Systematic review and meta-analysis of reproductive outcomes after high-intensity focused ultrasound (HIFU) treatment of adenomyosis.

High-intensity focused ultrasound (HIFU) has emerged as a promising uterus-sparing and possibly fertility-sparing treatment modality for women with adenomyosis, especially those who desire to conceive. We conducted this systematic review and performed a meta-analysis on clinical studies aimed to improve reproduction in women with adenomyosis. After extensive search of PubMed and CNKI, we identified 10 studies published in English and Chinese involving a total of 557 patients with adenomyosis who desired to conceive after HIFU treatment. We found a pooled estimate of pregnancy rate of 53.4% and of the live birth rate of 35.2%, and there was a substantial heterogeneity among these studies. While there is a potential for HIFU treatment to improve fertility for patients with adenomyosis who desired to conceive, such evidence is very weak as of now. Comparative studies with much higher methodological rigor, preferably randomized clinical trials, are badly needed to further illuminate this issue.

Risk factor for interstitial pregnancy following ipsilateral salpingectomy? A retrospective matched case control study.

BACKGROUND: Interstitial pregnancy may still happen even after ipsilateral salpingectomy, resulting in massive hemorrhage. Therefore, the purpose of the study is to identify risk factors associated with interstitial pregnancy following ipsilateral salpingectomy and discuss possible prevention. METHODS: We conducted a retrospective cohort study in a single, large, university-affiliated hospital. Data of 29 patients diagnosed with interstitial pregnancy following ipsilateral salpingectomy from January 2011 to November 2020 were assigned into the case group (IP group). Whereas there were 6151 patients with intrauterine pregnancy after unilateral salpingectomy in the same period. A sample size of 87 control patients was calculated to achieve statistical power (99.9%) and an α of 0.05. The age, BMI and previous salpingectomy side between the two group were adjusted with PSM at a ratio of 1:3. After PSM, 87 intrauterine pregnancy patients were successfully matched to 29 IP patients. RESULTS: After PSM, parous women were more common and intrauterine operation was more frequent in the IP group compared with control group (P<0.05). There was only one patient undergoing IVF-ET in the IP group as compared with 29 cases in the control group (3.4% vs. 33.3%, P<0.05). Salpingectomy was performed on 5 patients in the IP group and 4 patients in the control group due to hydrosalpinx (P<0.05). Logistic regression indicated that hydrosalpinx was the high risk factor of interstitial pregnancy following ipsilateral salpingectomy (OR = 8.175). CONCLUSIONS: Hydrosalpinx appears to be an independent factor contributing to interstitial pregnancy following ipsilateral salpingectomy in subsequent pregnancy.

Potential application of heat shock proteins as therapeutic targets in Parkinson's disease.

Parkinson's disease (PD) is a common chronic neurodegenerative disease, and the heat shock proteins (HSPs) are proved to be of great value for PD. In addition, HSPs can maintain protein homeostasis, degrade and inhibit protein aggregation by properly folding and activating intracellular proteins in PD. This study mainly summarizes the important roles of HSPs in PD and explores their feasibility as targets. We introduced the structural and functional characteristics of HSPs and the physiological functions of HSPs in PD. HSPs can protect neurons from damage by degrading aggregates with three mechanisms, including the aggregation and removing α-Synuclein (α-Syn) aggregates, promotion the autophagy of abnormal proteins, and inhibition the apoptosis of degenerated neurons. This study underscores the importance of HSPs as targets in PD and helps to expand new mechanisms in PD treatment strategies.

Postoperative reproductive results of infertile patients with intrauterine adhesions: A retrospective analysis.

OBJECTIVE: To explore the reproductive outcomes after hysteroscopic separation of intrauterine adhesions (IUA) in infertile patients due to IUA. METHODS: This retrospective study enrolled patients with fertility requirements and infertility due to IUA. Data were collected from the hospital medical records and by follow-up by telephone. The impact on pregnancy and pregnancy outcome of preoperative adhesion, menstrual conditions before and after surgery and postoperative re-adhesion was analysed. RESULTS: A total of 106 patients (median age, 28 years) were enrolled in the study. There was a significant correlation between preoperative menstrual patterns and pregnancy rate. There were 56 pregnancies (pregnancy rate 52.83%) after the operation. Patients with improved menstruation after the operation had a significantly higher pregnancy rate (pregnancy rate 56.25%; 45 of 80 patients) compared with the patients that did not experience any improvement in their postoperative menstrual status (pregnancy rate 21.43%; three of 14 patients). Of the 56 pregnancies, 40 (71.43%) resulted in live births and six (10.71%) patients had miscarriages. A total of 54 of 56 patients (96.43%) became pregnant within 2 years. CONCLUSION: Pregnancy after intrauterine adhesion separation has a high rate of miscarriage and obstetric complications, so close monitoring of the patient is required.

Clinical characteristics and pregnancy outcomes of infertile patients with endometriosis and endometrial polyps: A retrospective cohort study.

OBJECTIVE: The aim of this study was to discuss the clinical characteristics and the prognosis of surgically diagnosed endometriosis complicated by endometrial polyps and investigate the association between pregnancy outcomes during subsequent pregnancies. MATERIALS AND METHODS: From January 2013 to December 2016, 1263 infertile patients were enrolled in the study. We identified 451 patients with endometriosis, and divided them into a polyp group (n = 204) and a non-polyp group (n = 247) based on whether or not they were associated with endometrial polyps. Postoperative clinical pregnant women (n = 82) among the polyp group were then classified into a study group and a control group composed of those undergoing a singleton pregnancy (n = 164) who delivered during the same time period. Clinical statuses and complications during pregnancy and delivery were collected from hospitals and by telephone interviews and surveys through the mail. RESULTS: The prevalence rate of endometriosis infertile group was obviously higher than the non-endometriosis infertile group ([45.23%; 204/451] versus [17.12%; 139/812]). Women suffering from stage 1 to 4 endometriosis had a 42.44% (73/172), 40.69% (59/145), 55.89% (38/68) and 51.52% (34/66) occurrence rate of endometrial polyps, respectively. The frequency of endometrial polyps for stage 3 and 4 patients was obviously higher than that of stage 1 and 2 patients ([53.73%; 72/134] versus [41.64%; 132/317]). Moreover, the occurrence rate of deep infiltrating endometriosis (DIE) was 57.81% (37/64), which was obviously higher than that of ovarian endometriosis (42.42%; 98/231) and peritoneal endometriosis (44.23%; 69/156). Of the 204 women diagnosed with posterior endometrial polyps, 89 became pregnant, 7 pregnancies ended in a spontaneous abortion, and 82 successfully delivered a baby. The clinical pregnancy rate of patients in stages 1 and 2 was wholly higher than that of patients in stages 3 and 4 ([48.70%; 56/115] versus [37.71%; 26/82]). The postsurgical pregnancy status of patients suffering from peritoneal endometriosis was slightly better than those with ovarian or DIE, but differences were not statistically significant (P = 0.626). We also found that the pregnancy rate was statistically elevated in patients whose EFI scores range from 7 to 10. When compared to the control group, women with endometriosis and endometrial polyps had a higher risk of their pregnancy being complicated by placenta previa (13.41%) and cesarean delivery (59.76%). CONCLUSION: Patients with endometriosis have a higher frequency of endometrial polyps. We found that a combined hysteroscopy and laparoscopy surgical procedure is an effective way to increase pregnancy rates. Different endometriosis stages and types in patients were associated with clinical pregnancy and spontaneous abortion rates. Women affected by both endometriosis and endometrial polyps have an independently elevated risk of placenta previa and cesarean delivery during pregnancy.

Ovarian preservation and prognosis in adnexal torsion surgery - a retrospective analysis.

OBJECTIVES: This study aims to analyze the conditions of ovarian preservation during adnexal torsion surgery, and safety of ovarian preservation. MATERIAL AND METHODS: A retrospective analysis of 130 patients, who underwent surgery for ovarian benign tumor pedicle torsion in Fujian Provincial Maternal and Child Health Hospital from June 2013 to June 2018, was conducted. This study analyses the possible risk factors affecting the operation method using multiple logistic regression and analyses the complications and the recovery of ovarian function after the treatment of the ovarian preservation. RESULTS: Among these patients, 58 received ovarian cystectomy, while 72 received ovariectomy. There was no significant difference in terms of age, preoperative blood, operation time and surgical bleeding volume between the two groups (p > 0.05). However, there was a significant difference in preoperative adnexal blood flow, abdominal pain to the surgical interval, and a collection of torsion cycles (p < 0.05). There was an increased risk of ovarian resection in patients whose blood flow of the annex disappeared, whose time of abdominal pain was long, and whose number of twists were significant. For the preservation group, there were no increases in postoperative complications. CONCLUSIONS: According to clinical indicators, such as preoperative adnexal blood flow, abdominal pain to the interval of surgery and the number of torsion cycles, it was determined whether it was feasible to keep the ovary. Retaining the ovary is safe, effective and feasible in adnexal torsion.

Factors affecting pregnancy outcomes following the surgical removal of intrauterine adhesions and subsequent in vitro fertilization and embryo transfer.

This study aimed to investigate the clinical factors affecting pregnancy rates following the surgical removal of intrauterine adhesions (IUAs) and subsequent in vitro fertilization and embryo transfer (IVF-ET). We retrospectively evaluated case data from patients who had undergone hysteroscopic surgery to remove varying degrees of IUAs and who had subsequently received assisted reproductive treatments with IVF-ET (in all 140 cycles) at our hospital between January, 2011 and January, 2015. The patient data were divided into either the pregnancy or non-pregnancy groups based on the pregnancy outcomes, and a number of clinicopathological variables were compared these two groups, such as age, infertility (type and duration), the number of prior surgical treatments for and severity of IUAs, the baseline follicle-stimulating hormone/luteinizing hormone (FSH/LH) ratio and estradiol level, endometrial thickness on the day of human chorionic gonadotropin (hCG) administration, etc. We selected the variables with statistically significant differences to generate multivariate logistic regression and linear correlation analyses. We found that i) the mean endometrial thickness on the day of hCG administration was greater in the pregnancy group, and that the average gestational age was younger than that in the non-pregnancy group. The different age groups had significantly different pregnancy rates. The mean baseline FSH/LH ratio of the women in the pregnancy group was lower than that in the women in the non-pregnancy group. The number of embryos transferred in the pregnancy group was higher than that in the non-pregnancy group. However, the other variables exhibited similar values between these two groups. ii) Our multivariate logistic regression analyses revealed that age and endometrial thickness on the day of hCG administration had significant effects on the pregnancy outcome. The baseline FSH/LH ratio and the number of embryos transferred were similar between the groups. On the whole, age and endometrial thickness on the day of hCG administration are the most important predictors of pregnancy outcome in the patients undergoing IVF-ET following the surgical removal of IUAs. Importantly however, the identification of effective methods with which to improve the endometrial thickness and the ovarian response in patients with diminished ovarian reserves warrants further investigation in future research.