Characterization and risk factors for unexplained female infertility in Sudan:A case-control study

BACKGROUND Female infertility with unknown causes(unexplained)remains one of the mysteries in the reproductive health field,where the diagnostic evidence is still weak and the proposed treatments still work with unknown methods.However,several studies have proposed some possible causes and risk factors for unexplained female infertility.AIM To characterize and identify factors associated with unexplained infertility in Sudanese women.METHODS A matched(age and body mass index)case-control study was conducted from March 2021 to February 2022.The study samples were 210 women with unexplained infertility(UI)and 190 fertile women of reproductive age who were attending the maternity hospitals and fertility clinics in Khartoum,Sudan.The risk factors of unexplained infertility were identified using a structured,pretested questionnaire containing information on socio-demographic variables,anthropometrics,clinical diagnosis of infertility,behavioral factors,physical activity assessment,diversity,and consumption of different food groups by the study participants.RESULTS The results showed a higher proportion of women diagnosed with UI were residents of rural areas than controls(21.4%vs 11.1%,P<0.05),and previous miscarriages and/or abortions were more common in fertile women compared with infertile women(13.16%vs 5.71%,P<0.05).Additionally,infertile women had a significantly(P<0.05)higher proportion of family history of infertility(explained and unexplained)compared with controls.Finally,after controlling for the effects of potentially confounding variables using multivariable logistic regression analysis,only marital status,family history of infertility,use of modern contraceptives,smoking,caffeine consumption,physical activity level,meals consumed,other vitamin-A-rich fruits and vegetables,and other vegetables were found to be significant(P<0.05)factors associated with unexplained infertility among Sudanese women.CONCLUSION Married women with a family history of infertility who smoke and consume a high amount of caffeine,who live a sedentary lifestyle,and who consume more than two meals free of vitamin-Arich fruits and/or vegetables and/or other vegetables per day are at the highest risk of developing unexplained infertility.

针灸对原因不明复发性流产患者外周血CD4^+CD8^+T细胞的影响

复发性自然流产（recurrent spontaneous abortion,RSA）是指临床上连续2次或2次以上的自然流产,是一种常见的妊娠并发症,发生率占妊娠总数的0.4%~0.8%,其中约有40%~80%临床上找不到明确病因,称为原因不明复发性流产（unexplained recurrent spontaneous abortion,URSA）。URSA病因十分复杂,涉及遗传、内分泌、

晕厥患者50例直立倾斜试验阳性高峰时段的确定与护理

晕厥是因各种原因导致一过性脑供血不足引起的意识障碍,其中有相当一部分患者经过各种检查和询问病史仍不能明确病因,称不明原因晕厥（unexplained syncope,US）-（[1]）。直立倾斜试验（head-up tilt table test,HUTT）是利用体位的迅速改变,引起神经体液的过度反应,

Fertilization of IVF/ICSI Using Sibling Oocytes from Couples with Subfertile Male or Unexplained Infertility

The significance of the performance of conventional in vitro fertilization and intracytoplasmic sperm injection (IVF/ICSI) using sibling oocytes from couples with subfertile male or unexplained infertility was evaluated. A total of 410 sibling oocyte cumulus-corona complexes (OCCC) from 21 couples with subfertile male (group A) and 11 unexplained infertile couples (group B) were randomly divided, in order of retrieval, into two groups inseminated either by conventional IVF or by ICSI. The treatment outcomes and the influence of infertility factors on fertilization in each group were compared. The results showed that although the two pronuclear (2PN) fertilization rate per injected sibling oocytes was significantly higher after ICSI (group A: 68.2 %±28.8 %; group B: 66.2 %±24.9 %) than after conventional IVF (group A: 41.8 %±32.7 %; group B: 40.1 %±22.1 %), the other variables studied included: the fertilization rates of per allocated sibling oocytes IVF/ICSI, the fertilization rates of sibling oocytes IVF/ICSI after excluding failed IVF fertilization cycles, as well as the cleavage rates of normal fertilization were not statistically significant (P>0.05). Similarly, though the total fertilization failure rate in the IVF group (group A: 42.9 %; group B: 36.4 %) was significantly higher than in the ICSI group (group A: 4.8 %; group B: 0), we did not cancel cycles due to the normal fertilization of sibling oocytes. Embryo transfer was possible in all 32 couples. There were 10 clinical pregnancies in the two groups. We also discovered a possible association between some semen parameters and sperm functions of group A, and women age and duration of infertility of group B and fertilization. It is suggested that adoption of the split IVF/ICSI technology in the above cases may help eliminate fertilization failures. This is also a useful method to investigate the effect of single factor on the employment of assisted reproductive technology.

Unexplained abdominal pain due to a fish bone penetrating the gastric antrum and migrating into the neck of the pancreas: A case report

BACKGROUND Ingestion of foreign bodies results in gastrointestinal perforation in approximately 1% of patients,and fish bones are the objects that most commonly lead to bowel perforation. When it does occur,the terminal ileum is the most common site of perforation,followed by the duodenal C-loop. However,involvement of the pancreas is very rare. Because clinical symptoms are nonspecific and gastrointestinal perforation may present as only odynophagia or abdominal pain,a definite preoperative diagnosis and clinical intervention may be delayed.CASE SUMMARY We report the case of a 32-year-old man who presented to our hospital because of abdominal pain that had worsened over 5 d. He had no significant past history except that he had eaten fish 1 wk previously. Upper endoscopy revealed an irregular submucosal tumor on the front wall of the gastric antrum. Endoscopic ultrasonography and computed tomography showed a fish bone penetrating the gastric antrum and migratingin to the neck of the pancreas. The patient underwent laparoscopic surgery and had no complications one week after the operation.CONCLUSION A recent history of foreign body ingestion and imaging examinations are helpful for diagnosis of unexplained abdominal pain caused by foreign bodies.

Endoscopic ultrasound in common bile duct dilatation with normal liver enzymes

In recent years,the description of isolated bile duct dilatation has been increasingly observed in subjects with normal liver function tests and nonspecific abdominal symptoms,probably due to the widespread use of high-resolution imaging techniques.However,there is scant literature about the evolution of this condition and the impact of endoscopic ultrasound(EUS)in the diagnostic work up.When noninvasive imaging tests(transabdominal ultrasound,computed tomography or magnetic resonance cholangiopancreatography)fail to identify the cause of dilatation and clinical or biochemical alarm signs are absent,the probability of having biliary disease is considered low.In this setting,using EUS,the presence of pathologic findings(choledocholithiasis,strictures,chronic pancreatitis,ampullary or pancreatic tumors,cholangiocarcinoma),not always with a benign course,has been observed.The aim of this review has been to evaluate the prevalence of disease among nonjaundiced patients without signs of cytolysis and/or cholestasis and the assessment of EUS yield.Data point out to a promising role of EUS in the identification of a potential biliary pathology.EUS is a low invasive technique,with high accuracy,that could play a double cost-effective role:identifying pathologic conditions with dismal prognosis,in asymptomatic patients with negative prior imaging tests,and excluding pathologic conditions and further follow-up in healthy subjects.

Leptin levels in women with unexplained infertility:A systematic review and meta-analysis

BACKGROUND Unexplained infertility(UI)is usually used for any heterosexual couple who failed to have a successful clinical pregnancy without identifying clear causes after they undergo all standard fertility tests.Evidence shows that leptin is one of the most accurate biomarkers for UI.Nevertheless,conflicting results regarding leptin levels in women with UI have been reported.AIM To find the serum leptin levels in women with UI.METHODS All studies written in English and conducted before April 30,2021 from PubMed/MEDLINE,Embase,Cochrane Central Register of Controlled Trials,ClinicalTrials.gov,Google Scholar,OpenGrey,OATD,and the infertility conference abstract were included.Studies were found eligible if they provided the mean and standard deviation of leptin for the case group and control group.The quality assessment of individual studies was evaluated using the Joanna Briggs Institute Quality Assessment Tool.Data synthesis and statistical analysis were done using STATA software version 16.RESULTS A total of 378 studies were reviewed,and just six studies that fulfilled the eligibility criteria were included in this meta-analysis.The pooled result showed that leptin levels were significantly higher in women with UI compared to fertile women,with a standardized mean difference of 0.97(95%confidence interval:-0.49-2.43).However,heterogeneity across studies was highly significant(P<0.00001;I2=98.8%).CONCLUSION The results of this study suggest that leptin levels are elevated in women with UI compared with fertile women;hence,leptin could be a potential biomarker for UI in women,and it may be useful for identifying women with a high risk of infertility.

全科医生小词典——消化系统的医学难以解释的症状(MUS)

MUS（medically unexplained symptom）的定义是指医学无法解释的症状,表示一种状态,不是诊断性用语。消化科相关的MUS主要分为两类：无器质性消化疾病的MUS〔如功能性胃肠病（FGID）〕与器质性消化疾病伴随的MUS。其中,器质性消化疾病伴随的MUS包括炎症性肠病（IBD）残留症状（患者的各项炎症指标均处于稳定状态,但存在始终不能消退并难以解决的症状）和肝病相关MUS（肝功能正常,肝脏处于疾病代偿状态,而患者始终自诉存在肝病相关症状）。

Research advances of Chinese and Western medicine in the treatment of unexplained recurrent spontaneous abortion

Recurrent spontaneous abortion is a common disease in gynecology,and it seriously affects women's reproductive health and brings heavy burden and pain to society and families.The cause of recurrent spontaneous abortion is complicated,in addition to the well-defined genetic,anatomical,infection and endocrine factors,and there are still some unknown causes,which is called as unexplained recurrent spontaneous abortion,accounting for 40%of recurrent abortion.At present,there are a lot of researches on the treatment methods of the patients with the unexplained recurrent spontaneous abortion,which also shows that the treatment of traditional Chinese and Western medicine all have certain clinical application effect.Western medicine clinical methods mainly includes immunotherapy,immunosuppressive therapy,anticoagulation therapy,progesterone therapy,etc.Based on the experience of the professor and combined with many years of clinical practice,the author believes that the pathogenesis of this disease in traditional Chinese medicine is mainly due to impaired impulse and deficiency of Spleen,lack of qi and blood,can not nourishing the fetus;deficiency of Kidney Qi,blood flow was delayed,and blood stasis and could not raise the fetus.Clinical treatment is based on invigorating the kidney,tonifying spleen and nourishing blood,promoting blood circulation to remove blood stasis and dredging collaterals.Oral Chinese medicine combined with external acupuncture and moxibustion has achieved excellent effects in improving pregnancy rate.This article reviews the domestic and foreign methods of treating unexplained recurrent miscarriage in order to provide clinical reference.In the future,the combination of Chinese and Western medicine should become the main therapy to increase pregnancy rate.

Endometrial Injury and Sub Endometrial Doppler Study to Predict Uterine Receptivity in Women with Unexplained Infertility: A Randomized Controlled Trial

Objectives: The aim of this work was to compare the effectiveness and safety of endometrial scratching at different times of the menstrual cycle on cumulative pregnancy rate and also to assess and clarify its relationship and effect on sub-endometrial vasculature blood flow by Doppler ultrasound, in cases of unexplained infertility attempting to conceive spontaneously (without ovulation induction). Study Design: A prospective randomized clinical control study. Patients and Methods: A total of 252 eligible participants were included in the study and randomly allocated using block randomization into three groups: Group A (n = 84): endometrial scratching was performed during the pre-ovulatory days and Group B (n = 84): endometrial scratching has been done at day 7 of the cycle. Group C (control group): includes 84 cases without endometrial scratching. The Doppler ultrasound will be done. The pulsatility index (PI) and resistance index (RI) of endometrial and sub endometrial arteries were calculated. All women were followed up to 3 months. Results: Cumulative pregnancy rate is 21.42% and 28.57% in the study groups A and B respectively which is higher than group C (control group) (4.76%) but with statistically insignificant P-value = 0.254. There is statistically significant difference in RI & PI between the studied groups and the control group on day 13 (P value < 0.001). There is statistically significant difference in PI between day 13 and day 6 for the same group in both groups (A&B) (P value < 0.003), while there is no statistically significant difference in Group C (P value = 0.156). Conclusion: Endometrial scratching is a cost-effective and easy technique which may improve clinical pregnancy rates and endometrial blood flow in women with unexplained infertility.

医生小词典——消化系统的医学难以解释的症状

难以解释的症状（medically unexplained symptom,MUS）是指医学无法解释的症状,表示一种状态,不是诊断性用语。消化科相关的MUS主要分为两类：无器质性消化疾病的MUS〔如功能性胃肠病（FGID）〕与器质性消化疾病伴随的MUS。其中,器质性消化疾病伴随的MUS包括炎症性肠病（IBD）残留症状（患者的各项炎症指标均处于稳定状态,但存在始终不能消退并难以解决的症状）和肝病相关MUS（肝功能正常,

高中英语学困生英语学习焦虑研究

如何转化英语学困生一直是困扰教师的核心问题,学困生英语学习水平不高,对学习英语兴趣不大,对提高英语整体教学水平形成了极为不利的影响。高中阶段是学生学习生涯中最为关键的时期,学生偏科对整体学习水平的影响在这个时期尤为明显,高强度的学习压力和高考压力下,英语学困生对于英语学习表现出了过度的焦虑,这种焦虑的情绪不仅会影响学生英语学习,也会影响其他学科的学习效率。

Australian Family Physician 2015年9月目次选登

The management of unresolved gastrointestinal symptoms in Australian general practice澳大利亚全科医学未解决胃肠道症状的管理Managing medically unexplained illness in general practice全科医学疑难病管理Rare diseases are a'common'problem for clinicians疑难病对临床医生来说是"常见"问题A powerful team:the family physician advocating for patients with a rare disease强大团队:家庭医生积极帮助疑难病患者Is there a role for prazosin in the treatment of post-traumatic stress disorder?哌唑嗪在创伤后应激障碍治疗中是否有作用?

Increase of tumor necrosis factor receptor 1 expression in women with unexplained early spontaneous abortion

Objective: To investigate membrane tumor necrosis factor receptor 1 protein expression level in decidua and concentration of soluble tumor necrosis factor receptor 1 in serum in women with unexplained early spontaneous abortion, threatened abortion, and compare the levels with healthy pregnant women. Methods: Thirty-seven women with unexplained early spontaneous abortion, 27 women with threatened abortion, and 34 healthy pregnant women undergoing artificial abortion of pregnancy at 6 - 10 weeks of gestation were selected. Decidual samples were collected when women were undergoing artificial abortion, and blood samples were collected at the same time. The level of membrane tumor necrosis factor receptor 1 in decidua was detected by flow cytometer, and the concentration of soluble tumor necrosis factor receptor 1 in sera was measured with an enzyme-linked immunosorbent assay. Results: The percentages of membrane tumor necrosis factor receptor 1 positive decidual cells were 16.42 ± 7.10 Mean ± SD for women with unexplained early spontaneous abortion and 13. 14 ± 6.30 for healthy pregnant women ( P < 0.05). Serum concentration of soluble tumor necrosis factor receptor 1 was significantly higher in women with unexplained early spontaneous abortion than in healthy pregnant women and in women with threatened abortion, and no difference was found between healthy pregnant women and women with threatened abortion. Conclusion: Women with unexplained early spontaneous abortion present significantly higher expression of tumor necrosis factor receptor 1 than healthy pregnant women, suggesting that over-expression of tumor necrosis factor receptor 1 may contribute to the development of early spontaneous abortion.

Expression of AIF-1 and RANTES in Unexplained Spontaneous Abortion and Possible Association with Alloimmune Abortion

Objective To investigate the effects of allograft inflammatory factor-1 （AIF-1） and （RANTES） in sera and deciduas on unexplained early spontaneous abortion. Methods AIF-1 and RANTES were examined in sera and deciduas/endometria of 43 unexplained early spontaneous abortion women （group A）, 40 healthy women with early pregnancy（group B） and 20 healthy women with no pregnancy （group C）. Immunohistochemistry and enzyme linked immunosorbent assay （ELISA） were used in this study. Results AIF-1 protein was expressed both in deciduas of group A and in endometria of group C. In group A, H scores in the recurrent abortion deciduas specimens were significantly greater than those in the first abortion;in endometrium, expression of AIF-1 was greater in the secretory than in proliferative phase of group C. In group B, concentrations of RANTES in sera were higher in 7th-8th week of pregnancy than in 6th-7th and 〉8th week of pregnancy; expression of AIF-1 protein showed a negative correlation with RASNTES concentration; a significant increase of the RANTES levels in sera and tissue was observed in group B. Conclusion These results demonstrate, for the first time, that AIF-1 are expressed in deciduas of unexplained spontaneous abortion suggesting that AIF-1 involve in alloimmune abortion; RANTES might act as a novel blocking antibody;AIF-1 and RANTES might act as reliable markers for diagnosis of early alloimmune abortion.

Clinical pregnancy rate of women with unexplained infertility with or without cervical mucus aspiration before intrauterine insemination: A randomized controlled trial

Objective:To detect effect of removing cervical mucus before performing intrauterine insemination(IUI)on pregnancy rate in patients with unexplained infertility.Methods:The randomized controlled trial was conducted in Infertility Division of Department of Obstetrics and Gynaecology of a tertiary care hospital.Totally 80 patients of unexplained infertility were recruited.By computer generated block randomization in block size of 4 and 6,patients were randomly allocated at time of starting ovarian stimulation into the cervical mucus removal group or the non-removal of cervical mucus group before IUI,40 in each group.Ovarian stimulation with clomiphene 100 mg from day 2-6 of menstrual cycle along with human menopausal gonadotropin 150 IU was given alternate day starting from day 7.Follicular monitoring was done and further doses given as per response;trigger was planned when 1-3 follicle reach a diameter of>18 mm.IUI was planned after trigger.IUI was done as per the group allocated.Mucus cleaning was done in the cervical mucus removal group by aspirating mucus with IUI syringe and sterile cotton swab before IUI.The primary outcome was clinical pregnancy rate.Number of difficult IUIs and cycle cancellation due to ovarian hyperstimulation were also noted.Results:IUI was not done in 4 patients due to hyperstimulation.Pregnancies per IUI cycle occurred in 7.9%(3/38)in the cervical mucus removal group and 21.1%(8/38)in the non-removal of cervical mucus group.There was no statistically significant difference in clinical pregnancy rate between two groups(P=0.19).Conclusions:There is a trend towards a lower clinical pregnancy rate with removal of cervical mucus before IUI in women of unexplained infertility though the difference is not statistically significant.Further studies with large sample size need to be done on this intervention.

Investigation of FOXP3 (rs3761548) polymorphism with the risk of preeclampsia and recurrent spontaneous abortion: A systemic review and meta-analysis

Objective:To investigate the association between forkhead box P3(FOXP3)(rs3761548)polymorphism and the risk of preeclampsia and recurrent spontaneous abortion.Methods:Literature on the association of FOXP3 gene polymorphisms and susceptibility to preeclampsia and unexplained recurrent spontaneous abortion was retrieved by searching databases such as PubMed,Science Direct,Google Scholar and Embase from 2000 to 2021.The association measure was analyzed using an odds ratio(OR)and 95%confidence interval(CI).All the statistical analyses were executed using RevMan 5.4 software.Results:In the present meta-analysis,11 articles were analyzed.The pooled results showed no association between FOXP3 gene polymorphism(rs3761548)and preeclampsia risk in allelic,recessive,dominant and over dominant contrast models.FOXP3 gene polymorphism(rs3761548)showed an association with recurrent abortion in allelic,recessive and dominant models(OR 1.85,CI 1.59-2.14;OR 2.02,95%CI 1.56-2.62;OR 2.69,95%CI 1.50-4.83,respectively),while no association in the over dominant contrast model(OR 1.35,CI 0.87-2.10).Conclusions:In the present study,FOXP3 gene(rs3761548)polymorphism is associated with risk of recurrent spontaneous abortion but not preeclampsia.However,larger sample size and multiracial studies are needed in the future to confirm the findings.

Somatization Symptoms in a Primary Care Clinic at a Tertiary Hospital in Southern Nigeria

Background: Somatic symptoms that are not attributable to organic pathology are common in general practice settings however, data in most parts of Africa including southern Nigeria are still scarce. The aim of our study was to examine such somatic symptoms reported by patients attending a primary care facility at a tertiary hospital in southern Nigeria as well as to motivate future research in this area. Method: The study was conducted at the General Out Patient Clinic (GOPC) of the University of Calabar Teaching Hospital (UCTH). It was a cross sectional study in which data were obtained from the case notes of 115 patients that presented in the clinic with somatic complaints which could not be attributed to organic pathology by their physicians. Results: While 46 of the patients were males, 69 were females. Their mean age was 37.7 (SD = 11.9). Internal heat, crawling sensation, body pains and palpitations were the most prevalent symptoms reported by the patients. When the symptoms were sorted into various groups, the “subjective abnormal bodily sensation” was the most prevalent and far outnumbered the “pseudo neurological symptoms”. Conclusion: A number of patients attending the GOPC of the UCTH seek consultations for medically unexplained somatic symptom. The most prevalent of these symptoms are internal heat and crawling sensations both of which are not stated in the criteria recognized by the International Classification of Diseases—version 10 (ICD-10) for the diagnosis of psychiatric disorders.

Evaluation of Steroid Receptors mRNA Fingerprints in Two Groups of Normozoospermic Patients: Men from Unexplained Infertility Couples vs. Men from Couples with Tubal Factor Infertility

The study of sperm cellular components at molecular level is crucial for the diagnosis of male unexplained infertility. The aim of the study was to compare the molecular profile of steroid receptors and aromatase in spermatozoa obtained from two normozoospermic groups of patients issued from couples treated for infertility. We investigated 46 male patients from unexplained infertility couples and from men, 38 where female partners presented with tubal infertility. Sperm ERs (estrogen receptors: alpha and beta), GPER (G protein-coupled estrogen receptor), AR (androgen receptor) and aromatase mRNA expression levels by TaqMan qPCR were analyzed. AR transcript level was significantly lower in sperm of men from unexplained infertility couples vs. men from couples with tubal factor infertility (P = 0.04). Although the AR mRNA expression level did not had any effect on embryo development and its implantation, a significant correlation between AR mRNA levels and clinical pregnancy in unexplained infertility patients was observed. Taken together, AR transcript presence in ejaculated spermatozoa could be a potential marker for unexplained infertility.

Medically Unexplained Symptoms (MUS): What Do Current Trainee Psychologists, Neurologists and Psychiatrists Believe?

Objectives: Medically unexplained symptoms (MUS) are common in all medical settings. These conditions remain controversial, aetiology remains poorly understood and treatments have been slow to develop. This study aimed to examine the beliefs held by psychologists and other professionals about MUS, which may impact upon clinical practice. Design: 375 clinical psychology trainees from 23UKtraining courses, 12 neurologists and 19 psychiatrists in training completed a weblink survey designed to elicit a range of beliefs about MUS cause and treatment. Results: All three groups viewed MUS as a common clinical problem. Use of terminology differed between groups. All three groups held a view that sexual abuse was a medium to high risk factor for developing MUS. Only a minority of psychologists and psychiatrists doubted that the human mind is capable of massive repression for past distressing events;and few psychologists, and no psychiatrists, doubted the traditional psychodynamic causal model of MUS. Neurologists were generally more skeptical. Only a minority of all three groups disagreed that hypnosis was a helpful way to uncover memories that people can not access. Around one third of each group believed that traumatic memories recovered in therapy were reliable. Dualistic thinking was prevalent among all three groups, but more so among psychiatrists. Conclusions: The data show that many professsionals hold beliefs about MUS for which, empirical support is lacking. These beliefs may impact on clinical practice. Whether such beliefs are deemed to be correct or incorrect, they should be acknowledged.