Gynecological Endocrinology最新文献

Background: Gestational diabetes mellitus (GDM) is globally recognized as a significant pregnancy-related condition, contributing to complex complications for both mothers and infants. Traditional glucose tolerance tests lack the ability to identify the risk of GDM in early pregnancy, hindering effective prevention and timely intervention during the initial stages.

Objective: The primary objective of this study is to pinpoint potential risk factors for GDM and develop an early GDM risk prediction model using neural networks to facilitate GDM screening in early pregnancy.

Methods: Initially, we employed statistical tests and models, including univariate and multivariate logistic regression, to identify 14 potential risk factors. Subsequently, we applied various resampling techniques alongside a multi-layer perceptron (MLP). Finally, we evaluated and compared the classification performances of the constructed models using various metric indicators.

Results: As a result, we identified several factors in early pregnancy significantly associated with GDM (p < 0.05), including BMI, age of menarche, age, higher education, folic acid supplementation, family history of diabetes mellitus, HGB, WBC, PLT, Scr, HBsAg, ALT, ALB, and TBIL. Employing the multivariate logistic model as the baseline achieved an accuracy and AUC of 0.777. In comparison, the MLP-based model using NearMiss exhibited strong predictive performance, achieving scores of 0.943 in AUC and 0.884 in accuracy.

Conclusions: In this study, we proposed an innovative interpretable early GDM risk prediction model based on MLP. This model is designed to offer assistance in estimating the risk of GDM in early pregnancy, enabling proactive prevention and timely intervention.

Thyroid gland size increases during pregnancy due to physiological changes. 2-3% of pregnancies, a thyroid nodule (TN) may either newly develop or an existing one may increase in size. Factors such as age, parity, and iodine status can influence the development of TN. Surveillance of TN in pregnancy is essentially similar to that of the general population as it is contraindicated. Fine needle aspiration cytology (FNAC) can be delayed until after delivery unless malignancy is suspected. Surgery is reserved for severe cases, those with rapid growth, or those with suspicious features. Surgery is typically performed during the second trimester. Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer during pregnancy, which ranks second among cancers affecting pregnant women. Given the challenges involved, the prognosis is still favorable, have minimal impact on survival rates or recurrence. Treatment guidelines suggest regular monitoring of TSH and thyroid ultrasound (TUS), ensuring careful management of TC, especially in cases of aggressive.

This study evaluated whether intramuscular human chorionic gonadotropin (HCG) administration before endometrial transformation improves outcomes in frozen-thawed embryo transfer (FET) cycles pretreated with gonadotrophin-releasing hormone agonist (GnRH-a). We retrospectively analyzed 579 GnRH-a down-regulated hormone replacement FET cycles. Patients were divided into an HCG group (n=299 cycles, received HCG) and a control group (n=280 cycles, no HCG).The HCG group demonstrated significantly higher clinical pregnancy rates (58.5% vs. 49.3%, p<0.05) and embryo implantation rates (53.0% vs. 42.2%, p<0.05) compared to controls. Subgroup analysis showed HCG significantly increased clinical pregnancy rates in blastocyst transfer cycles (63.7% vs. 52.8%, p<0.05) but not in cleavage-stage transfers (52.5% vs. 43.3%, p>0.05). Multivariate logistic regression, adjusting for confounders, identified HCG administration as an independent factor positively associated with clinical pregnancy (OR = 1.751, 95% CI = 1.227-2.500, p=0.002).Administering intramuscular HCG before endometrial transformation in FET cycles pretreated with GnRH-a may improve  clinical pregnancy rate and embryo implantation rate.

Introduction: The clinical study aimed to evaluate the levels of serum kisspeptin, NKB, and GABA in Chinese patients with polycystic ovary syndrome (PCOS) and explore their association with hormonal profiles, as well as the relationship between these levels in PCOS patients and controls.

Methods: From December 2022 to December 2023, medical records of 60 individuals diagnosed with PCOS and 32 healthy subjects were obtained. Serum kisspeptin, NKB and GABA levels were quantified using enzyme-linked immunosorbent assay (ELISA) kits. To assess the correlation, either Pearson's or Spearman's analytical method was employed between serum kisspeptin, NKB, and GABA levels and hormonal profiles.

Results: The results showed that serum kisspeptin and NKB levels were significantly lower in PCOS patients (p﹤.05), while GABA levels were elevated compared to those in the control group (p﹤.05). In PCOS patients, kisspeptin was notably positive-correlated with LH and LH/FSH (p﹤.05), but no significant correlation was found between NKB, GABA, and hormonal profiles. In PCOS, GABA levels had a strong positive correlation with NKB levels (r = 0.613, p = .000), but this was not observed in the control group. In control patients, kisspeptin levels were positively associated with NKB (r = 0.475, p = .011), strongly negatively correlated with GABA levels (r = -0.773, p = .000), but these were not observed in the PCOS group.

Conclusion: The study concluded that patients with PCOS have dysregulated levels of serum kisspeptin, NKB, and GABA and that they may have paradoxical effects under physiological and pathological situations.

Objective: To determine the variation of serum AMH levels in healthy Chinese women and establish AMH reference ranges accordingly.

Methods: This prospective cross-sectional multicenter study was designed to enroll healthy Chinese women of reproductive age (20-39 years) and perimenopausal age (40-49 years) from five reproductive centers in different regions of China. The study began in May 2022 and finished in February 2023. Age-specific 2.5th-97.5th percentiles AMH reference ranges were established. Multivariable linear regressions were undertaken to analyze the association of serum AMH with different demographic and clinical variables, including antral follicle count (AFC).

Results: 1113 healthy Chinese women were enrolled, including 614 of premenopausal age and others of reproductive age. The AMH (ng/ml) reference ranges for Chinese women of reproductive age were 0.87-9.89 (20-24 years), 0.42-8.24 (25-29 years), 0.34-7.46 (30-34 years), and 0.28-5.66 (35-39 years). For perimenopausal women, their reference ranges were 0.12-4.63 (40-41 years), 0.01-4.12 (42-43 years), 0.01-2.65 (44-45 years), 0.01-1.90 (46-47 years), and 0.01-1.08 (48-49 years). The regression of AMH on AFC adjusted by age is Log10(AMH)=0.2594-0.0235*Age + 0.0632*AFC.

Conclusions: This study established the age-specific serum AMH reference ranges for healthy Chinese women of reproductive and premenopausal age, and observed that the consistent decrease of AMH after 20 years accelerated around the beginning of perimenopause (40 years).

Objectives: This study aims to investigate the effects and potential mechanisms of berberine in conjunction with Jianpi Yishen Huazhuo formulation (JPYSHZF) on obese rats that serve as a model for polycystic ovary syndrome (PCOS).

Methods: Letrozole combined with high-fat diet (HFD) was used to establish an overweight PCOS rat model. After successful modeling, each intervention group was monitored for 28 d. An oral glucose tolerance test (OGTT) is performed to assess glucose metabolism. Enzyme-linked immunosorbent assay (ELISA) was used to determine the levels of sex hormones and serum levels of gastrointestinal hormones in rats. Biochemical analyzers were used to assess blood lipid levels. The protein expression levels of p38, PI3K, GLUT4, and AKT in ovarian tissue were demonstrated using Western Blotting (WB). Real-time fluorescence quantitative PCR (RT-qPCR) was used to measure the mRNA expression levels of p38, PI3K, GLUT4 and AKT in the same tissue. The morphological changes of ovarian tissue were observed using Hematoxylin-eosin (HE).

Results: Treatment with berberine in conjunction with JPYSHZF has been shown to reduce serum testosterone T and luteinizing hormone (LH) levels while increasing serum follicle-stimulating hormone (FSH) and E2 levels. This combination therapy also decreases the LH/FSH ratio and ameliorates polycystic ovary-like pathological changes in the ovaries of rats with PCOS. Additionally, this treatment decreases serum TC, TG, and LDL-c levels while increasing HDL-c levels. It also reduces levels of GLU and Ghrelin while enhancing levels of CCK, PYY, and GLP-1. Furthermore, the relative 6 of PI3K and AKT proteins, as well as the mRNA levels of PI3K, GLUT4, and AKT, were found to be increased.

Conclusions: Berberine combined with JPYSHZF can improve the sex hormone levels, ovarian function, glucose and lipid metabolism levels, and gastrointestinal hormone levels in obese PCOS rats by activating the PI3K/AKT signaling pathway, thereby playing a role in treating obese PCOS.

This study aimed to investigate the prevalence, severity, and associated factors of menopausal symptoms among middle-aged Chinese women. A multicenter, population-based cross-sectional study was conducted, involving 7,485 women aged 40-69 years from Zhejiang Province, China. Data on demographic characteristics, socioeconomic status, and lifestyle factors were collected using a structured questionnaire. Menopausal symptoms were assessed using the modified Kupperman Menopausal Index (mKMI), and multinomial logistic regression models were employed to identify factors linked to menopausal syndrome. The participants had a mean age of 52.4 (±7.3) years, with 46.1% being nonmenopausal and 53.9% postmenopausal. The most common menopausal symptoms were sexual problems (43.6%), insomnia (33.1%), and fatigue (27.5%). Among nonmenopausal women, insomnia was the most prevalent symptom (26.9%), whereas postmenopausal women most frequently reported sexual problems (61.1%). Both the prevalence and severity of menopausal symptoms significantly increased from nonmenopausal to postmenopausal status (p < 0.001). Significant associations were found between menopausal syndrome and factors such as age, menopausal status, education level, residence, income, passive smoking, physical activity, and occupational toxic exposure (p < 0.05). In conclusion, Sexual problems are the most bothersome menopausal symptom among females in southeast China. Postmenopausal females experience more prevalent and more severe symptoms. Additionally, socioeconomic and lifestyle factors play a significant role in menopausal syndrome.

Objective: To investigate the effects of light fasting diet therapy, including flaxseed powder supplementation, on lipid metabolism and sex hormone levels in patients with polycystic ovary syndrome (PCOS) combined with infertility.

Methods: A total of 104 PCOS patients with combined infertility were divided into the control group (n = 52) and intervention group (n = 52) using a random number table method. Over a two-month study period, the control group received light fasting diet therapy with rice flour as a placebo, while the intervention group received light fasting diet therapy supplemented with flaxseed powder. Differences in general clinical data, anthropometric indicators, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), progesterone (P), fasting plasma glucose (FPG), fasting insulin (FINS), Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C)) were compared between the two groups.

Results: After treatment, both groups showed significant reductions in FSH, LH, E2, and P levels compared to baseline (p < .05). In the intervention group, the mean FINS and HOMA-IR levels were significantly lower than those in the control group following 2 months of treatment (p < .05). Furthermore, TC, TG, and LDL-C levels were significantly reduced in the intervention group compared to the control group (p < .05).

Conclusion: Light fasting diet therapy, especially with flaxseed powder, improves obesity, lipid, and glucose metabolism disorders in PCOS patients with infertility. However, longitudinal studies are needed to better understand these associations and assess long-term effects before considering this intervention as a standard clinical recommendation for PCOS.

Background: Polycystic ovary syndrome (PCOS) is an endocrine disorders and characterized by polycystic ovary morphology and oligomenorrhea, affecting fertility and health condition of female around the world. The causative factors of PCOS are complex, and genetic structure remains a long-standing medical challenge in genetics. Previous genome-wide association study (GWAS) showed that Wing-less-related integration site (Wnt) signaling is the most affected pathway among PCOS-related risk genes, and genetic mutations in the Wnt/β-catenin signaling may lead to abnormal development of PCOS.

Objective: To explore the possibility of axis inhibitor-2 (AXIN2) variants in Chinese women with PCOS and assess their pathogenicities.

Methods: A total of 365 Chinese women with PCOS and 905 women without PCOS as control were recruited from Jiangxi Provincial Maternal and Child Health Hospital, All of the 11 exons and flanking regions of the AXIN2 gene were amplified by polymerase chain reaction (PCR), the potential variants were analyzed by Sanger sequencing. The evolutionary conservation analysis of the identified Axin-2 mutant was analyzed among 15 vertebrates from human to zebrafish. The protein structure change was analyzed between the wild-type and mutation-type. The pathogenicity of AXIN2 variant was further analyzed in silico.

Results: We totally identified 7 genetic variants of AXIN2 in this study, including 4 synonymous and 3 missense. Among them, we find a rare deleterious missense variant [p.R714W (c.2140C > T)]. The allele frequencies of this variant were 0.82% and 0.17% in PCOS cases and matched controls, respectively. And it was ranging from 7.89e-5 to 1.47e-4 in public databases. Fisher's exact test indicated that the allele frequencies in PCOS were p < 0.05 compared to both the controls and the databases. Especially, the mutant amino acid site is highly conserved in vertebrates, while the mutation changed the 714th arginine to tryptophan resulting in significant change in the protein structural of Axin-2.

Conclusion: In this study, we identified a rare deleterious missense AXIN2 mutation [p.R714W (c.2140C > T)] in Chinese women with PCOS, and this mutant is probably pathogenic. This study may provide a new perspective on revealing the genetic variation of PCOS.