate logistic regression analysis accordingly.Main Outcomes MeasuresChanges in PISQ‐9, ICSI, ICPI, and pain VAS scores after treatment were assessed.ResultsMean age and duration of symptoms was 43.6 ± 11.8 and 5.1 ± 5.0 years, respectively. ICSI, ICPI, and pain VAS scores were significantly (P < 0.001) improved after 1 month and 6 months of treatment. Of the 87 (84.5%) sexually active women evaluated, PISQ‐9 total scores improved significantly (P < 0.001) from the baseline (mean 18.9 ± 6.4), after 1 month (20.4 ± 5.8), and 6‐months (21.5 ± 5.6) of treatment. Significantly improved PISQ‐9 items included “dyspareunia” (P < 0.001) and “negative reactions” (P = 0.015) during sexual intercourse, and “intensity” (P < 0.001) of sexual orgasms. After a logistic regression analysis, we found that a baseline PISQ‐9 score was negatively correlated with the duration of IC/BPS symptoms (P = 0.022). Meanwhile, the changes in PISQ‐9 scores were positively correlated with the reduction in ICSI scores after treatment (P = 0.045).ConclusionsIntravesical HA is an effective treatment for refractory IC/BPS. A longer duration of IC/BPS symptoms may be a predictor of poor sexual function. However, intravesical HA may improve sexual function along with the reduction of IC/BPS symptoms. Hung MJ, Su TH, Lin YH, Huang WC, Lin TY, Hsu CS, Chuang FC, Tsai CP, Shen PS, and Chen GD. Changes in sexual function of women with refractory interstitial cystitis/bladder pain syndrome after intravesical therapy with a hyaluronic acid solution. J Sex Med 2014;11:2256–2263.     

对输卵管妊娠术后发生持续性异位妊娠的探讨

目的探讨持续性异位妊娠发生的原因及预防措施。方法分析3年内因输卵管妊娠进行开腹或腹腔镜手术治疗496例患者的临床资料。结果 17例发生持续性异位妊娠。其中保守性手术后、保守性手术及术后药物治疗和根治性手术后持续性异位妊娠的发生率分别为7.78%、1.11%、0.74%。停经周数、术前血HCG水平和治疗方式与持续性异位妊娠发生密切相关。结论输卵管妊娠保守性手术后预防性应用药物治疗能明显降低持续性异位妊娠的发生率。     

复发性流产与男性精液常规及动态的相关性研究

目的探讨复发性流产与男性精液常规及动态的相关性。方法严格按照WHO技术规范,对我中心56例复发性流产患者丈夫精液做常规检查及动态分析,并设立正常对照组。结果精液检查统计分析结果表明复发性流产患者丈夫精液畸形精子指数明显高于正常对照组。精子的运动速度及前向性低于正常对照组。结论复发性流产者,其中一部分可能由于畸形精子指数高及精子运动参数异常导致。     

Preoperative determinants for failure of transobturator tapes in the management of female urodynamic stress incontinence

Objectives

To determine significant preoperative risk factors for failure of transobturator tapes.

Methods

Secondary analysis of data from the E-TOT (Evaluation of Transobturator Tapes) study. Patient-reported outcomes (n = 310) and objective outcomes (n = 297) were analyzed using univariate and multivariate analyses.

Results

On univariate analysis, body mass index (BMI) ≥  35, maximum urethral closure pressure (MUCP) ≤ 30 cm H₂O, preoperative mixed incontinence on urodynamics, history of at least one previous incontinence procedure, and preoperative symptoms of urgency, nocturia, or urgency incontinence were associated with failure. On multivariate regression, BMI ≥ 35 (OR 6.37; 95% CI, 1.73-23.44; P = 0.005), nocturia (OR 2.18; 95% CI, 1.04-4.58; P = 0.039), urgency incontinence (OR 3.35; 95% CI, 1.07-10.51; P = 0.039), and previous incontinence surgery (OR 2.33; 95%CI, 1.1-5.48; P = 0.048) were independently associated with patient-reported failure. MUCP ≤ 30 cm H₂O (OR 7.06; 95% CI, 2.85-17.48; P < 0.001) and previous incontinence procedure (OR 6.22; 95%CI, 2.34-16.52; P < 0.001) were independently associated with objective failure.

Conclusion

History of previous incontinence surgery was the only independent risk factor for failure of transobturator tapes based on both the patient-reported and objective outcome.     

Transperineal ultrasound imaging of the pelvic floor muscles in women with pelvic floor dysfunction symptoms: A cross-sectional study

Objective

Transperineal ultrasound (TPUS) assessment of the pelvic floor muscle (morphological and dynamic function) in women with pelvic floor dysfunction symptoms.

玻璃化冷冻保存对小鼠卵巢组织的影响

目的探讨玻璃化冷冻保存对小鼠卵巢组织内卵泡形态及卵巢组织激素分泌功能的影响。方法将23只4周龄ICR雌鼠随机分为新鲜卵巢组、去势组和玻璃化冷冻组，应用乙二醇（EG）和二甲基亚砜（DMSO）玻璃化冷冻小鼠卵巢组织。冷冻前后取部分小鼠卵巢组织行组织学观察；同时将部分新鲜和复苏组织自体移植入小鼠肾被膜下。移植术后5d开始观察小鼠的动情周期，术后30d测定小鼠血清雌激素浓度。结果冻融卵巢组织内存活的原始卵泡和初级卵泡与新鲜组织无显著差异（P〉0．05）；而次级卵泡的存活率显著下降（P〈0．01）。移植术后玻璃化冷冻组和新鲜卵巢组小鼠均出现动情周期，两组动情周期出现时间无明显差异（P〉0．05）。移植术后第30天两组小鼠血清雌激素浓度无显著差异（P〉0．05）。结论玻璃化冷冻法可以较好地保存小鼠卵巢组织内的原始卵泡和初级卵泡，且不影响卵巢组织的激素分泌。     

Hepatitis A and hepatitis B vaccination coverage among adults with chronic liver disease

BackgroundInfection with hepatitis A and hepatitis B virus can increase the risk of morbidity and mortality in persons with chronic liver disease (CLD). The Advisory Committee on Immunization Practices recommends hepatitis A (HepA) and hepatitis B (HepB) vaccination for persons with CLD.MethodsData from the 2014 and 2015 National Health Interview Surveys (NHIS), nationally representative, in-person interview surveys of the non-institutionalized US civilian population, were used to assess self-reported HepA (≥1 and ≥2 doses) and HepB vaccination (≥1 and ≥3 doses) coverage among adults who reported a chronic or long-term liver condition. Multivariable logistic regression was used to identify factors independently associated with HepA and HepB vaccination among adults with CLD.ResultsOverall, 19.4% and 11.5% of adults aged ≥ 18 years with CLD reported receiving ≥1 dose and ≥2 doses of HepA vaccine, respectively, compared with 14.7% and 9.1% of adults without CLD (p < .05 comparing those with and without CLD, ≥1dose). Age, education, geographic region, and international travel were associated with receipt of ≥2 doses HepA vaccine among adults with CLD. Overall, 35.7% and 29.1% of adults with CLD reported receiving ≥1 dose and ≥3 doses of HepB vaccine, respectively, compared with 30.2% and 24.7% of adults without CLD (p < .05 comparing those with and without CLD, ≥1 dose). Age, education, and receipt of influenza vaccination in the past 12 months were associated with receipt of ≥3 doses HepB vaccine among adults with CLD. Among adults with CLD and ≥10 provider visits, only 13.8% and 35.3% had received ≥2 doses HepA and ≥3 doses HepB vaccine, respectively.ConclusionsHepA and HepB vaccination among adults with CLD is suboptimal and missed opportunities to vaccinate occurred. Providers should adhere to recommendations to vaccinate persons with CLD to increase vaccination among this population.