EMs生育指数对Ⅲ～Ⅳ期EMs合并不孕术后非ART妊娠结局的预测价值

目的:探讨子宫内膜异位症生育指数(EFI)对中重度(Ⅲ~Ⅳ期)子宫内膜异位症(EMs)相关不孕术后非辅助生殖技术(ART)妊娠结局的预测价值。方法:回顾性分析北京大学深圳医院2011年1月—2012年12月行腹腔镜手术治疗的Ⅲ~Ⅳ期EMs合并不孕患者48例,按照EFI评分标准进行评分,随访其妊娠结局。结果:48例患者术后2年累积非ART妊娠25例(52.1%),术后6个月非ART妊娠20例(41.7%),术后7~12个月非ART妊娠4例(8.3%),术后13~24个月非ART妊娠1例(2.1%),随访不同时间段非ART妊娠率差异有统计学意义(χ2=30.301,P=0.000)。术后2年累积非ART妊娠率与EFI评分及术后是否使用促排卵治疗有关(P0.05),而与r-AFS分期无关(P0.05)。EFI评分的受试者工作特征(ROC)曲线下面积(AUC)为0.681(95%CI:0.527~0.834,P=0.033)。通过ROC曲线确定的EFI预测术后2年内非ART妊娠的临界值为5.5分(约登指数最大),其预测的敏感度为85.2%,特异度为42.9%。结论:EFI对于中重度EMs合并不孕患者术后非ART妊娠率有较好的预测价值。     

Scar Ectopic Pregnancy

Scar ectopic pregnancy is the rarest form of ectopic pregnancy and has been increasingly diagnosed all over the world. This is a life-threatening form of abnormal implantation of embryo within the myometrium and fibrous tissues in a previous scar on the uterus, especially following caesarean section. With the increasing rate of caesarean section, there is a substantial increase in this condition with better understanding of this disease. The early and accurate diagnosis with timely management can prevent pregnancy complications such as haemorrhage, uterine rupture and can preserve fertility.     

妇科恶性肿瘤患者保留生育功能的治疗要点

宫颈癌、卵巢癌和子宫内膜癌是妇科常见的三大恶性肿瘤,目前发病越来越年轻化,保留生育功能的治疗越来越受到重视。这需要我们正确理解妇科恶性肿瘤保留生育功能治疗的内涵,掌握治疗方法,把握治疗的适应证,本文从以上几点简述了妇科常见恶性肿瘤治疗要点,同时做到早期诊断、早期治疗以及正确认识癌前病变,是临床工作中的重点,我们也将会取得更大的成功。     

Lifespan extension and increased resistance to environmental stressors by N-Acetyl-L-Cysteine in Caenorhabditis elegans

OBJECTIVE:

This study was performed to determine the effect of N-acetyl-L-cysteine, a modified sulfur-containing amino acid that acts as a strong cellular antioxidant, on the response to environmental stressors and on aging in C. elegans.

METHOD:

The survival of worms under oxidative stress conditions induced by paraquat was evaluated with and without in vivo N-acetyl-L-cysteine treatment. The effect of N-acetyl-L-cysteine on the response to other environmental stressors, including heat stress and ultraviolet irradiation (UV), was also monitored. To investigate the effect on aging, we examined changes in lifespan, fertility, and expression of age-related biomarkers in C. elegans after N-acetyl-L-cysteine treatment.

RESULTS:

Dietary N-acetyl-L-cysteine supplementation significantly increased resistance to oxidative stress, heat stress, and UV irradiation in C. elegans. In addition, N-acetyl-L-cysteine supplementation significantly extended both the mean and maximum lifespan of C. elegans. The mean lifespan was extended by up to 30.5% with 5 mM N-acetyl-L-cysteine treatment, and the maximum lifespan was increased by 8 days. N-acetyl-L-cysteine supplementation also increased the total number of progeny produced and extended the gravid period of C. elegans. The green fluorescent protein reporter assay revealed that expression of the stress-responsive genes, sod-3 and hsp-16.2, increased significantly following N-acetyl-L-cysteine treatment.

CONCLUSION:

N-acetyl-L-cysteine supplementation confers a longevity phenotype in C. elegans, possibly through increased resistance to environmental stressors.     

宫腔镜治疗子宫中隔的疗效分析

目的探讨官腔镜治疗子宫中隔的效果。方法回顾性分析2003年1月～2011年10月114例官腔镜子宫中隔切除术（transcervical resection of septa,TCRS）的临床资料,随访其妊娠结局。结果官腔镜手术42．1％（48／114）B超监测完成,57．9％（66／114）在腹腔镜监测下完成。50．9％（58／114）术后放置官内节育器（IUD）。无子宫穿孔、出血等并发症。术后随访率92．1％（105／114）,随访时间6—96个月,（24．8±18．2）月。无宫腔粘连发生。术后妊娠率57．1％（60／105）,活产率49．5％（52／105）,自然流产率13．3％（8／60）。有自然流产史者术后妊娠率60．0％（24／40）,再次流产率12．5％（3／24）;有不孕史者术后妊娠率56．3％（27／48）,其中自然妊娠率39．6％（19／48）,体外受精一胚胎移植（IVF．ET）率16．7％（8／48）。术中放置IUD者术后妊娠率50．0％（26／52）,未放IUD者妊娠率64．2％（34／53）,差异无显著性（,：2．146,P=0．143）。结论宫腔镜子宫中隔切除术安全有效,不孕及有自然流产史的患者多可获得满意的妊娠结局。     

卵巢肿瘤保守性手术后IVF助孕的安全性和有效性

随着卵巢肿瘤筛查的普及和诊治水平的提高,早期诊断和治疗提高了该类患者的生存期以及生活质量,同时也让更多年轻的卵巢肿瘤患者保留了生育的机会。然而,由于手术及放、化疗等原因,部分卵巢肿瘤患者术后常常出现不孕,需要寻求辅助生殖技术助孕治疗。本文结合国内外相关文献及病例报道,对卵巢肿瘤患者术后体外受精(IVF)的时机、方案及安全性和有效性等方面进行总结和综述。     

Multivariate Cholesky Models of Human Female Fertility Patterns in the NLSY

Substantial evidence now exists that variables measuring or correlated with human fertility outcomes have a heritable component. In this study, we define a series of age-sequenced fertility variables, and fit multivariate models to account for underlying shared genetic and environmental sources of variance. We make predictions based on a theory developed by Udry [(1996) Biosocial models of low-fertility societies. In: Casterline, JB, Lee RD, Foote KA (eds) Fertility in the United States: new patterns, new theories. The Population Council, New York] suggesting that biological/genetic motivations can be more easily realized and measured in settings in which fertility choices are available. Udry’s theory, along with principles from molecular genetics and certain tenets of life history theory, allow us to make specific predictions about biometrical patterns across age. Consistent with predictions, our results suggest that there are different sources of genetic influence on fertility variance at early compared to later ages, but that there is only one source of shared environmental influence that occurs at early ages. These patterns are suggestive of the types of gene–gene and gene–environment interactions for which we must account to better understand individual differences in fertility outcomes. Edited by John Hewitt and Wendy Slutske     

Potent effect of KISS1-54 DNA vaccine compared with KISS1-10 DNA vaccine in inhibiting the fertility of female rats

BackgroundMost studies on immunocastration currently focused on male animals. However, immunization of male animals does not completely inhibit sexual behavior and fertility. This study aimed to compare the immunocastration effect of KISS1 DNA vaccines encoding different lengths of kisspeptins in female rats for effective castration effects on both male and female rats.MethodsFifteen female rats were randomly divided into three groups. The rats in T1 group or T2 group was orally given respectively KISS1-54 or KISS1-10 DNA vaccines with fused tPA signal peptide, and the control group (Group C) was orally administered with empty vector vaccine, at a dose of 5 × 10⁹ CFU/rat at weeks 0, 3 and 6 of the study. Blood samples were collected by retroorbital bleeding before primary immunization and at weeks 3 and 9 after primary immunization.ResultsBoth KISS1-54 and KISS1-10 DNA vaccines induced the body’s humoral immune response, and the anti-kisspeptin antibody titres in the T1 group were significantly higher than that in T2 and C groups (p < 0.05). The rats in T1 group has lower serum kisspeptin and estradiol levels than those in T2 and C groups and smaller litter size of rats than those in the control group after mating (p < 0.05). No significant difference was observed between T2 and C groups. The levels of KISS1 and GPR54 mRNA in the hypothalamus and ovaries of the T1 group were significantly lower than that in control group. However, the levels of KISS1 mRNA in the T2 group were significantly lower than that in the control group only in ovaries (p < 0.05).ConclusionThe oral KISS1-54 DNA vaccine with fused tPA signal peptide was more effective than that KISS1-10 DNA vaccine in suppressing fertility of female rats.     

Predictors of ovarian malignancy in children: Overcoming clinical barriers of ovarian preservation

Background/Purpose

Ovarian preservation is desirable in girls with benign ovarian masses. We aimed to 1) identify clinical predictors of malignant ovarian masses, 2) investigate how often ovarian tissue is present to preserve in benign masses, and 3) identify factors associated with successful ovarian preservation.

Methods

Retrospective analysis (1997–2012) of girls age 1–18 years with an ovarian mass managed operatively. Data on presenting symptoms, imaging, biochemical markers, treatment, outcome, and pathology were extracted.

Results

We identified 150 patients. Large mass size, solid components, and elevated tumor markers (AFP, βHCG, and/or LDH) were significantly predictive of malignancy. All masses < 10 cm, predominantly cystic, and with negative tumor markers were benign. Masses with all three of these characteristics would decrease a 20% malignancy pretest probability to a posttest probability of 0.25%. Benign masses managed by oophorectomy contained normal ovarian tissue in 76% of the specimens. For benign masses, successful ovarian preservation was significantly associated with size < 10 cm, predominantly cystic, laparoscopy, and absence of torsion or calcifications.

Conclusion

Ovarian masses that are < 10 cm, primarily cystic, and have negative tumor markers are most likely benign. Viable ovarian tissue is frequently present in benign masses, so significant efforts should be made for ovarian preservation.