Reproductive Medicine

生殖医学
  • 文章类型: Case Reports
    一名30多岁的妇女因急性下腹疼痛3天出现紧急情况,与任何月经无关,肠或泌尿症状。检查发现腹部盆腔肿块,对应于18周的妊娠子宫,伴有弥漫性压痛,并在她的下腹部受到保护。患者为浆膜下子宫肌瘤的随访病例,慢性肾病4期和风湿性心脏病对抗凝剂的影响。怀疑纤维样变性或扭转。超声显示大的后壁浆膜下肌瘤,骨盆中有游离液体。由于研究结果没有提示变性或带蒂纤维瘤,做了非对比CT,显示类似的肿块,从子宫底出现蒂,游离液,没有其他明显的急腹症原因。病人接受了紧急剖腹手术。术中,发现是浆膜下肌瘤,大网膜粘附在其上并绕其轴扭曲约八次。据报道,该病例突出了急性腹部的罕见原因。
    A woman in her 30s presented to emergency with complaints of acute lower abdominal pain for 3 days, not associated with any menstrual, bowel or urinary symptoms. Examination revealed an abdominopelvic mass corresponding to an 18-week gravid uterus with diffuse tenderness and guarding over her lower abdomen. The patient was a follow-up case of subserosal fibroid uterus, chronic kidney disease stage 4 and rheumatic heart disease on anticoagulants. Fibroid degeneration or torsion was suspected. Ultrasound revealed a large posterior wall subserosal fibroid with free fluid in the pelvis. As findings did not suggest degeneration or pedunculated fibroid, noncontrast CT was done, which showed a similar mass with a pedicle arising from the uterine fundus with free fluid with no other evident cause of acute abdomen. The patient was taken up for emergency laparotomy. Intraoperatively, it was found to be a case of subserosal fibroid with greater omentum adhered to it and twisted around its axis about eight times. This case is being reported to highlight a rare cause of acute abdomen.
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  • 文章类型: Journal Article
    作为最丰富的小RNA,piwi相互作用RNA(piRNAs)已被鉴定为一类新的非编码RNA,长度为24-32个核苷酸,它们在雄性生殖细胞中高水平表达。PiRNAs参与了几种生物过程的调节,包括细胞分化,发展,和男性繁殖。在这次审查中,我们专注于piRNAs在控制精子发生中的功能和分子机制,包括基因组稳定性,基因表达的调节,和男性生殖细胞发育。piRNA途径包括两个主要途径,即前粗线piRNA途径和粗线piRNA途径。在前粗线质阶段,piRNAs参与染色体重塑和基因表达调控,通过抑制转座子活性维持基因组稳定性。在粗线质阶段,piRNA通过与mRNA结合和RNA切割调节基因表达来介导雄性生殖细胞的发育。我们进一步讨论了piRNAs异常与男性不育之间的相关性以及piRNAs在生殖医学和未来研究中的应用前景。这篇综述为哺乳动物精子发生机制提供了新的见解,并为诊断和治疗男性不育提供了新的靶点。
    As the most abundant small RNAs, piwi-interacting RNAs (piRNAs) have been identified as a new class of non-coding RNAs with 24-32 nucleotides in length, and they are expressed at high levels in male germ cells. PiRNAs have been implicated in the regulation of several biological processes, including cell differentiation, development, and male reproduction. In this review, we focused on the functions and molecular mechanisms of piRNAs in controlling spermatogenesis, including genome stability, regulation of gene expression, and male germ cell development. The piRNA pathways include two major pathways, namely the pre-pachytene piRNA pathway and the pachytene piRNA pathway. In the pre-pachytene stage, piRNAs are involved in chromosome remodeling and gene expression regulation to maintain genome stability by inhibiting transposon activity. In the pachytene stage, piRNAs mediate the development of male germ cells via regulating gene expression by binding to mRNA and RNA cleavage. We further discussed the correlations between the abnormalities of piRNAs and male infertility and the prospective of piRNAs\' applications in reproductive medicine and future studies. This review provides novel insights into mechanisms underlying mammalian spermatogenesis and offers new targets for diagnosing and treating male infertility.
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  • 文章类型: Journal Article
    不孕症是一个日益严重的全球健康问题,对社会经济生计产生深远影响。由于男性和女性不育的原因非常复杂,迫切需要通过整合先进技术来促进和维持生殖健康。生物医学工程,应用于生物和医疗保健领域的成熟技术,已成为诊断和治疗不孕症的有力工具。如今,正在研究各种有前途的生物医学工程方法,以解决人类不孕症。生物医学工程方法不仅可以提高我们对生物工程设备中精子和卵泡发育的基本理解,生物材料,和相关的细胞,但也适用于子宫修复,子房,和宫颈阴道组织,恢复组织功能。这里,我们介绍了男性和女性不育,并全面总结了各种有前途的生物医学工程技术及其在生殖医学中的应用。此外,讨论了生物医学工程技术在临床转化中的挑战和前景。我们相信这次审查将促进工程师之间的沟通,生物学家,和临床医生,并可能在不久的将来为这些创新研究工作的临床转化做出贡献。
    Infertility is a rising global health issue with a far-reaching impact on the socioeconomic livelihoods. As there are highly complex causes of male and female infertility, it is highly desired to promote and maintain reproductive health by the integration of advanced technologies. Biomedical engineering, a mature technology applied in the fields of biology and health care, has emerged as a powerful tool in the diagnosis and treatment of infertility. Nowadays, various promising biomedical engineering approaches are under investigation to address human infertility. Biomedical engineering approaches can not only improve our fundamental understanding of sperm and follicle development in bioengineered devices combined with microfabrication, biomaterials, and relevant cells, but also be applied to repair uterine, ovary, and cervicovaginal tissues and restore tissue function. Here, we introduce the infertility in male and female and provide a comprehensive summary of the various promising biomedical engineering technologies and their applications in reproductive medicine. Also, the challenges and prospects of biomedical engineering technologies for clinical transformation are discussed. We believe that this review will promote communications between engineers, biologists, and clinicians and potentially contribute to the clinical transformation of these innovative research works in the immediate future.
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  • 文章类型: Journal Article
    目的:本文采用卫生经济学方法,探讨长方案和拮抗剂方案在中国人群体外受精和胚胎移植(ET)中的成本效益价值。
    方法:卫生经济学评价研究。
    方法:构建本研究模型所需的数据来自中国已发表的研究和其他次要来源。
    方法:没有患者参与本研究。
    方法:主要结局是活产率(LBR)和成本。从社会的角度来看,我们考虑了整个治疗周期的直接和间接成本.使用增量成本效益比和协议具有更高的净货币收益的可能性来衡量成本效益。进行了灵敏度分析,验证了仿真结果的可靠性。
    结果:对于中国人口,长方案导致比拮抗剂方案更高的LBR(29.33%vs20.39%),但同时,它更贵($29146.26(US$4333.17)vs$23343.70(US$3470.51)),在仅考虑一个新鲜ET循环的情况下。考虑后续冻结ET(FET)周期时也是如此(51.78%对42.81%;30日元703.02(4564.62美元)对24日元740.95(3678.24美元))。大多数亚组的结果与基本分析的结果一致。然而,对于某些人群,长方案是次等方案(效果较差,费用较高).
    结论:对于中国人群,当每个活产的货币价值大于65420元(9726美元)和66400元(9872美元)时,分别,只考虑一个新鲜周期,并考虑随后的冷冻周期,长协议是首选协议。对于不同年龄和卵巢反应能力的女性,该阈值也有所不同。对于POSEIDON(以患者为导向的策略,包括个体化D卵母细胞数量)组2,组3和组4的女性,建议将拮抗剂方案作为首选方案。这项研究的结果需要进一步的大规模随机对照试验来验证。
    OBJECTIVE: This paper uses health economics methods to discuss the cost-effectiveness value of long protocol and antagonist protocol for in vitro fertilisation and embryo transfer (ET) in the Chinese population.
    METHODS: Health economic evaluation study.
    METHODS: The data needed to construct the model for this study were derived from published studies and other secondary sources in China.
    METHODS: No patients participated in the study.
    METHODS: The main outcomes were live birth rate (LBR) and cost. From the societal perspective, we considered the direct and indirect costs over the course of the treatment cycles. A cost-effectiveness was measured using the incremental cost-effectiveness ratio and the probability that a protocol has higher net monetary benefit. Sensitivity analysis was carried out to verify the reliability of the simulation results.
    RESULTS: For the Chinese population, the long protocol resulted in a higher LBR than the antagonist protocol (29.33% vs 20.39%), but at the same time, it was more expensive (¥29 146.26 (US$4333.17) vs ¥23 343.70 (US$3470.51)), in the case of considering only one fresh ET cycle. It was the same when considering subsequent frozen ET (FET) cycles (51.78% vs 42.81%; ¥30 703.02 (US$4564.62) vs ¥24 740.95 (US$3678.24)). The results of most subgroups were consistent with the results of the basic analysis. However, for certain populations, the long protocol was the inferior protocol (less effective and more expensive).
    CONCLUSIONS: For the Chinese population, when the monetary value per live birth was greater than ¥65 420 (US$9726) and ¥66 400 (US$9872), respectively, considering only one fresh cycle and considering subsequent frozen cycles, the long protocol is the preferred protocol. This threshold also varies for women of different ages and ovarian response capacities. For women in POSEIDON (Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number) group 2, group 3 and group 4, antagonist protocol is recommended as the preferred protocol. The results of this study need to be verified by further large-scale randomised controlled trials.
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  • 文章类型: Case Reports
    一名20多岁的妇女被转诊到三级医院急诊科,以管理迁移的ImplanonNXT。患者的全科医生在1周前插入了植入物,但在插入后无法触诊植入物,因此,订购了超声扫描,显示左贵重静脉中的Iplanon积极迁移。她有轻微的胸痛,还有她的体检,心电图和血液检查无明显变化。胸部CT显示右下叶动脉内有31毫米异物。通过介入放射学在超声引导下进入右颈内静脉并将6FR猪导管插入肺动脉干来去除异物。通过血管造影确认该位置,并使用鹅颈圈套器去除异物。病人当天出院,无并发症,几个月后就怀孕了.
    A woman in her 20s was referred to a tertiary hospital emergency department for management of a migrating Implanon NXT. The Implanon was inserted 1 week prior by the patient\'s general practitioner who was unable to palpate the Implanon after insertion and hence, ordered an ultrasound scan which showed an actively migrating Implanon in the left basilic vein. She had mild chest pain, and her physical examination, ECG and blood tests were unremarkable. A CT chest showed a 31 mm foreign body within the right lower lobar artery. The foreign body was removed by interventional radiology by accessing the right internal jugular vein under ultrasound guidance and inserting a 6 FR pig catheter into the pulmonary trunk. The position was confirmed with angiogram and the foreign body was removed using a goose neck snare. The patient was discharged the same day with no complications, and fell pregnant a few months afterwards.
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  • 文章类型: Journal Article
    背景:许多癌症治疗对患者的生育能力构成威胁。癌症治疗前精液冷冻保存是保存生育能力的有效方法。关于加拿大肿瘤精子库样本使用情况的长期数据很少。
    方法:对加拿大学术生育中心2001年至2020年的所有肿瘤精子库样本进行回顾性图表回顾。
    结果:从2001年到2020年,有2504名患者收集了4521个样本。这些患者中最常见的诊断是睾丸癌(29.5%)和淋巴瘤(26.9%)。在这些病人中,只有81例(3.2%)患者通过宫腔内授精(IUI)或体外受精(IVF)治疗返回使用他们的样本,62例(2.5%)患者将他们的样本转移到另一家诊所.银行和使用精子之间的时间从1到131个月不等,银行后的中位数为18个月。回顾了67例患者的66个IVF周期(104个胚胎移植)和101个IUI周期。在使用样本的67对夫妇中,53.7%实现了临床妊娠。IUI每个周期的临床妊娠率为6.6%,IVF每个胚胎移植的临床妊娠率为30.8%。较高的精子浓度或总运动量与较高的怀孕机会无关。受孕的患者每个周期的可用胚胎平均比没有受孕的患者多1.9±0.8(p=0.02)。
    结论:精子冷冻保存为癌症患者在潜在的性腺毒性癌症治疗后获得父母身份提供了一个有价值的选择。然而,库存肿瘤精子样本的总体使用率很低。
    BACKGROUND: Many cancer treatments pose a threat to fertility for patients. Semen cryopreservation before cancer treatment is an effective method to preserve fertility. There are sparse long-term data on the usage of samples from Canadian oncology sperm banks.
    METHODS: A retrospective chart review of all oncology sperm banking samples at a Canadian academic fertility centre from 2001 to 2020 was conducted.
    RESULTS: From 2001 to 2020, 4521 samples were banked by 2504 patients. The most frequent diagnoses among these patients were testicular cancer (29.5%) and lymphoma (26.9%). Of these patients, only 81 (3.2%) patients returned to use their samples with intrauterine insemination (IUI) or in vitro fertilisation (IVF) treatment and 62 (2.5%) patients transferred their samples to another clinic. The time between banking and return for usage of the sperm ranged from 1 to 131 months with a median of 18 months after banking. A total of 66 IVF cycles (104 embryo transfers) and 101 IUI cycles from 67 patients were reviewed. Of the 67 couples who used their samples, 53.7% achieved a clinical pregnancy. The clinical pregnancy rate was 6.6% per cycle for IUI and 30.8% per embryo transfer for IVF. Higher sperm concentration or total motile count was not associated with a higher chance of pregnancy. Patients who conceived had on average 1.9 ± 0.8 (p=0.02) more usable embryos per cycle than those who did not conceive.
    CONCLUSIONS: Sperm cryopreservation provides a valuable option for patients with cancer to achieve parenthood after potentially gonadotoxic cancer treatment. However, the overall usage of banked oncology sperm samples is very low.
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  • 文章类型: Journal Article
    背景:适当的生殖和性健康素养对于青少年获得,理解,评估和应用做出明智决策所需的信息,由于低识字率导致有害的决策,冒险和较差的健康和自我管理。这些因素增加了与性和生殖有关的问题的规模和严重程度,包括意外怀孕,艾滋病毒/性传播感染,不安全的堕胎和死亡。然而,关于青少年生殖健康和性健康识字状况和影响因素的信息很少。
    目的:评估青春期后期高中生的生殖和性健康素养状况及其相关因素。
    方法:横截面,基于机构的研究。
    方法:该研究包括埃塞俄比亚南部地区ArbaMinch镇(Gamo区)的8所中学和Sawla镇(Gofa区)的3所中学。
    方法:这项研究是在2023年5月20日至6月20日之间进行的,对象是青春期晚期的高中生。使用多级采样,招募了577名学生。使用青少年健康素养测量工具评估生殖健康素养。将数据加载到EpiData-V.3.1中并使用SPSS-V.25进行分析。二元logistic回归分析用于确定相关因素。双变量逻辑回归中p值<0.25的变量是多变量逻辑回归的候选变量。检查并满足了Hosmer-Lemeshow拟合优度统计数据。在p值<0.05时显示统计学显著性。
    结果:生殖和性健康素养有限的学生比例为69.6%(CI为65.3%至72.8%)。有限的识字状态与学校类型显着相关(公立学校AOR0.28(0.17至0.46)),母亲的职业(商人AOR0.42(0.23至0.76)),家庭月收入(收入10000-20000比尔AOR0.45(0.22至0.95)),有规律的体育锻炼>30分钟(每周超过一次,AOR0.44(0.23至0.84)),和有关避孕套的知识(差AOR2.23(1.38至3.64))。
    结论:明显的青少年表现出有限的生殖和性健康素养。结果强调,所有相关各方都必须努力工作,以确保学校青少年能够轻松获得,理解,评估和使用生殖和性相关信息。
    BACKGROUND: Adequate literacy in reproductive and sexual health is essential for adolescents to obtain, comprehend, evaluate and apply information necessary for making well-informed decisions, as low literacy leads to harmful decision-making, risk-taking and poorer health and self-management. These factors increase the magnitude and severity of problems related to sexuality and reproduction, including unintended pregnancy, HIV/sexually transmitted infections, unsafe abortion and death. However, information regarding the status and affecting factors of literacy in the reproductive and sexual health of adolescents is scarce.
    OBJECTIVE: To assess reproductive and sexual health literacy status and associated factors among late-adolescent high school students.
    METHODS: A cross-sectional, institution-based study.
    METHODS: The study included eight secondary schools in Arba Minch town (Gamo Zone) and three in Sawla town (Gofa Zone) in the South Ethiopia Region.
    METHODS: The study was done between 20 May and 20 June 2023, among late adolescent high school students. Using multistage sampling, 577 students were recruited. Reproductive health literacy was assessed using the Health Literacy Measure for Adolescents tool. Data were loaded into EpiData-V.3.1 and analysed using SPSS-V.25. Binary logistic regression analyses were used to identify associated factors. Variables with a p value <0.25 in bivariable logistic regression were candidates for multivariable logistic regression. A Hosmer-Lemeshow goodness-of-fit statistic was checked and satisfied. Statistical significance was indicated at a p value<0.05.
    RESULTS: The proportion of students with limited reproductive and sexual health literacy was 69.6% (CI 65.3% to 72.8%). The limited literacy status was significantly associated with school type (public school AOR 0.28 (0.17 to 0.46)), mother\'s occupation (merchant AOR 0.42 (0.23 to 0.76)), family monthly income (income 10 000-20 000 birr AOR 0.45 (0.22 to 0.95)), having regular physical exercise >30 min (more than once per week, AOR 0.44 (0.23 to 0.84)), and knowledge about condoms (poor AOR 2.23 (1.38 to 3.64)).
    CONCLUSIONS: A notable segment of adolescents exhibited limited reproductive and sexual health literacy. The result emphasises the necessity of all relevant parties to work diligently to guarantee that school adolescents can easily obtain, comprehend, evaluate and use reproductive and sexuality-related information.
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  • 文章类型: Journal Article
    目的:本研究旨在描述对避孕药引起的不孕症的信念模式,并评估其与当前避孕药具使用的关系。包括这些关系是否因平价和居住地而异。
    方法:我们使用来自埃塞俄比亚行动绩效监测的数据,全国代表,对7491名妇女的横断面调查,15-49岁,评估是否同意“如果我使用计划生育,下次我想怀孕的时候可能会有麻烦。\'我们使用多级分层模型来确定3882名性活跃者中协议和使用激素避孕方法之间的关联,希望防止怀孕的多胎妇女。我们包括平等和居住的互动术语。
    结果:10名女性中有4名不同意(42.3%),10名女性中有2名强烈不同意(20.7%)。相对于强烈反对的女性,不同意的女性和同意的女性使用激素避孕方法的几率显著降低(校正OR(aOR)0.65,95%CI0.44~0.97和0.46,95%CI0.46,95%CI0.30~0.70).在高均等女性中,同意该声明的效果最强(aOR0.54,95%CI0.30至0.95)。在社区一级使用与声明的更大共识与使用激素避孕的几率降低有关,但仅限于农村妇女。
    结论:有必要通过提供全面的咨询以及通过社区教育或大众媒体宣传,努力解决有关避孕药具引起的生育障碍的问题,特别是在高均等妇女和农村社区中。干预措施应承认有可能延迟恢复生育的具体方法,并试图解决引起关注的根本原因。
    OBJECTIVE: This study aims to describe patterns of beliefs about contraceptive-induced infertility and assess their relationship with current contraceptive use, including whether these relationships vary by parity and residence.
    METHODS: We use data from Performance Monitoring for Action Ethiopia, a nationally representative, cross-sectional survey of 7491 women, aged 15-49, to assess agreement with the statement \'If I use family planning, I may have trouble getting pregnant next time I want to.\' We used multilevel hierarchical models to identify the association between agreement and use of a hormonal method of contraception among 3882 sexually active, fecund women who wish to prevent pregnancy. We include interaction terms for parity and residence.
    RESULTS: 4 in 10 women disagreed (42.3%) and 2 in 10 strongly disagreed (20.7%) with the statement. Relative to women who strongly disagreed, women who disagreed and women who agreed had significantly lower odds of using a hormonal method of contraception (adjusted OR (aOR) 0.65, 95% CI 0.44 to 0.97 and 0.46, 95% CI 0.46, 95% CI 0.30 to 0.70). The effect of agreeing with the statement was strongest among high parity women (aOR 0.54, 95% CI 0.30 to 0.95). Greater agreement with the statement at the community-level use was associated with a reduction in the odds of using hormonal contraception but only among rural women.
    CONCLUSIONS: Efforts to address concerns around contraceptive-induced fertility impairment through the provision of comprehensive counselling and through community education or mass media campaigns are necessary, particularly among high-parity women and in rural communities. Interventions should acknowledge the possibility of delayed return to fertility for specific methods and attempt to address the root causes of concerns.
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  • 文章类型: Journal Article
    男性不育症或不育症是一种常见疾病,通常以男性产生少量质量差的精子为特征。为了深入了解这种情况,我们对不育和可育男性的精液样本进行了定量蛋白质组学分析.至少6种蛋白质在选择性剪接的同种型的调节中显示出显著差异。为了研究异常可变剪接与劣质精子产生之间的联系,我们在果蝇中过度表达hnrnpH/F-直向同源物Glorund(Glo),这也被发现是丰富的质量差的人类精子。转基因动物产生少量的形态缺陷精子和异常形成的致密体,一个类似于哺乳动物的细胞器。此外,育性试验表明,转基因果蝇要么完全不育,要么高度不育。这些发现表明,hnrnpH/F的失调可能导致低质量精液的产生,导致男性不孕症或不孕症。
    Male subfertility or infertility is a common condition often characterized by men producing a low number of sperm with poor quality. To gain insight into this condition, we performed a quantitative proteomic analysis of semen samples obtained from infertile and fertile men. At least 6 proteins showed significant differences in regulation of alternatively spliced isoforms. To investigate this link between aberrant alternative splicing and production of poor-quality spermatozoa, we overexpressed the hnrnpH/F-orthologue Glorund (Glo) in Drosophila, which was also found to be abundant in poor quality human sperm. Transgenic animals produced low numbers of morphologically defective spermatozoa and aberrant formation of the \"dense body,\" an organelle akin to the mammalian manchette. Furthermore, fertility trials demonstrated that transgenic flies were either completely infertile or highly subfertile. These findings suggest that dysregulation of hnrnpH/F is likely to result in the production of low-quality semen, leading to subfertility or infertility in men.
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  • 文章类型: Journal Article
    欧洲妇产科委员会和学院(EBCOG)以及欧洲妇产科培训生网络(ENTOG)对气候变化和环境污染的影响表示关注。本文回顾了妇产科对生殖健康的影响以及对气候变化的贡献。结论是,气候变化的成因和影响对生育率和不良产科结局造成了明确的不利后果。人类,还有妇产科人员,必须意识到并负责其对气候变化的贡献,并考虑其行动和干预措施的影响。
    The European Board and College of Obstetrics and Gynaecology (EBCOG) and the European Network of Trainees in Obstetrics and Gynaecology (ENTOG) express their concerns on the effect of climate change and environmental pollution. This paper reviews the impact on reproductive health and the contribution to climate change by the field of obstetrics and gynaecology. It concludes that its contributors and the effects of climate change cause definite adverse consequences to fertility and adverse obstetric outcomes. Mankind, and obstetrics and gynaecology personnel as well, must be aware and responsible of its contribution to climate change and consider the impact of their actions and interventions.
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