Full-term live birth in a woman with 17α-hydroxylase and 17,20-lyase deficiency with assisted reproductive technology: a case report.

BACKGROUND: 17α-hydroxylase deficiency, which is caused by a CYP17A1 gene mutation, is a rare type of congenital adrenocortical hyperplasia that mainly manifests as hypertension, hypokalaemia and sexual dysplasia. To date, few pregnancies associated with this syndrome have been reported. CASE PRESENTATION: We describe a 35-year-old Chinese woman with nonclassical congenital adrenal hyperplasia (NCCAH) due to 17α-hydroxylase/17,20-lyase deficiency who achieved pregnancy after in vitro fertilization (IVF) and frozen-thawed embryo transfer. She had secondary amenorrhea since she was 27, and subsequently, high level of progesterone in the follicular phase was found during a blood test. A compound heterozygous mutation was found in the CYP17A1 gene, c.1263G > A and c.985_987delinsAA. The patient was given standardized treatment with dexamethasone. Due to ovulation disorder, IVF was performed. She underwent whole embryo vitrification freezing. Frozen-thawed embryo transplantation was performed following the artificial cycle protocol of endometrium preparation, resulting in a singleton pregnancy. At 39 weeks and 1 day of gestation, caesarean section was performed due to the breech position of the foetus. CONCLUSION: A high level of progesterone reduces endometrial receptivity. Standardized treatment with dexamethasone and frozen-thawed embryo transfer with an artificial cycle protocol of endometrium preparation should be the choice for infertile female patients with CYP17A1 deficiency.

Menstrual patterns and disorders among Chinese women of reproductive age: A cross-sectional study based on mobile application data.

ABSTRACT: Menstruation is an important indicator of women's health. Identification of abnormal menstrual patterns in adolescence may improve early diagnosis of potential health concerns in adulthood. This study aimed to evaluate menstrual patterns and disorders of Chinese women of reproductive age based on an APP.From December 2015 to January 2016, a cross-sectional study was conducted. We utilized a mobile application (APP) to collect information about participants' age at menarche, length of menstruation, duration of menstruation, amount of menstrual flow, regularity of menstrual cycle, prevalence of abnormal uterine bleeding and dysmenorrhoea.A total of 156,055 women (25,716 from the questionnaire survey and 130,000 from the mobile APP users) participated in the study. The average age of the subjects was 26.32 ±â€Š6.97 years (median age, 25 years). Mean age at menarche was 13.08 ±â€Š1.87 years; average length of menstrual cycle, 30.9 ±â€Š4.28 days (median 30 days); and average duration of menstruation, 5.01 ±â€Š1.13 days (median 5 days). Women with irregular menstrual cycles accounted for 36.41%. Women aged < 18 years and > 30 years were more likely to experience irregular menstrual cycles. The prevalence of secondary amenorrhoea was 4.07%. More than 20% of women reported abnormal menstrual flow. About 20.11% of women had abnormal uterine bleeding, and 77.65% had dysmenorrhoea. A hot compress was the most commonly used approach to ameliorate dysmenorrhoea. Women with low education and low income and those with high education and high income tended to have menstrual problems.A mobile APP as a survey tool has the advantages of large sample size, low cost, and high efficiency. The use of a mobile APP is an emerging approach for collecting big data in the field of health research. The results showed that the prevalence of menstrual disorders among Chinese reproductive women was high. Healthcare providers should educate girls and their caregivers about menstrual physiology, normal menstrual pattern, and reproductive health to prevent long-term diseases.

Cross-sectional study of contraceptive use among Chinese women of reproductive age: results based on a mobile application (APP)-derived data.

PURPOSE: To evaluate the contraceptive status among Chinese women of reproductive age and factors associated with contraceptive methods. METHODS: A cross-sectional study from November 2015 to January 2016 was conducted. We used APP to collect demographics and contraceptive use information of women aged 14-44 years in China. RESULTS: A total of 23,669 women completed the study. After data cleaning, 19,768 (83.5%) women were included in the final analysis. The prevalence of contraceptive use was 78.9%; while 21.05% of women did not use any method, condoms (40.10%), rhythm, or withdrawal (31.03%) were the most commonly used methods. When contraceptive methods were divided into four categories-long-acting contraceptives (LAC), short-acting contraceptive (SAC), Others, and "No use"-the prevalence was 6.1% (601/19,678), 40.8% (8022/19,678), 35.1% (6912/19,678), and 21.1% (4143/19,678), respectively. Women with a high level of education, being unmarried, and sexually active women tended to choose SAC; married women were associated with LAC usage. Women with irregular menstrual cycle used a high proportion of emergency contraception. CONCLUSIONS: The prevalence of contraceptive use was 78.9%, with condom use being most prominent. Young women of reproductive age have low awareness of contraception. Relevant departments should take necessary measures to improve this situation.

Dynamic self-representation of interdependent Chinese: The effect of bicultural experience.

The process of globalisation has increased the opportunity for Chinese individuals to utilise influences from other cultures that differ from their own collectivistic culture. The explorations of the impact of acculturation on Chinese individuals' self-construals have become intriguing. Thus, we recruited German-Chinese (N = 192) people who live in Germany and had direct bicultural experiences, as well as Mainland-Chinese (N = 192) people who live in Mainland China and had internalised a second culture through more indirect means of exposure. We investigated their accessibility to both interdependent and independent cultural frameworks using temporal self-construal priming. The results showed that priming effects were observed in both cultural groups. However, the self-construals of the German-Chinese participants were more flexible than those of Mainland-Chinese under self-construal priming. Also, the results suggested that women were easier to be influenced by direct bicultural experiences, due to their private and collective self were different between the two cultures. These findings provide evidence regarding the opinion that individuals could use influences from more than one culture. More importantly, these results suggest that the acculturation induced by direct bicultural experiences facilitates cultural frame switching.

Self-Construal Priming Modulates Self-Evaluation under Social Threat.

Previous studies have shown that Westerners evaluate themselves in an especially flattering way when faced with a social-evaluative threat. The current study first investigated whether East Asians also have a similar pattern by recruiting Chinese participants and using social-evaluative threat manipulations in which participants perform self-evaluation tasks while adopting different social-evaluative feedbacks (Experiment 1). Then further examined whether the different response patterns can be modulated by different types of self-construal by using social-evaluative threat manipulations in conjunction with a self-construal priming task (Experiment 2). The results showed that, as opposed to Westerners' pattern, Chinese participants rated themselves as having significantly greater above-average effect only when faced with the nonthreatening feedback but not the social-evaluative threat. More importantly, we found that self-construal modulated the self-evaluation under social-evaluative threat: following independent self-construal priming, participants tended to show a greater above-average effect when faced with a social-evaluative threat. However, this pattern in conjunction with a social threat disappeared after participants received interdependent self-construal priming or neutral priming. These findings suggest that the effects of social-evaluative threat on self-evaluation are not culturally universal and is strongly modulated by self-construal priming.

Association between Menopausal Symptoms and Overactive Bladder: A Cross-Sectional Questionnaire Survey in China.

PURPOSE: The association between menopause and overactive bladder is controversial. The purpose of this study was to determine the association between menopausal symptoms and overactive bladder, and identify the risk factors for overactive bladder. METHODS: A cross-sectional study was performed. The study included 403 women aged 36-76 years who visited the menopause clinic at Peking University First Hospital between September 2012 and December 2013. The overactive bladder symptom score and modified Kupperman index questionnaires were used. Differences were assessed using descriptive statistics to determine any association between the overactive bladder symptom score and modified Kupperman index score, and to evaluate the risk factors for overactive bladder. RESULTS: A total of 304 women were finally enrolled. The prevalence of overactive bladder was 9.43%, and the modified Kupperman index score; number of sexual problems; and frequency of urinary tract infections, vertigo, melancholia, and mood swings were significantly higher in patients with overactive bladder than in the patients without overactive bladder (p < 0.05). Menopausal symptoms (modified Kupperman index score ≥ 15) (odds ratio: 1.049, 95% confidence interval: 1.006-1.095, p = 0.025) and a low frequency of sexual intercourse in the last 6 months (odds ratio: 2.580, 95% confidence interval: 1.228-5.422, p = 0.012) were identified as independent risk factors for overactive bladder. The frequency of sexual intercourse was found to decrease with an increase in the severity of overactive bladder (p = 0.004, linear-by-linear association = 0.001). CONCLUSION: Menopausal symptoms may be closely associated with overactive bladder, and sexual activity may be associated with the severity of overactive bladder. Moreover, sexual problems, urinary tract infections, vertigo, melancholia, and mood swings may be associated with overactive bladder.

A critical role of temporoparietal junction in the integration of top-down and bottom-up attentional control.

Information processing can be biased toward behaviorally relevant and salient stimuli by top-down (goal-directed) and bottom-up (stimulus-driven) attentional control processes respectively. However, the neural basis underlying the integration of these processes is not well understood. We employed functional magnetic resonance imaging (fMRI) and transcranial direct-current stimulation (tDCS) in humans to examine the brain mechanisms underlying the interaction between these two processes. We manipulated the cognitive load involved in top-down processing and stimulus surprise involved in bottom-up processing in a factorial design by combining a majority function task and an oddball paradigm. We found that high cognitive load and high surprise level were associated with prolonged reaction time compared to low cognitive load and low surprise level, with a synergistic interaction effect, which was accompanied by a greater deactivation of bilateral temporoparietal junction (TPJ). In addition, the TPJ displayed negative functional connectivity with right middle occipital gyrus, which is involved in bottom-up processing (modulated by the interaction effect), and the right frontal eye field (FEF), which is involved in top-down control. The enhanced negative functional connectivity between the TPJ and right FEF was accompanied by a larger behavioral interaction effect across subjects. Application of cathodal tDCS over the right TPJ eliminated the interaction effect. These results suggest that the TPJ plays a critical role in processing bottom-up information for top-down control of attention.

Factors associated with menopausal symptoms among middle-aged registered nurses in Beijing.

OBJECTIVE: To determine factors related to menopause symptoms among middle-aged registered nurses in Beijing. METHODS: Self-administered questionnaires that included closed-ended questions on many factors possibly related to menopausal symptoms were distributed to 2100 registered nurses aged 40-55 at 20 hospitals in Beijing, China. RESULTS: Menopausal status was most associated with menopausal symptoms (p < 0.01), including hot flashes and sweating, paresthesiae, insomnia, arthralgia/myalgia, palpitations, skin formication and an unsatisfactory sexual life. The odds ratios (ORs) were highest for hot flashes and sweating. Upsetting events in the past year and being pessimistic were significantly inversely correlated with almost all the symptoms analyzed. Hot flashes and sweating (p < 0.01), paresthesiae (p < 0.01), unsatisfactory sexual life (p < 0.01), irritability (p < 0.05), depression or suspicion (p < 0.05) and dizziness (p < 0.05) were negatively correlated with the frequency of sexual activity. CONCLUSION: Many factors may influence symptoms of the menopause. We found that menopausal status was most strongly associated with most menopausal symptoms, especially hot flashes and sweating. Psychosocial factors also played an important role. A higher frequency of sexual activity negatively correlated with most menopausal symptoms.

Effects of physical exercise on health-related quality of life and blood lipids in perimenopausal women: a randomized placebo-controlled trial.

OBJECTIVE: This study aims to evaluate the treatment effects of physical exercise on menopausal symptoms in middle-aged female medical staff experiencing perimenopausal syndrome. METHODS: A total of 157 female medical staff aged 40 to 55 years and with a Kupperman index score of 15 points or higher were randomized 1:1 into an intervention group (n = 78) or a control group (n = 79). Women in the intervention group were asked to perform aerobic physical exercise (walking with strides) three times a week or more, whereas those in the control group continued as normal. Measurements were taken at baseline and on weeks 4, 8, and 12, with total Kupperman index score, scores on individual elements of the scale, weight, and waist circumference recorded. In addition, fasting blood glucose, triglycerides, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol were recorded at baseline and on week 12. The effects of physical exercise therapy on perimenopausal syndrome were evaluated by comparing changes in these parameters between the control group and the intervention group. RESULTS: Fifty-four and 57 women completed all three follow-ups in the intervention and control groups, respectively. On week 12, the mean (SD) change in total Kupperman index score (-9.23 [6.23]) from baseline to week 12; the mean (SD) changes in individual scores for paresthesia (-1.08 [1.51]), insomnia (-1.00 [1.46]), irritability (-1.00 [1.34]), joint or muscle pain (-0.75 [0.74]), fatigue (-0.56 [0.75]), headache (-0.54 [0.75]), formication (-0.38 [0.66]), and sexual life (-0.62 [1.71]); and the mean (SD) changes in total cholesterol (-0.76 [0.63] mmol/L) and triglycerides (-0.20 [0.50] mmol/L) were significantly higher in the intervention group than in the control group (P < 0.05). In the intervention group, total Kupperman index score, weight, body mass index, waist circumference, triglycerides, and total cholesterol were significantly lower on week 12 compared with baseline (P < 0.05). CONCLUSIONS: Physical exercise can substantially reduce menopausal symptoms and improve blood lipid status and body weight.

Effect of Isopropanolic Cimicifuga racemosa Extract on Uterine Fibroids in Comparison with Tibolone among Patients of a Recent Randomized, Double Blind, Parallel-Controlled Study in Chinese Women with Menopausal Symptoms.

Objective. Effect of isopropanolic Cimicifuga racemosa extract (iCR) on uterine fibroid size compared with tibolone. Method. The randomized, double-blind, controlled study in China enrolled 244 patients aged 40-60 years with menopausal symptoms (Kupperman Menopause Index ≥ 15). The participants were treated with either iCR of 40 mg crude drug/day (N = 122) or tibolone 2.5 mg/day (N = 122) orally for 3 months in 2004. Now, we investigated the subset of all women (N = 62) with at least one uterine fibroid at onset of treatment for the effect of iCR (N = 34) on fibroid size compared with tibolone (N = 28) by transvaginal ultrasonography. Results. The median myoma volume decreased upon iCR by as much as -30% (P = 0.016) but increased upon tibolone by +4.7%. The percentage of volume change, mean diameter change and geometric mean diameter change of the iCR group compared to tibolone were statistically significant (P = 0.016, 0.021, 0.016 respectively). Conclusion. Our results suggest that iCR (Remifemin) is a valid herbal medicinal product in patients with uterine myomas as it provides adequate relief from menopausal symptoms and inhibits growth of the myomas in contrast to tibolone.