Objective:To compare the clinical outcomes of platelet-rich plasma(PRP)and Granulocyte colony-stimulating factor(G-CSF))in patients with thin endometrium undergoing frozen-thawed embryo transfer(FET). Methods:A retrospective analysis of 186 patients with thin endometrium undergoing IVF-FET in Reproductive Center of Beijing Amcare Beisanhuan Women & children's Hospital from January 1,2020 to June 30,2023 was conducted.Patients were divided into PRP group(105 cases)and G-CSF(81 cases)group according to different clinical intervention with intrauterine infusion.Comparisons were conducted on the changes of endometrial thickness before and after infusion,and pregnancy outcomes including clinical pregnancy rate,biochemical pregnancy rate,ongoing pregnancy rate,early miscarriage rate.Then the patients in each group were divided into two subgroups as severe thin endometrium group and mild thin endometrium group with endometrial thickness of 6.5 mm as the boundary.The changes of endometrial thickness before and after infusion as well as pregnancy outcomes were compared. Results:The average increase of endometrial thickness before and after infusion was 25.04％in PRP group and 18.32％in G-CSF group respectively with significant differences(P=0.003).No significant differences were found in pregnancy outcomes between the two groups(P＞0.05).In severe thin endometrium group,the increase of endometrial thickness in PRP group was significantly higher than that in G-CSF group(31.23％vs.22.34％,P=0.009)while there were no significant differences in pregnancy outcomes between the two groups(P＞0.05).In mild thin endometrium group,the increase of endometrial thickness in PRP group was still significantly higher than that in G-CSF group(19.52％vs.13.11％,P=0.033)and no significant differences were found in pregnancy outcomes(P＞0.05). Conclusions:Both PRP and G-CSF intrauterine infusion can effectively improve the pregnancy outcomes of FET cycles in patients with thin endometrium,with PRP showing better performance in increasing endometrial thickness,indicating that PRP intrauterine infusion is an effective treatment.
Objective:To investigate the risk of anxiety and depression in patients before induced abortion by using the hospital anxiety and depression scale(HADS). Methods:The convenience sampling method was used to select 871 patients before artificial abortion in Peking University First Hospital,and the HADS scale was used to screen the occurrence of anxiety and depression.Among them,866 patients completed the HADS scale.Chi-square test and binary logistic regression were used to analyze the influencing factors of anxiety and depression. Results:Among 866 patients who completed the HADS scale measurement before induced abortion,the incidence rate of anxiety and depression before abortion was 18.59％(161/866).With the increase of weekly exercise frequency,monthly income personal and partner education level,life happiness level,sexual activity,the proportion of anxiety and depression gradually decreases.The proportion of anxiety and depression was highest among individuals who primarily engage in physical labor among different professions,and the proportion of anxiety and depression in married individuals was significantly lower than that in unmarried and divorced individuals(P＜0.05).The proportion of anxiety and depression among individuals living alone was the highest among different living conditions.Patients with more than 3 induced abortions had the highest proportion of anxiety and depression.The patients with 4 pregnancies had the highest proportion of anxiety and depression,while those with 2 pregnancies had the lowest proportion of anxiety and depression.Binary logistic regression analysis showed that weekly exercise frequency,residential status,personal education level,life happiness level,and pregnancy frequency were influencing factors for the occurrence of anxiety and depression. Conclusions:The proportion of patients undergoing artificial abortion who experience negative emotions such as depression and anxiety is relatively high.There are significant differences in the occurrence of anxiety and depression among artificial abortion patients with different characteristics.In the nursing work of obstetrics and gynecology,special attention should be paid to the groups who are more prone to anxiety and depression,targeted psychological nursing interventions should be taken,and personalized health education and psychological counseling should be done before surgery.
子宫破裂是一种严重的、危及孕产妇及新生儿生命的不良产科事件,具有极高的大出血率和死亡率.子宫破裂主要的危险因素是瘢痕子宫,既往无子宫手术史的孕妇发生子宫破裂极其罕见.本文报道1例罕见的非瘢痕子宫妊娠子宫不完全性破裂的病例,对其病情发展及诊治经过进行整理,并对相关文献进行复习,分析该类孕妇的临床特征,以期提高临床医生对此类疾病的警惕性,做到及早发现和及早干预,避免不良围产结局的发生.
Objective:To investigated the effect of different sperm morphological percentages on clinical pregnancy rate in intrauterine insemination(IUI). Methods:The clinical data of 2 637 IUI treatment cycles[controlling for female age＜40 years old and total progressive motile sperm count(TPMSC)≥5 million]performed at our reproduction center from December 2019 to December 2022 were retrospectively analyzed.The patients were divided into 3 groups according to the percentage of normal sperm morphology(＜1.0％,≥1.0％to＜4.0％,and ≥4.0％,respectively).The clinical characteristics and clinical pregnancy rate of patients were compared between the groups,and logistic regression models were used to analyze the relationship between sperm morphology and clinical pregnancy rate in IUI. Results:Of the 2,637 IUI treatment cycles included,clinical pregnancy was achieved in 321 cycles(12.17％).In the analysis strictly classified according to sperm morphology,the clinical pregnancy rates in the normal sperm morphology percentage＜1.0％,≥1.0％to＜4.0％,and ≥4.0％groups were 12.87％,11.63％,and 12.62％,respectively,and there was no significant difference in the comparison of the groups(P＞0.05).The multivariate logistic analysis showed that different levels of sperm morphology could not independently predict clinical pregnancy outcome in IUI[OR(95％CI)=1.016(0.973,1.061),P=0.470],whereas sexual dysfunction[OR(95％CI)=2.809(1.415,5.578),P=0.003]and ovulation induction protocol[OR(95％CI)=1.480(1.058,2.072),P=0.022]could independently predict clinical pregnancy outcome in IUI. Conclusions:Under the premise of controlling the age of the female partner and TPMSC,there was no significant difference in the clinical pregnancy rate among patients with different percentages of normal sperm morphology,including those with severe teratozoospermia.
Objective:To investigate the effects of endometrial preparation schemes on pregnancy outcome of frozen embryo transfer. Methods:The clinical data of the infertile patients(3 556 cycles)who underwent frozen embryo transfer(FET)assisted pregnancy in Reproductive Hospital of the Second Affiliated Hospital of Zhengzhou University from December 2014 to December 2022 were retrospective analyzed.The patients were divided into four groups according to the endometrial preparation scheme:the natural cycle group(Group A,n=467),the ovulation induction group(Group B,n=230),the hormone replacement group(Group C,n=2 112),and the pituitary down-regulation combined with hormone replacement group(Group D,n=747).The basic characteristics and the pregnancy outcomes were compared among the groups. Results:There was no significant difference in basic characteristics including age,infertile years,body mass index(BMI),the number of embryos transferred,the endometrial thickness on the transferred day,the number of embryos thawed,the embryo survival rate after thawed,and the high-quality embryos rate as well as the proportion of transferred embryos types among the four groups(P＞0.05).As for the pregnancy outcomes of four groups,the embryo implantation rate in Group D was significantly higher than those of the other three groups,and those of Group C and Group A were significantly higher than that of Group B(P＜0.05).The full-term labor rate in Group C was significantly higher than those of the other three groups,and that of Group D and Group A were significantly higher than that of Group B(P＜0.05).There were no significant differences in the clinical pregnancy rate,the ectopic pregnancy rate,the early abortion rate,the persistent pregnancy rate,the late abortion rate and the live birth rate among the four groups(P＞0.05). Conclusions:The pituitary down-regulation combined with hormone replacement can effectively increase the embryo implantation rate.The hormone replacement can effectively increase the full-term labor rate.Compared to these two endometrial preparation schemes,the pregnancy outcome of the natural cycle is acceptable,and the pregnancy outcome of the ovulation induction group is poor.Therefore,as for patients undergoing FET assisted pregnancy,an appropriate endometrial preparation scheme need to be developed based on their own characteristics.
成人型卵巢颗粒细胞瘤(AGCT)属于相对罕见的性索间质肿瘤,占所有恶性卵巢肿瘤的2％～5％,绝大部分以分泌过多雌激素为主,分泌雄激素为主的占比不足3％,而以促黄体生成素(LH)升高为特征的AGCT更为罕见.本文报道一例继发性闭经的育龄女性,LH明显升高,阴道超声显示左卵巢内小囊肿,按多囊卵巢综合征治疗,后因卵巢囊肿增大行腹腔镜探查证实为卵巢肿瘤而行左附件切除术,组织和分子病理学检测均证实为AGCT,术后随访血清LH下降至正常范围,且月经周期恢复正常.分享本例并对相关文献进行复习,旨在拓宽对卵巢内分泌肿瘤的认知,加强对性激素水平异常的识别和鉴别诊断.
[人类辅助生殖技术的诞生,使得成千上万的不孕不育夫妇实现了生育自己后代的愿望.随着相关学科的发展,人类辅助生殖技术及其衍生技术也得到了迅速发展.相对于其他的医疗技术,该技术的特殊性是采用医学方法在体外对配子和胚胎进行以生殖为目的的操作,因此,所涉及的医学伦理问题复杂,并存在一定的医疗风险.
Objective:To analyze the risk factors of ovarian hyper-stimulation syndrome(OHSS)in patients with polycystic ovary syndrome(PCOS)undergoing GnRH antagonist(GnRH-ant)protocol,and establish predictive model. Methods:The clinical data of 1 052 cycles of PCOS patients who underwent ovulation induction with GnRH-ant protocol in the Reproductive Center of Nanjing Maternity and Child Health Hospital from January 2015 to December 2022 were retrospective analyzed.The cycles were divided into the two groups based on the presence or absence of OHSS:the patients'cycles that met the criteria for moderate to severe OHSS for whole embryo freezing were in the OHSS group(n=61),while the cycle that did not experience OHSS and did not undergo whole embryo freezing due to OHSS were in the non-OHSS group(n=991).The risk factors of OHSS were screened by logistic univariate analysis,stepwise logistic multifactor regression analysis and least absolute shrinkage operator(LASSO)regression,and the clinical prediction model was established by using column charts.The discrimination of three models was compared by using the receiver operating characteristic(ROC)curve,and the C-index index was calculated separately through Bootstrap resampling.The calibration of the model was evaluated by using Hosmer-Limeshow goodness of fit test,and the calibration curve was drawn.The clinical decision curve(DCA)of the predictive model was drawn to evaluate its effectiveness. Results:The results of logistic univariate analysis show that 18 factors,including body mass index(BMI),basal LH,basal FSH,anti-Mullerian hormone(AMH),etc.were the risk factors for OHSS.The results of stepwise regression logistic multivariate analysis showed that antral follicle count(AFC),initiation dose of gonadotropin(Gn),Gn days,estrogen(E2)and progesterone levels on trigger day were the five risk factors for OHSS.LASSO regression results showed that three variables including AFC,E2 and progesterone levels on trigger day,were the risk factors for OHSS.ROC curve analysis results showed that the area under the ROC curve(AUC)of the three prediction models were as follows:logistic univariate model[0.874,95％CI(0.834,0.914)],stepwise regression model[0.859,95％CI(0.816,0.902)],LASSO regression model[0.839,95％CI(0.791,0.887)]respectively,with the moderate predictive value.The internal validation results showed that C-index indices were 0.830,0.848,and 0.835,respectively.Hosmer-Lemeshow goodness of fit test showed that the three models had good calibration as follows:logistic univariate analysis(x2=8.473,P=0.389),stepwise regression method(x2=11.412,P=0.179),LASSO regression(x2=13.361,P=0.100).The Brier score showed that the logistic univariate analysis score was 0.047,the stepwise regression score was 0.045,and the LASSO regression score was 0.043.The DCA results showed that all three models had good clinical applicability. Conclusions:Three factors(AFC,E2 and progesteron on trigger day)selected by LASSO regression can predict the risk of OHSS in patients with PCOS during ovulation induction with GnRH-ant protocol.
Objective:To explore the application of non-invasive prenatal testing(NIPT)in detecting fetal chromosomal aneuploidy and the significance of high-risk Z-value classification. Methods:A total of 7 478 pregnant women who experienced NIPT at the Genetic Consultation Clinic of Wuhai Maternal and Child Health Hospital from June 2015 to January 2023 were recruited.The NIPT of fetal free DNA from maternal peripheral blood was conducted.The Z value was developed by a bioinformatics analysis and those of high-risk women were divided into four groups:Group A(3≤Z≤5),Group B(5＜Z≤8),Group C(8＜Z≤12)and Group D(Z＞12).The false positive rates were compared among four groups.Fluorescence in situ hybridization(FISH)detection of amniocentesis fluid and analysis of fetal chromosome karyotype were conducted among high-risk pregnant women. Results:A total of 62 chromosomal abnormalities were detected in 7 478 NIPT samples,with a positive rate of 0.83％,including 44 cases with high-risk for trisomy 21,12 cases with high-risk for trisomy 18 and 5 cases with high-risk for trisomy 13,and 1 chromosomal abnormality.Among them,54 pregnant women voluntarily underwent amniocentesis for prenatal diagnosis,and 50 of them underwent FISH technology and chromosomal karyotype analysis.Forty cases were confirmed in Wuhai Maternal and Child Health Hospital,in which 29 cases of trisomy 21,9 cases of trisomy 18,1 case of trisomy 13,and 1 case of trisomy X.Four cases underwent amniocentesis in other hospitals.Among them,3 cases of trisomy 21 and 1 normal case were found.Subsequent follow-up revealed that among 8 women without amniocentesis,5 women underwent induction of labor.Four cases were confirmed as trisomy 21 and 1 case as trisomy 13.A child suffered from trisomy 21 was born due to personal reasons.Intrauterine fetal death and a normal infant delivered by cesarean section at 34 gestational week were found in a case of twins.A women with high-risk of trisomy 18 ultimately delivered a normal baby.The positive predictive values(PPV)of NIPT for trisomy 21,trisomy 18,and trisomy 13 were 86.4％(38/44),75.0％(9/12),and 40.0％(2/5),respectively.Excluding one case of sex chromosome abnormality,the evaluation results of Z values of the remaining 61 high-risk cases showed that the false positive rates were 69.2％,14.3％,5.3％and 0 when the Z values were between 3 and 5,greater than 5 but not more than 8,greater than 8 and not more than 12,and greater than 12,respectively. Conclusions:There is a high screening accuracy for trisomy 21 and trisomy 18 by NIPT.Some diagnostic indicators such as sensitivity,specificity,positive predictive value,and negative predictive value should be used in NIPT for prenatal diagnosis of fetal chromosomal aneuploidy diseases.False positives appear mainly when the Z values are between 3 and 5,and the Z-value is negatively correlated with the false positive rate.Proper classification of high-risk Z values for NIPT can further improve the positive predictive results of trisomy 21,trisomy 1-8,and trisomy 13,and are beneficial to guiding clinical physicians in genetic counseling for high-risk pregnant women.
Objective:To explore the recurrence risk and the high risk factors of postmenopausal endometrial polyps. Methods:A total of 455 patients who underwent hysteroscopy due to postmenopausal endometrial polyps or endometrial thickening in Peking Union Medical College Hospital between January 2017 and December 2019 were retrospectively analyzed.Clinical characteristics,including age,ultrasound image,hysteroscopy,the post-operative pathological diagnosis,previous medical history,tumor markers,sex hormones,and follow-up,were collected.The recurrence rate of postmenopausal endometrial polyp after hysteroscopy were evaluated and the potential high risk factors were analyzed by Logistic regression. Results:The average age of patients was 61.13±6.78(51-85)years old.The average menopausal age was 50.91±3.43(40-54)years old.The post-operative pathological diagnoses of 455 patients were as follows:431(94.73％)endometrial polyps wih 15(3.30％)adenomyoma-like polyps and 24(5.27％)endometrial lesions among which 15(3.30％)were malignant including endometrial atypical hyperplasia and endometrial cancer.After 3-year follow-up,the recurrence rate of benign polyps was 6.26％(27/431).Polyps with/without atrophic endometrium had the lowest recurrence rate of 5.47％,followed by adenomyoma-like polyps of 13.33％,and recurrence rate of polyps with proliferative endometrium was the highest(21.43％),showing significant differences(P＜0.05).The recurrence peak was 1-2 years after hysteroscopy.The results of Logistic regression analyses showed that history of endometrial polypectomies before menopause and pathological type of the polyp and its accompanying endometrium were the two independent high risk factors of recurrence.Among 27 patients with polyp recurrence,4 patients experienced hysteroscopic resection again,and the post-operative pathological results remained benign. Conclusions:The recurrence rate of postmenopausal endometrial polyps after hysteroscopy was relatively lower,and the recurrent polyps mainly remained benign.Patients with adenomyoma-like polyps and polyps accompanied with proliferative endometrium should be followed up strictly because of recurrent tendency.
Objective:To explore the effects of insulin resistance(IR)on peripheral vascular elasticity and left ventricular function changes in patients with polycystic ovary syndrome(PCOS). Methods:The clinical data of 135 PCOS patients who visited our hospital from June 2021 to December 2022 were collected.The patients were divided into the normal BMI group(18.5-24 kg/m2)(n=76)and abnormal BMI group(≥24 kg/m2)(n=59)according to body mass index(BMI).According to the insulin resistance index(HOMA-IR),the normal and abnormal BMI groups were subdivided into NIR groups(HOMA-IR＜2.69)and IR groups(HOMA-IR≥2.69),respectively.All patients were examined by conventional and carotid artery transient wave intensity technique(WI)techniques.The general parameters including BMI and waist-hip ratio(WHR),serological parameters including total testosterone(TT),total cholesterol(TC),triglycerides(TG),apolipoprotein B/apolipoprotein A1(Apo B/A1)and HOMA-IR,WI parameters including stiffness degree(β),pressure-strain elasticity modulus(Ep),pulse wave velocity(PWVβ),arteria compliance(AC),negative area(NA),accelerating wave intensity(W1),decelerating wave intensity(W2),the time between the peak of R wave to the peak of Wl(R-1st)and intima media thickness(ITM),left ventricular ejection fraction(LVEF),the ratio of E and A peak flow velocity during mitral valve diastolic period(E/A)were compared among the groups.The correlation between WI parameters and IMT,HOMA-IR and LVEF were analyzed by Pearson's correlation. Results:Compared with PCOS patients with normal BMI,the incidence of IR was significantly higher in PCOS patients with abnormal BMI(44.07％ vs.26.32％,P＜0.05).In the normal BMI group,there was no significant difference in general and serological parameters between the NIR and IR subgroups(P＞0.05).In the abnormal BMI group,the values of WHR,TC,TG,Apo B/A1 and TT in the IR group were significantly higher than those in the NIR group(P＜0.05).There was no significant difference in conventional cardiovascular parameters between the NIR subgroup and the IR subgroup in the normal BMI group(P＞0.05).In the abnormal BMI group,ITM values of the IR group were significantly higher than those in NIR group(0.97 vs.0.80),while E/A values(0.92 vs.1.24)were significantly lower than those in the NIR group(P＜0.05).Comparison of WI cardiovascular parameters,β and Ep values in the IR group were significantly higher than those in the NIR group,whereas AC and WI values were significantly lower than those in the NIR group in normal BMI group(P＜0.05).In the abnormal BMI group,β,Ep,PWVβ,NA and R-1st values in the IR group were significantly higher than those in the NIR group,while AC,WI and W2 values were significantly lower(P＜0.05).In PCOS-IR patients,β,Ep,and AC were significantly correlated with IMT and HOMA-IR(r＞0.70,all P＜0.05),and W1 was significantly correlated with LVEF and HOMA-IR(r=0.72,-0.74,all P＜0.05). Conclusions:IR affects cardiovascular function to varying degrees in PCOS patients with different BMI,and WI technology is able to detect changes in peripheral vascular elasticity and left ventricular function in patients with subclinical symptoms of PCOS-IR,thus providing a new basis for clinical diagnosis and treatment.
Objective:To investigate the correlation between the presence of hepatitis B virus in serum and seminal plasma and sperm quality such as sperm parameters,morphology and sperm DNA integrity. Methods:The semen samples from males who were treated at the Reproductive Medicine Center in Reproductive Medicine Center of First Hospital of Wenzhou Medical University from January 2016 to December 2021 were selected.The serum hepatitis B marker titer was detected by microparticle enzyme immunoassay.Serum and seminal plasma HBV-DNA was detected by the fluorescent quantitative PCR.All semen samples were analyzed for semen parameters,sperm morphology and sperm DNA-fragmetation-index(DFI).The patients were divided into four groups based on their HBV testing status:Group A(HBsAg negative,n=1 122),Group B(serum HBsAg positive,but HBeAg,HBV-DNA and seminal plasma HBV-DNA copy negative,n=460),Group C(serum HBsAg,HBeAg and HBV-DNA copy positive,but seminal plasma HBV-DNA copy negative,n=81),Group D(serum HBsAg,HBeAg and HBV-DNA copy positive,and seminal plasma HBV-DNA copy positive,n=112).The basic information,liver function and sperm quality differences were compared among the groups. Results:Among the 2 063 patients who were initially enrolled,45.6％(941/2 063)were infected with HBV,and 1 775 patients were finally included in the analysis.Compared with non-infected individuals(Group A),the levels of alanine aminotransferase(ALT)and aspartate aminotransferase(AST)in HBV infected individuals(Groups B,C and D)were significantly increased(P＜0.05),while sperm concentration and percentage of progressively motile(PR)sperm were significantly decreased(P＜0.05),while percentage of immotile(IM)sperm was significantly increased(P＜0.05).Further inter-group analysis revealed that the sperm concentration in group D[(55.5+41.4)]X106/ml]and the percentage of progressively motile sperm[(45.8±22.1)％]were significantly lower than those in Group B[(66.9±46.3)X 106/ml,(51.5± 18.6)％]and Group C[(80.9±65.1)× 106/ml,(53.0±20.4)％](P＜0.05),the percentage of immotile sperm was significantly higher than that of group B and C(P＜0.05).Sperm concentration in Group A[(103.4±74.6)]×106/ml]and the percentage of progressively motile sperm[(58.4±17.8)％]were the highest among the four groups(P＜0.05).The results of sperm morphology analysis showed that the percentage of normal sperm morphology in Groups B,C and D with(2.5±1.7)％,(2.1±1.4)％and(2.4± 2.0)％,was significantly lower than that in Group A(3.1±1.9)％(P＜0.05),respectively.However,there was no significant difference in the percentage of normal sperm morphology among Groups B,C and D(P＞0.05).Compared with Group A,the sperm DNA fragmentation index(DFI)of Groups B,C and D significantly increased(P＜0.05),with Group D having the highest DFI(26.2±15.7)％,which was significantly higher than Group B[(17.8±10.8)％],Group C[(16.2±7.6)％]and Group A[(13.5± 7.3)％](P＜0.05). Conclusions:Whether in serum or seminal plasma,a positive copy of hepatitis B virus can have a certain impact on the quality of sperm,especially when the HBV DNA copy in serum and seminal plasma is both positive,which may have a further negative impact on various parameters of sperm.
应激性心肌病(SCM),又称Tako-Tsubo综合征,其发病机制尚不明确,容易漏诊、误诊.本文报告了 2例双胎妊娠剖宫产术后并发应激性心肌病病例.两例患者分别因"胎儿窘迫"、"妊娠期重度胆汁淤积症"于孕34～35周行剖宫产术,术后1～4 h因血压升高检测心肌酶,发现心肌酶升高,后完善相关检查,诊断为急性SCM.经无创呼吸机辅助通气、白蛋白输注、降压、维持出入量负平衡、抗感染、抗凝、改善心肌重构等治疗,分别于手术7 d和15 d后出院.孕期及产后并发SCM的病例少见,剖宫产及双胎妊娠期可能是其危险因素.本文分享两例SCM的治疗过程以及预后情况,为临床类似病例的诊治提供经验.
子宫内膜异位症近年来被认为是一种慢性疾病,需要进行长期管理;长期管理的目标是减轻和消除疼痛、促进和保护生育能力、降低和减少复发、警惕和早期发现恶变,提高患者的生命质量.本文报道了 1例卵巢子宫内膜异位囊肿患者经手术治疗后采用药物进行长期管理,经过长达5年的随访过程,痛经完全改善,基本能维持正常月经周期,安全性良好;并对相关文献进行复习,以提高临床医生对卵巢子宫内膜异位囊肿手术后长期管理重要性的认识,为更好地改善患者生命质量提供临床依据.
Objective:To explore the clinical diagnostic value of combined detection of peripheral blood forkhead box protein p3(Foxp3),regulation on activation normal T-cell expressed and secreted(RANTES)for unexplained recurrent miscarriage. Methods:A retrospective study was conducted on 128 patients with unexplained recurrent miscarriage admitted to the First Hospital of Zhangjiakou from July 2021 to September 2022.And 128 healthy women with early pregnancy who underwent physical examination were regarded as the control.Enzyme linked immunosorbent assay(ELISA)was applied to detect Foxp3 and RANTES levels,and flow cytometry was used to detect the percentages of T helper cell(Th17)and regulatory T cells(Treg)in peripheral blood.The Pearson and Spearman correlation analyses were conducted to analyze the correlation between peripheral blood Foxp3 and RANTES levels,immune indicators and unexplained recurrent miscarriage.The diagnostic value of peripheral blood Foxp3 and RANTES levels for unexplained recurrent miscarriage was evaluated with the receiver operating characteristic(ROC)curve. Results:Compared with the control group,the peripheral blood Foxp3 and RANTES levels as well as Treg ratio in the study group were obviously lower(P＜0.05),while the percentage of Th17 and Th17/Treg ratio were obviously higher(P＜0.05).The results of Pearson correlation analysis showed that the levels of Foxp3 and RANTES in peripheral blood of patients in the study group were obviously negatively correlated with the percentage of Th17 and Th17/Treg ratio(P＜0.05),and obviously positively correlated with the percentage of Treg(P＜0.05).The results of Spearman correlation analysis showed that the levels of Foxp3 and RANTES in peripheral blood were obviously negatively correlated with the occurrence of unexplained recurrent miscarriage(r=-0.539,-0.554,P＜0.05).The analysis of ROC curve showed that the AUC of serum Foxp3 level alone in diagnosing unexplained recurrent abortion was 0.820[95％CI(0.767,0.865)],and its sensitivity and specificity were 70.31％and 85.94％respectively.And the AUC of unexplained recurrent miscarriage diagnosed solely by serum RANTES level was 0.840[95％CI(0.789,0.883)],with sensitivity and specificity of 69.53％and 85.16％,respectively.In addition,the AUC of unexplained recurrent miscarriage diagnosed by the combination of serum Foxp3 and RANTES levels was 0.909[95％CI(0.867,0.942)],which was obviously higher than those diagnosed by Foxp3 level alone(Z=4.165,P=0.000)and RANTES level alone(Z=3.183,P=0.002). Conclusions:The levels of Foxp3 and RANTES are associated with immune imbalance in pregnant women with unexplained recurrent miscarriage,and their combined detection results might have high diagnostic value for unexplained recurrent miscarriage.
Objective:To systematically evaluate the effect of selective 5-hydroxytryptamine reuptake inhibitors(SSRIs)on semen parameters. Methods:Seven Chinese and English databases(from their inception to April 2023)were searched using a computerized search strategy to collect prospective and retrospective studies on the relationship between SSRIs treatment and semen parameters.The inclusion and exclusion criteria were developed.The patients treated with SSRIs was recruited in the study group.The final included studies were analyzed using RevMan5.4 software. Results:A total of 7 literatures were finally included with a total sample size of 491 cases.The literature qulity was evaluated with Newcastle-Ottawa Scale(NOS).All literatures were high qulity ones,with 8 scores in 2 articles,7 scores in 4 articles and 6 scores in one article.The meta-analysis results showed that the treatment with SSRIs had no effects on sperm concentration and motility(P＞0.05).However,when subgoups was developed by different periods of treatment,the significantly reduced sperm concentration[95％CI(-45.50,-39.34),P＜0.000 01]and motility[95％CI(-33.38,-1.80),P=0.03]were observed when the patients were treated with SSRIs for 3 months and more.The intake of SSRIs could significantly reduced the percentage of sperm with normal morphology[95％CI(-16.29,-3.77),P=0.002]and significantly increased the sperm DNA fragmentation index(DFI)[95％CI(6.66,21.93),P=0.002].In the subgroup analysis,there was no statistically significant diffference in the semen morphology between the treatment period of 2 months and less and that of 3 months and more,but there was no effect of SSRIs treatment on semen volume[95％CI(-0.75,0.65),P=0.89]. Conclusions:SSRIs have a harmful effect on male semen parameters,and the longer the treatment period,the more significant the impact on semen quality.Large randomized clinical trials should be conducted to verify our conclusion.
患者,女性,31岁,因"造影发现双侧输卵管梗阻7个月"收入院治疗,在全麻下行宫、腹腔镜联合探查术,术中发现右侧输卵管长度约16 cm,形态好,左侧输卵管峡部通畅,长度约4 cm;经评估后,行左侧输卵管峡部与右侧输卵管峡部对侧吻合术,术后患者恢复良好,正常自然妊娠.本文对该病例的诊疗资料及相关文献进行整理和分析,为该类患者的治疗提供了一种新的思路.
目的 探讨"二孩"或"三孩"高龄疤痕子宫孕妇再次剖宫产产后出血状况及相关影响因素.方法 选取2019年5月至2023年5月于武义县中医院行剖宫产生育"二孩"或"三孩"的高龄疤痕子宫产妇398例为研究对象,统计其产后出血的发生情况,并通过单因素及多因素Logistic分析产后出血发生的影响因素.结果 398例剖宫产生育"二孩"或"三孩"的高龄疤痕子宫产妇中,有59例(14.82％)发生产后出血.单因素及多因素Logistic分析结果表明:年龄≥40岁(OR=4.011)、剖宫产生育三孩(OR=4.035)、合并妊娠期高血压(OR=3.364)、既往流产≥3次(OR=6.760)、前置胎盘(OR=11.348)、胎盘植入或粘连(OR=9.143)及子宫收缩乏力(OR=10.633)是产后出血发生的危险因素(P＜0.05),而距前次剖宫产时间≥24个月是避免产后出血发生的保护性因素(OR=0.381,P＜0.05).结论 生育"二孩"或"三孩"高龄疤痕子宫孕妇再次剖宫产产后出血发生率较高,产后出血与年龄、生育孩次、合并妊娠期高血压、既往流产次数、前置胎盘、胎盘植入或粘连、子宫收缩乏力及距前次剖宫产时间等有关,临床上应引起关注.
Objective:To investigate the effects of long-acting GnRH agonist(GnRH-a)pretreatment and body mass index(BMI)on the pregnancy outcomes of the first frozen-thawed embryo transfer(FET)cycle in patients with polycystic ovary syndrome(PCOS). Methods:A retrospective cohort study was conducted to analyze the clinical data of 438 PCOS patients who underwent the first FET in our center from January 2017 to December 2021.They were divided into hormone replacement treatment group(HRT group,n=330)and GnRH-a+HRT group(down-regulation group,n=108)according to the endometrial preparation protocol.According to BMI levels,the patients were divided into normal weight group(BMI＜24 kg/m2,n=226)and overweight/obesity group(BMI≥24 kg/m2,n=2 1 2).Baseline data and clinical pregnancy outcomes were compared between the groups,and multivariate modified Poisson regression was used to analyze the factors affecting live birth and abortion. Results:The implantation rate,clinical pregnancy rate,ongoing pregnancy rate and live birth rate of down-regulation group were higher than those of HRT group,and the abortion rate was lower than that of HRT group,but the difference was not significant(P＞0.05).The overweight/obesity group had significantly higher late abortion rate than the normal weight group(12.4％ vs.5.5％,P=0.032)and significantly lower live birth rate than the normal weight group(48.6％ vs.60.6％,P=0.011).The implantation rate,clinical pregnancy rate and ongoing pregnancy rate in overweight/obesity group were lower than those of normal weight group,but there was no significant difference(P＞0.05).Modified Poisson regression analysis showed that BMI(RR=0.95,95％CI=0.93-0.98,P=0.001)and endometrial thickness(RR=1.05,95％CI=1.00-1.11,P=0.035)were independent predictors of live birth,and BMI was the risk factor of miscarriage,with an increase of 1 kg/m2 in BMI associated with 13％increase in miscarriage(RR=1.13,95％CI=1.05-1.21,P=0.002). Conclusions:For PCOS patients undergoing fresh cycle whole embryo freezing and the first FET treatment,GnRH-a pretreatment cannot improve the pregnancy outcomes.High BMI is the high-risk factor affecting live birth,suggesting that weight control may improve the pregnancy outcomes of frozen-thawed embryo transfer in PCOS patients.
Due to physical,psychological and environmental changes,pregnant women generally have the problem of sleep disorders,and sleep disorders worsen with the increase of gestational age.Postpartum depression is a common type of postpartum mental disorder,mainly manifested as persistent and severe emotional depression during the postpartum period,as well as a series of symptoms,and in severe cases,there may even be a tendency to commit suicide or infanticide.In recent years,the impact of prenatal sleep disorders on postpartum depression has gradually attracted attention.The current view suggests that poor prenatal sleep quality is one of the risk factors for increasing postpartum depression.This paper reviews the possible mechanisms by which prenatal sleep disorders affect the occurrence of postpartum depression,the impact of different manifestations of prenatal sleep disorder on postpartum depression,and the intervention measures of prenatal sleep disorder,so as to provide some reference for improving the evaluation of pregnant women's sleep status in clinical work and formulating corresponding intervention strategies if necessary.
