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15 March 2016, Volume 35 Issue 2
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专家论坛

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Ethic Thinking of Oocyte Donation in IVF-ET Technology SHI Xiao;QUAN Song 2016, 35 (2):  93-95.  Abstract ( 1465 )   PDF (422KB) ( 7815 )   The development of in vitro fertilization-embryo transfer （ＩＶＦ－ＥＴ） with oocyte donation technology brings new hope for infertility patients with ovarian failure, as well as some new ethic problems for the whole society. The conflicts between the development of new technology and ethical problems should be integrated in consideration, which is the precondition of the reasonable application of this new technology. The hot ethic issues at present include the supply-demand imbalance of oocyte, donor compensation, requirement for donor and recipient, anonymous and child informed. We reviewed the previous publications and proposed some suggestions for these problems: to match gradually the supply-demand imbalance by increasing donation and developing oocyte-frozen technology, to plan the compensation according to the economic development and health-economic study, to adjust properly the requirement for donor-oocytes since the pregnant rate was increasingly improved, to evaluate comprehensively the psychology and economic state of recipient before IVF, and to reconsider accordingly the anonymous and child-informed regulations. Related Articles | Metrics

论著

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Construction of LV-calb2 and LV-siRNA-calb2 and Expression in Leydig Cells of Teste XU Wen-dan;DAI Xiao-nan;ZHU Qian;ZHANG Bei;GAO Chao;GAO Li;LIU Jia-yin;CUI Yu-gui 2016, 35 (2):  96-100.  Abstract ( 1419 )   PDF (704KB) ( 7807 )   Objective：To explore the effect of CALB2 on steriodogenesis in testicular Leydig cell，we firstly established LV-calb2 and LV-siRNA-calb2 lentivirus vectors. Methods：Firstly，the over-expression and interference plasmids were synthysized，and the bacterial competent cells were prepared ahead. Secondly，polymerase chain reaction（PCR） and gene sequencing were administered to ensure the LV-calb2 and LV-siRNA-calb2 lentivirus vectors constructed successfully. At last，the infection efficiency was tested and then the level of testosterone in MLTC-1 and the level of progesterone in R2C were measured by radioimmunaossay after MLTC-1 and R2C were infected with LV-calb2 and LV-siRNA-calb2 respectively. Results：PCR and gene sequencing confirmed that LV-calb2 and LV-siRNA-calb2 lentivirus vectors were established，with the capacity to infect efficiently MLTC-1 and R2C. Testosterone production was significantly increased in the MLTC-1 infected with LV-calb2 （P＜0.001）, while progesterone production was significantly decreased in R2C infected with LV-siRNA-calb2（P＜0.05）. Conclusions：This study successfully constructed LV-calb2 and LV-siRNA-calb2 lentivirus vectors which could infect Leydig cells with high-efficiency. The preliminary result indicated that CALB2 promoted steriodogenesis in Leydig cells. Related Articles | Metrics

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Clinical Analysis of Prenatal Diagnosis and Chromosomal Karyotypes of Fetal Cord Blood in 175 Cases YAN Xiao-nan;LIU Fu-min;WANG Wen;CHEN Hong;YE Yue-xian 2016, 35 (2):  101-105.  Abstract ( 1498 )   PDF (739KB) ( 7783 )   Objective：To analyze the correlation between the clinical indications of prenatal diagnosis and the chromosomal abnormalities of fetal cord blood in the second and third trimester, so as to evaluate the application of cordocentesis in the prenatal diagnosis. Methods：Cordocentesis were performed in 175 pregnant women with the indications of prenatal diagnosis. Fetal chromosomal karyotypes were examined. The constituent ratio of clinical indications and the detection rate of chromosomal abnormalities were assessed. Results：17（9.71%） chromosomal aberrations were detected in fetal cord blood of 175 cases. Trisomy consisted of 76.47% (13/17) of all abnormalities, including 8 cases with trisomy 21 and 5 cases with trisomy 18. Two fetuses were diagnosed with sex chromosomal abnormalities, one fetus with chromosomal translocation, and one fetus with chromosomal inversion. The indications of cordocentesis were consisted of the soft marker abnormalities in fetal ultrasonic, the high-risk in serum screening, abnormal reproductive history, advance maternal age, fetal sonographic structural anomalies, and the high-risk in NIPT. The detection rate for above indications were 6.12% (3/49), 9.38% (3/32), 0 (0/29), 5.00% (1/20), 33.33% (5/15) and 80.00% (4/5), respectively. Conclusions：The detection rate of chromosomal aberration in pregnant women with fetal sonographic structural anomalies and high-risk NIPT is relatively high, and trisomy 21 and trisomy 18 are the leading fetal chromosomal abnormalities in the second and third trimester. Related Articles | Metrics

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The Diagnostic Value of Ultrasound in Intrauterine Adhesions CHEN Can-ming;WANG Yi-fang;YOU Pei;HUANG Tao;REN Wei-juan;GU Xiao-yan 2016, 35 (2):  106-108.  Abstract ( 1432 )   PDF (651KB) ( 7860 )   Objective：To evaluate the application of ultrasound in diagnosis of intrauterine adhesions, so as to find a simple and practicable method for the intrauterine adhesion screening. Methods：Ultrasound and hysteroscopy were performed in 68 cases of the intrauterine adhesions suspected clinically. The diagnosis results were compared with the SPSS software, to evaluate their diagnostic values. The imaging features of intrauterine adhesions, together with hysteroscopic observation, were analyzed. Results：The imaging characteristics of two-dimensional ultrasound and three-dimensional ultrasound in diagnosing intrauterine adhesions were included: sensitivity (65%, 90%), specificity (100%, 100%), the positive predictive value (100%, 100%), the negative predictive value (28%, 57%), Jorden index (0.65, 0.90), Kappa (0.30, 0.68). Compared with the hysteroscopy, both two-dimensional ultrasound Kappa=0.50(Z=4.41，P＜0.01) and three-dimensional ultrasound Kappa=0.35(Z=3.60，P＜0.01) were feasible in diagnosis of different degrees of intrauterine adhesions. Conclusions：Ultrasonography can be used in diagnosis of intrauterine adhesions. Compared with two-dimensional ultrasound, three-dimensional ultrasound has higher diagnostic value. However, ultrasonography still has the missed diagnosis rate and the misdiagnosis rate on some degrees. Hysteroscopy can clarify a diagnosis. Ultrasound, as a noninvasive and relatively simple method, should be recommended as the intrauterine adhesions screening before hysteroscopy. Ultrasonography may provide an effective reference for hysteroscopic surgery. Related Articles | Metrics

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A Prognostic Analysis of 225 Cases of Endometrial Carcinoma ZHANG Ying-lan;LYU Chang-shuai;LANG Jing-he;ZHOU Xing-nan 2016, 35 (2):  109-112.  Abstract ( 1388 )   PDF (774KB) ( 7776 )   Objective：To explore the factors related to prognosis of endometrial carcinoma, so as to improve accordingly clinical treatment. Methods：All the clinical data of 225 cases of endometrial carcinoma, from January 2003 to June 2010, was analyzed. The Kaplan-Meier test and multivariate Proportional hazards regression model（Cox regression） were used for finding those risk factors related to the prognosis of endometrial carcinoma. Results：The overall 5-year survival rate was 90.6%. The Kaplan-Meier test suggested that the FIGO surgical stage, histological grade, depth of myometrial invasion, pathological type, postoperative adjuvant therapy, lymph node metastasis and peritoneal cytology be related to the survival rate（P＜0.05）. There was not significant difference in the survival rate between patients with and without the lymphatic nodes removed（P＞0.05）. Interestingly, there was not significant difference in the survival rate between those early stage patients with and without adjuvant therapy （P＞0.05）. The Cox regression showed that the pathological type, FIGO surgical stage and histological grade were the independent risk factors of the prognosis of endometrial carcinoma（P＜0.05）, and that the prognosis of those patients with the late pathological stage and poor histological grade was dissatisfactory. Conclusions：The overall 5-year survival rate of endometrial carcinoma was satisfactory. The pathological type, FIGO surgical stage and histological grade are the independent predictive factors for the prognosis of endometrial carcinoma. Meanwhile, the depth of myometrial invasion and the peritoneal cytology are not related to the prognosis of endometrial carcinoma. Related Articles | Metrics

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Cesarean Scar Pregnancy：New Analysis on Chinese Literatures LUO Wen-xiang;ZHANG Hong-hui;CUI Xiang-hua;SUN Chao;SUN Yan;ZHU Li-juan;WANG Ai-li;SHI Li-fang;CHEN Jin-chan;YANG Xiu-lan;LIU Jie-na;ZHANG Jian 2016, 35 (2):  113-117.  Abstract ( 1375 )   PDF (846KB) ( 7765 )   Objective：To understand the present situation of cesarean scar pregnancy (CSP) in China. Methods：The WANFANG database was used to search all Chinese literatures on the CSP from 1982 to 2015 by the key words as "scar pregnancy", "pregnancy at the scar", "incision pregnancy" or all kinds of the Chinese expressions of "scar pregnancy", and by the search strategy as "cross-database search" and "all the journals". Statistical analysis was based on multiple parameters, including the province (or municipality), the year of publication, the rank of hospital, and the related complications. Results：①There were a total of 4 281 articles on CSP and 114 571 cases. Thirty provinces (or municipalities) were involved, including the top 5 provinces of Guangdong, Henan, Zhejiang, Jiangsu and Hubei; and the last 5 provinces of Xinjiang, Hainan, Ningxia, Gansu and Qinghai. ② The article on CPS was firstly published in 1999. The number of literatures and the number of cases were increased year by year. ③The numbers of literatures were 59.87%, 30.69%, 2.50%, 1.38% and 5.56%; the numbers of cases 60.03%, 30.93%, 2.41%, 1.20% and 5.43%, in five ranks of hospitals: tertiary hospital, secondary hospital, primary hospital, other medical institution like the family planning guidance and service center, and other unasserted hospital. ④The numbers of cases of CSP at the early stage, the middle stage and the late stage of pregnancy were 98.70% , 0.60% and 0.70% , respectively. The incidences of abnormal placenta, abnormal pregnancy and other complications were 0.91%, 0.04% and 0.01%. Thirteen cases （0.01%） of IVF-ET were recorded. Conclusions：①There was a possible regional characteristic on the CSP in China. ② CSP showed a rapid increasing trend year by year. ③The fundamental measures to prevent or reduce CSP include preferably understanding the potential serious complications of CSP after cesarean section, strictly mastering the indication of cesarean section and controlling the rate of cesarean section. Related Articles | Metrics

综述

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Protein Acetylation Promotes Sperm DNA Stability and Motility ZHANG Bei;CUI Yu-gui 2016, 35 (2):  118-122.  Abstract ( 1466 )   PDF (812KB) ( 7716 )   During spermatogenesis, the protein acetylation level regulated by both acetyltransferases (HATs) and histone deacetylases (HDACs) ensures the reconstruction of highly condensed chromatin and sperm motility. The acetyltransferase CREB-binding protein (CBP) and p300 can acetylate all the histones of H2A, H2B, H3 and H4, which can be blocked by the complex of inhibitor of acetyltransferases (INHAT). Testis-specific bromodomain (BRDT) protein, a conserved nucleoprotein member of the bromodomain and extra-terminal (BET) family, can recognize those acetylated or unacetylated histones. BRDT participates in the regulation of gene transcription in the early stage of spermatogenesis; BRDT can recognize the high-acetylated histones, which mediates the replacement from histone to protamine in the elongated spermatids. The deacetylated α-Tubulin, one of nonhistone proteins, impairs the sperm motility. Acetylation α-tubulin (Ac-α-Tu) is reduced in patients with asthenozoosperm. Related Articles | Metrics

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Research Progress of the CDYLs Gene Family Related to Dyszoospermia YANG Xiao;CHEN Tai-zhong;FEI Cheng;HUANG Yi-zhe;XIA Xiao-yu 2016, 35 (2):  123-127.  Abstract ( 1408 )   PDF (832KB) ( 7782 )   As located in AZF region of Y chromosome, CDY (chromodomain protein，Y-linked) gene has been regarded as one of the candidates of Y chromosome microdeletion related to dyszoospermia. Actually, CDY gene originated from the reverse transcription and transposition of autosomal CDYLs (CDY-like) mRNA. During the evolution, autosomal CDYLs acquired the diversity of protein function by acquisition of new exons. The function of CDYLs/CDY protein closely depends on its two domains, the chromo domain mediating the gene silence process by binding to the methylated histones and the crotonase domain which might be involved in spermatogenesis via its histone acetylase activity. Herein, the research progress about the CDYLs/CDY gene family was reviewed. Related Articles | Metrics

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Wnt Signal Pathway during Folliculogenesis ZHOU Tuan-ping;CUI Yu-gui;QIAN Ri-cheng 2016, 35 (2):  128-131.  Abstract ( 1512 )   PDF (800KB) ( 7804 )   The transduction of Wnt signal involves the interaction between Wnt and Fzd as well as cooperation with single-pass co-receptors, which induces the β-catenin translocation to nucleus and the transcription of target genes. This Wnt pathway drives the proliferation of granulosa cells via the intracellular β-catenin translocation. Wnt4 is a pleiotropic player during prenatal and postnatal follicular development, maturation and survival. Fzd1 participates in regulating the expression of those genes involved in cumulus expansion. β-catenin also participates in steroidogenesis and luteogenesis. The maladjustment of β-catenin may lead to premature ovarian failure，granulosa cell tumors and luteal phase defects. In this review, we summarized the classical Wnt/β-catenin pathway and its roles in folliclogenesis. Related Articles | Metrics

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Progress in Diagnosis and Treatment of 45，X/46，XY Mosaic Disorders of Sexual Development WANG Cong;WU Qing-hua;SHI Hui-rong 2016, 35 (2):  132-136.  Abstract ( 1908 )   PDF (927KB) ( 7837 )   45，X/46，XY mosaic disorders of sexual development (DSDs) is a rare but very challenging disease， which may be related to the micro-deletions of Y chromosome，and the mutation or abnormal adjustments of SRY and other sex-determination genes. The main characteristics of clinical phenotype are dysplasia of the external genital organs and gonad，short stature and phenotypic abnormalities associated with Turner syndrome. It can be clearly diagnosed through cellular and molecular genetic test. The external masculinization score，hormonal levels，imaging test，laparoscopic exploration and pathology of gonads are of great significance to guide the subsequent therapy. There are still many controversies about the gender distribution，hormone replacement therapy，methods and time of resection of sexual gland and other surgical intervention. The principles of multidisciplinary diagnosis and individualized treatment has gradually become a consensus. This consensus should be better implemented in clinical practice. Related Articles | Metrics

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Research Progress of Fetal Growth Retardation and DNA Methylation ZHANG Qing-hua;HAO Sheng-ju;SUN Xiao-hong;YAN You-sheng;FENG Xuan;ZHAO You-hong 2016, 35 (2):  137-141.  Abstract ( 1414 )   PDF (955KB) ( 7787 )   Fetal growth restriction (FGR) is one of the serious obstetric idiopathic diseases, which has a significant effect on perinatal morbidity and mortality. FGR also has great effects on postnatal development, including adult cardiovascular and compensatory disease prevalence. Recent studies have found that DNA methylation plays a critical role in the development of FGR. This article summarizes the progress of the DNA methylation related to FGR, in order to provide important clues for us to assess the biology of FGR development and the adult disease risks , and provide a potential way for the prevention, diagnosis and treatment of FGR. Related Articles | Metrics

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Increased Level of Progesterone on the Day of hCG to the Disadvantage of IVF Outcomes WANG Mei-xian;SHAO Xiao-guang 2016, 35 (2):  142-145.  Abstract ( 1398 )   PDF (874KB) ( 7804 )   During controlled ovarian stimulation (COS), the concentration of serum progesterone sometimes increases on the day of human chorionic gonadotropin (hCG) administration. The occurrence rate of increased progesterone level was different, due to the different cutoff value based on some publications. The progesterone concentration is positively related to the number of mature follicles, the estradiol level and the total administration dose of follicle-stimulating hormone(FSH). The premature progesterone elevation could change endometrial gene expression, accelerate endometrial maturation, and affect endometrium from early- to mid-secretory phase, which result in the developmental asynchronism between endometrium and embryo, and affect the endometrial receptivity. The progesterone elevation on the day of hCG is negatively related to the implantation rate and the rate of live birth in IVF. Those negative effects of progesterone elevation can be avoided by the moderate COS protocol, the low dose of FSH, the earlier administration of hCG, the frozen-thawed embryo transfer, and the blastocyst embryo transfer. Related Articles | Metrics

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Expression and Effect of MicroRNA in Patients with Polycystic Ovary Syndrome ZHENG Sai-hua;LI Xue-lian 2016, 35 (2):  146-150.  Abstract ( 1395 )   PDF (915KB) ( 7900 )   Non-coding microRNAs (microRNAs, miRNAs) are able to regulate the expression of target genes at the post-transcriptional level. Altered miRNA levels are associated with the pathological development of diabetes, insulin resistance, inflammation and various cancers. The miRNAs profiles express differently in the serum and follicular fluid of women with polycystic ovary syndrome (PCOS). Altered miRNA levels may participate in the development of PCOS. Here, we summarize the effects of miR-93, miR-222, miR-92a/b, miR-224, miR-320, miR-9, miR-483-5p, miR-513a-3p, miR-24, miR-133b, miR-26b and miR-378 in insulin resistance, steroid hormone synthesis and secretion, granule cell proliferation, follicular development dysplasia and ovulation disorder in PCOS patients, so as to explore the roles of miRNAs in the pathogenesis of PCOS. Related Articles | Metrics

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Diagnosis of Tubal Patency by Ultrasonic Tomography: Clinical Application and Progress XIANG Yu-ting;BAI Wen-pei 2016, 35 (2):  151-154.  Abstract ( 1373 )   PDF (954KB) ( 7889 )   About 25%-35% of female infertility are involved in tubal factors. The examination of oviduct patency is a clinical routine for the diagnosis of female infertility. The diagnostic techniques by ultrasonic tomography include: hysterosalpingography(HSG), laparoscopy with chromotubation (LC), transvaginal sonography (TVS), saline-infusion sonography (SIS) and 4-dimensional hysterosalpingo-contrast sonography (4D-HyCoSy). HSG is widely used with relatively high accurate diagnosis but also high false positive rate, and X-Ray exposure. Although LC was considered as a "gold standard", LC is a invasive and expensive diagnosis. TVS and SIS have been rarely used because of their limited value in diagnosis. The 4D-HyCoSy not only enjoys accuracy and convenience, but also avoids risks like iodine allergy, radiation and pulmonary embolism. Related Articles | Metrics

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Research Progress of Mitogen-activated Kinase Phosphatase-1 in Obstetrical and Gynecological Related Diseases SU Lin;CHEN Qiong-hua 2016, 35 (2):  155-159.  Abstract ( 1343 )   PDF (1019KB) ( 7795 )   The mitogen-activated kinase phosphatase (MKPs), a intracellular phosphatase family that could hydrolyze the mitogen-activated protein kinases (MAPKs) in cells, participate in the regulation of cell stress, differentiation, proliferation and apoptosis by the negative feedback regulation of MAPKs. The abnormal expression of MKP-1 was associated with the cancer occurrence and development. MKP-1 shows the strongest ability of dephosphorylation, which has been well studied as a member of the MKPs family. In this review, we summarized the effects of MKP-1 in the diseases associated with obstetrics and gynecology, including genital neoplasms, endometriosis and preeclampsia. The expression pattern, pathological function and molecular mechanism of MKP-1 in obstetrical and gynecological diseases were elucidated. After that, we focused on the pathophysiological effect of MKP-1 in endometriosis. The interaction between MKP-1 and MAPKs could provide us more references for the prospective research. Related Articles | Metrics

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The Role of HMGB1 in Immunological Pathogenesis of Endometriosis through Regulating Treg Cells XIE Hong-yu;LIANG Yan-chun;YAO Shu-zhong 2016, 35 (2):  160-164.  Abstract ( 1368 )   PDF (1020KB) ( 7820 )   Immunological pathogenesis is one of the important mechanisms of endometriosis. Recently，studies show that the over-expressed high mobility group box 1 protein （HMGB1） plays some roles in the development of endometriosis by regulating inflammation，neoangiogenesis，invasiveness，migration and apoptosis of ectopic endometrium. Regulatory T cells （Treg cells） are also closely related to endometriosis. Abnormal amount and dysfunction of Treg cells in endometriosis lead to an imbalanced immunological microenvironment （including immuno-deficiency and immune-escape），promoting the implantation and growth of ectopic endometrium. Growing studies suggest that HMGB1 plays an important role in immunological pathogenesis of endometriosis by enhancing the secretion of Treg cells，reducing apoptosis of Treg cells and strengthening the immunosuppression of Treg cells. Related Articles | Metrics

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Treatment of Thin Endometrium: A Brief Review YU Ling;WANG Shu-fang;YE Ming-xia;ZUO Zhao;YAO Yuan-qing 2016, 35 (2):  165-169.  Abstract ( 1388 )   PDF (1059KB) ( 7839 )   Thin endometrium can cause unsuitable endometrial receptivity, affect the embryo implantation, and ultimately reduce the pregnancy rate. A variety of methods have been tried to treat this disease so far. However, there is not a universal method with the exact efficacy, which means that the treatment of thin endometrium is still a challenge for clinician. Several treatment modalities have been offered to patients with thin endometrium, including the endometrial local micro-injury, hormones (estrogen and GnRH-agonist), vasoactive medicines (aspirin, vitamin E, pentoxifylline, L-arginine and sildenafil), intrauterine infusion of G-CSF and the new clinical trial of regenerative medicine. We reviewed and compared those treatments of thin endometrium, so as to provide a reference for clinician to treat individually patients by improving endometrial receptivity, increasing the pregnancy rate, and optimizing patient management. Related Articles | Metrics

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Syndactyly: Classification and Genetics LIU Jin-xiu;CHEN Wei;WANG Xiang-rong;ZHOU Qing;SI Biao;DUAN Wen-yuan 2016, 35 (2):  170-176.  Abstract ( 1576 )   PDF (1244KB) ( 7785 )   Syndactyly (SD) is one of the most common hereditary limb malformations depicting the fusion of certain fingers or toes. It may occur as an isolated entity or a component of more than 300 syndromic anomalies. Syndactylies exhibit great inter- and intra-familial clinical variability. Phenotype can be unilateral or bilateral and symmetrical or asymmetrical within a subject. At least nine non-syndromic syndactylies have been characterized. Most of the syndactyly types are inherited as autosomal dominant but two autosomal recessive and an X-linked recessive entity have also been described. Whereas the underlying genes/mutations for types Ⅱ-a, Ⅲ, Ⅳ, Ⅴ, Ⅶ and Ⅷ have been worked out, the etiology and molecular basis of the other syndactyly types remain unknown. In this communication, based on the classification of Sajid Malik, we summarized the results of genetic studies on syndactyly in recent years, which will contribute to further investigation of the pathogenic mechanism and implementation of genetic diagnosis of syndactyly. Related Articles | Metrics