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polycystic liver disease: Classification, diagnosis, treatment process, and clinical management

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World Journal of Hepatology 2020年第3期12卷 72-83页

作者： Ze-Yu Zhang Zhi-Ming Wang Yun Huang Department of Hepatobiliary Surgery Xiangya HospitalCentral South UniversityChangsha 410000Hunan ProvinceChina

polycystic liver disease(PLD)is a rare hereditary disease that independently exists in isolated PLD,or as an accompanying symptom of autosomal dominant polycystic kidney disease and autosomal recessive polycystic kidney disease with complicated mechanisms.PLD currently lacks a unified diagnostic standard.The diagnosis of PLD is usually made when the number of hepatic cysts is more than 20.Gigot classification and Schnelldorfer classification are now commonly used to define severity in PLD.Most PLD patients have no clinical symptoms,and minority with severe complications need treatments.Somatostatin analogues,mammalian target of rapamycin inhibitor,ursodeoxycholic acid and vasopressin-2 receptor antagonist are the potentially effective medical therapies,while cyst aspiration and sclerosis,transcatheter arterial embolization,fenestration,hepatic resection and liver transplantation are the options of invasion therapies.However,the effectiveness of these therapies except liver transplantation are still uncertain.Furthermore,there is no unified strategy to treat PLD between medical centers at present.In order to better understand recent study progresses on PLD for clinical practice and obtain potential directions for future researches,this review mainly focuses on the recent progress in PLD classification,clinical manifestation,diagnosis and treatment.For information,we also provided medical treatment processes of PLD in our medical center.

关键词： polycystic liver disease Autosomal dominant polycystic kidney disease Autosomal recessive polycystic kidney disease Isolated polycystic liver disease Diagnosis Treatment

Risk factors of polycystic ovarian syndrome among Li People

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Asian Pacific Journal of Tropical Medicine 2015年第7期8卷 585-588页

作者： Bao Shan Jun-hong Cai Shu-Ying Yang Zhuo-Ri Li Department of Gynecology and Obstetrics Hainan Provincial People's Hospital Central Laboratory Hainan Provincial People's Hospital Department of Surgery Hainan Provincial People's Hospital

Objective: To study the relevant risk factors of polycystic ovarian syndrome(PCOS) of Li People so as to provide basis for early diagnosis and treatment of PCOS. Methods: With casecontrol study method, 285 cases of PCOS of Li People were as recruited case group, and 580 cases of non-PCOS of female Li People as control group. Questionnaire was adopted to collect data regarding risk factors of PCOS, then the risk factors of PCOS was searched by univariate and multivariate analysis. Results: Multivariate analysis showed that the risk factors of PCOS included in menstrual cycle disorder(OR=5.824), bad mood(OR=2.852), family history of diabetes(OR=7.008), family history of infertility(OR=11.953), menstrual irregularity of mother(OR=2.557) and lack of physical exercise(OR=1.866). Conclusions: To target the high risk factors of menstrual cycle disorder, family history of diabetes, family history of infertility, family history of diabetes, bad mood and lack of physical exercise of female population, we should implement early screen, diagnose and treatment of POCS in order to reduce the incidence rate of PCOS and improve prognosis of PCOS.

关键词： Li people polycystic ovarian syndrome Risk factors

Recurrent renal cell carcinoma leading to a misdiagnosis of polycystic liver disease: A case report

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World Journal of Gastroenterology 2019年第18期25卷 2264-2270页

作者： Chen Liang Kazuhiro Takahashi Masanao Kurata Shingo Sakashita Tatsuya Oda Nobuhiro Ohkohchi Department of Surgery University of Tsukuba Department of Diagnostic Pathology University of Tsukuba

BACKGROUND polycystic liver disease(PCLD) with a large cystic volume deteriorates the quality of life of patients through substantial effects on the adjacent organs,recurrent cyst infections, cyst rupture, and hemorrhage. Surgical or radiological intervention is usually needed to alleviate these symptoms. We report a rare case of the cystic metastasis of renal cell carcinoma(RCC), which was misdiagnosed as PCLD, as a result of the clinical and radiological similarity between these disorders.CASE SUMMARY A 74-year-old female who had undergone nephrectomy for papillary-type RCC(PRCC) was suffering from abdominal pain and the recurrent intracystic hemorrhage of multiple cysts in the liver. Imaging studies and aspiration cytology of the cysts showed no evidence of malignancy. With a diagnosis of autosomal dominant polycystic liver disease, the patient received hepatectomy for the purpose of mass reduction and infectious cyst removal. Surgery was performed without complications, and the patient was discharged on postoperative day 14. Postoperatively, the pathology revealed a diagnosis of recurrent PRCC with cystic formation.CONCLUSION This case demonstrates the importance of excluding the cystic metastasis of a cancer when liver cysts are observed.

关键词： polycystic liver disease polycystic kidney disease Cystic metastasis Renal cell carcinoma Case report

Neuroendocrine characteristics of induced pluripotent stem cells from polycystic ovary syndrome women

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Protein & Cell 2019年第7期10卷 526-532页

作者： Zheying Min Yue Zhao Jing Hang Yun Ren Tao Tan Yong Fan Yang Yu Key Laboratory for Major Obstetric Diseases of Guangdong Province The Third Affiliated Hospital of Guangzhou Medical University Guangzhou 510150 China Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology and Key Laboratory of Assisted Reproduction Ministry of Education Center for Reproductive Medicine Department of Obstetrics and Gynecology Peking University Third Hospital Beijing 100191 China Peking-lsinghua Center for Life Sciences Academy for Advanced Interdisciplinery Studies Peking University Beijing 100871 China Yunnan Key Laboratory of Primate Biomedical Research Institute of Primate Translational Medicine Kunming University of Science and Technology Kunming 650500 China

Dear Editor, polycystic ovary syn drome (PCOS) is a comm on female reproductive endocrinopathy that afflicts up to 10%-15% of women in reproductive age worldwide (Nestler, 2016). Women with PCOS exhibit hyperandrogenism, intermittent/ absent menstrual cycles, and polycystic ovaries on ultrasound (Rotterdam, 2004). The pathophysiology of PCOS extends beyond infertility and hirsutism to hypothalamic neuroendocrine dysfunotion (Goodarzi et al., 2011). Most wome n with PCOS exhibit in creased luteinizing horm one (LH) levels, resulting from high-frequency gonadotropin-releasing hormone (GnRH) secretion (Cimino et al., 2016). Pren ata I testostero ne (T) treatment in sheep results in disrupted steroid feedback on gonadotropin release, which in creases pituitary sen sitivity to GnRH and subseque ntly leads to LH hypersecretion (Sullivan and Moenter, 2004;Cardoso et al., 2016). A recent study shows that GnRHdependent LH pulsatility and secretion are elevated by anti- Mullerian hormone (AMH) in PCOS disease. The increased prenatal AMH reprograms fetus and induces PCOS in adults (Tata et al., 2018). Furthermore, the androgen receptor (AR) plays a role in hyperandrogenism and ovarian folliculoge esis in PCOS (Wang et al., 2015;Abbott, 2017). However, the disease mechanism behind PCOS remains unclear, and current management focuses on treating the symptoms but not the mechanism (Chen et al., 2016;Shi et al., 2018). A further understanding of this disease is necessary to uncover the pathology of PCOS and develop new potential therapeutic avenues and drugs.

关键词： Neuroendocrine characteristics induced pluripotent stem cells polycystic ovary

Effects of Metformin Treatment on Soluble Leptin Receptor Levels in Women with polycystic Ovary Syndrome

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Current Medical Science 2019年第4期39卷 609-614页

作者： Ru-biao LIU Yi LIU Li-qun LV Wei XIAO Cheng GONG Jian-xin YUE Department of Obstetrics and Gynecology Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430022China Department of Obstetrics and Gynecology the Central Hospital of WuhanTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430014China Department of Otorhinolaryngology Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430022China

The effects of metformin treatment on soluble leptin receptor (sOB-R) levels in women with polycystic ovary syndrome (PCOS) were investigated.This prospective and open-label study was conducted by the Department of Obstetrics & Gynecology at Union Hospital,Tongji Medical College of Huazhong University of Science and Technology,China.Fifty-five women with PCOS and insulin resistance (IR) were treated with metformin for 6 months.According to body mass index (BMI),the patients were divided into two groups:lean PCOS group (BMI 23 kg/m^2,n=21).Before and after treatment,serum luteinizing hormone (LH),follicle stimulating hormone (FSH),testosterone (T),androstenedione (A),dehydroepiandrosterone sulfate (DHEAS),insulin and sOB-R levels were determined.Thirty-one BMI-matched ovulatory women served as controls.The results showed:(1) The Homeostatic Model Assessment of Insulin Resistance (HOMA-IR),androgen levels and hirsutism scores were higher,and sOB-R levels were lower in PCOS groups than in control group.A subgroup analysis of lean and overweight or obese PCOS patients revealed there was significant difference in sOB-R level between lean PCOS group and overweight or obese PCOS group.There were no significant differences in anthropometric parameters between lean PCOS patients and BMI-matched controls.However,sOB-R level was significantly lower in lean PCOS women than in controls.(2) There was no correlation between sOB-R level and BMI,waist and hip circumference,total testosterone,androstendione,DHEAS,LH or hirsutism scores in PCOS patients,but there was a significant negative correlation between sOB-R and HOMA-IR.(3) After treatment with metformin for 6 months,serum insulin levels decreased,and sOB-R levels increased significantly (P<0.01).It was suggested that considering low sOB-R levels supposedly compensate diminished leptin action,PCOS per se might cause leptin resistance.It is likely that reduction of hyperinsulinemia produced by metformin effectively imp

关键词： polycystic ovary syndrome metformin insulin resistance leptin resistance soluble leptin receptor

MIF May Participate in Pathogenesis of polycystic Ovary Syndrome in Rats through MAPK Signalling pathway

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Current Medical Science 2018年第5期38卷 853-860页

作者： Dan-ni ZHOU Sai-jiao LI Jin-li DING Tai-lang YIN Jing YANG Hong YE Chongqing Institute of Reproduction and Genetics Chongqing Health Center for Women and ChildrenChongqing 400010China Reproductive Medical Center Hubei Clinic Research Center for Assisted Reproductive Technology and Embryonic DevelopmentRenmin Hospital of Wuhan UniversityWuhan 430060China

The polycystic ovary syndrome (PCOS) model was established in fats and correlation between the expression of macrophage migration inhibitory factor (MIF) and cytokinesis with the MAPK signalling pathway in the rat ovary was measured. The PCOS model in rats was established by dehydroepiandrosterone (DHEA).Thirty sexually immature female Sprague-Dawley rats were randomly and equally assigned to three groups:control group,PCOS group,and PCOS with high-fat diet (HFD) group.Serum hormones were assayed by radioimmunoassay (RIA).The ovaries'were immunohistochemically stained with MIF,and the expression of MIF,p-JNK and p-p38 was detected by Western blotting in ovaries.The serum testosterone level,LH concentration,LH/FSH ratio,fasting insulin level and HOMA IR index in the PCOS group (6.077±0.478,13.809±1.701,1.820±0.404,10.83±1.123 and 1.8692±0.1096)and PCOS with HFD group (6.075±0.439,14.075±1.927,1.779±0.277,10.20±1.377 and 1.7736±0.6851)were significantly higher than those in the control group (4.949±0.337, 2.458±0.509,1.239±0.038,9.53±0.548 and 1.5329±0.7363),but there was no significant difference between the PCOS group and PCOS with HFD group.The expression levels of MIF,p-JNK,and p-p38 in the PCOS group (0.4048±0.013,0.6233±0.093 and 0.7987±0.061)and PCOS withHFD group (0.1929±0.012,0.3346±0.103 and 0.3468±0.031)were obviously higher than those in control group (0.2492±0.013, 0.3271±0.093 and 0.3393±0.061),but no Significant difference was observed between PCOS group and PCOS with HFD group.It was suggested that MIF may participate in the pathogenesis of PCOS through the MAPK signalling pathway in PCOS rats induced by DHEA.

关键词： polycystic ovary syndrome high-fat diet dehydroepiandrosterone migration inhibitory factor MAPK signalling pathway rats

Flexible GnRH Antagonist Protocol versus Progestin-primed Ovarian Stimulation (PPOS) Protocol in Patients with polycystic Ovary Syndrome: Comparison of Clinical Outcomes and Ovarian Response

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Current Medical Science 2019年第3期39卷 431-436页

作者： Zhuo-ni XIAO Jia-li PENG Jing YANG Wang-ming XU Center for Reproductive Medicine Renmin Hospital of Wuhan University Wuhan 430060China

polycystic ovary syndrome (PCOS) is one of the most common causes of infertility in women. Progestin-primed ovarian stimulation (PPOS) protocol, which used oral progestin to prevent premature luteinizing hormone (LH) surges in ovarian stimulation, has been proved to be effective and safe in patients with PCOS. The aim of the present study was to compare the efficacy of PPOS protocol with that of the traditional gonadotropin-releasing hormone (GnRH) antagonist protocol in patients with PCOS. A total of 157 patients undergoing in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) were recruited into this study. The patients were divided into two groups by the stimulation protocols: the GnRH antagonist protocol group and the PPOS protocol group. There was no significant difference in the clinical characteristics between the two groups. Dose and duration of gonadotropin were higher in the PPOS protocol group. Estradiol levels on the day of human chorionic gonadotropin (hCG) administration were significantly lower in the PPOS protocol group. Fertilization rates and the number of good quality embryos were similar between the two groups. Remarkably, we found 6 patients with moderate ovarian hyperstimulation syndrome (OHSS) in the GnRH antagonist protocol group but 0 in the PPOS protocol group. A total of 127 women completed their frozen embryo transfer (FET) cycles. There were no significant differences between the two groups in terms of clinical pregnancy rate per transfer, implantation rate, first-trimester miscarriage rate and on-going pregnancy rate per transfer. To conclude, PPOS protocol decreased the incidence of OHSS without adversely affecting clinical outcomes in patients with PCOS.

关键词： polycystic ovary syndrome ovarian hyperstimulation syndrome progestin-primed ovarian stimulation GnRH antagonist protocol controlled ovarian hyperstimulation

Correlation between IL-1β,IL-1Ra gene polymorphism and occurrence of polycystic ovary syndrome infertility

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Asian Pacific Journal of Tropical Medicine 2013年第3期6卷 232-236页

作者： Yu-Hong Xia Li Yao Zhan-Xin Zhang Department of Gynaecology and Obstetrics People's Hospital of Zhengzhou

Objective:To explore the relationship between IL-1β.IL-1Ra gene polymorphism and the occurrence of polycystic ovary syndrome(PCOS) infertility.Methods:A total of 59 PCOS infertility cases visiling the reproductive center of our hospital from Mar.2010 to Mar.2012 and 56 healthy women were selected.ELISA method was used lor the detection of IL-1β.IL-1Ra lewis,and the levels of serum supersensitivity C reaction protein(US-CRP).insulin(FINS),follieule-stimulating hormone(FSH) and fasting blood—glucose(FRG) were detected.PCR analysis technology was adopted to detect the gene polymorphism of the.511 site of IL-1βand the second introne of IL- 1Ra.Results:The levels of IL-1β.IL-1Ra.US-CRP.FINS and FBG in blood scrum of patients in PCOS group were significantly higher than those in control group(P<0.05 or P<0.01).The level of FSH in PCOS group was significantly lower than that in control group(P<0.05).The genotypic frequency of T/T.the 511 site of IL-1βin PCOS group was 42.37%.significantly higher than 1250%in control group

关键词： polycystic ovary syndrome Infertility IL-1β IL-1Ra Gene polymorphism

Controversial conclusions from two randomized controlled trials for acupuncture’s effects on polycystic ovary syndrome or in vitro fertilization support

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Journal of Integrative Medicine 2020年第2期18卷 89-91页

作者： Sherman Gu Arthur Yin Fan Federation of Chinese Medicine&Acupuncture Societies of Australia Ltd(FCMA) MelbourneVictoria 3150Australia Knox Chinese Healing&Myotherapy Wantirna SouthVictoria 3152Australia American TCM Association ViennaVA 22182USA McLean Center for Complementary and Alternative Medicine PLCViennaVA 22182USA

Two reports of trials investigating the potential effect of acupuncture in increasing live birth rate(LBR) in women with polycystic ovary syndrome(PCOS) or those undergoing in vitro fertilization(IVF) were published by Journal of American Medical Association in 2017 and 2018 respectively. The trial investigators did not recommend acupuncture for the women with PCOS or IVF based on their findings. This paper raises the concern that the findings that acupuncture did not increase LBR for women with PCOS or undergoing IVF may be the result of methodological flaws in the studies and unintended bias such as use of an invalid control intervention and underestimation of the true acupuncture effect. Therefore, their findings may not be a valid reflection of acupuncture’s effect in improving LBR in women with these clinical conditions.

关键词： Acupuncture Randomized controlled trial polycystic ovary syndrome Fertilization in vitro Traditional Chinese medicine