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Background: To make a group consensus about non-pharmacological interventions of traditional Chinese medicine in treating polycystic ovary syndrome based on the previous guidelines, literature, and expert viewpoints. Methods: Organized by Chinese Integrative Medicine & Traditional Chinese Medicine Academy, Chinese Maternal and Child Health Association, China, 29 experts from 18 Chinese provinces and 2 international experts, who specialize in gynecology, obstetrics, pediatrics, endocrinology, cardiovascular, psychology, reproductive genetics, nursing, acupuncture and tuina, traditional Chinese medicine, integrative medicine, and other disciplines, discussed and revised the recommendations one by one through in-person or online communication. Each recommendation was approved by ≥90% of the experts before it could be established. The main outcome measure is an optimal clinical regimen for addressing the requirements of women with PCOS and improving their quality of life. Result(s): The writing panel drafted the initial report, following a consensus process via adequate communication, which was then reviewed and revised by the consensus panel. This consensus provides 12 non-pharmacological interventions (including acupuncture, thumbtack needle, thread-embedding therapy, TEAS, AA, acupoint hot compress, cupping, acupressure, moxibustion, five elements music, aromatherapy, traditional Chinese exercises) for 8 phenotypes of PCOS, resulting in 34 items of clinical practice recommendations. Conclusion(s): The consensus provides 12 non-pharmacological interventions of traditional Chinese medicine for 8 phenotypes of PCOS, resulting in 34 items of clinical practice recommendations, which may be improved by more high-quality multicenter clinical trials.

Objective As one of the most common endocrine disorders in women of reproductive age, polycystic ovary syndrome (PCOS) is highly heterogeneous with varied clinical features and diverse gestational complications among individuals. The patients with PCOS have 2-fold higher risk of preterm labor which is associated with substantial infant morbidity and mortality and great socioeconomic cost. The study was designated to identify molecular subtypes and the related hub genes to facilitate the susceptibility assessment of preterm labor in women with PCOS. Methods Four mRNA datasets (GSE84958, GSE5090, GSE43264 and GSE98421) were obtained from Gene Expression Omnibus database. Twenty-eight candidate genes related to preterm labor or labor were yielded from the researches and our unpublished data. Then, we utilized unsupervised clustering to identify molecular subtypes in PCOS based on the expression of above candidate genes. Key modules were generated with weighted gene co-expression network analysis R package, and their hub genes were generated with CytoHubba. The probable biological function and mechanism were explored through Gene Ontology analysis and Kyoto Encyclopedia of Genes and Genomes pathway analysis. In addition, STRING and Cytoscape software were used to identify the protein-protein interaction (PPI) network, and the molecular complex detection (MCODE) was used to identify the hub genes. Then the overlapping hub genes were predicted. Results Two molecular subtypes were found in women with PCOS based on the expression similarity of preterm labor or labor-related genes, in which two modules were highlighted. The key modules and PPI network have five overlapping five hub genes, two of which, GTF2F2 and MYO6 gene, were further confirmed by the comparison between clustering subgroups according to the expression of hub genes. Conclusions Distinct PCOS molecular subtypes were identified with preterm labor or labor-related genes, which might uncover the potential mechanism underlying heterogeneity of clinical pregnancy complications in women with PCOS.

Background: At present, Chinese herbal medicine (CHM) has already been widely used as an important adjuvant treatment for polycystic ovary syndrome (PCOS) patients undergoing in vitro fertilization-embryo transfer (IVF-ET). This systematic review and meta-analysis were designed to evaluate the effects of CHM on the pregnancy outcomes of infertile women with PCOS undergoing IVF-ET. Methods: We searched seven electronic databases systematically for published articles to January 2021. All randomized controlled trials (RCTs) comparing CHM with blank or placebo for infertile PCOS patients undergoing IVF-ET were included. The measures of treatment effect were the pooled odds ratios (OR) of the clinical pregnancy rate, the abortion rate and the ovarian hyperstimulation syndrome (OHSS) incidence. Results: This meta-analysis included 10 studies involving 663 patients comparing CHM with blank or placebo for infertile PCOS patients undergoing IVF-ET. The pooled data showed that CHM could improve the clinical pregnancy rate (OR = 2.41, 95% CI: 1.73–3.35, p < 0.01) and reduce the OHSS incidence (OR = 0.31, 95% CI: 0.18–0.55, p < 0.01) of infertile PCOS patients with IVF-ET treatment. No significant difference in the abortion rate was found between the CHM and control groups (OR = 0.64, 95% CI: 0.23–1.81, p = 0.40). Discussion: CHM can be used as an auxiliary treatment for infertile PCOS patients undergoing IVF-ET.

Background: Observational studies have reported that individuals diagnosed with polycystic ovary syndrome (PCOS) face a heightened vulnerability to developing post-traumatic stress disorder (PTSD). However, it is unclear whether this relationship is causal. Consequently, we implemented a bidirectional Mendelian randomization (MR) analysis to examine the empirical causal association of PCOS and PTSD. Methods: We acquired genetic association data for PCOS through a comprehensive meta-analysis from several large-scale genome-wide association studies (GWASs), which enrolled 10,074 cases and 103,164 controls. For PTSD, we obtained data from a GWAS performed by the Psychiatric Genomics Consortium Posttraumatic Stress Disorder (PGC-PTSD) group. The study included a total of 23,212 cases of PTSD and 151,447 controls of European ancestry. For both PCOS and PTSD, we carefully selected genetic instruments that met the rigorous significance threshold (p < 5 × 10-8, r2 < 0.01). To investigate the causal association between PCOS and PTSD, we conducted bidirectional Mendelian randomization (MR) analyses. The primary analysis employed the inverse-variance weighted (IVW) method, complemented by alternative MR approaches such as the maximum-likelihood method, MR-Egger regression, Mendelian randomization-Robust Adjusted Profile Score (MR-RAPS), and MR Pleiotropy RESidual Sum and Outlier (MR-PRESSO) test. Sensitivity analyses were also carried out to verify the robustness of this association. Results: In this study, we identified and utilized 14 genetic variants as instruments for PCOS, while 2 genetic variants were selected as instruments for PTSD. Our findings demonstrated that a genetic predisposition to PCOS was significantly associated with an elevated risk of developing PTSD (odds ratio (OR) = 1.11, 95% confidence interval (CI): 1.03–1.19, p = 7.27 × 10-3 for IVW). MR-Egger regression analysis was performed, and the results did not provide evidence of directional pleiotropy (p intercept = 0.187). Sensitivity analyses utilizing alternative MR methods consistently yielded similar results, supporting the robustness of our findings. Furthermore, in the reverse MR analysis, we observed no significant association between genetic predisposition to PTSD and the risk of developing PCOS (OR = 1.15, 95% CI: 0.69–1.91, p = 0.586 for IVW). Comparable null associations were also observed when alternative MR methods were employed. Conclusions: Through a genetic epidemiological approach, we found that genetic predisposition to PCOS was associated with an increased risk of PTSD, suggesting a potential causal relationship between PCOS and PTSD. Nonetheless, further investigation is necessary to elucidate the underlying mechanism through which PCOS contributes to the development of PTSD.

Abstract Background Traditional Chinese medicine (TCM) has gained increasing acceptance and popularity by the global community. The current study aimed to investigate self-reported evaluations of learning TCM and opinions about TCM courses among undergraduate international students majoring in conventional medicine at a university in China. Methods A cross-sectional survey was conducted at the Zhejiang University School of Medicine. A self-reported questionnaire was administered to international undergraduates who were enrolled in the TCM course during the 2018 and 2019 academic years (n = 157). The course employed a student-centered, multiform learning model. Demographic data and self-reported evaluations of TCM learning background and TCM learning course were obtained to conduct the analysis. Results A total of 133 students responded to the questionnaire. Among the respondents, 21.0% had some TCM-related knowledge, and 51.1% were interested in learning TCM before the course. Ninety-six students (85.7%) were from Asia. Students from Thailand showed significantly more interest in learning TCM than did students from other Asian countries (p = 0.025). After the course, 77.2% of students agreed that the course had brought about many benefits, 86.4% were satisfied with the course content, and 77.3% were satisfied with the teaching method. Students expressed their willingness to further learn acupuncture and to obtain more skilled practice through more visualized learning methods. Conclusions The majority of the international students we surveyed agreed that the TCM course improved their interest in and understanding of TCM. It is thus suggested that TCM education should be directed toward students’ learning barriers and needs.

Background: Evidence from observation studies has implied an association between polycystic ovary syndrome (PCOS) and risk of depression. Nevertheless, it remains elusive if the identified correlation is causal or owing to biases in observation researches. Hence, we utilized a bidirectional two-sample Mendelian randomization (MR) method to evaluate the potential causal relationship between PCOS and depression. Methods: Genetic instruments for PCOS and depression were acquired from two large genome-wide association studies (GWASs). MR analyses were completed via the inverse-variance weighted (IVW) method and weighted median approaches. The underlying pleiotropy was tested by MR-Egger regression, and leave-one-out method was used to evaluate the stability of MR results. Results: Using the IVW analyses (odds ratio (OR) = 1.07, 95% confidence interval (CI) = 1.01–1.06, p < 0.01) and weighted median approach (OR = 1.04, 95% CI = 1.00–1.08, p < 0.05), we found that PCOS was related to an elevated risk of depression. MR-Egger regression did not identify potential horizontal pleiotropy. Sensitivity analyses using leave-one-out method also provided supportive evidence. In the reverse MR analyses, we did not observe causal effect of depression on PCOS (p > 0.05). Conclusions: The present study provides evidence to support a potential causal association between PCOS and an elevated risk of depression. Hence, early psychological intervention for PCOS might show anti-depression benefits.

Background: This study explored the mechanisms underlying altered neurobehavioural development of female offspring born to mothers with polycystic ovary syndrome (PCOS). Methods: In total, 20 women with PCOS and 32 healthy women who underwent caesarean deliveries with a single female foetus were recruited. Infants were assessed with Dubowitz scoring. Swan71 cell line with stable FOS overexpression was used to verify the regulatory effects of FOS on brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) expression. Learning and memory in female first-generation (F1) and second-generation (F2) offspring in a rat model of PCOS was tested using the Morris water maze at puberty and adulthood. Transcriptome analysis of pubertal hippocampi and hypothalami of female F1 offspring was conducted. Findings: Total score and behaviour subscales of Dubowitz scoring were significantly lower in female infants of women with PCOS. FOS and NGF protein levels were downregulated in placental villi of the PCOS group. FOS played a key role in BDNF inhibition and enhancing NGF in Swan71 cells. PCOS female F1 rats exhibited lower target crossing times during puberty when compared to controls. Transcriptome analysis revealed significant changes in hippocampal and hypothalamic neuronal pathways in female F1 rats at puberty. Interpretation: FOS regulation of neurotrophins in the placenta negatively affects neurobehavioural development of female offspring of PCOS mothers. Funding: This study was funded by the National Key R&D Program of China (2018YFC1004900 to F.Q. and F.W.) and the National Natural Science Foundation of China (81874480 to F.Q.; 81873837 to F.W.).