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ObjectiveTo study the changes of mitochondrial function of ovarian granulosa cells in women of different ages and the effect of Erzhi-Tiangui prescription on in vitro fertilization-embryo transfer （IVF-ET） outcomes for elderly women， so as to verify the connotation of the "Seven-Seven" theory in the Huangdi's Internal Classic （《黄帝内经》）. MethodA total of 150 infertility patients undergoing IVF-ET at the Reproductive and Genetic Center of Integrative Medicine， Affiliated Hospital of Shandong University of Traditional Chinese Medicine were recruited and assigned into "hree-Seven/Four-Seven （30 cases）， Five-Seven （60 cases）， and Six-Seven （60 cases） groups according to the "Seven-Seven" theory. The Five-Seven and Six-Seven groups were further assigned into control and Chinese medicine subgroups using the random number plus envelope method， and the Chinese medicine group was administrated with Erzhi Tiangui prescription from the start day of controlled ovulation stimulation cycle to the trigger day. The IVF outcome was observed， and Western blot was employed to determine the levels of mitofusin 1 （MFN1）， mitofusin 2 （MFN2）， and dynamin-related protein 1 （Drp1） in the ovarian granulosa cells. ResultCompared with the Three-Seven/Four-Seven group， the control subgroups of the Five-Seven and Six-Seven groups showed decreased retrieved oocytes， two pronuclear （2PN） embryos， available embryos， high-quality embryos， clinical pregnancy rate， and live birth rate （P<0.05）. Moreover， the control subgroup of the Six-Seven group showed decreased fresh embryo transfer rate（P<0.05）. Compared with the control subgroup of the Five-Seven group， that of the Six-Seven group showed reduced retrieved oocytes， 2PN embryos， available embryos， high-quality embryos， and clinical pregnancy rate （P<0.05）. The Chinese medicine subgroup had more retrieved oocytes， 2PN oocytes， and available embryos than the control subgroup in the Five-Seven groups （P<0.05）. The Chinese medicine subgroup had more retrieved oocytes， than the control subgroup in the Six-Seven groups （P<0.05）. The control subgroup of the Six-Seven group showed lower expression levels of Mfn1 and Mfn2 and higher level of Drp1 than the control subgroup of the Five-Seven group （P<0.05）， which indicated that the levels of Mfn1 and Mfn2 in ovarian granulosa cells were down-regulated while the expression of Drp1 was up-regulated with aging （P<0.05）. The Chinese medicine subgroup had higher Mfn2 level and lower Drp1 level than the control subgroup in the Five-Seven group （P<0.05）， and the Chinese medicine subgroup had higher Mfn1 and Mfn2 levels and lower Drp1 level than then control subgroup in the Six-Seven group （P<0.05）. ConclusionsThe prognosis of IVF in women after "Five-Seven" became worse with aging， and the mitochondria in ovarian granulosa cells showed decreased fusion ability and increased fission， which verified the connotation of the "Seven-Seven" theory from the mitochondrial function. Erzhi Tiangui prescription can regulate the mitochondrial function of ovarian granulosa cells in elderly women， up-regulate the expression levels of Mfn1 and Mfn2 to promote mitochondrial fusion， and down-regulate the expression of Drp1 to reduce mitochondrial fission， thus alleviating the ovarian hypofunction caused by aging， improve the development potential of oocytes， and improve the IVF outcomes of elderly women. However， this prescription has limited efficacy for the elderly women in the age range of "Six-Seven".
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Introducción: Durante el proceso de envejecimiento pueden originarse diferentes síndromes en el adulto mayor. Entre los más comunes está la incontinencia urinaria de esfuerzo, con alteraciones en vejiga y estructuras del área pélvica, así como en el funcionamiento de las vías urinaria bajas. Objetivo: Evaluar la efectividad de la reeducación del suelo pélvico en mujeres adultas mayores con incontinencia urinaria de esfuerzo. Métodos: Estudio descriptivo y longitudinal en mujeres adultas mayores con incontinencia urinaria de esfuerzo del Centro Gerontológico de Guano, Ecuador. Universo de 20 pacientes, 100 por ciento de la población diagnosticada, edades ≥ 65 años, sin otros antecedentes de trastornos médicos. Resultados: Se destaca como antecedentes de los sujetos estudiados: índice de masa corporal: 60 por ciente de obesidad, seguido del 25 por ciento de sobrepeso, ginecobstétricos: 95 gestaciones, 77 por ciento partos normales y 12 por ciento de cesarias. En la evaluación inicial, mediante la escala de valoración modificada de Oxford, en el 60 por ciento de las adultas se obtuvo grado 2, caracterizada por contracciones musculares débiles del suelo pélvico, evaluación insatisfactoria. En la segunda medición se obtuvieron resultados significativamente superiores a los de la primera medición, 70 por ciento se evaluó satisfactoriamente. Durante el proceso de reeducación del suelo pélvico, se establecieron relaciones de integración entre los elementos participación activa y consiente del paciente, equipo de salud y familia, en función de una mayor calidad de vida, de importancia para el tratamiento. Conclusiones: Se alcanzó el 70 por ciento de efectividad en la reeducación de suelo pélvico aplicada a las mujeres adultas mayores con incontinencia urinaria de esfuerzo(AU)
Introduction: In the aging process, different syndromes can appear in the elderly. Stress urinary incontinence is among the most common, with alterations in the bladder and the pelvic area structures, as well as in the functioning of the lower urinary tract. Objective: To assess the effectiveness of pelvic floor re-education in elder women with stress urinary incontinence. Methods: Descriptive and longitudinal study in elder women with stress urinary incontinence in the Gerontological Center of Guano, Ecuador. Group sample of 20 patients, 100% of the population diagnosed, ages? 65 years, without other pathological background. Results: It is highlighted as a background of subjects studied: body mass index: 60 percent of obesity, followed by 25 percent of overweight; gineco-obstetrics: 95 gestations, 77 percent normal births and 12 percent of C-sections. In the initial assessment, through the modified Oxford valuation scale, in 60 percent of adults, Grade 2 was obtained. That was characterized by weak pelvic floor muscle´s contractions, unsatisfactory evaluation. In the second measurement, the obtained results were significantly higher than those of the first measurement, and 70 percent is evaluated as satisfactorily. During the process of pelvic floor's re-education, integration relationships were established between the elements, also active and conscious participation of the patient, the health team and the family, in order to obtain a greater life quality which is important for the treatment. Conclusions: 70 percent of effectiveness is achieved in pelvic floor re-education performed in elder women presenting stress urinary incontinence(AU)