Journal of Obstetrics and Gynaecology最新文献

Background: This study investigates how clinical factors and hormonal levels affect oocyte retrieval in modified natural cycles, aiming to improve understanding and enhance treatment protocols.

Methods: A retrospective analysis of data from 306 women undergoing in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) at a fertility clinic (2018-2023) was conducted. Clinical factors and hormonal levels were analysed. Follicular development was monitored via ultrasound.

Results: Baseline comparisons between the oocyte retrieval and non-retrieval groups showed no significant differences in age, body mass index, infertility types, duration, associated conditions (e.g. tubal issues, ovulation disorders and endometriosis) or assisted reproductive methods (p > 0.05). After human chorionic gonadotropin (HCG) injection, both groups showed significant increases in progesterone, oestradiol and luteinising hormone levels (p < 0.0001). Before HCG injection, the retrieval group had significantly higher levels of progesterone, oestradiol and LH (p < 0.05), with oestradiol remaining higher afterward (p < 0.01). There were significant differences between the two groups on anti-Müllerian hormone levels (p ˂ 0.05). No significant differences were found in follicle-stimulating hormone, total testosterone, thyroid hormone levels and antral follicle count (p > 0.05).

Conclusions: In conclusion, the findings suggest that clinical factors do not impact oocyte retrieval in modified natural cycle assisted reproductive techniques. However, high hormone levels on the day of HCG injection in the study subjects may indicate a greater possibility of successful oocyte retrieval.

Background: Gushen Antai recipe (GSAT), known herbal medicine, has long been used in China to treat early pregnancy loss. Several randomised controlled trials have demonstrated its efficacy in improving clinical pregnancy rates. This study aimed to elucidate the mechanism of GSAT in patients undergoing in vitro fertilisation-embryo transfer (IVF-ET).

Methods: Patients undergoing IVF-ET were recruited on day 14 after embryo transfer. Participants either received GSAT alongside hormonal medication for 2 weeks (intervention group) or received hormonal treatment (control group). Plasma metabolites and inflammatory factors was analysed by gas chromatography-mass spectrometry and enzyme-linked immunosorbent assay, respectively. Faecal microbiota was assessed by 16S rRNA sequencing.

Results: GSAT was found to contain 56.44% flavonoids, primarily come from Scutellariae Radix, including baicalin, baicalein, wogonoside, wogonin, oroxylin A and Chrysin 6-C-glucoside 8-C-arabinoside. At the end of the fourth week after embryo transfer, plasma levels of interleukin (IL)-2 and tumour necrosis factor-α were significantly lower in the intervention group than in the control group, whereas the anti-inflammatory cytokine IL-10 were markedly higher (687.3 vs. 448.5 pg/mL, p < 0.01). Moreover, the plasma IL-10 levels and proportion of four kinds of fatty acids (lauric acid, myristic acid, palmitic acid, linoleic acid) in plasma correlated with each other. These fatty acids were not directly detected in GSAT and may originate from biosynthesis by gut microbiota.

Conclusions: The alteration of plasma cytokine levels (IL-10, TNF-α and IL-2) associated with GSAT intervention was linked to specific fatty acids produced by characteristic intestinal microbiota. These results provide insights into the mechanism underlying the role of the GSAT in improving clinical pregnancy rates.

Background: Pelvic inflammatory disease (PID) is a common gynaecologic condition linked to infertility, ectopic pregnancy, and reproductive tract cancers. While active smoking has been associated with PID, the impact of environmental tobacco smoke (ETS) on non-smoking women remains unclear. Most studies rely on self-reported exposure, which may be inaccurate. Cotinine, a stable nicotine metabolite, serves as an objective biomarker of tobacco exposure. This study investigated the association between serum cotinine levels and PID risk in non-smoking women using data from the National Health and Nutrition Examination Survey (NHANES).

Methods: This cross-sectional study included 3,718 non-smoking women aged ≥18 years from NHANES 2013-2020. ETS exposure was assessed using serum cotinine measured by isotope dilution high-performance liquid chromatography with tandem mass spectrometry. Cotinine levels were categorised as unexposed, low, or high exposure. PID was identified based on self-reported treatment for pelvic infections. Weighted logistic regression was used to examine associations between cotinine and PID, adjusting for confounders identified by a directed acyclic graph. Restricted cubic spline and subgroup analyses were also conducted.

Results: Among participants, 3.1% reported a history of PID. Those with PID had higher serum cotinine levels. In fully adjusted models, each one-unit increase in log₂-transformed cotinine was associated with a 10% increase in PID risk (OR = 1.10; 95% CI: 1.02-1.19). High ETS exposure (≥3 ng/mL) was linked to a significantly higher risk of PID compared to unexposed individuals (OR = 2.53; 95% CI: 1.05-6.08). A linear dose-response relationship was observed. Subgroup analyses showed consistent results across all strata.

Conclusion: Serum cotinine-defined ETS exposure was significantly associated with increased PID risk in non-smoking women. Reducing ETS exposure may help prevent reproductive tract infections.

Background: This study aimed to investigate the association between smoke exposure and the risk of osteoporosis in postmenopausal women in the United States, using data from the National Health and Nutrition Examination Survey (NHANES).

Methods: A cross-sectional analysis was conducted using NHANES data from 2005 to 2010, 2013 to 2014, and 2017 to 2018. The study population consisted of postmenopausal women aged 18 years and older. Their bone health status was assessed using self-reported osteoporosis and dual-energy X-ray absorptiometry (DXA) measurements, smoke exposure was evaluated through serum cotinine levels, and multivariate logistic regression models were used to examine the association between smoke exposure and osteoporosis risk, adjusting for sociodemographic factors, health behaviours, and comorbidities.

Results: The analysis comprised 4,140 postmenopausal women, and data analysis showed that active smoking was significantly associated with an increased risk of osteoporosis, with an adjusted odds ratio (OR) of 2.020 (95% confidence interval [CI]: 1.35-3.03), after adjusting for potential confounders. Additionally, age, race/ethnicity, socioeconomic status, marital status, and body mass index were identified as significant predictors of osteoporosis risk.

Conclusions: Smoke exposure, particularly active smoking, was associated with an elevated risk of osteoporosis among postmenopausal women in the United States. The findings underscore the need to address modifiable risk factors, such as smoking cessation, and implement targeted interventions to mitigate disparities in bone health.

Background: Premature ovarian insufficiency (POI) has multiple contributing factors. This study aims to systematically evaluate these factors and their mechanisms, identify high-risk groups, support early intervention, and provide a basis for future research.

Methods: Following the PRISMA guidelines, a search was conducted across 11 Chinese and English databases, including PubMed, Embase, and the Cochrane Library, up to January 2024. Observational studies on patients with ovarian insufficiency were included. A meta-analysis using Stata 14 was performed to calculate odds ratios (OR) and 95% confidence intervals (CIs) for factors influencing POI.

Results: A total of 38 studies with 4,968 cases and 5,158 controls were included. The following factors were identified as risk factors for POI: abnormal menstruation (OR = 2.707, 95% CI: 1.705-4.299), hair dyeing (OR = 4.725, 95% CI: 2.914-7.660), chemical exposure (OR = 3.314, 95% CI: 2.283-4.811), Type A personality (OR = 6.106, 95% CI: 4.696-7.939), survival stress (OR = 3.292, 95% CI: 2.380-4.555), sleep deprivation (OR = 3.340, 95% CI: 2.363-4.721), bad mood (OR = 4.654, 95% CI: 2.783-7.781), smoking history (OR = 2.748, 95% CI: 1.928-3.917), family history of POI (OR = 4.338, 95% CI: 2.422-7.768), history of mumps (OR = 5.802, 95% CI: 3.460-9.730), number of abortions (OR = 2.292, 95% CI: 1.887-2.785), and history of pelvic surgery (OR = 4.836, 95% CI: 3.066-7.628). Physical exercise (OR = 0.270, 95% CI: 0.106-0.692) and vegetable intake (OR = 0.434, 95% CI: 0.337-0.560) were protective factors. Sensitivity analysis and publication bias tests confirmed robustness.

Conclusions: POI is related with abnormal menstruation, hair dyeing, chemical exposure, Type A personality, survival stress, sleep deprivation, bad mood, smoking history, family history of POI, history of mumps, number of abortions, and history of pelvic surgery. Physical exercise and vegetable intake may provide protection. These findings inform clinical strategies for early identification and management.

Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) is a novel minimal invasive technique which employs the vaginal orifice for surgical access, after which endoscopic instruments are introduced, thus obviating the need for any external skin incisions. This approach has gained traction as it is associated with reduced morbidity, improved cosmesis, lower pain scores and decreased length of hospital stay, with no increase in adverse events, when compared with conventional laparoscopic surgery. Initially limited to hysterectomy and adnexectomy, its role has now expanded to include indications such as urogynaecology, oncology and fertility. Clinicians wishing to implement vNOTES need to undergo appropriate training and appreciate judicious governance. Further randomised controlled trials will allow us to better understand if this newer technique will offer well-evidenced preferable outcomes and become the preferred surgical approach.

Background: To investigate the mechanism and prognostic value of LINC01094 in cervical cancer (CC).

Methods: This study included 113 patients with CC. Their cervical tumour tissues and tumour-free cervical tissues were collected, with patient follow-up for a five-year prognostic period. Reverse transcription-quantitative PCR (RT-qPCR) was used to identify LINC01094 and measure miR-1266-5p expression, Kaplan-Meier curves were used to predict patient survival, and multivariate Cox regression analysis revealed the factors affecting CC prognosis. A dual luciferase reporter (DLR) assay was performed to verify the targeting relationship of reciprocal genes. The Cell Counting Kit-8 (CCK8) assay was used to measure cell proliferation, and the Transwell recorded cell migration and invasion.

Results: Lower LINC01094 expression and higher level of miR-1266-5p expression were detected in-tumour tissues than in the tumour-free cervical tissues, with a negative correlation. Low LINC01094 expression, International Federation of Gynaecology and Obstetrics (FIGO) stage, and lymph node metastasis were identified as risk factors for CC prognosis, LINC01094 downregulation predicted higher patient mortality. The DLR assay identified miR-1266-5p as a possible target gene of LINC01094. Additional experiments revealed miR-1266-5p downregulation and decreased cell proliferation, migration and invasion of CC cells transfected with oe-LINC01094. These effects were restored after co-transfection with miR-mimic.

Conclusions: Low LINC01094 expression in patient with CC is a risk factor for prognosis. Overexpression of LINC01094 targeting miR-1266-5p prevents the progression of CC neoplasm.

Background: The relationship between dietary antioxidants and pelvic inflammatory disease (PID) remains poorly understood. This study aimed to investigate this association in US women using both observational data and Mendelian randomisation (MR) to assess causality.

Methods: We conducted a cross-sectional analysis of 4,003 women aged ≥20 from the National Health and Nutrition Examination Survey (2013-2018). The Composite Dietary Antioxidant Index (CDAI) was calculated from six dietary antioxidants. PID was self-reported. Multivariable logistic regression was used to assess the association between the CDAI and PID, with subgroup analyses to test robustness. Subsequently, a two-sample MR analysis using the inverse-variance weighted (IVW) method was performed to evaluate a potential causal link.

Results: The prevalence of PID was 5.6% (224/4,003). In the fully adjusted logistic regression model, a higher CDAI was associated with lower odds of PID (Odds Ratio [OR] 0.95, 95% Confidence Interval [CI] 0.92-0.99). Among individual components, higher zinc intake was also inversely associated with PID (OR 0.96, 95% CI 0.93-0.99, P = 0.037). The inverse association between the CDAI and PID was consistent across all subgroups. However, the MR analysis did not find a significant causal relationship between antioxidant levels and PID risk.

Conclusions: A higher dietary antioxidant intake, as measured by the CDAI, is associated with a lower prevalence of PID in US women. However, our MR findings do not support a causal role for individual antioxidants in the development of PID. Further longitudinal studies are warranted to enhance our understanding of the interactions between antioxidants and PID.

Prospective parallel genetic testing of both germline and tumour DNA in ovarian cancer patients (OC) is the recommended model in several different countries across the globe and the UK. The high (∼67%) chance of identifying germline PVs in patients with tumour PVs has led to a discourse surrounding the need for consent for tumour genetic testing in OC. We discussed with OC patients during focus group workshops, physicians, and charity representatives about consent options for tumour testing in OC patients: verbal consent prior to testing (Option 1) and reflex testing (Option 2). Most patients (97%; 33/34) did not feel that consent was required and were happy with reflex testing (Option 2). Physician consensus was that reflex testing was preferred and most charity representatives (4/5; 80%) agreed. All groups wanted an opt-out option and a patient information sheet about tumour testing. This can inform new recommendations in the UK and foster further discussions regarding consent for OC tumour testing.