Minimal studies focused on the association of mixed neonicotinoids (NEOs) exposure in seminal plasma with semen quality parameters, and further mixed effects on male reproductive health. In this study, we analyzed the concentrations of 6 parent neonicotinoids (p-NEOs) and 8 metabolite neonicotinoids (m-NEOs) using 155 male seminal plasma samples collected in Wuhan, China. Imidacloprid-olefin (IMI-olefin, 87.1

Background The incidence of malignant tumors/precancerous lesions is rising, yet their impact on pregnancy outcomes in women undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) remains unclear.Methods A single-center retrospective cohort study was conducted at the Reproductive Medicine and Genetics Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology between January 2015 and December 2022. Propensity score matching (PSM) was applied to match the baseline data of the two groups, and the primary outcome were the conservative/optimistic cumulative live birth rates (CLBR) across multiple cycles.Results A total of 1004 patients were enrolled, including 251 individuals in the malignant tumors/precancerous lesions group (363 oocyte retrieval cycles) and 753 PSM controls (895 oocyte retrieval cycles). Compared with the controls, patients with a history of malignant tumors/precancerous lesions exhibited significantly lower ovarian reserve and poorer embryo outcomes (all p < 0.05). Both conservative and optimistic CLBR were lower in the malignant tumors/precancerous lesions group across multiple cycles (p < 0.05). After multiple oocyte retrievals, the conservative CLBR for malignant tumors/precancerous lesions plateaued at around 53% after four cycles, while optimistic CLBR reached 70% after four cycles. Among patients with prior malignant tumors/precancerous lesions who completed follow-up, the overall recurrence rate after IVF/ICSI treatment was 7.03% with no adverse events.Conclusions Patients with a previous history of malignant tumors/precancerous lesions demonstrated inferior live birth outcomes compared to controls. Multiple ovarian stimulations improved live birth opportunities without significantly increasing the risk of tumor recurrence.

Recently, the global incidence of malignant tumors has been increasing with a notable trend toward younger patients, representing a major public health challenge. Fertility preservation has emerged as a key issue at the intersection of oncology and reproductive medicine. Ovarian tissue cryopreservation and transplantation (OTCT) offers a unique and valuable strategy, particularly for prepubertal girls and patients requiring immediate gonadotoxic therapy. Although OTCT can effectively restore ovarian endocrine function and fertility, its clinical application is largely limited by safety concerns, especially the potential risk of reintroducing viable malignant cells via transplanted ovarian tissue. Therefore, accurate detection of minimal residual disease (MRD) in cryopreserved ovarian tissue and effective tumor cell decontamination strategies are essential to ensure clinical safety. In addition, long-term follow-up data on the health status of offspring born after OTCT remain insufficient. This narrative review systematically summarizes the safety concerns of OTCT, focusing on cancer-specific ovarian tissue contamination risks, current MRD detection and purging techniques, as well as the intergenerational safety of offspring. Based on recent evidence, this review can further provide key conclusions and practical recommendations for the safety assessment of OTCT, with the aim of promoting the safe, standardized, and widespread clinical application of this technique.

Recurrent implantation failure (RIF) remains clinically unresolved at this stage. Hydroxychloroquine, as an immunomodulator, is still lacking clinical evidence, but it is being used by increasing numbers of reproductive centers and physicians worldwide, so a well-designed randomized controlled trial (RCT) is urgently needed to elucidate whether hydroxychloroquine can improve pregnancy outcomes in patients with RIF. In this study, we plan to recruit 686 volunteers who will undergo IVF/ICSI at 5 reproductive centers from 6 December 2022. Participants will be randomized to two parallel groups and treated with hydroxychloroquine sulfate tablets or placebo from the start of endometrial preparation to 14 days after frozen embryo transfer (if not pregnant) or to 12 weeks of pregnancy (if pregnant). The primary outcome is live birth rate, and the secondary outcomes include biochemical pregnancy rate, clinical pregnancy rate, embryo attachment rate, first trimester abortion rate and ongoing pregnancy rate, birth weight, pregnancy and perinatal complications, congenital anomaly, and other adverse events. This study aims to evaluate whether hydroxychloroquine (HCQ) improves pregnancy outcomes in patients with recurrent implantation failure (RIF). Secondary objectives include comparative analysis of gestational complications between the intervention and control groups. ChiCTR2100047584 [Chinese Clinical Trial Registry (ChiCTR): registered on 20 June 2021]. LM2021267 [Ethics Committee of Peking University Third Hospital].

Predicting in vitro fertilization (IVF) pregnancy outcomes is crucial for individualized decision-making. However, due to complex interactions among multiple factors, accurate manual integration and assessment are challenging. This study aims to develop an interpretable machine learning (ML) model for predicting the probability of clinical pregnancy after fresh and frozen-thawed embryo transfer. This retrospective study included infertile patients undergoing fresh or frozen-thawed embryo transfer between December 2023 and June 2025. Endometrial regions of interest (ROIs) were manually segmented on mid-sagittal uterine ultrasound images. The K-means clustering algorithm was employed to partition the ROIs into habitat subregions. Radiomic features were extracted from the entire ROI and each subregion. After feature selection using Mann–Whitney U tests, Pearson correlation, and mRMR, 11 machine learning algorithms were trained in combination with clinically independent predictors. Model hyperparameters were optimized through five-fold stratified cross-validation and grid search. The optimal classifier was selected based on performance evaluation to construct the final predictive model, subsequently validated on an independent test set. Shapley Additive Explanations (SHAP) provided model interpretability. This study included 543 patients, randomly divided into a training cohort of 380 and a test cohort of 163. ROIs were subdivided into four habitat subregions. Imaging features were systematically extracted from the entire ROI and each subregion. Following mRMR, 15 habitat subregion features were incorporated into the model. Based on area under the ROC curve, the ExtraTrees model demonstrated optimal predictive performance on the test set (AUC: 0.766; 95

Introduction We aimed to evaluate the clinical utility of autoimmune screening and the effectiveness of immunomodulatory treatment in preimplantation genetic testing (PGT) patients. Material and methods In this retrospective cohort study, 151 PGT patients who experienced a failed first frozen embryo transfer (FET) were divided into two groups. Patients underwent immune marker screening before their second FET. Among them, 42 were classified into the immune-positive group and received targeted interventions, while 109 were categorized into the immune-negative group, which was further divided into an empirical medication subgroup (n = 43) and a no-intervention subgroup (n = 66). Baseline characteristics and pregnancy outcomes were analyzed using statistical methods, including univariate and multivariate logistic regression analyses. Results We found that among PGT patients with first transfer failure, 28% (42/151) showed abnormal immune markers. Targeted therapy in immune-positive patients was associated with significantly improved clinical pregnancy rates compared to their first unscreened cycle (64.29% vs. 33.33%, p = 0.005), while reducing the miscarriage rate. In contrast, empirical immunomodulation in immune-negative patients did not provide any additional benefit in terms of live birth rate (39.53% vs. 43.94%, p = 0.649). Multivariate analysis confirmed that embryo quality was an independent positive predictor of both hCG positivity (p = 0.034) and clinical pregnancy (p = 0.022), whereas maternal age showed an inverse association with the likelihood of success (p < 0.05). Conclusions Immune abnormalities are relatively prevalent in the PGT population. Targeted immunomodulatory interventions in immune-positive patients were associated with improved pregnancy outcomes. We recommend that these patients should undergo immune screening and targeted interventions before embryo transfer. However, empirical therapy in immune-negative individuals is unjustified.

Background This study aimed to describe carrier findings, genetic counseling recommendations, and subsequent ART plan choices observed after untargeted whole-exome sequencing (WES)-based carrier screening in infertile Chinese Han couples attempting assisted reproductive technology (ART). Methods This retrospective, exploratory, single-center descriptive study included infertile couples who had undergone genetic counseling and WES for carrier screening in an in vitro fertilization (IVF) clinic affiliated with a university in Central China. Genetic findings, counseling recommendations, and ART plans documented after WES were summarized descriptively. No comparator group, validated decision-making survey instrument, or pre-specified before-after decision outcome was available. Results A total of 130 infertile or subfertile couples were enrolled. Overall, 82.7% (215/260; 95% CI 77.6-86.8%) of individuals carried at least one P/LP variant, including 77.7% (101/130; 95% CI 69.8-84.0%) of males and 87.7% (114/130; 95% CI 80.9-92.3%) of females. The carrier burden was 1.6038 variants per person. GJB2-associated deafness was the most prevalent finding, occurring in 13.8% (36/260) of individuals. After excluding somatic and autosomal-dominant secondary findings from the reproductive carrier-risk denominator, 7.7% (10/130; 95% CI 4.2-13.6%) of couples met the strict AR/XL at-risk-couple definition. Among these 10 couples, PGT-M was recorded as the post-WES ART plan for three couples (30.0%; 95% CI 10.8-60.3%). Conclusion In this retrospective descriptive cohort, WES-based carrier screening identified a high carrier burden and generated counseling recommendations that were followed by different ART plan choices among AR/XL at-risk couples. Genetic counseling before and after WES remains important for couples receiving positive carrier-screening results.

For poor ovarian response patients, obtaining higher number of transferable and high-quality embryos is crucial and progestin-primed ovarian stimulation protocol is becoming widespread and constantly improving in this population. Letrozole has shown promise in numerous protocols and individuals. This study aims to evaluate the effect of the early addition of letrozole in progestin-primed ovarian stimulation protocol among expected poor ovarian response patients. This retrospective cohort study was performed in POSEIDON group 3 and 4 patients who underwent in vitro fertilization or intracytoplasmic sperm injection with their first progestin-primed ovarian stimulation protocol from January 1, 2018 to December 31, 2021. Totally 557 patients were enrolled in this research with 189 ovarian stimulation cycles for POSEIDON group 3 patients and 368 ovarian stimulation cycles for POSEIDON group 4 patients. The primary outcome of this study was the cumulative live birth rate and cumulative clinical pregnancy rate, and the second outcomes included the laboratory outcomes and pregnancy outcomes, maternal and neonatal complications also were encompassed. In this study, progestin-primed ovarian stimulation protocol combined with letrozole (study group) was associated with a significantly higher number of oocytes for retrieval and maturation [3.0 (2.0, 5.0) vs. 2.0 (1.3, 4.0), P < 0.001; 3.0 (2.0, 5.0) vs. 2.0 (1.0, 3.8), P < 0.001] as well as 2PN embryos [2.0 (1.0, 3.0) vs. 2.0 (1.0, 3.0), P = 0.026] among POSEIDON group 4 patients. In POSEIDON group 3 patients, the letrozole cotreatment did not show an advantage in these indicators. There was no significant difference in both cumulative live birth rate and cumulative clinical pregnancy rate between the study and control group in POSEIDON group 3 and 4 patients. Multivariate logistic regression model showed that significant favorable effects of the number of available embryos on cumulative live birth rate in all included patients. These findings indicate that advanced-aged poor ovarian response patients may benefit more from using letrozole as an advantageous adjuvant agent in the progestin-primed ovarian stimulation protocol to obtain more oocytes and embryos in clinical practice. Trial registration This trial was retrospectively registered

Widespread human exposure to bisphenols and triclosan (TCS) is well-documented; however, their human metabolic fate and true internal exposure remain poorly characterized, due to a lack of direct metabolic profiling and methodological limitations in deconjugation efficiency, hindering accurate risk assessment. To address this gap, this study directly quantified both free and conjugated forms of four bisphenols and TCS in 182 human urine samples. Among the analytes, bisphenol A (BPA) exhibited the highest total urinary concentration, followed by bisphenol F (BPF), bisphenol AF (BPAF), TCS, and bisphenol S (BPS). Distinct metabolic patterns were observed: BPA and TCS were predominantly glucuronidated (51.2 % and 82.2 %, respectively); BPF was primarily sulfated (69.9 %); whereas BPS (72.9 %) and BPAF existed mostly in their free forms. Furthermore, marked sex-specific differences were identified: male-exclusive positive linear correlations between free and conjugated forms were found for BPA and BPF; a female-specific positive linear correlation was observed for TCS; and the percent compositions of BPS-sulfate and BPS-glucuronide also differed significantly by sexes. Risk assessment showed the mean estimated daily intakes of BPA, BPS, and BPF exceeded established safety thresholds by approximately 790-, 11-, and 11-fold, respectively, indicating potential health concerns. Our study provides an integrated metabolic profiling of these compounds, highlighting the necessity of considering chemical speciation and demographic factors in future exposure assessment and risk evaluation.

The incidence of early-onset malignancies in reproductive-aged women is rising, necessitating effective fertility preservation strategies. Ovarian tissue cryopreservation (OTC) remains the sole option for prepubertal girls and patients requiring urgent oncologic treatment. However, post-transplant follicular attrition-driven by ischemia-reperfusion injury, oxidative stress, and aberrant primordial follicle activation-remains a major barrier. This comprehensive review elucidates the multiscale mechanisms of cryopreservation-induced follicular damage and evaluates cutting-edge strategies, including antifreeze protein-engineered cryoprotectants, angiogenesis-modulating scaffolds, and mTOR pathway inhibition. By integrating recent advances in biomaterial science and cryobiology, this study provides actionable insights to enhance OTC clinical efficacy and advance reproductive medicine.

Assessing blastocysts from a three-dimensional (3D) perspective introduces a novel approach to clinical embryo evaluation. Currently, assisted reproduction laboratories lack clinically compatible methods to reconstruct 3D blastocyst structures without interfering with embryo culture. To address this, we developed an interference-free and non-invasive method that uses widely adopted time-lapse (TL) imaging systems to reconstruct 3D blastocyst structures directly from multi-focal images and quantitatively calculate various 3D morphological parameters, without requiring embryologist intervention. In this study, we reconstructed 3D structures for 2025 blastocysts using 22,275 TL images and analyzed the association between 20 3D morphological features and embryo transfer outcomes. Several parameters were significantly associated with clinical pregnancy and live birth (P < 0.05). This method is fully compatible with current clinical workflows, providing objective and comprehensive 3D data for blastocyst assessment. It holds strong potential for future implementation in standardized and automated embryo selection based on quantitative morphological criteria.

Interprofessional teaching rounds are a practical application of interprofessional education in bedside teaching, yet there is a lack of research on how interprofessional teaching rounds should be implemented into medical education. This study aimed to describe our experience in developing and implementing interprofessional teaching rounds during a clerkship rotation for medical students, and compares its strengths and weaknesses relative to traditional teaching rounds. Medical students were assigned to either the interprofessional teaching round group (n = 24) or the traditional teaching round group (n = 25), and each group participated in their assigned type of teaching round. A quiz including medical knowledge of gynecological and obstetric diseases was used to assess the students' diagnostic and treatment abilities after teaching rounds. Additionally, a survey was conducted among students to evaluate whether the interprofessional teaching rounds were helpful. The results showed that when using interprofessional teaching rounds, the test score for medical knowledge related to the diagnosis and treatment of gynecological and obstetric diseases was significantly higher than the traditional teaching round group (85.5 ± 11.2 vs 78.3 ± 12.5, p = 0.038). Additionally, the interprofessional teaching rounds significantly enhanced understanding of clinical application, identification, and appropriate problem-solving in cases, as well as examination of different disciplinary aspects of a case, and improvement of interdisciplinary collaboration skills compared to traditional teaching rounds. Our study demonstrates that interprofessional teaching rounds can serve as an effective teaching method for enhancing medical students' ability to collaborate interprofessionally and to solve clinical problems comprehensively.

Introduction Polycystic ovary syndrome (PCOS), recognised as the predominant aetiological factor in ovulatory dysfunction-related infertility, accounts for approximately 70% of anovulatory infertility cases. Patients with PCOS have significantly higher anti-Müllerian hormone (AMH) levels than their counterparts undergoing in vitro fertilisation (IVF) for non-PCOS indications (eg, male/tubal factors). Several studies have suggested that a high AMH level is associated with adverse pregnancy outcomes in IVF, particularly preterm delivery. However, most of these studies are retrospective studies, and their results are inconsistent. The majority of AMH measurements are conducted before pregnancy; however, AMH levels fluctuate dynamically during pregnancy. There is a pressing need for a well-structured prospective study to definitively establish whether high AMH levels during pregnancy are associated with IVF/intracytoplasmic sperm injection (ICSI) pregnancy outcomes in PCOS patients.Methods and analysis This prospective cohort study will be conducted at four reproductive medicine centres. The plan is to enrol 1,320 PCOS patients and 1320 non-PCOS women who undergo IVF/ICSI and achieve singleton clinical pregnancies. Serum samples will be collected at about 6 weeks of gestation to measure the serum AMH level. Follow-up visits will be conducted at 12, 28 and 37 weeks of gestation, delivery and 6 weeks after delivery to obtain information about pregnancy outcomes and complications. The primary outcome is preterm delivery.Ethics and dissemination The study was approved by the Medical Research Ethics Committee of Peking University Third Hospital (M2022618). Informed consent will be obtained from all patients. The results of this clinical study will be presented at scientific conferences and submitted to a peer-reviewed journal.Trial registration number ChiCTR2300068554.

Background: Tuberculosis is a communicable disease that is a major cause of ill health and one of the leading causes of death worldwide. Latent tuberculosis infection (LTBI) widely exists in people all over the world, especially in patients with unexplained infertility, and the relationship between latent tuberculosis infection and ovarian reserve, as well as pregnancy outcomes of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI), remains poorly understood. Methods: A single-center, retrospective cohort study was conducted at the Reproductive Medicine and Genetics Centre, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, between January 2018 and December 2020. The study aimed to investigate whether LTBI affects ovarian reserve and pregnancy outcomes in infertile women undergoing assisted reproductive technology. The primary outcomes were ovarian reserve and cumulative live birth rate per IVF/ICSI cycle, while secondary outcomes included pregnancy outcomes and maternal and neonatal complications. Results: A total of 11523 assisted reproductive technology cycles were ultimately included in the comparison of ovarian reserves, and 9141 IVF/ICSI cycles were ultimately included in the comparison of clinical outcomes between the LTBI and control groups. The data revealed that women with LTBI had significantly lower anti-Müllerian hormone (4.61 ± 3.99 ng/mL vs. 4.88 ± 4.22 ng/mL, P=0.035, β=-0.23, 95% CI -0.43 to -0.04) and antral follicle counts [11.00 (8.00, 17.00) vs. 12.00 (8.00, 19.00), P=0.048, β=-0.26, 95% CI -0.53 to -0.01]. The conservative and optimistic cumulative live birth rates (61.42% vs. 61.94%, adjusted OR: 0.95, 95% CI: 0.82-1.10; 72.65% vs. 73.25%, adjusted OR: 0.94, 95% CI: 0.78-1.14), the live birth rates after fresh embryo transfer (39.28% vs. 40.83%, adjusted OR: 0.97, 95% CI: 0.82-1.14) and other secondary outcomes in the LTBI group were comparable to those in the control group after excluding factors such as age, ovarian reserve, and the number of oocytes retrieved. Conclusions: LTBI may affect the ovarian reserve but not directly affect the pregnancy outcomes of IVF/ICSI in infertile women.

STUDY QUESTION:Can the density of the inner cell mass (ICM) be a new indicator of the quality of the human blastocyst? SUMMARY ANSWER:The densification index (DI) developed in this study can quantify ICM density and provide positive guidance for ploidy, pregnancy, and live birth. WHAT IS KNOWN ALREADY:In evaluating the quality of ICM, reproductive care clinics still use size indicators without further evaluation. The main disadvantage of this current method is that the evaluation of blastocyst ICM is relatively rough and cannot meet the needs of clinical embryologists, especially when multiple blastocysts have the same ICM score, which makes them difficult to evaluate further. STUDY DESIGN, SIZE, DURATION:This observational study included data from 2272 blastocysts in 1991 frozen-thawed embryo transfer (FET) cycles between January 2018 to November 2021 and 1105 blastocysts in 430 preimplantation genetic testing cycles between January 2019 and February 2023. PARTICIPANTS/MATERIALS, SETTING, METHODS:FET, ICSI, blastocyst culture, trophectoderm biopsy, time-lapse (TL) monitoring, and next-generation sequencing were performed. After preliminary sample size selection, the 11 focal plane images captured by the TL system were normalized and the spatial frequency was used to construct the DI of the ICM. MAIN RESULTS AND THE ROLE OF CHANCE:This study successfully constructed a quantitative indicator DI that can reflect the degree of ICM density in terms of fusion and texture features. The higher the DI value, the better the density of the blastocyst ICM, and the higher the chances that the blastocyst was euploid (P < 0.001) and that pregnancy (P < 0.001) and live birth (P = 0.005) were reached. In blastocysts with ICM graded B and blastocysts graded 4BB, DI was also positively associated with ploidy, pregnancy, and live birth (P < 0.05). ROC analysis showed that combining the Gardner scoring system with DI can more effectively predict pregnancy and live births, when compared to using the Gardner scoring system alone. LIMITATIONS, REASONS FOR CAUTION:Accurate calculation of the DI value places high demands on image quality, requiring manual selection of the clearest focal plane and exposure control. Images with the ICM not completely within the field of view cannot be used. The association between the density of ICM and chromosomal mosaicism was not evaluated. The associations between the density of ICM and different assisted reproductive technologies and different culture conditions in embryo laboratories were also not evaluated. Prospective studies are needed to further investigate the impact of ICM density on clinical outcomes. WIDER IMPLICATIONS OF THE FINDINGS:ICM density assessment is a new direction in blastocyst assessment. This study explores new ways of assessing blastocyst ICM density and develops quantitative indicators and a corresponding qualitative evaluation scheme for ICM density. The DI of the blastocyst ICM developed in this study is easy to calculate and requires only TL equipment and image processing, providing positive guidance for clinical outcomes. The qualitative evaluation scheme of ICM density can assist embryologists without TL equipment to manually evaluate ICM density. ICM density is a simple indicator that can be used in practice and is a good complement to the blastocyst scoring systems currently used in most centers. STUDY FUNDING/COMPETING INTEREST(S):This work was supported by the National Key Research & Development Program of China (2021YFC2700603). The authors report no financial or commercial conflicts of interest. TRIAL REGISTRATION NUMBER:N/A.

Objectives To evaluate the knowledge, attitudes and practices towards diagnosing and managing paediatric sepsis among paediatric physicians and nurses.Design A cross-sectional, questionnaire-based study.Setting 21 hospitals in Hubei Province between February 2023 and March 2023.Participants Paediatric physicians and nurses.Interventions None.Primary and secondary outcome measures The questionnaire contained 35 items across four dimensions (demographic information, knowledge, attitude and practice).Results The study included 295 participants (173 women). The average knowledge, attitude and practice scores were 10.93±2.61 points (possible range, 0–20 points), 32.22±2.65 points (possible range, 7–35 points) and 36.54±5.24 points (possible range, 9–45 points), respectively. Knowledge had a direct influence on both attitude (β=0.240, 95% CI 0.136 to 0.365, p=0.009) and practice (β=0.278, 95% CI 0.084 to 0.513, p=0.010), which also indirectly influenced practice through attitude (β=0.162, 95% CI 0.078 to 0.290, p=0.007). Attitude directly influenced practice (β=0.677, 95% CI 0.384 to 0.902, p=0.025). A higher attitude score was associated with good practice (OR=1.392; 95% CI 1.231 to 1.576; p<0.001), while not working in a tertiary hospital reduced the odds of good practice (OR=0.443; 95% CI 0.2390.821; p=0.010).Conclusions The knowledge regarding paediatric sepsis, especially knowledge about sepsis management, is poor among paediatric physicians and nurses in Hubei Province. The findings of this study may facilitate the development and implementation of training programmes to improve the diagnosis and management of paediatric sepsis.

Purpose:The knowledge, attitude, and practices (KAP) concerning antibiotics by healthcare students have the potential impact on controlling antibiotic abuse and antimicrobial resistance (AMR) growth. This study aims to evaluate the levels and explore the associated factors with KAP on antibiotic use and AMR in Chinese nursing students.Methods:A cross-sectional survey using a self-administered questionnaire consisting of demographics and selected features and KAP on antibiotic use and AMR was conducted to measure KAP levels among nursing students at various universities in Hubei Province, China. The logistic regression analyses were performed to analyze the potential factors associated with the KAP.Results:The survey eventually included a total of 1959 nursing students. The mean scores for KAP were 57.89 ±26.32, 55.00 ±12.50, and 71.88 ±15.63, respectively. Regarding knowledge, 54.3% of participants were unaware that antibiotic was ineffective against viral infections. Regarding attitude, 36% of participants agreed that current antibiotic abuse existed; 96.2% of participants thought it necessary to set up a special course on antibiotics. Regarding practice, only 48.4% of participants usually purchased antibiotics with a prescription. Multivariable analyses indicated that lack of discussion on AMR in school courses was an independent risk factor against KAP, respectively. The main knowledge sources of antibiotic being outside the classroom was an independent risk factor related to knowledge and practice. The average score >80 points was an independent protective factor related to knowledge and practice.Conclusion:The KAP level on antibiotic use and AMR among Hubei nursing students was general and required further strengthening. Nursing students with risk factors should be prioritized in educational interventions. The findings of our study pointed out some directions for tailored interventions to improve the training on antibiotics.

The oocyte maturation defect 6 is an autosomal recessive hereditary disease caused by a homozygous variant in ZP2 gene. It is characterized by female primary infertility due to an abnormally thin zona pellucida (ZP) and defective sperm binding. Here we identified a compound heterozygous variant (c.1924C > T and c.1695-2A > G) in ZP2 gene in a Chinese Han family. Quantitative real-time PCR showed that the variant c.1924C > T significantly decreased the expression of truncated ZP2 message RNA by the nonsense-mediated decay pathway. Minigene assays showed the c.1695-2A > G variant led to an extra—61—nt preservation of intron 15 at the junction between exons 15 and 16 during transcription. Both variants (c.1924C > T and c.1695-2A > G) resulted in truncated ZP2 proteins (p.R642X and p.C566Hfs*2) that lost the transmembrane domain, which prevented the secretion of the mutant ZP2 proteins and produced a structurally abnormal ZP, thus resulting in female infertility. This study further elucidated the pathogenic mechanism of these two variants and provided new support for the genetic diagnosis of female infertility.

Choriocarcinoma is a highly malignant trophoblastic tumor that occurs mostly in women of childbearing age. The main mode of metastasis is hematogenous metastasis. The most common sites of metastasis are the lung, vagina and brain, while splenic metastasis is rare. Because of its rapid development, extensive metastasis can occur in a short period, and some patients only show metastatic symptoms, which are often missed or misdiagnosed as ectopic pregnancy or other diseases. We describe a rare case of splenic metastatic choriocarcinoma with acute abdominal pain caused by nontraumatic splenic rupture. In addition, we review the previous literature on splenic metastasis of choriocarcinoma and summarize the clinical manifestations, management measures and prognoses. Our case and literature review indicate that splenic metastatic choriocarcinoma is rare and difficult to distinguish from splenic ectopic pregnancy and other diseases. Clinicians should strengthen their understanding of this disease and avoid misdiagnosis.

Abstract Background Fertility preservation (FP) is gradually becoming a crucial cure during fertility counseling for all breast cancer (BC) women of reproductive age, but certain limiting factors hinder patients' decisions. This study aimed to collect cases involving fertility preservation before anticancer treatments and assisted reproductive technology (ART) after anticancer therapies in young breast cancer (BC) patients and survivors and to share some clinical experiences. Methods We retrospectively analyzed 18 BC patients who underwent FP before (neo)adjuvant chemotherapy and 8 survivors who chose ART after completing anticancer treatments in a single reproductive medicine center between January 2015 and June 2023. Baseline characteristics and outcomes of FP and ART were analyzed. Results 8 survivors of a median age of 35.5 years (range 32.3–41.0 years) underwent ART after anticancer therapies and behaved diminished ovarian reserve (DOR) or even premature ovarian insufficiency (POI) with undesirable outcomes. Receiving FP before (neo)adjuvant chemotherapy in 18 patients does not delay subsequent treatments, patients receiving neoadjuvant chemotherapy tend to prefer RS-COS protocol that shorten the time from diagnosis to initiation of chemotherapy (median days 26.0 vs. 42.0, p = 0.002) compared to the majority of patients receiving cCOS protocol, and there is no difference in other FP results. COS with letrozole can control the serum estradiol level in a relatively safe condition. During a median follow-up period of 17.5 months (range 8.8–31.0 months), only 1 (5.6%) woman suffered recurrence with bone metastasis when she received neoadjuvant chemotherapy after FP, 2 (11.1%) patients experienced ovarian hyperstimulation syndrome (OHSS) after COS, and 3 (37.5%) survivors had a live birth after ART. Conclusions Embryo and oocyte cryopreservation after COS based on letrozole is a preferred and optimal FP option for young BC patients before (neo)adjuvant chemotherapy. Using ART to get pregnant in BC survivors is feasible and not associated with adverse cancer outcomes. It is important that these patients are closely monitored to reduce the potential risks of OHSS and recurrence.