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Murphy, M. K., J. E. Hall, J. M. Adams, H. Lee, and C. K. Welt. "Polycystic Ovarian Morphology in Normal Women Does Not Predict the Development of Polycystic Ovary Syndrome." Journal of Clinical Endocrinology & Metabolism 91, no. 10 (October 1, 2006): 3878–84. http://dx.doi.org/10.1210/jc.2006-1085.
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Abstract Context: Polycystic ovarian morphology (PCOM) is present in 25% of normal women in the absence of polycystic ovary syndrome (PCOS); however, the natural history of PCOM is unknown. Objective: We hypothesized that the presence of PCOM predisposes the development of PCOS. Design: The study was a longitudinal follow-up study over 8.2 ± 5.2 yr (mean ± sd; range 1.7–17.5 yr). Setting: The study took place in an outpatient setting. Subjects: Women who took part in a previous study as a normal control and had an ultrasound examination (n = 40) participated. Intervention: Subjects underwent an interval menstrual history, physical exam, blood sampling, and repeat ultrasound in the follicular phase. Main Outcome Measure: Development of PCOS was diagnosed by irregular menses and hyperandrogenism, in the absence of other disorders. Changes in ovarian morphology over time were evaluated. Results: At the baseline visit, 23 women (57.5%) had PCOM and 17 (42.5%) had normal ovarian morphology. One subject with PCOM developed irregular menses and presumptive PCOS. Eleven subjects with PCOM no longer met the criteria for PCOM at follow-up. There was no factor that predicted the change to normal ovarian morphology at the follow-up visit. Conclusions: These data suggest that PCOM in women with regular ovulatory cycles does not commonly predispose the development of PCOS. Although it is unusual to develop PCOM if the ovaries are normal on first assessment, ovaries in women with PCOM no longer meet the criteria for PCOM in approximately half of cases over time.
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Lazareva, Lyudmila, and Larisa Suturina. "Polycystic Ovarian Morphology: Diagnostic Criteria and Prevalence." International Journal of Biomedicine 12, no. 1 (March 10, 2022): 100–103. http://dx.doi.org/10.21103/article12(1)_ra6.
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The purpose of this brief review was to systematize the current information on the diagnosis, prevalence, and ethnic aspects of polycystic ovarian morphology (PCOM). The information search was conducted using Internet resources (Medline, Pubmed, Cochrane Library, and Google Scholar) and literature sources for the period from January 1999 to August 2021. The review includes only full-text articles. Based on the analysis of the literature, we demonstrated that the diagnostic value of PCOM has changed since the moment of the first description of polycystic ovarian syndrome (PCOS). Currently, ovarian size, ovarian volume and antral follicle count are key criteria for most PCOS phenotypes and complications. The diagnostic value of PCOM depends on age and racial characteristics, which requires large-scale epidemiological studies to determine PCOM characteristics in different populations. Standardizing PCOM diagnostic criteria is the key to PCOS effective diagnosis and, consequently, to preventing complications and comorbidities associated with PCOS.
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Merino, Paulina M., Claudio Villarroel, Cristián Jesam, Patricia López, and Ethel Codner. "New Diagnostic Criteria of Polycystic Ovarian Morphology for Adolescents: Impact on Prevalence and Hormonal Profile." Hormone Research in Paediatrics 88, no. 6 (2017): 401–7. http://dx.doi.org/10.1159/000481532.
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Background: The ultrasonographic criteria used to identify polycystic ovarian morphology (PCOM) during adolescence have changed over time. Recently, a Worldwide Pediatric Consensus (PedC) defined PCOM using stricter criteria than the previous recommendations of the Rotterdam Consensus (RC) and Androgen Excess-Polycystic Ovarian Syndrome Society (AES/PCOS) criteria. The aim of this study was to determine the prevalence of PCOM in healthy adolescents according to the 3 reported diagnostic criteria and compare the hormonal profile in females with and without PCOM based on the PedC criteria. Methods: Nonobese adolescents (n = 102) with regular menstrual cycles were studied. Transabdominal ultrasound and hormonal profiles were assessed during the follicular phase. PCOM was defined on the basis of the 3 published criteria. Results: On the basis of the PedC, RC, and AES/PCOS criteria, PCOM was diagnosed in 13, 34, and 24% of adolescents, respectively. Adolescents with and without PCOM according to the PedC criteria had similar androgen levels. Serum anti-Müllerian hormone (AMH) levels were elevated in adolescents with PCOM, irrespective of the criteria used. Conclusions: Use of the new PedC diagnostic criteria for PCOM results in a lower prevalence of this ultrasonographic pattern in adolescents, but this condition is not associated with hyperandrogenism. Elevated AMH is associated with PCOM in adolescents regardless of the criteria used to determine the ultrasonographic pattern.
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Wongwananuruk, Thanyarat, Panicha Chantrapanichkul, Vichuta Unalome, Suchada Indhavivadhana, Manee Rattanachaiyanont, Kitirat Techatraisak, Surasak Angsuwathana, and Kittayaporn Silprasit. "Polycystic ovarian morphology in Thai women of reproductive age with polycystic ovary syndrome." Asian Biomedicine 14, no. 6 (December 1, 2020): 271–77. http://dx.doi.org/10.1515/abm-2020-0036.
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Abstract Background Advancements in ultrasound technology have facilitated identifying polycystic ovarian morphology (PCOM) in women with and without polycystic ovary syndrome (PCOS), but it still has limitations due to follicle counting methods and variation of phenotypes according to ethnicity. Ethnicity-specific ovarian morphology may help to establish ethnicity-specific follicle count cut points for defining PCOM in women with PCOS. Objectives To investigate the prevalence and factors associated with PCOM in Thai women of a reproductive age with PCOS. Methods This prospective cross-sectional study was conducted in our gynecology department at a tertiary teaching hospital from February 2016 to May 2017. We included women with PCOS, who were measured for weight, height, waist circumference, and blood pressure. Blood samples were taken to measure fasting blood glucose, lipid profile, testosterone level, and 2 h post-load 75 g oral glucose tolerance test (OGTT). Transvaginal or transrectal sonography was performed to evaluate their ovaries. Results All 143 patient participants we included had oligomenorrhea, 77.6% of them had acne, and 64.3% hirsutism. Their average total testosterone level was 0.47 ± 0.10 ng/mL. The prevalence of PCOM was 55.2%. The proportions of PCOM diagnosed by ovarian follicle and ovarian volume criteria were 36.4% and 42.0%, respectively. There were 20.0 ± 9.5 follicles per ovary, 8.3 ± 3.1 follicles per cross section, and the mean ovarian volume was 7.9 ± 3.0 mL. Conclusion The overall prevalence of PCOM in Thai women of reproductive age with PCOS was 55.2%. Our univariate analysis found no factors significantly associated with PCOM.
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Bell, Robin J., Rakibul M. Islam, Marina A. Skiba, Dilinie Herbert, Alejandra Martinez Garcia, and Susan R. Davis. "Substituting serum anti-Müllerian hormone for polycystic ovary morphology increases the number of women diagnosed with polycystic ovary syndrome: a community-based cross-sectional study." Human Reproduction 37, no. 1 (November 6, 2021): 109–18. http://dx.doi.org/10.1093/humrep/deab232.
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Abstract STUDY QUESTION Can serum anti-Müllerian hormone (AMH) replace polycystic ovary morphology (PCOM) determined by ultrasound as a diagnostic component of polycystic ovary syndrome (PCOS)? SUMMARY ANSWER Despite good correlations between serum AMH and PCOM, the use of a high serum AMH as a proxy for PCOM resulted in the reclassification of PCOS in 5% of study participants, with the main effect being more women identified, although some women previously classified as having PCOS were no longer classified as such. WHAT IS KNOWN ALREADY AMH has been proposed as an alternative to PCOM as a diagnostic component of PCOS. Previous studies are limited by poorly defining PCOS, use of infertile women as comparators, measurement of hormones by immunoassay that lack precision in the female range, low-resolution ovarian ultrasound and inconsistent handling and storage of serum samples. STUDY DESIGN, SIZE, DURATION This is an Australian cross-sectional study of 163 non-healthcare-seeking women. PARTICIPANTS/MATERIALS, SETTING, METHODS Serum AMH was measured by both the Ansh picoAMH assay and the Beckman Coulter Access 2 (BA2) assay, in parallel with androgens measured by liquid chromatography–tandem mass spectrometry, in blood samples of women, not pregnant, breast feeding or using systemic steroids, who also underwent high-resolution ovarian ultrasound. PCOS was determined by the Rotterdam criteria with PCOM defined by the Androgen Excess-PCOS Taskforce recommendation of ≥25 follicles in at least one ovary. Cut-off serum concentrations that best identified women as having PCOM were identified by receiver operator characteristic (ROC) curves. MAIN RESULTS AND THE ROLE OF CHANCE A total of 163 women, mean (SD) age 32.5 (5.5) years, who provided a blood sample and had both ovaries visualized on ultrasound were included in the analysis. Women with isolated PCOM had higher median (range) Ansh AMH and BA2 AMH concentrations than those with no PCOS characteristics [56.9 pmol/l (34.6, 104.2) versus 18.7 (3.2, 50.9), P = 0.002 and 38.5 pmol/l (22.2, 100.2) versus 16.7 (3.5, 38.9), P = 0.002, respectively]. An AMH ≥ 44.0 pmol/l, suggested by the ROC curve, identified 80.6% of women with PCOM, falsely identified 15.2% of women without PCOM as having PCOS and had a positive predictive value of 55.6%. The negative predictive value was 94.9%. An AMH BA2 assay cut-off of ≥33.2 pmol/l provided a sensitivity of 80.6%, a specificity of 79.5% and a positive predictive value for PCOM of 48.1%. The negative predictive value was 94.6% for PCOM. When serum AMH was used in the place of PCOM as a diagnostic criterion for PCOS, the Ansh assay resulted in an additional seven women classified as having PCOS and no longer classified one woman as having PCOS. For the BA2 assay, eight additional and two fewer women were classified as having PCOS. Overall, both assays resulted in six more women being classified as having PCOS. LIMITATIONS, REASONS FOR CAUTION Women with functional hypogonadotrophic hypogonadism were not excluded and may have been misclassified as having an oligo-amenorrhoea-PCOM phenotype. As study participants were predominantly Caucasian/White, our findings cannot be generalized to women of other ethnicities. WIDER IMPLICATIONS OF THE FINDINGS Although serum AMH reflects the number of developing ovarian follicles, the absolute values vary between assays and specific reference ranges for individual assays are required. Irrespective of the assay used, replacing PCOM with serum AMH to diagnose PCOS in a community-based sample altered the number of women classified as having or not having PCOS. Consequently, although overall the risk of women being identified as having PCOS would be increased, some women would no longer be classified as having this condition. STUDY FUNDING/COMPETING INTEREST(S) The study was supported by the Norman Beischer Research Foundation and the Grollo-Ruzzene Foundation. S.R.D. is an NHMRC Senior Principal Research Fellow (Grant No. 1135843). S.R.D. reports unrelated support that includes grants from the NHMRC Australia, personal fees for educational activities from Besins Healthcare, Abbott Chile, BioFemme and Pfizer Australia, personal Advisory Board/consultancy fees from Theramex, Abbott Laboratories, Astellas, Mayne Pharmaceuticals, Roche Diagnostics, Lawley Pharmaceuticals and Que Oncology and has received institutional grant funding from Que Oncology and Ovoca research. The other authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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RIEPSAMEN, Angelique H., Mark W. DONOGHOE, Inthrani R. INDRAN, Shelly LIEN, Leah HECHTMAN, David M. ROBERTSON, Robert B. GILCHRIST, Eu-Leong YONG, and William L. LEDGER. "Serum GDF9 and BMP15 as Markers of Ovarian Function in Healthy Women and Women with Polycystic Ovary Syndrome." Fertility & Reproduction 04, no. 03n04 (September 2022): 141. http://dx.doi.org/10.1142/s266131822274053x.
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Background: The oocyte-secreted factors growth differentiation factor-9 (GDF9) and bone morphogenetic protein-15 (BMP15) are key regulators of female fertility and are predominantly expressed by oocytes. Recently, methods to quantitate these proteins in serum have demonstrated diagnostic potential. It is unknown if concentrations reflect ovarian and endocrine function, particularly in women with polycystic ovary syndrome (PCOS), where GDF9/BMP15 function is suggested to be aberrant. Aim: To determine if serum GDF9/BMP15 are associated with ovarian and endocrine parameters, and the ovarian pathologies, PCOM and PCOS. Method: Women aged 21-45 years (n=381) were from a cross-sectional study at the National University Hospital, Singapore, including healthy volunteers and referrals from gynecological clinics. Transvaginal ultrasound scans, blood tests and questionnaire were performed. Serum GDF9 and BMP15 were assessed relative to ovarian (cycle regularity, ovarian volume, AFC, AMH) and androgenic (testosterone, DHT, androstenedione, DHEAS, SHBG, mFG score) characteristics. PCOM and PCOS were determined using the Rotterdam criteria. Statistical analyses used parametric survival models and Kendall’s tau correlation appropriate for data containing values below the limit of detection. Results: Serum GDF9 and BMP15 were detectable in 40% and 41% of women, respectively. Serum GDF9 positively correlated with ovarian volume (p=0.02), AFC (p=0.004), and weakly with AMH (p=0.05). Furthermore, irregular menstrual cycles were associated with high GDF9 (p=0.005), and similar, although non-significant associations were seen for BMP15. When stratified into PCOS (n=130), PCOM (n=59), and control (n=192), GDF9 and BMP15 concentrations were not significantly different, and were not associated with the majority of androgenic features of PCOS. However, the relationship between GDF9 and AFC was significantly different between PCOM, PCOS and control women (p=0.02). Conclusion: These results suggest that serum GDF9 and BMP15 reflect ovarian characteristics but not androgenic characteristics of PCOS, and that the relationships between GDF9 and AFC may be aberrant in women with PCOM/PCOS.
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Merino, Paulina M., Ethel Codner, and Fernando Cassorla. "A rational approach to the diagnosis of polycystic ovarian syndrome during adolescence." Arquivos Brasileiros de Endocrinologia & Metabologia 55, no. 8 (November 2011): 590–98. http://dx.doi.org/10.1590/s0004-27302011000800013.
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Polycystic ovarian syndrome (PCOS) is a lifelong disorder characterized by hyperandrogenism and ovulatory dysfunction, with a wide spectrum of clinical symptoms and signs. Three different sets of diagnostic criteria have been established in order to define this disease in adult women, but there is controversy regarding the use of these criteria in adolescence. During puberty, the adult criteria for ovulatory dysfunction does not seem applicable, because an irregular menstrual pattern and a decreased ovulatory rate is a physiologic event during this period of life. Also, a higher prevalence of polycystic ovarian morphology (PCOM) may be observed during this period, so PCOM is not a useful criterion to define PCOS in young women. These findings suggest that a key factor to diagnose to PCOS during adolescence is hyperandrogenism. In addition, since PCOM is not clearly associated with hyperandrogenism during this period of life, the term "polycystic ovarian syndrome" during adolescence creates confusion and may be misleading.
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Goyal, Nitin, Georgios Tsivgoulis, Chris Nickele, Vinodh T. Doss, Dan Hoit, Andrei V. Alexandrov, Adam Arthur, and Lucas Elijovich. "Posterior circulation CT angiography collaterals predict outcome of endovascular acute ischemic stroke therapy for basilar artery occlusion." Journal of NeuroInterventional Surgery 8, no. 8 (August 17, 2015): 783–86. http://dx.doi.org/10.1136/neurintsurg-2015-011883.
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IntroductionThe natural history of acute ischemic stroke (AIS) due to basilar artery occlusion (BAO) is poor. Endovascular reperfusion therapy (EVT) improves recanalization rates in patients with emergent large vessel intracranial occlusion.ObjectiveTo examine the hypothesis that good collateral patterns identified by pretreatment CT angiography (CTA) might be associated with favorable outcomes after EVT.MethodsWe conducted a retrospective chart review of patients presenting with AIS due to BAO in a tertiary care stroke center during a 4-year period. BAO was diagnosed by CTA in all cases. Admission stroke severity was documented using the National Institute of Health Stroke Scale (NIHSS) score. Pretreatment collateral score for posterior circulation was defined as follows: 0, no posterior communicating artery (PCOM); 1, unilateral PCOM; 2, bilateral PCOM. Favorable outcome was defined as modified Rankin Scale score of 0–2 at 3 months.ResultsA total of 21 patients with AIS due to BAO (age range 31–84 years, median admission NIHSS score: 18 points, range 2–38) underwent EVT. Eleven of 21 patients (52.4%) had bilateral PCOMs, while unilateral PCOM was seen in 3 patients (14.3%). Patients with bilateral PCOMs tended (p=0.261) to have less severe stroke at admission than those with absent/unilateral PCOM (median NIHSS score 18 vs 27 points). Neurological improvement during hospitalization (quantified by the median decrease in NIHSS score) and the rate of 3-month functional independence were greater in patients with good collaterals (16 vs 0 points (p=0.016) and 72.7% vs 0% (p=0.001)).ConclusionsThe presence of bilateral PCOMs on pretreatment CTA appears to be associated with more favorable outcomes in BAO treated with EVT.
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Nikbakht, Roshan, Mahvash Zargar, Farideh Moramezi, Mahnaz Ziafat, Hamed Tabesh, Ali Reza Sattari, and Shahab Aldin Sattari. "Insulin Resistance and Free Androgen as Predictors for Ovarian Hyperstimulation Syndrome in Non-PCOS Women." Hormone and Metabolic Research 52, no. 02 (January 23, 2020): 104–8. http://dx.doi.org/10.1055/a-1079-5342.
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AbstractWe evaluated the effect of insulin resistance and free androgen index (FAI) in non-PCOS (polycystic ovary syndrome) infertile women following controlled ovarian hyperstimulation. A prospective study was done on 144 infertile non-PCOS women with regular menstrual cycle. At first, insulin resistance (IR), free androgen index (FAI), PCOM (polycystic ovary morphology), AFC (antral follicle count), and AMH (anti-Müllerian hormone) were assessed. The patients underwent assisted reproductive technology (ART), and then preovulatory follicles and oocytes retrieved were recorded. The variables of the study were compared between two groups of patients with ovarian hyperstimulation syndrome (OHSS) (n=66) and non-OHSS patients (n=78). Of the 9 variables: BMI, HOMA-IR, FAI, AFC, AMH, PCOM, and preovulatory follicles were risk factors, while the age and retrieved oocytes were not. The 7 variables that showed significance in the univariate analyses were determined as independent variables included in the multivariable logistic regression analysis, as a result, a total of 5 risk factors, BMI, HOMA-IR, FAI, PCOM, and preovulatory follicles entered the equation. The maximum contribution was HOMA-IR followed by PCOM, FAI, preovulatory follicles and BMI. Patients with OHSS had higher chance to have ovaries with polycystic morphology (74%), about three times more than patients who did not develop OHSS (29%) (p<0.001). The best cut-points for IR, FAI, AFC, AMH, and preovulatry follicles were 2.36, 3.9, 8, 3.3 ng/ml, and 10, respectively. Patients with a higher value of BMI, FAI, HOMA-IR, and preovulatory follicles and the presence of PCOM are more likely to develop OHSS, which are not confined to PCOS patients.
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Balogun, Mobolanle, Olayinka Coker, Titilola Samuel, Patrick Sluss, Christiana Udenze, Ricardo Azziz, Christian Chigozie Makwe, Joseph Ayo Olamijulo, and Ayesha Akinkugbe. "PMON245 Clinical Phenotypes of Polycystic Ovary Syndrome (PCOS) in Nigerian Women: Preliminary Results of the Nigeria PCOS Epidemiology & Phenotype (Nigeria-Pep) Study." Journal of the Endocrine Society 6, Supplement_1 (November 1, 2022): A696. http://dx.doi.org/10.1210/jendso/bvac150.1436.
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Abstract Background Although the phenotype of polycystic ovary syndrome (PCOS) is heterogeneous, there is paucity of data on the prevalence and phenotype of PCOS in sub-Saharan Africa. Methods We studied 75 consecutive consenting women, aged 18-45 years, who presented with features suggestive of PCOS. A standardized proforma was used to obtain relevant information. Anthropometric measurements were determined, and terminal hair growth was assessed using the modified Ferriman-Gallwey (mF-G) method. All subjects underwent an oral glucose tolerance test (OGTT) and pelvic ultrasonography on day 2-7 of the menstrual cycle. An mF-G score of ≥ 6 was regarded as evidence of clinical hyperandrogenism (HA). Menstrual dysfunction (MD) was defined as menstrual cycle lengths >35 or <25 days. Polycystic Ovarian Morphology (PCOM) was defined as an antral follicle count (AFC) of ≥12 2-9 mm follicles and/or an ovarian volume ≥10 cm3, in at least one ovary. Results The mean (SD) age of the study population was 28.6 (5.8) years, and the mean (SD) body mass index (BMI) was 26.3 (5.6) kg/m2. Three (4.0%) participants were underweighted, 27 (36.0%) had normal BMI, 30 (40%) were overweight, and 15 (20.0%) were obese. The mean (SD) systolic and diastolic blood pressures were 107.4 (12.6) mmHg and 72.6 (8.2) mmHg, respectively. OGTT results indicated that the mean (SD) fasting blood glucose was 86.6 (10.6) mg/dl and the mean (SD) 2-hr. postprandial glucose was 109.8 (22.2) mg/dl. Two women had impaired glucose tolerance and one had type 2 diabetes mellitus. Of the 75 subjects recruited, 26 (34.7%) had HA, 54 (72.0%) had MD, and 63 (84.0%) had PCOM. Of all subjects, 20 (26.7%) had HA+MD+PCOM, consistent with PCOS Phenotype A; one (1.3%) had HA+MD only, consistent with Phenotype B; four (5.3%) had HA+PCOM only, consistent with Phenotype C; and 28 (37.3%) had MD+PCOM only, consistent with Phenotype D. In 22 (29.4%) no evidence of PCOS was found. Overall, our results indicate that of subjects evaluated clinically, 53 (70.6%) had PCOS. Conclusions Our preliminary results indicate that in a referral (clinical) population in Lagos, Nigeria, using only the clinical presentation without circulating androgen measures, PCOS was detected in two-thirds, with Phenotype D (aka, 'non-hyperandrogenic PCOS’) being the most common presentation (53%), followed by Phenotype A (aka 'classic or full PCOS’) observed in 38% of all women with PCOS seen. However, as 72% of all subjects had MD and 63% had PCOM, many more of these women could have been diagnosed with PCOS if the presence of hyperandrogenemia could have been demonstrated. Overall, these observations suggest that accurate measurement of circulating androgen, lacking in many parts of Sub-Sahara Africa, may be critical to accurately detecting PCOS in that region. Studies are ongoing. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.
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Zhao, Yang, Yinlong Zhao, Chunpeng Wang, Zhenzhen Liang, and Xin Liu. "DIAGNOSTIC VALUE OF ANTI-MÜLLERIAN HORMONE AS A BIOMARKER FOR POLYCYSTIC OVARY SYNDROME: A META-ANALYSIS UPDATE." Endocrine Practice 25, no. 10 (October 2019): 1056–66. http://dx.doi.org/10.4158/ep-2019-0098.
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Objective: A previous meta-analysis carried out on the predictive ability of anti-Müllerian hormone (AMH) for polycystic ovary syndrome (PCOS) showed that independent AMH may be a useful initial diagnostic test for PCOS. The aims of this study were to update the meta-analysis and to evaluate the diagnostic efficacy of AMH when it replaces polycystic ovary morphology (PCOM) in the Rotterdam criteria. Methods: Two independent reviewers searched PubMed, Cochrane Library, and the Web of Science databases systematically to identify relevant articles by using the key words “anti-Müllerian hormone” and “polycystic ovary syndrome.” The deadline for manuscript inclusion was July 31, 2018. A random effects model was used and subgroup analysis and meta regression were performed to identify possible sources of heterogeneity. The methodologic quality of each study was assessed by QUADAS-2 and funnel plot asymmetry test. Results: According to the inclusion criteria, 29 studies were included in this meta-analysis. The pooled sensitivity, specificity, and diagnostic odds ratio (DOR) for AMH alone detecting PCOS were 0.76 (95% confidence interval [CI] 0.71 to 0.81), 0.86 (95% CI 0.82 to 0.90) and 20 (95% CI 12 to 33), respectively. When AMH replaces polycystic ovary morphology (PCOM) for the diagnosis of PCOS, the pooled sensitivity, specificity, and DOR rose to 0.93 (95% CI 0.89 to 0.96), 0.99 (95% CI 0.95 to 1.00), and 1,634 (95% CI 217 to 12,324), respectively. The area under the summary receiver-operating characteristic curve for AMH alone and for AMH replacing PCOM detecting PCOS were 0.88 (95% CI 0.85 to 0.91) and 0.97 (95% CI 0.95 to 0.98), respectively, which was found to be significantly different ( Z = 4.89, P<.01). Conclusion: When AMH replaces PCOM in the Rotterdam criteria, the diagnostic efficacy for polycystic ovary syndrome is better. Abbreviations: AMH = anti-Müllerian hormone; AUC = area under the summary receiver operating characteristic curve; BMI = body mass index; CI = confidence interval; DOR = diagnostic odds ratio; HA = hyperandrogenism; IBC = Immunotech-Beckman Coulter; NLR = negative likelihood ratio; OA = oligo-anovulation; PCOM = polycystic ovary morphology; PCOS = polycystic ovary syndrome; PLR = positive likelihood ratio; QUADAS = the Quality Assessment of Diagnostic Accuracy Studies; SENS = sensitivity; SPEC = specificity
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Gu, Heng, Longyu Li, Bingyi Zhou, Mingzhen Li, Wenyao Zhong, Xiangcai Wei, and Xingmin Zhong. "Single nucleotide polymorphisms in binding site of miRNA-135a and targeted gene IRS2 are correlated with multiple clinical features of PCOS: A study in Chinese women." Technology and Health Care 30 (March 2, 2022): 71–80. http://dx.doi.org/10.3233/thc-228007.
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BACKGROUND: The etiology of polycystic ovary syndrome (PCOS) remains unclear with highly heterogeneous clinical manifestations, recently growing evidence revealing genetic variants play a crucial part in its pathogenesis. OBJECTIVE: This study aimed to examine the correlation between SNPs in miRNA-135a’s binding site of targeted gene IRS2 and clinical manifestations of PCOS in Chinese females. METHOD: A total of 126 Chinese women with PCOS and 109 healthy women were enrolled, divided into 4 groups based on different clinical features of hyperandrogenemia (HA), insulin resistance (IR), polycystic ovary morphology (PCOM) and obesity. We analyzed 2 single nucleotide polymorphisms (SNPs) of the IRS2 gene (rs2289046 and rs1865434) and clinical features’ laboratory measurements such as sex hormone, fasting plasma glucose (FPG), fasting plasma insulin (FINS). RESULTS: Located in miRNA-135a binding site of IRS2 gene, the rs2289046’s triple genotypes distribution showed a significant difference between PCOS/control group and PCOM/non-PCOM group (P< 0.05) while the rs1865434’s triple genotype distribution showed a significant difference between obesity/non-obesity group (P< 0.05). CONCLUSION: The results revealed the two SNPs as rs2289046 and rs1865434 in the IRS-2 binding region of miRNA-135a have correlations with the clinical features of PCOS in Chinese population.
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Krishnan, Abhaya, Sridhar Muthusami, Loganayaki Periyasamy, Jone A. Stanley, Vasudevan Gopalakrishnan, and Ilangovan Ramachandran. "Effect of DHT-Induced Hyperandrogenism on the Pro-Inflammatory Cytokines in a Rat Model of Polycystic Ovary Morphology." Medicina 56, no. 3 (February 27, 2020): 100. http://dx.doi.org/10.3390/medicina56030100.
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Background and Objectives: Polycystic ovary syndrome (PCOS) is one of the most prevalent disorders among women of reproductive age. It is considered as a pro-inflammatory state with chronic low-grade inflammation, one of the key factors contributing to the pathogenesis of this disorder. Polycystic ovary is a well-established criterion for PCOS. The present investigation aimed at finding the role of hyperandrogenism, the most important feature of PCOS, in the development of this inflammatory state. To address this problem, we adopted a model system that developed polycystic ovary morphology (PCOM), which could be most effectively used in order to study the role of non-aromatizable androgen in inflammation in PCOS. Materials and Methods: Six rats were used to induce PCOM in 21-days-old female Wistar albino rats by using a pre-determined release of dihydrotestosterone (DHT), a potent non-aromatizable androgen, achieved by implanting a DHT osmotic pump, which is designed to release a daily dose of 83 μg. Results: After 90 days, the rats displayed irregular estrous cycles and multiple ovarian cysts similar to human PCOS. Elevated serum inflammatory markers such as tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β), and the presence of a necrotic lesion in the liver, osteoclast in the femur, multinucleated giant cells and lymphocytes in the ovary based on histopathological observation of DHT-treated rats clearly indicated the onset of inflammation in the hyperandrogenic state. Our results show no significant alterations in serum hormones such as luteinizing hormone (LH), follicle stimulating hormone (FSH), insulin, and cortisol between control and hyperandrogenised rats. DHT was significantly elevated as compared to control. mRNA studies showed an increased expression level of TNF-α and IL-1β, further, the mRNA expression of urocortin 1 (Ucn-1) was stupendously elevated in the liver of hyperandrogenised rats. Conclusions: Thus, results from this study provide: (1) a good PCOM model system in order to study the inflammatory changes in PCOS aspects, (2) alteration of inflammatory markers in PCOM rats that could be either due to its direct effect or by the regulation of various inflammatory genes and markers in the liver of hyperandrogenic state suggesting the regulatory role of DHT, and (3) alteration in stress-related protein in the liver of PCOM rats.
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Alamoudi, Abrar, Irfan Ullah Khan, Nida Aslam, Nourah Alqahtani, Hind S. Alsaif, Omran Al Dandan, Mohammed Al Gadeeb, and Ridha Al Bahrani. "A Deep Learning Fusion Approach to Diagnosis the Polycystic Ovary Syndrome (PCOS)." Applied Computational Intelligence and Soft Computing 2023 (February 14, 2023): 1–15. http://dx.doi.org/10.1155/2023/9686697.
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One of the leading causes of female infertility is PCOS, which is a hormonal disorder affecting women of childbearing age. The common symptoms of PCOS include increased acne, irregular period, increase in body hair, and overweight. Early diagnosis of PCOS is essential to manage the symptoms and reduce the associated health risks. Nonetheless, the diagnosis is based on Rotterdam criteria, including a high level of androgen hormones, ovulation failure, and polycystic ovaries on the ultrasound image (PCOM). At present, doctors and radiologists manually perform PCOM detection using ovary ultrasound by counting the number of follicles and determining their volume in the ovaries, which is one of the challenging PCOS diagnostic criteria. Moreover, such physicians require more tests and checks for biochemical/clinical signs in addition to the patient’s symptoms in order to decide the PCOS diagnosis. Furthermore, clinicians do not utilize a single diagnostic test or specific method to examine patients. This paper introduces the data set that includes the ultrasound image of the ovary with clinical data related to the patient that has been classified as PCOS and non-PCOS. Next, we proposed a deep learning model that can diagnose the PCOM based on the ultrasound image, which achieved 84.81% accuracy using the Inception model. Then, we proposed a fusion model that includes the ultrasound image with clinical data to diagnose the patient if they have PCOS or not. The best model that has been developed achieved 82.46% accuracy by extracting the image features using MobileNet architecture and combine with clinical features.
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Rosato, Richard, Gabriela Comptdaer, Ryan Mulligan, Jeffrey M. Breton, Emal Lesha, Alexandra Lauric, and Adel M. Malek. "Increased focal internal carotid artery angulation in patients with posterior communicating artery aneurysms." Journal of NeuroInterventional Surgery 12, no. 11 (May 23, 2020): 1142–47. http://dx.doi.org/10.1136/neurintsurg-2020-015883.
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BackgroundAneurysms at the posterior communicating artery (PCOM) origin represent the most common location on the internal carotid artery (ICA), and are associated with greater recurrence following endovascular treatment. We evaluate the association between ICA angulation in three-dimensional (3D) space and PCOM aneurysmal development, using high-resolution 3D rotational angiography (3DRA) studies.Methods3DRA datasets were evaluated in 70 patients with PCOM aneurysms, 31 non-aneurysmal contralateral, and 86 healthy controls (187 total). The local angle formed by upstream and downstream ICA segments at the PCOM origin, αICA@PCOM, was measured using 3DRA multiplanar reconstruction. Computational fluid dynamics (CFD) analysis was performed on parametric and patient-based models.ResultsαICA@PCOM was significantly larger in aneurysm-bearing ICA segments (68.14±11.91°) compared with non-aneurysmal contralateral (57.17±10.76°, p<0.001) and healthy controls (48.13±13.68°, p<0.001). A discriminant threshold αICA@PCOM value of 61° (87% specificity, 80% sensitivity) was established (area under the curve (AUC)=0.88). Ruptured PCOM aneurysms had a significantly larger αICA@PCOM compared to unruptured (72.65±15.16° vs 66.35±9.94°, p=0.04). In parametric and patient-based CFD analysis, a large αICA@PCOM induces high focal pressure at the PCOM origin, relatively low wall shear stress (WSS), and high proximal WSS spatial gradients (WSSG).ConclusionICA angulation at PCOM origin is significantly higher in vessels harboring PCOM aneurysms compared with contralateral and healthy ICAs. This sharper bend in the ICA leads to high focal pressure at the aneurysm neck, low focal WSS and high proximal WSSG. These findings underline the importance of morphological ICA variations and the likelihood of PCOM aneurysm, an association which can inform clinical decisions and may serve in predictive analytics.
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Ahmed, Batarfi, Bajouh, and Bakhashab. "Serum Anti-Müllerian Hormone in the Diagnosis of Polycystic Ovary Syndrome in Association with Clinical Symptoms." Diagnostics 9, no. 4 (October 1, 2019): 136. http://dx.doi.org/10.3390/diagnostics9040136.
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Polycystic ovary syndrome (PCOS) is one of the most prevalent endocrine diseases affecting women of reproductive age. The pathogeny of PCOS is still not completely understood, but one contributing factor that has been proposed is anti-Müllerian hormone (AMH). There is currently no clear correlation between levels of AMH and incidence of PCOS in Saudi Arabian patients. The goal of this study was to determine the threshold of AMH and correlate it with PCOS clinical features to facilitate a proper diagnosis for PCOS. In this case-control study, we recruited 79 PCOS women and 69 normal ovulatory women; PCOS patients were diagnosed according to the Rotterdam criterion. On days 2–4 of the menstrual cycle, transvaginal/abdominal ultrasound was performed and serum levels of AMH, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) were measured for all participants. The receiver operating characteristic curve (ROC) was used to determine the AMH diagnostic cut-off at 3.19 ng/mL, with 72% sensitivity and 70% specificity; AMH > 3.19 ng/mL was significantly correlated with PCOS. High AMH levels were correlated with age at menarche, polycystic ovarian morphology (PCOM), and oligo/amenorrhea. Serum AMH is a promising diagnostic marker of ovarian dysfunction in PCOS patients especially in cases in which the evaluation of PCOM was complicated.
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Pea, Jeffrey, Jahnay Bryan, Alexis L. Oldfield, Faith E. Carter, Lynn M. Johnson, and Marla E. Lujan. "LBMON234 Ultrasonographic Criteria In The Diagnosis Of Polycystic Ovary Syndrome: A Systematic Review And Meta Analysis." Journal of the Endocrine Society 6, Supplement_1 (November 1, 2022): A649. http://dx.doi.org/10.1210/jendso/bvac150.1342.
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Abstract Ultrasonographic evaluation of polycystic ovarian morphology (PCOM) is part of the diagnostic evaluation of polycystic ovarian syndrome (PCOS). The relevance of PCOM as a diagnostic criterion for PCOS was reaffirmed in the most recent International Evidence-Based Guideline for the Assessment and Management of PCOS. However, there remains a lack of clarity regarding the best practices and specific ultrasonographic markers to define PCOM. We synthesized evidence on diagnostic test accuracy of ovarian ultrasound features to comprehensively determine the most suitable markers to diagnose PCOS. The primary outcome was diagnostic accuracy measures (e. g., thresholds, sensitivity, specificity) for PCOS using the following ovarian markers: follicle number per ovary (FNPO) or per single cross-section (FNPS), ovarian volume (OV), and stromal features. Databases of PubMed, Web of Science, Scopus, CINAHL, and CENTRAL were searched until 7 November 2021 to identify studies that compared ultrasound markers between women with PCOS to those without PCOS. Risk of bias and applicability assessment for diagnostic test accuracy studies were determined using the QUADAS-2 and QUADAS-C tool for a single index test or between multiple index tests, respectively. From a total of 1869 records initially identified, 22 studies were included and 18 (N=6,337; [n=2991 PCOS; n= 3346 Control]) were pooled for meta-analysis. FNPO was the most accurate diagnostic marker (sensitivity: 84%, CI: 81% to 87%; specificity: 91%, CI: 87% to 94%). OV and FNPS had similar but inferior pooled sensitivity (OV: 81%, CI: 75% to 86%; FNPS: 81%, CI: 70% to 89%) and specificity (OV: 79%, CI: 73% to 84%; FNPS: 83%, CI: 75% to 88%) compared to FNPO. Majority of studies had high risk of bias for patient selection and index test methodology across all markers. Subgroup analysis indicated that stratification based on age, body mass index (BMI), and previously proposed thresholds did not account for the heterogeneity in diagnostic accuracy observed across studies. For FNPO, studies that used a transducer frequency <8MHz or the Rotterdam criteria had improved positive likelihood ratio (+LR) and sensitivity, respectively. European studies had improved diagnostic accuracy (specificity, diagnostic odds ratio, +LR) compared to North American studies for FNPO, potentially due to BMI differences between PCOS populations (North America: 30.29 ± 0.61kg/m2, Europe: 27.62 ± 0.73kg/m2). Our findings support the use of FNPO as the gold standard in the ultrasonographic diagnosis of PCOS, with OV and FNPS as robust alternatives if total antral follicle counts cannot be obtained. These findings also identify avenues for future research to refine the ultrasonographic definition of PCOM for timely diagnosis of PCOS and investigations into phenotypic variations in pathogenesis and response to treatment in this condition (PROSPERO ID: CRD42021259118). Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.
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Makolle, Sarah, Sophie Catteau-Jonard, Geoffroy Robin, and Didier Dewailly. "Revisiting the serum level of anti-Müllerian hormone in patients with functional hypothalamic anovulation." Human Reproduction 36, no. 4 (February 13, 2021): 1043–51. http://dx.doi.org/10.1093/humrep/deab024.
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Abstract STUDY QUESTION Are serum levels of anti-Müllerian hormone (AMH) normal in patients with functional hypothalamic anovulation (FHA)? SUMMARY ANSWER Our study confirms that in the general FHA population, serum AMH levels are not decreased, but if patients with polycystic ovarian morphology (PCOM) are excluded, levels become significantly lower, as in other situations of gonadotropic insufficiency. WHAT IS KNOWN ALREADY In most situations of low LH (physiological, pharmacological or pathological), serum AMH levels are low. However, paradoxically, many publications have reported normal or even increased serum AMH levels in FHA patients. STUDY DESIGN, SIZE, DURATION Retrospective observational study conducted in an academic centre. The data concerning the study population was collected between 2006 and 2015 from a database including clinical, biological and ultrasound information. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 45 FHA patients were compared to 37 controls matched based on age and body mass index (BMI). Serum LH, FSH, androstenedione, total testosterone, prolactin and AMH levels were measured by immunoassay. We defined PCOM with strict criteria: a follicle number per ovary (FNPO) ≥ 12 or ≥ 19 per ovary, depending on the date on which the assessment was carried out and the ultrasound device. An AMH level ≥ 35 pmol/l could be a substitute for an excess FNPO. Controls meeting these criteria were not included in this study. MAIN RESULTS AND THE ROLE OF CHANCE There was no significant difference in the ranges of AMH levels between FHA and controls. Using strict criteria to define PCOM status, 46.7% of FHA patients had PCOM. After excluding these patients, the levels of AMH were significantly lower (P < 0.002) in FHA patients compared to controls. Within the FHA group, patients with PCOM had significantly higher ranks of AMH levels and BMI than those without PCOM. However, within the PCOM+ subgroup, the ranks of LH, FSH and A levels were still lower than in controls (P < 0.0001, <0.002 and <0.05, respectively). The positive correlation between AMH and LH was significant in the controls but not in the FHA group. However, in the FHA PCOM+, there was a strong positive correlation between BMI and LH. LIMITATIONS, REASONS FOR CAUTION This is a retrospective study; our controls did not represent the general population as they were recruited in an ART centre; we used a modified classification for PCOM using follicle count and/or AMH level with in-house thresholds to define the follicle excess; the AMH assay used is no longer commercially available. WIDER IMPLICATIONS OF THE FINDINGS Besides biasing the results of AMH assay in FHA patients, the presence of PCOM in FHA patients despite low gonadotropin and androgen levels raises the issue of epigenetically acquired amplification of androgen and/or FSH sensitivity within granulosa cells from polycystic ovaries. In terms of clinical practice, it seems important not to diagnose a low ovarian reserve in FHA patients too quickly on the basis of a decreased AMH level alone. On the contrary, a high AMH level in the context of a menstrual disorder and PCOM should not lead to a misdiagnosis of polycystic ovary syndrome (PCOS) if the basal LH is low. STUDY FUNDING/COMPETING INTEREST(S) None TRIAL REGISTRATION NUMBER N/A
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Aljammal, Diana Sulieman, Shefaa Saleh Almashaqbeh, Hend Moqbel Harahsheh, Rana Ahmed Alkrimeen, and Rawan Nahed Hiyari. "Using Ultrasound in the Confirmation of Polycystic Ovary Syndrome." SAS Journal of Medicine 8, no. 8 (August 9, 2022): 528–32. http://dx.doi.org/10.36347/sasjm.2022.v08i08.003.
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Background: Polycystic ovary syndrome (PCOS) is found in 6–15% of females of reproductive age (1, 2) with polycystic ovaries on pelvic ultrasonography. Polycystic ovaries are nonspecific on ultrasound, overlapping with findings in 40% of people who do not have the syndrome. Aim: To assess the advantages of transabdominal pelvic ultrasound in the confirmation of PCOS. Methods: This prospective investigation compared 45 female participants with PCOS, average age 14.9 years (group I) with 82 female participants with acute appendicitis, average age 14.3 years (group II), at Hashim Bin Al-hussein Military Hospital, Zarqa, Jordan, during the period 2018-2020. Transabdominal pelvic ultrasound was assessed in the two groups. Ovarian volume (0.5 x length x width x thickness) and follicle (3–10 mm in a single plane (follicle number per section) for each ovary) were followed up. The modified Rotterdam criteria (volume more than 10 ml +/- number of follicles more than 10) for polycystic ovaries were used. Pelvic transabdominal ultrasound was performed in cases of doubtful appendicitis with longitudinal and transverse images of the two ovaries and uterus (and endometrial stripe). Correlation between continuous variables was conducted using nonparametric Wilcoxon tests and correlation between categorical variables was performed using Fisher’s exact test. A P-value of less than 0.05 was considered statistically significant. Results: The modified Rotterdam criteria for polycystic ovary morphology (PCOM) were recorded more commonly in group I (66.7% [30/45]) than in group II (10.97% [9/82]). In group I, 30 participants were positive for PCOM: 12/30 (40%) by number of follicles more than 10, 4/30 (13.3%) by volume and 14/30 (46.7%) by number and volume. Most ultrasounds were accurate for confirmation (group I = 93.3% [42/45] and group II = 91.5% [75/82]). In group II, nine participants were positive for PCOM: three by follicle criteria, two by volume and four by volume and ..........
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Skiba, Marina A., Robin J. Bell, Dilinie Herbert, Alejandra Martinez Garcia, Rakibul M. Islam, and Susan R. Davis. "Use of community-based reference ranges to estimate the prevalence of polycystic ovary syndrome by the recognised diagnostic criteria, a cross-sectional study." Human Reproduction 36, no. 6 (April 8, 2021): 1611–20. http://dx.doi.org/10.1093/humrep/deab069.
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Abstract STUDY QUESTION Does the application of reference ranges for sex steroids and the modified Ferriman-Gallwey (mFG) scale established in the community from which the study sample was drawn, combined with the most conservative polycystic ovary morphology (PCOM) criteria to the recognised diagnostic criteria for polycystic ovary syndrome (PCOS) improve the certainty of diagnosis of PCOS in non-healthcare-seeking women? SUMMARY ANSWER Despite application of the stringent definitions of the elements used to diagnose PCOS in a non-healthcare seeking community-based sample, the risk of diagnostic uncertainty remains. WHAT IS KNOWN ALREADY There is heterogeneity in prevalence estimates for PCOS due, in part, to lack of standardisation of the elements comprising the recognised National Institutes of Health (NIH), Rotterdam and Androgen Excess Society (AE-PCOS) diagnostic criteria. The AE-PCOS Society proposed refinements to the definitions of biochemical androgen excess and PCOM that can now be incorporated into these sets of diagnostic criteria to estimate PCOS prevalence. STUDY DESIGN, SIZE, DURATION An Australian cross-sectional study of 168 non-healthcare-seeking women. PARTICIPANTS/MATERIALS, SETTING, METHODS The 168 included women were aged 18–39 years, euthyroid and normoprolactinemic, not recently pregnant, breast feeding or using systemic hormones. Each provided menstrual history and assessment of the mFG, had measurement of sex steroids by liquid chromatography, tandem mass spectrometry, and a pelvic ultrasound. The presence of PCOS was determined using modified (m) NIH, Rotterdam, and AE-PCOS criteria according to AE-PCOS Society recommendations. MAIN RESULTS AND THE ROLE OF CHANCE Overall, 10.1% of the included participants met the mNIH PCOS criteria, which requires the presence of menstrual dysfunction, while 18.5% met the mRotterdam and 17.5% the AE-PCOS criteria, with the latter requiring hyperandrogenism. Eight of the 27 participants with menstrual dysfunction, 10 of 31 women with PCOM, and 39 of 68 women with hyperandrogenism had no other feature of PCOS. Of the 19 participants with hyperandrogenaemia, 10 met the mNIH criteria (52.5%) and 14 met both the mRotterdam and AE-PCOS criteria (78.9%). Women who had the combination of hyperandrogenism and PCOM explained the greatest discrepancy between the mNIH and the other criteria. LIMITATIONS, REASONS FOR CAUTION Clinical androgenisation relied on participant self-assessment, which has been shown to be valid when compared with clinician assessment. The sample size was a function of both the strict inclusion criteria and the requirements of non-healthcare-seeking women having a blood draw and pelvic ultrasound which may have introduced a selection bias. WIDER IMPLICATIONS OF THE FINDINGS Despite applying stringent cut-offs for serum androgens, the mFG scale and the ovarian follicle count, these criteria remain arbitrary. Accordingly, healthy women may be captured by these criteria, and misidentified as having PCOS, while women with the condition may be missed. Consequently, PCOS remains a diagnosis to be made with care. STUDY FUNDING/COMPETING INTEREST(S) The study was supported by the Grollo-Ruzzene Foundation. Dr S.R.D. is an NHMRC Senior Principal Research Fellow (Grant no. 1135843). S.R.D. has been paid for developing and delivering educational presentations for Besins Healthcare, BioFemme and Pfizer Australia, has been on Advisory Boards for Theramex, Abbott Laboratories, Mayne Pharmaceuticals and Roche and a consultant to Lawley Pharmaceuticals and Que Oncology and has received has received institutional grant funding for Que Oncology research; there are no other relationships or activities that could appear to have influenced the submitted work. TRIAL REGISTRATION NUMBER N/A
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Sharma, Prakash, Subita Lalchan, Subhash KC, Merina Gyawali, and Niraj Kushwaha. "Impact of gender and age on inner diameter of arteries forming circle of Willis assessed by multidetector CT." Journal of Brain and Spine Foundation Nepal 2, no. 1 (August 10, 2021): 37–41. http://dx.doi.org/10.3126/jbsfn.v2i1.39016.
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Introduction: The circle of Willis (CoW), which is located at the base of the brain is the most important anastomosis between the internal carotid and vertebral system. It is the main distributor of blood to the brain. Methods: CT head and CT angiography were performed using standard scan parameters. Only the tests with normal radiological reports and appropriate technical standards were included in the study. Component of circle of Willis: Anterior cerebral artery (ACA), Middle cerebral artery (MCA), Anterior communicating artery (Acom), Posterior Communicating artery (PCom), Basilar artery (BA) and Posterior cerebral artery (PCA) were identified and their internal diameter were measured. Results: Basilar artery was the artery with largest internal diameter with mean diameter of 2.5 ±0.52 mm. Men had significantly larger arterial sizes than women in all of the intracranial arteries examined except right PCom, Left PCom and right MCA. Right ACA had significantly larger internal diameter in <40 years’ age group. BA, left PCA, Bilateral PCom and MCA showed larger diameter in age group ≥40 years. Conclusion: Men had significantly larger arterial sizes than women in all of the intracranial arteries examined except right PCom, Left PCom and right MCA.
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Reynolds, Matthew R., Jarod L. Roland, Ashwin A. Kamath, DeWitte T. Cross, and Ralph G. Dacey. "Microsurgical confirmation of perforating arteries arising from the fundus of a posterior communicating artery aneurysm." Neurosurgical Focus 39, videosuppl1 (July 2015): V16. http://dx.doi.org/10.3171/2015.7.focusvid.14628.
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Perforating arteries rarely project from the fundus of an aneurysm. We present the case of a 35-year-old woman who was found to have a right posterior communicating artery (PCOM) aneurysm via catheter angiography. Superselective microcatheter angiography revealed that perforating arteries arose from the aneurysm fundus that supplied the anterolateral thalamus. Microsurgical exploration confirmed several small perforating arteries arising from the aneurysm dome as well as an atretic distal PCOM artery. Given the complex anatomy, the lesion was unsuitable for clipping. We propose that this aneurysm represents a developmental variant whereby the proximal PCOM artery becomes atretic and terminates in PCOM perforators.The video can be found here: http://youtu.be/iDcp9fsDjq4.
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Banaszewska, Beata, Martyna Siakowska, Izabela Chudzicka-Strugala, R. Jeffrey Chang, Leszek Pawelczyk, Barbara Zwozdziak, Robert Spaczynski, and Antoni J. Duleba. "Elevation of markers of endotoxemia in women with polycystic ovary syndrome." Human Reproduction 35, no. 10 (September 1, 2020): 2303–11. http://dx.doi.org/10.1093/humrep/deaa194.
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Abstract STUDY QUESTION Is polycystic ovary syndrome (PCOS) associated with an elevation of markers of endotoxemia? SUMMARY ANSWER In women with PCOS serum levels of lipopolysaccharides (LPS), the LPS to high-density lipoprotein (HDL) ratio and LPS-binding protein (LBP) are significantly greater than those of normal control subjects. WHAT IS KNOWN ALREADY Mononuclear cells from women with PCOS respond excessively to LPS by releasing pro-inflammatory cytokines. In rat ovarian theca-interstitial cell cultures LPS stimulates androgen production. STUDY DESIGN, SIZE, DURATION Cross-sectional study comparing markers of endotoxemia in women with PCOS (n = 62), healthy ovulatory women with polycystic ovary morphology (PCOM, n = 39) and a control group of healthy ovulatory women without PCOM [normal (NL), n = 43]. PARTICIPANTS/MATERIALS, SETTING, METHODS LPS was measured using a chromogenic assay. LBP was measured by ELISA. Total cholesterol and lipids were measured using a homogeneous enzyme colorimetric method. Androgens, gonadotrophins, prolactin, insulin, high-sensitivity C-reactive protein (hs-CRP) and sex hormone-binding globulin were determined by electrochemiluminescence assays. Glucose was measured using an enzymatic reference method with hexokinase. MAIN RESULTS AND THE ROLE OF CHANCE Women with PCOS, when compared with NL subjects, had a significantly higher mean LPS (P = 0.045), LPS/HDL ratio (P = 0.007) and LBP (P = 0.01). Women with PCOM had intermediate levels of markers of endotoxemia. Comparison among all groups revealed that markers of endotoxemia correlated positively with testosterone level, ovarian volume, number of antral follicles and hirsutism score, but negatively with the number of spontaneous menses per year. In multiple regression analysis, all measures of endotoxemia correlated independently and positively with hs-CRP and with ovarian volume. LIMITATIONS, REASONS FOR CAUTION This cross-sectional study reveals that markers of endotoxemia are associated with several clinical features observed in women with PCOS. However, responsible mechanisms and causation remain unknown. Steroid quantification was carried out by electrochemiluminescence assays and not by the current gold standard: liquid chromatography-mass spectrometry. Hence, the relationship of endotoxemia with features of PCOS and the extent to which endotoxemia contributes to reproductive and metabolic dysfunction warrants further investigation. WIDER IMPLICATIONS OF THE FINDINGS This study reveals the novel observation that markers of endotoxemia are elevated in young and otherwise healthy women with PCOS without significant metabolic dysfunction. Moreover, the association of clinical and endocrine markers of PCOS with those of endotoxemia may represent a pathophysiologic link to reproductive dysfunction as well as metabolic and long-term cardiovascular risks associated with this disorder. STUDY FUNDING/COMPETING INTEREST(S) Intramural funding from Poznan University of Medical Sciences. The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A
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Basma, Jaafar, Kenneth A. Moore, Khaled Krisht, Tarek Abuelem, Kenan Arnautovic, L. Madison Michael, Emad Aboud, and Ali F. Krisht. "Morphometric Comparison of the Pterional Trans-Sylvian and the Pretemporal Trans-Clinoidal Approaches to the Posterior Communicating Artery." Operative Neurosurgery 20, no. 1 (August 29, 2020): E22—E30. http://dx.doi.org/10.1093/ons/opaa261.
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Abstract BACKGROUND Posterior communicating (Pcom) aneurysms in the modern era have tended toward increased complexity and technical difficulties. The pretemporal approach is a valuable extension to the pterional approach for basilar apex aneurysms, but its advantages for Pcom aneurysms have not been previously elucidated. OBJECTIVE To quantify characteristics of the pretemporal approach to the Pcom. METHODS We dissected 6 cadaveric heads (12 sides) with a pretemporal transclinoidal approach and measured the following variables: (1) exposed length of internal carotid artery (ICA) proximal to the Pcom artery; (2) exposed circumference of ICA at the origin of Pcom; (3) deep working area between the optic nerve and tentorium/oculomotor nerve; (4) superficial working area; (5) exposure depth; and (6) the frontotemporal (superior posterolateral) and (7) orbito-sphenoidal (inferior anterolateral) angles of exposure. RESULTS Compared with pterional craniotomy, the pretemporal transclinoidal approach increased the exposed length of the proximal ICA from 3.3 to 11.7 mm (P = .0001) and its circumference from 5.1 to 7.8 mm (P = .0003), allowing a 210° view of the ICA (vs 137.9°). The deep and superficial working areas also significantly widened from 53.7 to 92.4 mm2 (P = .0048) and 252.8 to 418.2 mm2 (P = .0001), respectively; the depth of the exposure was equivalent. The frontotemporal and spheno-Sylvian angles increased by 17° (P = .0006) and 10° (P = .0037), respectively. CONCLUSION The pretemporal approach can be useful for complex Pcom aneurysms by providing easier proximal control, wider working space, improved aneurysm visualization, and more versatile clipping angles. Enhanced exposure results in a potentially higher rate of complete aneurysm obliteration and complication avoidance.
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Kazemi, Maryam, Kathleen M. Hoeger, Steven D. Spandorfer, and Marla E. Lujan. "Ethnic Disparities in Cardio-Metabolic and Reproductive Profiles in Women With Polycystic Ovary Syndrome per the New International Guideline: A United-States Based Multi-Center Study." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A739—A740. http://dx.doi.org/10.1210/jendso/bvab048.1504.
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Abstract The magnitude and direction to which cardio-metabolic and reproductive aberrations may disproportionately impact diverse populations of women with PCOS are relevant yet unclear. The uncertainty stems, in part, from heterogeneity in PCOS diagnostic criteria used and technical challenges in the reliable assessment of this clinical population. We evaluated whether cardio-metabolic (abdominal adiposity, hypertension, impaired glucoregulatory status) and reproductive (hyperandrogenism, polycystic ovarian morphology [PCOM], menstrual irregularity) outcomes were different in PCOS (n = 120, 18-36 yrs.) across 4 groups: (1) Non-Hispanic White (n = 76); (2) Non-Hispanic Black (n = 14); (3) Non-Hispanic Asian (n = 15); and, (4) Hispanic White (n = 15). Women were prospectively recruited across 3 academic medical centers in New York State and were matched for age and body mass index. PCOS was defined by the Rotterdam criteria using the recommended thresholds of the 2018 International Evidence-based Guideline for the Assessment and Management of PCOS. Concerning abdominal adiposity, the Asian group (mean ± standard deviation; 0.78 ± 0.06) had a lower waist to hip ratio (WHR) compared to the White group (0.85 ± 0.09; P = 0.01). Also, the Asian group had a higher sex hormone binding globulin (SHBG, 65.9 ± 23.4 nmol/L) compared to all other groups (White [40.5 ± 22.3]; Black [43.8 ± 21.9]; Hispanic [36.8 ± 18.8] nmol/L; All: P < 0.04). In contrast, the White group were most hyperandrogenic, evidenced by their higher modified Ferriman-Gallwey (mFG) scores (10 ± 4) compared to other groups (Black [4 ± 0]; Asian [2 ± 0]; Hispanic [4 ± 1]; All: P ≤ 0.001). Consistently, the White group (1.0 ± 0.5 ng/dL) exhibited increased free testosterone (FT) compared to other groups (Black [0.5 ± 0]; Asian [0.4 ± 0]; Hispanic [0.6 ± 0.1] ng/dL; All: P ≤ 0.001), unlike total testosterone (P = 0.12). Regarding PCOM, the White group exhibited higher follicle numbers per ovary (FNPO 2-9 mm, 48 ± 22) compared to other groups (Black [30 ± 16]; Asian [26 ± 5]; Hispanic [22 ± 17]; All: P ≤ 0.05). Unlike Black (12.4 ± 1.3 mm; P = 0.05) and Hispanic (13.5 ± 1.1 mm; P = 0.89) groups, the White group (13.9 ± 2.1 mm) also exhibited larger ovarian volume (OV) compared to Asian group (12.4 ± 1.5 mm; P = 0.03). Women had comparable blood pressure (systolic, diastolic), fasting glucose, homeostatic model assessment of insulin resistance, or intermenstrual interval length (All: P ≥ 0.09). Overall, Asian women in the US likely exhibit the mildest PCOS metabolic (decreased WHR, increased SHBG) phenotype, whereas White women show the most severe reproductive (increased mFG, FT, FNPO, OV) phenotype. If confirmed by larger studies, our observations warrant additional population-specific diagnostic considerations to prevent and manage PCOS cardio-metabolic (e.g., metabolic syndrome risk) and reproductive (e.g., hirsutism, PCOM) complications across ethnicities.
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Kim, Bum Joon, Seung Min Kim, Sung-ho Ahn, Dong-Wha Kang, Sun U. Kwon, and Jong S. Kim. "Lateral Thalamic Infarction and the Vascular Geometry of the Posterior Cerebral Artery." Cerebrovascular Diseases 41, no. 1-2 (November 19, 2015): 8–12. http://dx.doi.org/10.1159/000439062.
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Background: The geometric properties of the parental artery affect the development of local atherosclerosis and perforator infarction. In this study, we aimed at investigating the association between vascular geometry of the posterior cerebral artery (PCA) and the development of isolated lateral thalamic infarction (LTI), the most frequent type of thalamic infarction. Methods: The geometric properties of the corresponding PCA in LTI patients were assessed and they include the diameters of the distal basilar artery (BA) and proximal PCA, distal BA - PCA angle, first PCA angle (angle between P1 and P2), and the presence of the posterior communicating artery (Pcom). These parameters obtained from the ipsilesional PCA were compared with the contralesional PCA and the corresponding PCA in age- and sex-matched controls. Results: Forty-five LTI patients were enrolled. The ipsilesional PCA in LTI patients demonstrated a greater ipsilesional P1 - P2 angle (81.4 ± 22.6 vs. 71.3 ± 23.2°, respectively; p = 0.04) and a higher prevalence of Pcom (42.2 vs. 13.3%; p = 0.002) when compared to control subjects. In comparison with the contralesional PCA, ipsilesional PCA demonstrated a smaller diameter, larger angle between P1 and P2 segment, and a higher prevalence of Pcom. The presence of hyperlipidemia (OR 3.548 (1.283-9.811); p = 0.02) and Pcom (OR 3.507 (1.104-11.135); p = 0.03) was a factor that was independently associated with LTI. Conclusions: Local hemodynamics in the PCA may be influenced by the P1 - P2 angle and the presence of Pcom, which are associated with the development of LTI.
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Robin, G., C. Gallo, S. Catteau-Jonard, C. Lefebvre-Maunoury, P. Pigny, A. Duhamel, and D. Dewailly. "Polycystic Ovary-Like Abnormalities (PCO-L) in Women with Functional Hypothalamic Amenorrhea." Journal of Clinical Endocrinology & Metabolism 97, no. 11 (November 1, 2012): 4236–43. http://dx.doi.org/10.1210/jc.2012-1836.
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Context: In the general population, about 30% of asymptomatic women have polycystic ovary-like abnormalities (PCO-L), i.e. polycystic ovarian morphology (PCOM) at ultrasound and/or increased anti-Müllerian hormone (AMH) serum level. PCOM has also been reported in 30–50% of women with functional hypothalamic amenorrhea (FHA). Objective: The aim of this study was to verify whether both PCOM and excessive AMH level indicate PCO-L in FHA and to elucidate its significance. Design: We conducted a retrospective analysis using a database and comparison with a control population. Setting: Subjects received ambulatory care in an academic hospital. Patients: Fifty-eight patients with FHA were compared to 217 control women with nonendocrine infertility and body mass index of less than 25 kg/m2. Interventions: There were no interventions. Main Outcome Measures: We measured serum testosterone, androstenedione, FSH, LH, AMH, and ovarian area values. The antral follicle count (AFC) was used as a binary variable (i.e. negative or positive) because of the evolution of its sensitivity over the time of this study. The ability of these variables (except AFC) to detect PCO-L in both populations was tested by cluster analysis. Results: One cluster (cluster 2) suggesting PCO-L was detected in the control population (n = 52; 24%), whereas two such clusters were observed in the FHA population (n = 22 and n = 6; 38 and 10%; clusters 2 and 3, respectively). Cluster 2 in FHA had similar features of PCO-L as cluster 2 in controls, with higher prevalence of positive AFC (70%) and PCOM (70%), higher values of ovarian area and higher serum AMH (P < 0.0001 for all), and testosterone levels (P < 0.01) than in cluster 1. Cluster 3 in FHA was peculiar, with frankly elevated AMH levels. In the whole population (controls + FHA), PCO-L was significantly associated with lower FSH values (P < 0.0001). Conclusion: PCO-L in FHA is a frequent and usually incidental finding of unclear significance, as in controls. The association of PCO-L with hypothalamic amenorrhea should not lead to a mistaken diagnosis of PCOS.
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Rudnicka, Ewa, Michał Kunicki, Anna Calik-Ksepka, Katarzyna Suchta, Anna Duszewska, Katarzyna Smolarczyk, and Roman Smolarczyk. "Anti-Müllerian Hormone in Pathogenesis, Diagnostic and Treatment of PCOS." International Journal of Molecular Sciences 22, no. 22 (November 19, 2021): 12507. http://dx.doi.org/10.3390/ijms222212507.
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Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among reproductive-aged women. It is characterized by chronic anovulation, hyperandrogenism, and the presence of polycystic ovary in ultrasound examination. PCOS is specified by an increased number of follicles at all growing stages, mainly seen in the preantral and small antral follicles and an increased serum level of Anti-Müllerian Hormone (AMH). Because of the strong correlation between circulating AMH levels and antral follicle count on ultrasound, Anti-Müllerian Hormone has been proposed as an alternative marker of ovulatory dysfunction in PCOS. However, the results from the current literature are not homogeneous, and the specific threshold of AMH in PCOS and PCOM is, therefore, very challenging. This review aims to update the current knowledge about AMH, the pathophysiology of AMH in the pathogenesis of PCOS, and the role of Anti-Müllerian Hormone in the treatment of this syndrome.
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Wojciechowska, Anna, Adam Osowski, Marcin Jóźwik, Ryszard Górecki, Andrzej Rynkiewicz, and Joanna Wojtkiewicz. "Inositols’ Importance in the Improvement of the Endocrine–Metabolic Profile in PCOS." International Journal of Molecular Sciences 20, no. 22 (November 18, 2019): 5787. http://dx.doi.org/10.3390/ijms20225787.
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Polycystic ovary syndrome (PCOS) is one of the most common causes of infertility and metabolic problems among women of reproductive age. The mechanism of PCOS is associated with concurrent alterations at the hormonal level. The diagnosis assumes the occurrence of three interrelated symptoms of varying severity, namely ovulation disorders, androgen excess, or polycystic ovarian morphology (PCOM), which all require a proper therapeutic approach. The main symptom seems to be an increased androgen concentration, which in turn may contribute to different metabolic disorders. A number of papers have demonstrated the significant role of inositol therapy in PCOS. However, there is a lack of detailed discussion about the importance of myo-inositol (MI) and d-chiro-inositol (DCI) in reference to particular symptoms. Thus, the aim of this review is to present the effectiveness of MI and DCI treatment for PCOS symptoms. Moreover, the review is focused on analyzing the use of inositols, taking into account their physiological properties, together with the mechanism of individual PCOS symptom formation.
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Yang, Yi, Yurong Cheng, Ye Yuan, Guoren Wang, Lei Chen, and Yongjiao Sun. "Privacy-preserving cooperative online matching over spatial crowdsourcing platforms." Proceedings of the VLDB Endowment 16, no. 1 (September 2022): 51–63. http://dx.doi.org/10.14778/3561261.3561266.
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With the continuous development of spatial crowdsourcing platform, online task assignment problem has been widely studied as a typical problem in spatial crowdsourcing. Most of the existing studies are based on a single-platform task assignment to maximize the platform's revenue. Recently, cross online task assignment has been proposed, aiming at increasing the mutual benefit through cooperations. However, existing methods fail to consider the data privacy protection in the process of cooperation and cause the leakage of sensitive data such as the location of a request and the historical data of cooperative platforms. In this paper, we propose Privacy-preserving Cooperative Online Matching (PCOM), which protects the privacy of the users and workers on their respective platforms. We design a PCOM framework and provide theoretical proof that the framework satisfies the differential privacy property. We then propose two PCOM algorithms based on two different privacy-preserving strategies. Extensive experiments on real and synthetic datasets confirm the effectiveness and efficiency of our algorithms.
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Zanaty, Mario, Nohra Chalouhi, Robert M. Starke, Pascal Jabbour, Katherine O. Ryken, Ketan R. Bulsara, and David Hasan. "Failure of the Pipeline Embolization Device in Posterior Communicating Artery Aneurysms Associated with a Fetal Posterior Cerebral Artery." Case Reports in Vascular Medicine 2016 (2016): 1–4. http://dx.doi.org/10.1155/2016/4691275.
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The pipeline embolization device has emerged as an important endovascular option. This is in part due to safety, efficacy, and possibly the ability to shorten the operative time considerably. With this new technology, some limitations are emerging as experience accumulates. We report three cases of posterior communicating (PCOM) artery aneurysms associated with fetal posterior cerebral artery where pipeline embolization was unsuccessful in obliterating the aneurysms. PCOM artery aneurysms associated with a fetal PCA should be managed either by microsurgical clipping or coiling when feasible.
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Modarres, Maryam, Kunal Rathod, Prashant Purohit, Vicky Minns, Bassam Nusair, Kuga Vigneswaran, Phoebe Howells, Mike Savvas, and Haitham Hamoda. "A review of 300 consecutive cases of Polycystic ovarian syndrome: clinical presentation and management." MOJ Women's Health 9, no. 3 (2020): 92–96. http://dx.doi.org/10.15406/mojwh.2020.09.00277.
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Background: Polycystic ovary syndrome (PCOS) is a common heterogeneous endocrine disorder. The prevalence of PCOS varies depending on which criteria are used to make the diagnosis, but can be as high as 15%–20%. Aim and objectives: To review the demographic details, presenting symptoms, biochemical features and management in women with PCOS and differentiate patients who have polycystic ovarian morphology (PCOM) and have hypothalamic amenorrhoea. Method: Retrospective observational study of 300 consecutive new cases with suspected PCOS were referred to the reproductive endocrinology clinic in a tertiary referral hospital (Kings college hospital, London) from 2008-2015. Electronic medical records were reviewed and Microsoft Excel software was used for data collection and analysis. Inclusion and exclusion criteria’s: All patients with suspected PCOS fulfilling Rotterdam criteria were included in the study. Phenotypically similar androgen excess disorders like congenital adrenal hyperplasia (CAH), androgen secreting-tumor and Cushing’s syndrome were excluded. Results: The mean (+/-SD) age was 30 (+/-6.7) years [range 14-49]. A total of 213 (71%) had oligomenorrhoea, 61 (20.3%) had amenorrhoea, while 26 (8.6%) had regular cycles. 135 (45%) presented with subfertility, while 93 (31%) had hirsutism. Mean (+/-SD) FSH and LH were 5.5 IU/L (+/-2.8) and 17.8 IU/L (+/-7.9), respectively, while mean (+/-SD) estradiol level was 253.4 pmol/L (+/-267.1). 27/61 (44.2%) women with amenorrhoea, had low estradiol [mean (+/-SD) <176 pmol/l (123.8+/-30.8 )]. Mean (+/-SD) anti-Mullerian hormone (AMH) was 44.6 pmol/L (+/-33.1). 39/45 (87%) had elevated AMH while 6/45 (13%) had normal AMH levels. Mean (+/-SD) testosterone level was 2.0nmol/L (+/-1.5) and 36 (16%) patients had elevated total testosterone levels. Mean (+/-SD) Sex Hormone Binding Globulin (SHBG) and Free Androgen Index (FAI) were 45.9 (+/- 29.4) and 5.8 (+/- 6.6). 20/43 (47% of women assessed) had elevated androstenedione levels with a Mean (+/-SD) of 13.06 (+/- 7.5). Elevated triglycerides and/or total cholesterol was noted in 13/44 (29.5% of women assessed). 13/28 (46.4% of women assessed) had raised HbA1C. In a total of six (2%) patients, the ovaries did not appear polycystic. Conclusion: A significant proportion of women with hypothalamic amenorrhea with PCOM were classed as PCOS.
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KAKIZAWA, Toshiyuki, Shigeru MITSUKA, Masami KANEKO, Hideo SASAKI, Ryouiti KIMURA, Akira FUKAMATI, Hideaki NUKUI, et al. "PC-Pcom Aneurysm with Ipsilateral ICA Occlusion." Surgery for Cerebral Stroke 16, no. 1 (1988): 53–58. http://dx.doi.org/10.2335/scs1987.16.1_53.
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Meczekalski, Blazej, Olga Niwczyk, Anna Kostrzak, Marzena Maciejewska-Jeske, Gregory Bala, and Anna Szeliga. "PCOS in Adolescents—Ongoing Riddles in Diagnosis and Treatment." Journal of Clinical Medicine 12, no. 3 (February 3, 2023): 1221. http://dx.doi.org/10.3390/jcm12031221.
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Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. A diagnosis of PCOS is established when a patient exhibits two of three Rotterdam criteria: oligoovulation or anovulation, excess androgen activity, and polycystic ovarian morphology. The pathogenesis of PCOS, as it affects adolescents, is often discussed in terms of a “two-hit” theory. This refers to a stepwise process in which the first “hit” is an inborn congenitally programmed predisposition, while the second “hit” arises from a provocative factor such as insulin resistance. The dynamic physiological and anatomical changes which occur in puberty make for a challenging diagnosis in this group of patients. It is important to be mindful of the physiological particularities in adolescence which often mimic the symptoms of PCOS. In their first-year post-menarche, approximately 75% of menstruating adolescents report their cycle to last between 21–45 days. Recent studies have shown that regular menstrual cyclicity is only achieved within 2–3 years post-menarche. Anovulation, as a crucial diagnostic element for PCOS, features in about half of early-post-menarchal adolescents. Hirsutism and acne are the most common clinical manifestations of hyperandrogenism, and mild features are developed by most adolescents as a result of elevated androgen levels. Distinguishing between a pathological sign and normal features of maturation is often difficult. A polycystic ovarian morphology (PCOM) through ultrasound has been found in up to 40%, 35%, and 33.3% of patients when assessed at 2, 3, and 4 years, respectively, after menarche. PCOM in adolescence is not associated with future abnormalities in ovulatory rate or menstrual cycle duration. For this reason, international guidelines recommend against the use of pelvic ultrasound until 8 years post-menarche. The primary aim of management is focused mainly on improving hormonal and metabolic status, the prevention of future comorbid complications, and generally improving the overall quality of life in young women with PCOS. Considerable controversy surrounds the choice of optimal pharmacological treatment to address PCOS in adolescents. Reliable studies, which include this sub-section of the population, are very limited. There is a lack of robust and reliable trials in the literature addressing the use of combined oral contraceptives. Further work needs to be undertaken in order to provide safe and effective care to the adolescent population in this regard.
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Hoyos, Luis R., Jenny A. Visser, Anke McLuskey, Gregorio D. Chazenbalk, Tristan R. Grogan, and Daniel A. Dumesic. "Loss of anti-Müllerian hormone (AMH) immunoactivity due to a homozygous AMH gene variant rs10417628 in a woman with classical polycystic ovary syndrome (PCOS)." Human Reproduction 35, no. 10 (September 11, 2020): 2294–302. http://dx.doi.org/10.1093/humrep/deaa199.
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ABSTRACT Anti-Müllerian hormone (AMH) is produced by granulosa cells of pre-antral and small antral ovarian follicles. In polycystic ovary syndrome (PCOS), higher levels of serum AMH are usually encountered due to the ample presence of small antral follicles and a high AMH production per follicular unit which have led to the proposal of AMH as a serum diagnostic marker for PCOS or as a surrogate for polycystic ovarian morphology (PCOM). However, heterozygous coding mutations of the AMH gene with decreased in vitro bioactivity have been described in some women with PCOS. Such mutation carriers have a trend toward reduced serum AMH levels compared to noncarriers, although both types of women with PCOS have similar circulating gonadotropin and testosterone (T) levels. This report describes a normal-weight woman with PCOS by NIH criteria with severely reduced AMH levels (index woman with PCOS). Our objective was to examine the molecular basis for her reduced serum AMH levels and to compare her endocrine characteristics to similar-weight women with PCOS and detectable AMH levels. Twenty normoandrogenic ovulatory (control) and 13 age- and BMI-matched women with PCOS (19–35 years; 19–25 kg/m2) underwent transvaginal sonography and serum hormone measures including gonadotropins, sex hormone-binding globulin, total and free T, androstenedione, dehydroepiandrosterone sulfate, estrone, estradiol and AMH. The latter was measured by ELISA (Pico-AMH: Ansh Labs, Webster, TX, USA). Women with PCOS and detectable AMH had higher serum AMH (10.82 (6.74–13.40) ng/ml, median (interquartile range)), total and free T (total T: 55.5 (49.5–62.5) ng/dl; free T: 5.65 (4.75–6.6) pg/ml) levels and greater total antral follicle count (AFC) (46 (39–59) follicles) than controls (AMH: 4.03 (2.47–6.11) ng/ml; total T: 30 (24.5–34.5) ng/dl; free T: 2.2 (1.8–2.45) pg/ml; AFC 16 (14.5–21.5) follicles, P < 0.05, all values), along with a trend toward LH hypersecretion (P = 0.06). The index woman with PCOS had severely reduced serum AMH levels (∼0.1 ng/ml), although she also had a typical NIH-defined PCOS phenotype resembling that of the other women with PCOS and elevated AMH levels. All women with PCOS, including the index woman with PCOS, exhibited LH hypersecretion, hyperandrogenism, reduced serum estrogen/androgen ratios and PCOM. A homozygous Ala515Val variant (rs10417628) in the mature region of AMH was identified in the index woman with PCOS. Recombinant hAMH-515Val displayed normal processing and bioactivity, yet had severely reduced immunoactivity when measured by the commercial pico-AMH ELISA assay by Ansh Labs. In conclusion, homozygous AMH variant rs10417628 may severely impair serum AMH immunoactivity without affecting its bioactivity or PCOS phenotypic expression. Variants in AMH can interfere with serum AMH immunoactivity without affecting the phenotype in PCOS. This observation can be accompanied by discordance between AMH immunoactivity and bioactivity.
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Mohamed Micdhadhu, Mohamed Azlam, Ko Hin Kho, Mazeda Murad, and Irene Looi. "Fetal posterior communicating artery as a conduit for concurrent anterior and posterior circulation infarct: A case report." Journal Of Cardiovascular, Neurovascular & Stroke 3, no. 4 (December 1, 2021): 7–11. http://dx.doi.org/10.32896/cvns.v3n4.7-11.
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Fetal type posterior cerebral artery (FTPCA) is a variant of posterior circulation of brain, in which the distal part of posterior cerebral artery (PCA) is perfused by a branch of internal carotid artery (ICA) via fetal posterior communicating artery (fetal PCOM). In the presence of fetal PCOM, a paradoxical concurrent infarction of anterior and posterior circulation may happen. We report a 67-year-old man who presented with sudden onset right sided weakness and aphasia, with National Institutes of Health Stroke Scale (NIHSS) score of 22 and clinically diagnosed to have left total anterior circulation infarct (TACI). Subsequently, he received IV Alteplase as a standard hyperacute ischemic stroke treatment. Computed tomography angiography (CTA) of brain showed left FTPCA with prominent left fetal PCOM. Subsequent computed tomography (CT) of brain showed concurrent left middle cerebral artery (MCA) and PCA territories infarct. CTA brain is commonly done in ischemic stroke cases to assess presence of large vessel occlusions and intracranial or extracranial atherosclerotic disease. However, this case depicts its additional role in detecting anatomical variants of cerebral circulation. In terms of clinical importance, presence of multiple territories infarction portends a poorer neurological outcome.
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Rossen, James D., Edgar A. Samaniego, Mishelle Paullus, and Santiago Ortega-Gutierrez. "Hybrid Retrograde-Antegrade Recanalization of Acute Basilar Artery Occlusion." Interventional Neurology 6, no. 3-4 (2017): 263–67. http://dx.doi.org/10.1159/000479704.
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Acute basilar artery (BA) occlusion has a very poor prognosis. Recanalization can be challenged by bilateral vertebral artery (VA) occlusions, arterial dissection, or advanced atherosclerotic disease. We describe a case in whom the BA was accessed and recanalized through a retrograde-antegrade approach from the anterior circulation using a large posterior communicating artery (PCOM). Once the BA had been crossed retrogradely through the PCOM, another microcatheter was advanced antegradely through the VA into the BA and right posterior cerebral artery using the “buddy-wire” technique. In this way the BA was recanalized and reconstructed with stents. This technical note demonstrates a new approach to BA treatment when the antegrade access is hampered by advanced VA/BA disease or dissection.
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Moon, Bo Min, Yun Sang Kim, Sun Eung Kim, Hye Gwang Mun, and Woo Sik Pae. "Reconstruction Using an Osteofasciocutaneous Fibula Free Flap for a Distal Tibial Defect in Refractory Chronic Osteomyelitis: A Case Report." Journal of Wound Management and Research 18, no. 2 (June 30, 2022): 148–53. http://dx.doi.org/10.22467/jwmr.2022.01935.
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The fibular free flap (FFF) is an option used for tibial defect reconstruction in post-traumatic chronic osteomyelitis (PCOM). However, as the tibia is a weight-bearing bone, there exists a risk of compression fracture risk after FFF. This complicates reconstructing distal tibial defects adjacent to the articular cartilage. We report a successful case of reconstruction using FFF for a bone defect adjacent to the distal tibial articular surface in refractory PCOM. The patient was a 73-year-old woman with refractory PCOM in the right distal tibia secondary to a tibial fracture from a traffic accident that occurred 28 years ago. After bone debridement, the tibial bone defect was 8 cm in length, and its distal margin was located 0.5 cm above the articular surface of the tibiotalar joint. Tibial bone and soft tissue defects were reconstructed using a contralateral FFF consisting of an 8-cm fibula bone and a 14×5-cm-sized skin paddle. After 2 months, an Ilizarov apparatus was applied and maintained for 3 months. After 6 months, she started weight-bearing. The follow-up period was 15 months. Imaging studies revealed bone block union. The patient displayed no difficulty in ambulation and had no additional infections or flap necrosis.
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Baietto, Oliviero, and Paola Marini. "Naturally occurring asbestos: Validation of PCOM quantitative determination." Resources Policy 59 (December 2018): 44–49. http://dx.doi.org/10.1016/j.resourpol.2018.06.006.
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Singh, Shakun, Arshiya Firdaus, Rachna Choudhary, and Vandana Dhama. "Role of anti-mullerian hormone as a diagnostic tool for polycystic ovary syndrome." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 9, no. 9 (August 27, 2020): 3730. http://dx.doi.org/10.18203/2320-1770.ijrcog20203847.
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Background: PCOS has been recognized as the most frequent endocrinopathy among reproductive aged women. This study has been done to determine whether the measurement of serum AMH can be used to diagnose PCOS and as a tool to predict the prognosis of PCOS.Methods: This was a prospective case control study on a woman attending gynae OPD of LLRM Medical College, Meerut, from May 2018 to June 2019. Study comprised of 50 women diagnosed with PCOS using Rotterdam criteria and 50 controls. Clinical data were collected including history, oligomenorrhea, hirsutism, examination included BMI, FG score and blood investigations including serum FSH, LH, TSH, prolactin, estradiol and serum AMH level. USG was done for all women.Results: Both PCOS cases and controls were matched for age and BMI. Mean level of AMH in PCOS cases and controls was 7.1096 and 2.423 respectively, AMH was two to three times higher in women with PCOS than controls which was statistically significant (p<0.05). Most frequent phenotype of PCOS in this study was phenotype A (48%). Highest mean level of AMH was also found in phenotype A (OA+HA+PCOM), thus reflecting the severity of PCOS. Maximum diagnostic potential for PCOS was at cut off 4.22 ng/ml with sensitivity of 92.5% and specificity of 100%.Conclusions: AMH level can be used as diagnostic and prognostic modalities in PCOS. AMH value rises when hyperandrogenism is present therefore serum AMH levels also reflect the phenotype of PCOS and severity of PCOS.
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Antunes, Bárbara, Stephen Barclay, Isla Kuhn, Kathy Eagar, Claudia Bausewein, Fliss Murtagh, Simon Etkind, et al. "Implementing patient-centred outcome measures in palliative care clinical practice for adults (IMPCOM): Protocol for an update systematic review of facilitators and barriers." F1000Research 12 (February 28, 2023): 224. http://dx.doi.org/10.12688/f1000research.131479.1.
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Background: Despite the development of patient-centred or patient-reported outcome measures (PCOMs or PROMs) in palliative and end-of-life care over recent years, their routine use in practice faces continuing challenges. Objective: To update a highly cited literature review, identify and synthesise new evidence on facilitators, barriers, lessons learned, PCOMs used, models of implementation, implementation outcomes, costs, and consequences of implementing PCOMs in palliative care clinical practice. Methods: We will search MEDLINE, PsycINFO, CINAHL, Embase, Emcare, SCI-Expanded, SSCI, ESCI, and BNI. The database search will be supplemented by a list of studies from the expert advisory committee, hand-searching of reference lists for included articles, and citations of the original review. We will include primary studies using a PCOM during clinical care of adult patients with advanced disease in palliative care settings and extract data on reported models of implementation, PCOMs, facilitators, barriers, lessons learned, costs, and implementation outcomes. Gough’s Weight of Evidence Framework will be used to assess the robustness and relevance of the studies. We will narratively synthesise and tabulate the findings. This review will follow PRISMA, PRISMA-Abstract, PRISMA-P, and PRISMA-Search as the reporting guidelines. Source of funding: Marie Curie. The funder is not involved in designing or conducting this study. Protocol registration: CRD42023398653 (13/02/2023)
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Lasiste, Jade Marie, Pablo Zoroquiain, Denise Miyamoto, and Miguel Burnier. "Metformin activity in an in vitro model of posterior capsule opacification." Vision Pan-America, The Pan-American Journal of Ophthalmology 17, no. 4 (December 31, 2018): 105–12. http://dx.doi.org/10.15234/vpa.v17i4.511.
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Purpose: To determine the activity of metformin in an in vitro model of posterior capsule opacification (PCO).Design: Experimental laboratory research. Methods: The HLE-B3 lens epithelial cell line was treated with PCO induction media (PCOM) supplemented with transforming growth factor-beta (TGF-β) and fibroblast growth factor (FGF). Different metformin concentrations (0-100 mM) were used. The following cellular parameters were assessed: (1) survival, using a viability assay; (2) morphology, via microscopy and image analysis; (3) migration, using the wound assay; (4) and expression of epithelial (Pax6, E-cadherin) and mesenchymal (α-smooth muscle actin or α-SMA, fibronectin) markers via Western blot. Expression of the uptake receptor SLC22A1 was evaluated in HLE-B3 and in human donor eyes with Western blot and immunohistochemistry, respectively. Statistical analysis of variance (ANOVA) with Tukey post-hoc test was done for analysis of cytotoxicity, morphology and migration data. Results: Metformin was lethal to half (LC50) of the cells at 30 mM, and a decrease in viability (P<0.05) was noted at 5 mM. LECs in PCOM treated with 1 mM metformin showed increased Pax6 and E-cadherin and decreased α-SMA and fibronectin expression. LECs in PCOM treated with metformin also maintained epithelial morphology. Migration was inhibited with 0.5 mM metformin (P<0.05). Both HLE-B3 and the lens epithelium in donor eyes were found to express SLC22A1.Conclusion: Metformin decreased survival and migration in LECs, maintaining epithelial phenotype and reducing mesenchymal marker expression. Metformin therefore has potential as an adjunct in PCO prevention.Financial Disclosures: This work was partially funded by Mitacs Canada.
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Onwubalili, Laura, Maryam Modarres, Mike Savvas, and Haitham Hamoda. "Evaluation of in vitro fertilization outcomes in women with polycystic ovarian morphology (pcom) compared to women with non-polycystic ovarian morphology (non-pcom)." European Journal of Obstetrics & Gynecology and Reproductive Biology 234 (March 2019): e76. http://dx.doi.org/10.1016/j.ejogrb.2018.08.322.
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MacLean, MA, T. Huynh, M. Schmidt, VM Pereira, and A. Weeks. "P.193 Competitive Flow Diversion: Proposed Classification System." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 48, s3 (November 2021): S76. http://dx.doi.org/10.1017/cjn.2021.469.
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Background: Competitive flow diversion (CFD) is a novel application of flow diversion stenting (FDS), redirecting flow into a normal artery proximal or distal to the aneurysmal parent artery. A classification system for CFD has not been previously reported. Methods: Report of operative technique and novel classification system for CFD. Results: A patient with subarachnoid haemorrhage and three aneurysms arising from the Pcomm-P1 complex, was treated with endovascular coiling and CFD. The PCOM aneurysm was coiled. Two aneurysms arose from the distal right P1- PCA. After a failed attempt to treat with FDS across the P1-PCA, the P1-aneurysms were successfully treated with CFD distal to the P1-PCA, from Pcomm to P2. Over 12 months, CFD redirected flow via ICA-Pcomm-P2, reducing the size of the P1-PCA, obliterating the P1-aneurysms. Herein, we classify competitive flow diversion into two types. Type I CFD is when the parent artery harbouring the aneurysm is “jailed” proximally. Type II CFD occurs when flow is diverted from the parent artery distal to the aneurysm origin. Conclusions: Herein, we propose a novel classification for CFD. We describe the first case of aneurysm occlusion in the circle of Willis with Type II CFD, and use of CFD for the treatment of multiple adjacent aneurysms.
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Langenau, Erik, Sarah B. Frank, Sarah J. Calardo, and Michael B. Roberts. "Survey of Osteopathic Medical Students Regarding Physician Shadowing Experiences Before and During Medical School Training." Journal of Medical Education and Curricular Development 6 (January 2019): 238212051985204. http://dx.doi.org/10.1177/2382120519852046.
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Introduction: Shadowing a physician is an observational experience which includes a student observing a licensed healthcare provider caring for patients. Shadowing is commonly done by students before and during medical school, but little is known about the nature or extent of these extra-curricular observational experiences. Objective: We hypothesized that shadowing experiences were common yet variable. We investigated the prevalence, nature, and perceived value of medical student experiences with shadowing physicians (both before and during medical school). Methods: This survey-based study was non-experimental with a cross-sectional convenience sample of osteopathic medical students about their shadowing experiences before and during medical school. The survey was sent to all matriculated osteopathic medical students (OMS1-4) for the 2017 to 2018 academic year from two medical schools: Philadelphia College of Osteopathic Medicine (PCOM) (1084 total students) and PCOM-Georgia (554 total students). The final survey instrument included three sections: demographics (6 questions), pre-medical shadowing experiences (21 questions), and medical student shadowing experiences (24 questions). Results: Respondents (357) identified themselves as OMS1 (96), OMS2 (89), OMS3 (73), OMS4 (95) and other (2, OMS5) with enrollment at PCOM-Philadelphia (242) and PCOM-Georgia (115). Among survey respondents, 339 (95.5%) reported shadowing a physician as a pre-medical student, and 110 (30.8%) reported shadowing (outside of their required clinical rotations) a physician during medical school. Requirements to participate were inconsistent; fewer than 50% of shadowing experiences required Health Insurance Portability and Accountability Act of 1996 (HIPAA) training, proof of vaccination, or purified protein derivative (PPD) documentation. In addition to observation, pre-medical and medical students, respectively, participated in history taking (44 [13%], 47 [42.7%]), physical examinations (45 [13.3%], 44 [40%]) and procedures (13, [3.8%], 20 [18.2%]) during their shadowing experiences. Motivations to participate in shadowing varied between pre-medical and medical student experiences, but both groups mentioned their desire to learn more about a particular discipline, obtain letters of recommendation, and gain patient care experience. Students recommended both pre-medical (273 [80.5%]) and medical school (93 [84.5%]) shadowing to future students. Conclusion: Shadowing remains a common and important tool for students to learn about patient care, medicine and careers. The nature of each shadowing experience and participation requirements are quite variable. Measures to ensure patient safety, confidentiality, liability and supervision are inconsistently applied. Promoting guidelines, as well as codes of conduct, for shadowing could serve as a helpful resource for students, academic advisors and supervising clinicians.
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Amini, Leila, Najmeh Tehranian, Mansoureh Movahedin, Fahimeh Ramezani Tehrani, and Haleh Soltanghoraee. "Polycystic Ovary Morphology (PCOM) in Estradiol Valerate Treated Mouse Model." International Journal of Women's Health and Reproduction Sciences 4, no. 1 (January 1, 2016): 13–17. http://dx.doi.org/10.15296/ijwhr.2016.04.
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Puri, A. S., and E. Erdem. "Unusual Intracranial Stent Navigation through the Circle of Willis in a Patient with Recurrent Basilar Tip Aneurysm during Stent-Assisted Coiling." Interventional Neuroradiology 15, no. 1 (March 2009): 81–86. http://dx.doi.org/10.1177/159101990901500113.
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We describe a case of unusual Enterprise stent navigation through the Circle of Willis in a patient with a basilar tip aneurysm, left internal carotid artery (ICA) occlusion and previous right ICA stenting. Basilar tip aneurysms are known for their therapeutic challenges, especially when the posterior cerebral arteries (PCAs) are incorporated in the aneurysm neck. This becomes more technically demanding if the vertebral artery does not offer a route for stent navigation. We undertook stent-assisted coiling using the horizontal stenting of posterior cerebral arteries via both the posterior and anterior communicating artery navigation. This was necessary because the vertebral arteries were very tortuous, hence not suitable for stent navigation due to their small size and stenosis at their origin. Another compounding factor was the anatomy of the aneurysm neck in relation to the T-shaped origin of both P1 PCAs from the basilar artery. The right ICA was stented previously and the whole navigation was done through this stented artery as the opposite left ICA was occluded at the bifurcation. In addition, there was no visualized posterior communicating artery (PCOM) on the right side, so following navigation through the anterior communicating artery (ACOM) the left PCOM artery was catheterized to reach the PCAs. After horizontal placement of stent, coiling was performed for the residual aneurysm. The outcome of this intervention revealed successful placement of the Enterprise stent in bilateral posterior cerebral arteries covering the aneurysm. Further coiling of the basilar artery aneurysm was done with a good result. No complication was seen in the angiography suite or later in the course of action. Horizontal stent placement in wide-necked basilar aneurysms can be performed via the PCOM and ACOM arteries.
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Grzywna, Natalia, Sylwia Zdun, Klaudia Walczak, Patrycja Walczak, Sylwia Nemeczek, Konrad Merkisz, Jakub Grzybowski, Agnieszka Marciniak, Karolina Jaskuła, and Władysław Orłowski. "Vitamin D supplementation in Polycystic ovary syndrome." Journal of Education, Health and Sport 13, no. 2 (December 29, 2022): 190–95. http://dx.doi.org/10.12775/jehs.2023.13.02.027.
Full textAbstract:
Introduction and Purpose. Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women of reproductive age worldwide. Patients may present with a wide range of symptoms. According to the most commonly used Rotterdam criteria, the presence of 2 out of 3 criteria is required for diagnosis: clinical and/or biochemical markers of hyperandrogenism (HA); ovulation disorders (oligo- or anovulation); polycystic ovaries on ultrasound (PCOM); and exclusion of disorders mimicking the clinical features of PCOS. The basis of treatment are birth control pills, metformin and antiandrogens. The pathogenesis of the syndrome is not fully understood. The aim of the study is to summarize the potential health benefits of vitamin D supplementation for women with PCOS based on publications from the last 10 years available on Pubmed. State of knowledge. Vitamin D receptors have been identified not only in calcium-regulating tissues, but also in many reproductive organs, such as the ovary (especially granulosa cells), uterus, placenta, testes, as well as hypothalamus and pituitary gland. In recent years, there have been studies analyzing the effect of vitamin D supplementation on the hormonal balance, metabolism and clinical symptoms in women with PCOS. Summary. The results of studies on vitamin D supplementation in women with PCOS are mixed. Some of them are promising and confirm a beneficial effect on glucose metabolism and insulin resistance, lipid metabolism, hormonal balance, alleviation of HA-related symptoms, improvement of menstrual frequency; while the results of other studies do not show significant improvement and do not confirm these effects. Therefore, there is a need for further research on the relationship between the pathogenesis of PCOS and vitamin D and the impact of its supplementation.
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Miranda, Neyton de O., Teógenes S. de Oliveira, José de A. de Matos, and Ariana Carvalho Pinto. "Variabilidade espacial da fertirrigação em Latossolo Vermelho Amarelo cultivado com melão." Revista Brasileira de Engenharia Agrícola e Ambiental 10, no. 2 (June 2006): 331–37. http://dx.doi.org/10.1590/s1415-43662006000200012.
Full textAbstract:
Este trabalho, realizado em Mossoró, RN, investigou a variabilidade de parâmetros da fertirrigação por gotejamento, sua dependência espacial e correlação com a produtividade e qualidade de frutos de melão. Em uma malha de 20 por 20 m foram tomadas 75 amostras, para se determinar: produção de frutos tipo exportação (PEXP), mercado nacional (PNAC) e comerciável (PCOM), peso médio de frutos comerciáveis (PMCOM), teor de sólidos solúveis totais (SST), firmeza de polpa, espessura da polpa (ESPOLP), elevação, distância até a entrada de água, além da quantidade de adubo aplicada e vazão dos gotejadores com os respectivos coeficientes de uniformidade de emissão (CUE). A variabilidade foi determinada através da estatística descritiva e da geoestatística. A vazão e a quantidade de adubo aplicada no primeiro teste, foram menores que o esperado. O CUE foi bom e excelente para vazão, e regular e bom para a quantidade de adubo aplicada. A dependência espacial foi observada para vazão e quantidade de adubo aplicada, cujas isolinhas permitiram localizar-se áreas onde ocorreu déficit ou excesso. As correlações sugerem influência da vazão sobre PNAC, PCOM e PMCOM, e da quantidade de adubo sobre PEXP e ESPOLP.
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Hejčl, Aleš, Jan Lodin, Filip Cihlář, and Martin Sameš. "Spontaneous Subarachnoid Hemorrhage in a Patient with a Co-Existent Posterior Communicating Artery Aneurysm and Cervical Spine Aneurysm Associated with Ventral Arterio-Venous Fistula." Brain Sciences 10, no. 2 (January 28, 2020): 70. http://dx.doi.org/10.3390/brainsci10020070.
Full textAbstract:
Severe spontaneous subarachnoid hemorrhage (SAH) is predominantly caused by aneurysm rupture, with non-aneurysmal vascular lesions representing only a minority of possible causes. We present the case of a 58-year old lady with a coincidental posterior communicating artery (PCom) aneurysm and a high cervical spine arterio-venous fistula associated with a small ruptured aneurysm. After the emergency clipping of the PCom aneurysm, additional diagnostic procedures—repeated digital subtraction angiography and spinal magnetic resonance imaging, revealed the actual cause of the SAH, a type-A ventral intradural fistula at cervical level C2/3. The fistula was treated micro surgically via a ventral approach using C3 somatectomy and C2-4 stabilization after the initial failure of endovascular therapy. Furthermore, the patient was treated for complications associated with severe SAH, including acute hydrocephalus and meningitis. In cases where the SAH pattern and perioperative findings do not suggest an intracranial aneurysm as the source of SAH, further diagnostic investigation is warranted to discover the real cause. Patients with severe non-aneurysmal SAH require a similar algorithm in diagnosing the cause of the hemorrhage as well as complex conditions such as ruptured aneurysms.