Lack of the zona pellucida (ZP) is one of the manifestations of an oocyte maturation disorder. In recent years, genetic factors have attracted much attention as a possible cause of ZP anomalies. In this study, we report a form of primary infertility characterized by abnormal eggs that lack the ZP, which resulted from a compound heterozygous autosomal recessive mutation in ZP1. This compound heterozygous mutation has been reported for the first time, and our results may expand the spectrum of known mutations in ZP genes and provide evidence of oocyte maturation disorders during genetic counseling.

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Primary dysmenorrhea (PDM) is the painful menses with spasmodic cramping in the lower abdomen in the absence of any discernable macroscopic pelvic pathology. The prevalence of dysmenorrhea changes between 16% and 91% in women. About 2%–29% of the women studied suffer from severe pain. This review focuses on the current knowledge, particularly with regard to the latest research on the etiology of PDM. Full-text manuscripts on PDM were searched on PubMed and Google Scholar. One or more of the following search terms were used to obtain articles published: PDM, pain, functional magnetic resonance imaging, brain image, etiology, epidemiology, metabolism, hormone, gene variation, and quality of life. In this review, we detailed four potential etiology aspects of PDM: brain abnormality, gene expression, metabolism, and hyperalgesia. We highlighted the latest brain research on PDM patients and investigated genetic aspects. We are dedicated to identifying more metabolic variations and expand the previous knowledge on the sensitive pain threshold.

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Objective: To explore the clinical significance of the quantitative detection of human papillomavirus (HPV) E6/E7mRNA in triage of patients with atypical squamous cells of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesion (LSIL). Methods: A cross-sectional screening study was conducted among women who underwent outpatient gynecological screening at the Obstetrics and Gynecology Hospital of Fudan University from September 2015 to July 2016. A total of 500 patients from our hospital with ASC-US or LSIL based on cytology testing were subjected to HPV DNA and HPV E6/E7 mRNA quantitative analysis. Results: The specificity of the HPV E6/E7 mRNA test for detecting ≥ high-grade squamous intraepithelial lesion (HSIL+) was statistically higher than that of the HPV DNA test (61.3% vs. 40.0%, P < 0.05), whereas there was no significant difference in the sensitivity of HPV E6/E7 mRNA test and HPV DNA test (90.0% vs. 95.0%, P > 0.05). The positive rates of HPV in the participants tested by HPV E6/E7 mRNA and HPV DNA were, respectively, 42.8% (214/500) and 62.8% (314/500), with statistical significance (P < 0.05). Conclusions: The HPV E6/E7 mRNA test was slightly less sensitivity than that of the HPV DNA test for diagnosing HSIL+ in patients with ASC-US and LSIL, but the difference was not significant, although the specificity of the former was significantly higher. HPV E6/E7 mRNA detection can effectively reduce overdiagnosis and overtreatment of patients with ASC-US and LSIL and has important clinical value in triage of patients with ASC-US and LSIL.

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Objective: The aim of this study is to evaluate the diagnostic accuracy of colposcopically directed biopsy (CDB) and loop electrosurgical excision procedure (LEEP) for cervical lesions and assess their ability to detect glandular involvement. Methods: This retrospective study reviewed 4689 cervical lesions that were tested by CDB and LEEP at a tertiary hospital. The sensitivity, specificity, and predictive value of CDB and LEEP and the ratio of glandular involvement detected by these two methods were analyzed. Results: CDB and LEEP had sensitivities of 95.4% and 80.0%, respectively, for diagnosing high-grade intraepithelial or more severe lesions (HSIL+) (P = 0.000) and 31.8% and 87.9%, respectively, for diagnosing adenocarcinoma in situ or more severe lesions (AIS+) (P = 0.001). CDB and LEEP had sensitivities of 18.1% and 90.2%, respectively, for diagnosing invasive squamous cell carcinoma (P = 0.000) and 5.9% and 98.0%, respectively, for diagnosing invasive adenocarcinoma (P = 0.000). The negative predictive values of CDB and LEEP for diagnosing HSIL+ were 88.6% and 64.4%, respectively (P = 0.000). The ratios of glandular involvement were 0.2% (CDB) and 2.4% (LEEP) in low-grade intraepithelial lesions (LSILs) and 8.9% (CDB) and 59.0% (LEEP) (P = 0.000) in HSIL+. Conclusions: LEEP is superior to CDB for diagnosing AIS and detecting early invasive cancer. It should be offered as an additional investigation to all patients with AIS, HSIL, or LSIL with glandular involvement on CDB.

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Objective: Primordial follicle assembly and the transition from primordial follicle to primary follicle are critical processes in ovarian biology. These processes determine the size of the primordial follicle pool, which may limit the reproductive lifespan of a female. When the follicle pool is depleted, reproduction ceases and females enter menopause. In this study, we aimed to explore the role of differentially expressed genes (DEGs) in the processes of primordial follicle assembly and the transformation from primordial to primary follicle. Methods: The gene chip GSE9300 was downloaded from the Gene Expression Omnibus database. DEGs between ovaries on postnatal day 0 and ovaries on postnatal day 4, as well as ovaries on postnatal day 4 and ovaries cultured for 7 days from postnatal day 0 were identified. Gene ontology (GO), pathway enrichment analysis, and protein–protein interaction network construction were performed. Results: In total, 99 upregulated genes and 123 downregulated genes were identified in the process of primordial follicle assembly, and 101 upregulated genes and 98 downregulated genes were identified in the process of transformation from primordial to primary follicle. The GO analysis showed that response to estradiol was associated with two of the processes of assembly and subsequent development of primordial follicle, but the genes involved in response to estradiol between the two processes were significantly different. Furthermore, the two groups of DEGs were all associated with metabolic pathways. Conclusions: DEGs may provide new insights into the exploration of mechanisms related to primordial follicle assembly and subsequent development.

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Objective: The effect of alterations in vaginal flora during pregnancy remains uncertain. We compared the flora distribution in women with spontaneous abortion (SA) and those in normal condition. Methods: Samples of vaginal discharge were obtained from 3,233 women attending the Gynecological and Public Health Centre of our hospital from January 2010 to December 2013. Pathogen culture testing was performed by the Microbiological Diagnostic Centre of our hospital, including SA group (n = 1,513), normal first-trimester group (NP group, n = 908), and nonpregnant women (control group, n = 812). Results: Of 3,233 vaginal discharge samples, 425 samples (13.15%) were positive for pathogen. The pathogen detection rate was 19.96% (302/1,513), 7.93% (72/908), and 6.28% (51/812) in the SA, NP, and control groups, respectively. The five most common bacteria were Enterococcus faecalis, Candida albicans, Escherichia coli, group B Streptococcus (GBS), and Ureaplasma urealyticum (Uu) in the SA group; Uu, C. albicans, Candida tropicalis, GBS, and E. faecalis in the NP group; and Candida glabrata, Uu, E. coli, Gardnerella vaginalis, and C. albicans in the control group. Conclusions: In the SA group, the pathogen detection rate was markedly elevated. An infection of Candida sp. in pregnant women was relatively common. In routine antenatal care, overtreatment is not recommended in asymptomatic candidiasis. There was no significant difference in the detection rate of Uu between the SA group and the other two groups, suggesting that it does not cause SA.

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For hundreds of years, Ding 1541 is used in traditional Chinese medicine (TCM) for the treatment of numerous ailments, including qi and blood stasis-related disorders. It showed good efficacy in relieving irregular menstruation, dysmenorrhea, metrorrhagia, and metrostaxis. Now, Ding 1541 has been widely used in various conditions, including primary dysmenorrhea, menstrual disorder, endometriosis, infertility, premenopausal syndrome, polycystic ovary syndrome, and premature ovarian failure. Compared with western medicine treatment, Ding 1541 has showed some advantages. In this review, we tried to summarize the underlying mechanisms for Ding 1541's effects. We collected clinical data and briefly analyzed these diseases based on the theories of TCM and the pathology. These data suggested that the underlying mechanisms of Ding 1541 involved increasing uterine blood supply, decreasing menstrual blood prostaglandin F2α level, improving the immune, and enhancing the function of the hypothalamus-pituitary-ovary, etc.

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Perforated Meckel's diverticulum is an extremely rare cause of an acute abdomen in pregnancy. Its clinical presentation is similar to that of appendicitis and diagnosis is delayed in most cases. We present a patient who developed increasing abdominal pain and leukocytosis at 28 weeks of gestation. She was misdiagnosed with appendicular peritonitis until acute exploratory laparotomy. Regarding related published cases up to now, most cases did not make a correct preoperative diagnosis of Meckel's diverticulum. This case suggests that Meckel's diverticulum in pregnancy may have serious consequences. A high index of suspicion and a low threshold for surgical intervention are required to minimize morbidity and mortality.

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Objective: This study compared spindles, cytoskeleton, and developmental potential between vitrified and slow-frozen oocytes using PolScope and electron microscopy. Methods: Oocytes were randomly divided into control, slow freeze-thaw, and vitrification freeze-thaw groups (0, 1, and 3 h). PolScope was used to observe spindles, angle of spindles to the first polar bodies, surface areas of oocytes, and lining and outer ret of zona pellucida. Surfaces and ultrastructure of oocytes were observed by scanning electron microscopy and transmission electron microscopy. These measures were used to characterize the impacts of two freezing methods on the developmental capacity of human oocytes. Results: The visible frequency of spindle formation was 92.4%, 56.4%, 11.2%, 24.8%, and 61.1% in control group, slow freeze-thaw group, and the three vitrification freeze-thaw groups (0, 1, and 3 h), respectively. Compared to oocytes in the slow freeze group, the angle of the spindle to the first polar body in oocytes in the 3-h vitrification freeze-thaw group was less (37.3° vs. 68°, P = 0.023). No significant differences were observed between the surface area of oocytes, or lining and outer ret of oocyte zona pellucida between freeze-thaw in these same two groups. Microvilli appeared normal. However, protrusions on oocyte surfaces were increased, and microvilli were laid down on the membrane surface in the 3-h vitrification freeze-thaw group in comparison to the slow-freeze group. Similar comparisons showed better recovery of perivitelline space and mitochondria between the 3-h vitrified and slow-frozen groups. Bipronuclear (2PN) fertilization rate observed in the slow-freeze group (65.7%) was lower than the rate seen in controls (79.2%, P = 0.041). No significant differences were observed in 2PN fertilization, cleavage, and blastocyst formation rates between the 3-h vitrification freeze-thaw and control groups. Conclusions: Results suggest that vitrification freeze-thaw for oocyte cryopreservation was a better choice than slow freeze-thaw.

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Thyroid diseases are common in women of childbearing age. Different factors of maternal thyroid function occur during pregnancy; therefore, guidelines recommend trimester-specific pregnancy reference range for thyroid-stimulating hormone. Manifestly, thyroid dysfunctions have deleterious obstetrical and neonatal outcomes. Therefore, an adequate treatment is important to prevent adverse pregnancy complications. Furthermore, iodine deficiency during pregnancy could originate maternal and fetal problems. Consequently, scientific organizations recommend prenatal iodine supplementation for all pregnant women. However, treatment of thyroid autoimmunity is intriguing, but adequately powered randomized controlled trials are needed. The aim of this article was to summarize the reported results of the literature related to the management of thyroid disease during pregnancy in order to help endocrinologists in decision-making processes.

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