A case report of Ovarian hyperstimulation syndrome and corpus luteum rupture in twin pregnancies with IVF-ET.

INTRODUCTION: Ovarian hyperstimulation syndrome (OHSS) is a common complication during assisted conception treatment, mostly seen in patients with ovarian hyperresponsiveness such as polycystic ovary syndrome, especially in post-invitro fertilization and embryo transfer (IVF-ET) pregnancies. Its main symptoms are abdominal distension, abdominal pain, nausea and vomiting with ascites, pleural fluid, leukocytosis, hemoconcentration and hypercoagulation. This disease is a self-limiting disease and can be gradually cured by rehydration, albumin infusion and correction of electrolyte disorders in moderate to severe cases. Luteal rupture is a more common gynecological emergency abdomen. The combination of twin pregnancy, OHSS and ruptured corpus luteum is very rare. We successfully avoided the stimulation of the risk of pregnancy abortion by surgical exploration through dynamic ultrasound monitoring and vital signs observation in the absence of experience in primary care, and the patient hard-won twin pregnancy was successfully treated conservatively. PATIENT CONCERNS: The patient is a 30-year-old post-IVF-ET woman with an established twin pregnancy, OHSS and sudden onset of lower abdominal pain. DIAGNOSIS: Twin pregnancy, OHSS combined with ruptured corpus luteum. INTERVENTIONS: Rehydration, albumin infusion, low molecular heparin for thromboprophylaxis, luteinizing support, ambulatory ultrasound monitoring. OUTCOMES: After more than 10 days of standardized treatment for OHSS, dynamic ultrasound monitoring and close observation of vital signs, the patient was discharged cured of her condition and is continuing her pregnancy. CONCLUSION: Our case shows that the possibility of acute abdominal rupture of the corpus luteum is still present in the case of combined OHSS in pregnancy, and that some patients with corpus luteum rupture can heal spontaneously during close testing to avoid the increased risk of miscarriage with surgical exploration.

Chemical constituents with inhibition against TNF-α from Merrillanthus hainanensis.

Two new steroidal glycosides oxystauntoside A (1) and oxystauntoside B (2), together with sixteen known compounds (3-18) were isolated from the 95% ethanol extract of Merrillanthus hainanensis. Their structures were characterized by extensive spectroscopic analysis including NMR and mass spectra and single crystal X-ray crystallography. The absolute configuration of 1 and 2 were further determined by ECD calculations. All of these compounds were isolated from M. hainanensis for the first time. All the fractions and compounds were tested for the anti-inflammatory activity against the TNF-α factor. The ethyl acetate fraction showed the most potent inhibition (71.3%) at 10 µg/mL and compounds 5 (78.9%) and 9 (73.4%) in this fraction with both carboxyl and phenolic hydroxyl groups showed significant inhibition at 10 µM. Our study provided the first scientific report for the medicinal value of M. hainanensis.

Two novel mutations in PADI6 and TLE6 genes cause female infertility due to arrest in embryonic development.

PURPOSE: This study aims to identify genetic causes of female infertility associated with recurrent failure of assisted reproductive technology (ART) characterized by embryonic developmental arrest. METHODS: We recruited infertile patients from two consanguineous families from the Reproductive Medicine Center of Guizhou Provincial People's Hospital. Peripheral blood was collected for genomic DNA extraction. Two affected individuals and their family members were performed with whole-exome sequencing and Sanger validation in order to identify possible causative genes. For further analyzing the effect of splicing mutation on mRNA integrity in vivo, TLE6 cDNA from the peripheral blood lymphocyte of the affected individual was sequenced. In addition, the possible impact of the pathogenic mutation on the structure and function of the protein were also assessed. RESULTS: Two novel homozygous mutations in the peptidylarginine deiminase type VI (PADI6) and the transducin-like enhancer of split 6 (TLE6) genes were identified in the two families. One patient carried the frameshift deletion mutation c.831_832del:p.S278Pfs*59 of the PADI6 gene and the other patient carried the splicing mutation c.1245-2 A>G of the TLE6 gene. The analysis of the mRNA from the proband's peripheral blood leukocytes confirmed aberrant splicing. CONCLUSIONS: Our findings expand the mutational spectrum of PADI6 and TLE6 associated with embryonic developmental arrest and deepen our understanding of the genetic causes of infertility with recurrent ART failure.

Identification of three molecular subtypes based on immune infiltration in ovarian cancer and its prognostic value.

BACKGROUND: Increasing studies suggest that tumor immune infiltration is a relative factor of prognosis in ovarian cancer (OvCa). The present study explored the composition of tumor-infiltrating immune cells (TIICs) in OvCa using CIBERSORT algorithm and further assessed their values for prognosis and therapeutic strategies by molecular subtypes. METHODS: Publicly available databases including The Cancer Genome Atlas (TCGA) and GTEx were searched. Ovarian tumor samples were available from TCGA, and normal ovarian samples were obtained from the GTEx dataset. The relative proportions of immune cell profiling in OvCa and normal samples were evaluated by CIBERSORT algorithm. Association between each immune cell subtype and survival was inferred by the fractions of 22 immune cell types. "CancerSubtypes" R-package was employed to identify the three types of molecular classification and analyze the functional enrichment in each subclass. Response to immunotherapy and anticancer drug targets was predicted via TIDE algorithm and GDSC dataset. RESULTS: Substantial variation reflecting individual difference was identified between cancer and normal tissues in the immune infiltration profiles. T cells CD4 memory activated, macrophages M1 were associated with improved overall survival (OS) as evaluated by univariate Cox regression and multivariate Cox. Three subtypes were identified by ´CancerSubtypes' R-package and every sub-cluster possessed specific immune cell characterization. Meanwhile, Cluster II exhibited poor prognosis and sensitive response to immunotherapy. CONCLUSIONS: The cellular component of immune infiltration shows remarkable variation in OvCa. Profiling of immune infiltration is useful in prediction of prognosis of OvCa. The results from profiling might be considered in therapeutic modulation.

Effectiveness of interventions for pain relief in hysterosalpingographyAnetwork meta-analysis and systematic review.

OBJECTIVE: We aimed to evaluate the effectiveness of placebo, oral opioid analgesic (OOA), intravenous opioid analgesic (IOA), non-opioid analgesic (NOA), topical anesthetic (TA) and locally injected anesthetic (LIA) for pain relief duringhysterosalpingography (HSG) using a Bayesian network meta-analysis of data from randomized controlled trials. METHODS: PUBMED, EMBASE, and CENTRAL search engines were used to search and identify clinical trials that evaluated interventions for pain relief in HSG. Methodological studies quality was assessed by the Cochrane Collaboration tool for assessing risk of bias. RESULT: Sixteen trials involving 1263 participants were included in this study. IOA got excess but not statistically significant lower visual analogue score (VAS) pain score during HSG or more than 30 minutes after HSG compared with the other groups. OOA resulted in excess but not statistically significant higher VAS pain score during HSG compared with the other groups except placebo group. According to SUCRA regarding the lower VAS pain score during HSG, the treatments rank was the following: IOA, TA, NOA, LIA, OOA and placebo; as regard lower VAS pain score at 30 minutes or more after HSG, the treatments rank was the following: IOA, LIA, OOA, TA, NOA and placebo. CONCLUSION: This new Bayesian data network meta-analysis from randomized controlled trials demonstrated that IOA resulted in the highest probability to reduce the pain during HSG or at 30 minutes or more after HSG among the six interventions considered.

[The affection of antigen presentation ability, which sources from the spleen macrophage of Balb/c mouse during late gestation, on maternal Th2/Th1 type of immune].

OBJECTIVE: To study the relationship between antigen presentation ability of spleen macrophage and maternal Th2>Th1 immune bias in Balb/c mice during late pregnancy. METHODS: Balb/c mice during late gestation were adopted in our study, and mice of same species in estrus were used as control. With antigen stimulation, the spleen macrophages of Balb/c mice were pulsed as antigen presentation cells (APC). T cells sensitized previously by pulsed macrophage (1 degree APC) were cultured in mixture with macrophage pulsed by same antigen (2 degrees APC). An antigen special lymphocyte transformation test in vitro was used to evaluate the antigen presentation ability of spleen macrophage from mice of late gestation, and a flow cytometry method was used to measured the ration of CD4, CD8, IL-10 and IFN-gamma positive cell in T cells which had being induced to proliferate. RESULTS: When spleen macrophage from mice during late gestation was used as 1 degree APC, the proliferation of sensitized T cell induced by macrophage from late pregnancy mice used as 2 degree APC was no more intense than that from estrous mice (P > 0.05). When spleen macrophage from mice in oestrus was used as 1 degree APC, the proliferation of sensitized T cell induced by macrophage from late pregnancy mice as 2 degrees APC was lower intense than that from estrous mice (P < 0.05). The type of 1 degree APC did not affect the ratio of IL-10 positive T cell, and macrophage from late pregnancy mice could induce more IL-10 positive T cell than that from estrous mice when they were used as 2 degrees APC (P < 0.05). The type of 1 degree or 2 degrees APC did not affect the ratio of IFN-gamma positive T cell. CONCLUSION: The spleen macrophage from mice during late gestation is not an effective APC, but can induce maternal Th2 type of immune and maintain the Th1 type immune at a lower stage during pregnancy, which means it may has some important role in pregnancy.

[Study of fetal lymphocyte of intrahepatic cholestasis of pregnancy].

OBJECTIVE: To explore effect of fetal lymphocyte on pathogenesis of intrahepatic cholestasis of pregnancy (ICP). METHODS: Twenty pregnant women with ICP and 20 normal pregnant women were enrolled in the study. The single mixed lymphocyte culture/reaction (MLC/MLR) was conducted using inactive lymphocyte obtained from maternal peripheral blood and lymphocyte of cord blood from fetus. Antigen-induced-lymphocyte-proliferation-reaction was used for dermic soluble antigen and decidual soluble antigen obtained from maternal blood and cord blood from fetus. The intense of proliferation was calculated and compared between normal and ICP-complicated pregnancies. RESULTS: (1) The level of intense of proliferation of fetal lymphocyte was significantly increased in ICP group 2.75 +/- 0.36 than those of normal control group 1.45 +/- 0.19 in single mixed lymphocyte culture (P < 0.05). (2) The level of intense of proliferation of fetal lymphocyte was significantly increased in ICP group 1.45 +/- 0.19 than those of normal control group 0.67 +/- 0.24 in decidual soluble antigen induced lymphocyte proliferation reaction (P < 0.05). (3) The level of intense of proliferation of fetal lymphocyte was significantly increased in ICP group (1.22 +/- 0.44) than those of normal control group (0.66 +/- 0.27) in dermic soluble antigen induced lymphocyte proliferation reaction. CONCLUSIONS: (1) The fetal lymphocyte may be one of the effector cells in pathogenesis of ICP. (2) The disturbance of fatal-maternal immune-tolerance is one of the important mechanisms underlying ICP.

[The role of progesterone in human early pregnancy is mediated by insulin-like growth factors binding protein1-3].

OBJECTIVE: To determine whether the functional role of progesterone in human early pregnancy is mediated by progesterone receptor(PR) and insulin-like growth factor binding protein 1-3(IGFBP1-3). METHODS: Sample collection was conducted in accordance to the principle of informed content. Decidua and villi were obtained from 48 healthy women in 5-7 weeks of pregnancy, and endometrium in mid-secretory phase was obtained as control. The serum levels of progesterone were detected by radioimmunoassay, and the expressions of IGFBP1-3 and progesterone receptor were detected by immunohistochemistry (LsAB)and quantified by a computer image analysis system. RESULTS: Serum progesterone increased gradually and reached peak level in 5-6 weeks, which was significantly higher than that during the mid-secretory phase (P<0.05). The expression of progesterone receptor in luminal epithelium and decidual cells had significant correlations with serum progesterone, but its expression in glandular epithelium and trophoblast cells had no correlations with serum progesterone. IGFBP1-3 in luminal, glandular epithelium, and decidual cells had significant correlations with serum progesterone, but their expression in trophoblast cells had no correlations with serum progesterone. CONCLUSION: Progesterone plays an important role in the support and maintenance of early pregnancy, and its effect may be mediated by progesterone receptor and IGFBP1-3, in decidual-trophoblast interface.

[A change in antigen presentation ability of spleen macrophage from Balb/c mouse during late pregnancy].

OBJECTIVE: To study the antigen presentation ability of spleen macrophage from Balb/c mouse during late gestation. METHODS: The spleen of Balb/c mouse during late gestation was collected aseptically and macrophage was separated; the mice in estrus were used as control. The ability of macrophage to prime original T cells to human gamma globulin antigen (HGG-Ag) or placenta antigen (Pla-Ag) was evaluated by a delayed-type hyper sensitivity (DTH) response induced by the same antigen, and the ability of macrophage to induce the proliferation of primed normal T cells to HGG-Ag or Pla-Ag was assessed by an antigen special lymphocyte transformation in vitro. RESULTS: After being sensitized previously by spleen macrophage from Balb/c mice during late gestation that has been pulsed by HGG-Ag or Pla-Ag, the DTH intensity of mice response to the same antigen was significantly weaker than that being sensitized by macrophage from mice in estrus (P < 0.05). When spleen macrophage from Balb/c mice during late gestation was used as antigen presentation cell (APC), the proliferability of primed T cell induced by HGG-Ag or Pla-ag was significantly lower than that when macrophage from estrous Balb/c mouse was used in vitro (P < 0.05). CONCLUSION: The antigen presentation ability of spleen macrophage from Balb/c mouse is inhibited during late pregnancy. This may be the important mechanism by which maternal immune system tolerates embryo antigen and may be responsible for the down-regulation of maternal cell mediated immunity during pregnancy.