Urinary angiotensinogen excretion is associated with blood pressure in obese young adults.

Intrarenal RAS has been suggested to be involved in the pathogenesis of hypertension. It was recently reported that urinary angiotensinogen excretion levels are associated with intrarenal RAS. However, few markers predicting intrarenal RAS have been investigated in obese young subjects. The present study evaluated the association between blood pressure and intrarenal RAS activity, inflammation and oxidative stress in obese young adults. Urinary angiotensinogen excretion and urinary monocyte chemotactic protein (MCP)-1, and urinary thiobarbituric acid reaction substance (TBARS) as markers of intrarenal RAS activity, inflammation, and oxidative stress, respectively, were determined from morning urine of 111 young male adults. Participants were divided into two groups based on the body mass index (BMI). Natural log-transformed urinary angiotensinogen excretion level was significantly associated with blood pressure, MCP-1 excretion, and TBARS excretion elevation in the obese group (BMI ≥25 kg/m(2)). Multivariable analyses showed that every 1 standard deviation increase in natural-log transformed urinary angiotensinogen and MCP-1 excretion, but not TBARS excretion level was associated with elevated blood pressure in the obese group. These results indicate that urinary angiotensinogen and MCP-1 excretion were associated with blood pressure elevation in this population of obese young adults. It suggested that inappropriate RAS activity and inflammation precedes hypertension in obese young subjects and urinary angiotensinogen could be a screening maker for hypertension in young obese subjects.

Long-term outcome, including pregnancy rate, recurrence rate and ovarian reserve, after laparoscopic laser ablation surgery in infertile women with endometrioma.

AIM: To retrospectively assess the long-term outcome, including pregnancy rate, recurrence rate and ovarian reserve, after laser ablation surgery in infertile women with endometrioma. METHODS: From March 1997 to June 2007, 45 subfertile women underwent ablation surgery with a potassium-titanyl-phosphate laser for ovarian endometrioma. These patients were reviewed retrospectively. RESULTS: Of the 45 women, 22 became pregnant spontaneously. Among the 23 women who did not become pregnant after more than 6 months postoperatively, 16 elected to undergo in vitro fertilization (IVF), 12 of them became pregnant. The remaining 11 women did not become pregnant. Eleven women had recurrence detected by ultrasound. The mean number of oocytes retrieved per cycle during IVF was 7.3 +/- 3.6 and 4.6 +/- 2.7 from the ovary treated by ablation surgery and the contralateral ovary, respectively. CONCLUSION: The overall long-term pregnancy rate (combining spontaneous pregnancy and IVF) after laparoscopic ablation surgery for endometrioma was 75.6%. Surgery did not have any adverse effect on the ovarian reserve during subsequent IVF.

Mutational analysis of the PTEN gene in women with premature ovarian failure.

Recent studies in mammals have suggested that the phosphatase and tensin homolog deleted on chromosome 10 (PTEN) - phosphatidylinositol-3, 4, 5-trisphosphate pathway in oocytes might be related to the pathogenesis of premature ovarian failure (POF). The aim of this study was to investigate whether mutations of the PTEN gene are present in women with POF. We analyzed the coding region of the PTEN gene in 20 women with idiopathic POF and 20 normal controls. The PTEN gene was amplified by the polymerase chain reaction using genomic DNA isolated from blood samples. Amplified DNA was analyzed by denaturing gradient gel electrophoresis and direct sequencing. No causative mutation was detected in the coding regions of this gene. Although we found a point variation in exon 7 of one POF patient, this was a single nucleotide polymorphism that has already been reported.

Concomitant treatment of severe uterine adenomyosis in a premenopausal woman with an aromatase inhibitor and a gonadotropin-releasing hormone agonist.

OBJECTIVE: To assess the effect of aromatase inhibitors with GnRH agonist for a severe symptomatic adenomyosis that is refractory to GnRH agonist and danazol with GnRH agonist. DESIGN: Case report. SETTING: Clinical practice in university hospital. PATIENT(S): A 34-year-old woman with a complaint of severe dysmenorrheal, symptomatic anemia, and a desire to retain fertility. INTERVENTION(S): Aromatase inhibitor anastrozole given orally (1.0 mg or 2.0 mg daily) for 16 weeks and GnRH agonist given monthly (injected SC, 1.8 mg) for 4 months. MAIN OUTCOME MEASURE(S): Measurements of uterine volume and levels of serum E(2), estrone, A, dehydroepiandrosterone sulfate, LH, FSH, and CA125. RESULT(S): Uterine volume was reduced. The reduction rate of uterine volume estimated by magnetic resonance imaging and ultrasonography was 60% after 8 weeks of treatment. CONCLUSION(S): Aromatase inhibitor with GnRH agonist therapy was useful for the management of a severely adenomyotic woman whose desire was for conservative treatment.

Effect of micro-environment maintenance on embryo culture after in-vitro fertilization: comparison of top-load mini incubator and conventional front-load incubator.

PURPOSE: To investigate the effect of microenvironment maintenance on embryo culture and clinical results using two types of incubators. METHODS: Temperature and oxygen concentration in a mini-incubator and a conventional incubator were compared following a 5-s door opening/closing procedure. Embryos of 30 in-vitro fertilization embryo transfer (IVF-ET) cases were randomly allocated to either one of the incubator, cultured, and the early-stage good embryo formation rate and the good blastocyst formation rate were compared, as indicators for micro-environment maintenance ability. RESULTS: Temperature recovery after a 5-s door opening/closing procedure was approximately 5 min for the mini-incubator and 30 min for the conventional incubator. The oxygen concentration return was significantly improved in the mini-incubator (3.0 +/- 0 min) compared with the conventional incubator (7.8 +/- 0.9 min). Both the early-stage good embryo formation rate and the good blastocyst formation rate were significantly higher in the mini-incubator (39.5% and 15.1%) than the conventional incubator (28.4% and 7.8%). CONCLUSION: The microenvironment maintenance ability of incubators appears to significantly influence the formation of good embryos.

Effectiveness of antiadhesion barriers in preventing adhesion after myomectomy in patients with uterine leiomyoma.

BACKGROUND: Myomectomy often causes adhesion formation and decreases subsequent fertility. The purpose of the present study was to evaluate the effectiveness of several antiadhesion barrier materials in preventing adhesion after myomectomy. METHODS: We prospectively classified 63 women undergoing myomectomy alone into four groups according to the type of antiadhesion material used: Hyaluronic acid-carboxymethylcellulose film (Seprafilm) (n = 21, Group 1), Dextran 40 (10% Dextran 40 Low Injection) (n = 17, Group 2), factor 13 with fibrinogen (Beriplast) (n = 12, Group 3) and control (n = 13, Group 4). We performed early second-look laparoscopy after the seventh post-operative day in all patients and examined adhesion formation in the abdominal cavity. The incidence of adnexal adhesions was evaluated according to the American Fertility Association (AFS) adhesion score. RESULTS: The incidence of uterine adhesion was 14.3% in Group 1, 70.6% in Group 2, 75.0% in Group 3 and 76.9% in Group 4. Adhesion formation in Group 1 was significantly less than that in Group 2 (p = 0.0004), Group 3 (p = 0.0005) and Group 4 (p = 0.0003). The incidence of peritoneal adhesion was 14.3% in Group 1, 29.4% in Group 2, 41.6% in Group 3 and 69.2% in Group 4. Adhesion formation in Group 1 was significantly less than that in Group 4 (p = 0.001). AFS scores in Groups 1-4 were 0.38+/-1.02, 4.58 +/- 7.02, 0.83 +/- 1.99 and 8.53 +/- 8.79 (mean +/- S.D.), respectively. Group 1 had the lowest AFS score and the difference between Group 1 and Group 4 was significant (p < 0.0001). The AFS score in Group 3 was also significantly less than that of Group 4 (p = 0.0009). CONCLUSION: Seprafilm was highly effective and was superior to the other antiadhesion materials tested in preventing uterine adhesions after myomectomy.

Effectiveness of 2-step (consecutive) embryo transfer. Comparison with cleavage-stage transfer.

OBJECTIVE: To evaluate the effectiveness of 2-step (consecutive) embryo transfer (ET), in which two cleaved embryos are transferred on day 2 (first step of ET) and a single blastocyst is transferred on day 5 (second step of ET) in comparison with conventional day 2 ET. STUDY DESIGN: Observational comparative study at different time periods. Subjects were those who had > or = 4 embryos on day 2 after oocyte retrieval. Those in the conventional group (n = 60) received conventional day 2 ET, in which 3 cleaved embryos were transferred on day 2 between January 1999 and June 2000. Those in the 2-step group (n = 124) received 2-step embryo transfer, in which 2 cleaved embryos were transferred on day 2 and a blastocyst was transferred on day 5 between September 2000 and February 2002. Patients who planned to receive 2-step ET but could not proceed to the second step of ET because of failure to produce blastocysts were included in the 2-step group. RESULTS: The ongoing pregnancy rate with 2-step ET (51.6%) was significantly higher than with conventional ET (26.7%) (P < .01). The clinical pregnancy rate and implantation rate in conventional and 2-step ET were 30.0% vs. 59.7% and 11.1% vs. 27.8%, respectively (P < .001). CONCLUSION: Two-step ET may benefit patients who can obtain a sufficient number of embryos.