Objective:To compare the clinical efficacy of transdermal estradiol patch and oral estradiol valerate in hormone replacement frozen-thawed embryo transfer cycle.Methods:Clinical data of 363 patients undergoing hormone replacement frozen-thawed embryos transfer from June 2018 to December 2019 were retrospectively analyzed. Patients in group A received transdermal estradiol patch. Patients in group B received estradiol valerate orally. The clinical outcomes of the two groups were compared.Results:The clinical pregnancy rate was 55.7% (113/203) in group A and 58.4% (87/149) in group B, with no significant difference between the two groups ( P=0.663). There were no significant differences in human chorionic gonadotropin (hCG) positive rate [63.5%(129/203) vs. 65.8% (98/149)], early abortion rate [10.6% (12/113) vs. 9.2% (8/87)] and ectopic pregnancy rate [1.8% (2/113) vs. 4.6% (4/87)] between the two groups (all P>0.05). The serum estradiol level in group B [(271.6±73.8) ng/L] was significantly higher than that in group A [(209.5±65.9) ng/L] on the day of endometrial conversion of progesterone ( P=0.008). Conclusion:The clinical effect of the transdermal estradiol patch is the same as that of oral estradiol valerate in hormone replacement frozen-thawed embryo transfer cycle. It is recommended for patients with chronic liver and kidney disease, high risk factors for thrombosis, dyslipidemia.

Background To determine the small nucleolar RNA (snoRNA) expression profiles in the endometrium during the implantation phase and identify their potential biological functions. Methods We used RNA sequencing to analyze the expression changes of snoRNAs in the endometrium of women during the implantation phase of the natural cycle and in the GnRH antagonist stimulation protocol. The expression of snoRNA ENST00000391318 was manipulated in endometrial cells by lentivirus. CCK-8, clone formation, flow cytometry, scratch and Transwell assays were used to detect the effects of ENST00000391318 on the proliferation, apoptosis, migration and invasion of endometrial cells. RNA pulldown and luciferase reporter gene experiments were used to detect the binding of ENST00000391318 to miRNA. Results Endometrial SNORNA ENST00000391318 was upregulated in the GnRH antagonist stimulation protocol. SNORNA ENST00000391318 overexpression inhibited cell proliferation and the cell cycle in Ishikawa cells, and SNORNA ENST00000391318 knockdown promoted cell proliferation and the cell cycle in Ishikawa cells. SNORNA ENST00000391318 overexpression inhibited cell migration and invasion in Ishikawa cells. SNORNA ENST00000391318 inhibited the expression of endometrium receptivity factor. miRNA-3928-5p is a target of SNORNA ENST00000391318 in Ishikawa cells. SNORNA ENST00000391318 regulates the expression of CDH11 through interaction with miRNA-3928-5p in Ishikawa cells. Conclusions The ENST00000391318/miR-3928-5p/CDH11 signaling pathway can regulate the receptivity of the endometrium for patients in the GnRH antagonist stimulation protocol. SNORNA ENST00000391318 downregulates the function of miR-3928-5p through a ceRNA mechanism to upregulate the expression of CDH11. SNORNA ENST00000391318 downregulates the receptivity of the endometrium by upregulating the expression of CDH11.

目的:探讨经阴道超声检测激素替代周期胚胎移植中内膜转化日子宫内膜厚度 、子宫内膜血流等参数对妊娠结局的评估价值.方法:选择100例于激素替代周期行冻融胚胎移植的不孕症患者,根据妊娠结果分为妊娠组(n=60)与未妊娠组(n=40).比较两组子宫内膜转化日的子宫内膜厚度、内膜血流搏动指数(pulsatility index,PI)、阻力指数(resistance index,RI)、收缩期峰值流速与舒张末期流速比值(systolic-diastolic ratio,S/D)等参数.结果:两组内膜转化日的雌二醇(estradiol,E2)、黄体生成素(luteinizing hormone,LH)、卵泡刺激素(follicle stimulation hormone,FSH)水平,优质胚胎数及子宫内膜厚度差异均无统计学意义.与未妊娠组比较,妊娠组内膜PI、RI、S/D等血流动力学参数明显降低(P<0.05).转化日子宫内膜厚度<8 mm者妊娠率低于子宫内膜厚度≥8 mm者(P<0.05).妊娠组转化日内膜S/D>3者的比例低于非妊娠组(P<0.05).结论:经阴道超声检测子宫内膜血流参数,有助于预测激素替代周期胚胎移植的妊娠结局.

To report a case of treating cornual pregnancy combined with intrauterine pregnancy following embryo transfer after bilateral salpingectomy with a laparoscopic approach. A 40-year-old pregnant woman who presented with minor vaginal bleeding at 5 weeks gestation. A cornual pregnancy with uterine pregnancy by ultrasonography at 7 weeks 4 days gestation was diagnosed. The cornual pregnancy was successfully removed via laparoscopy, and the uterine horn was repaired. The intrauterine single pregnancy progressed and a caesarean section was performed at 37 weeks gestation, resulting in the healthy male infant.

患者女，20岁。因停经42 d，下腹痛1 d，自测尿人绒毛膜促性腺激素（HCG）阳性来院就诊。超声检查：子宫前位，大小形态正常，肌层回声均匀，内膜厚19 mm，回声不均匀，宫腔内未见孕囊回声，双侧卵巢大小形态正常。子宫右侧与右卵巢较近处探及混合性回声区：38 mm×40 mm×34 mm，内见孕囊回声：21 mm×17 mm×18 mm，可见卵黄囊及胚芽，胚芽长3 mm，原始心管搏动可见。子宫后方探及深约21 mm液性区，腹腔内未见明显液性区。超声诊断：右附件区混合性占位（符合右侧输卵管妊娠声像图表现），盆腔积液。

目的 探讨超声及临床髋关节检查在新生儿发育性髋关节发育不良(DDH)早期筛查中的意义.方法 采用前瞻性的方法,分两阶段对我院2011年8月1日至2013年3月29日出生的新生儿分别进行髋关节临床检查和超声检查,并对筛查结果进行分析.第一阶段为2011年8月1日至2013年1月29日,筛查出生3 ～ 10天的新生儿,了解我院新生儿DDH的患病率、DDH发生的高危因素,以及髋关节超声筛查和临床物理检查两者之间的吻合度等.第二阶段为2013年1月30日至2013年3月29日,对初诊与复诊的一致性及灵敏度和特异度进行调查.结果 第一阶段共筛查5193例新生儿,临床髋关节检查阳性616例(11.86％),超声检查阳性556例(10.71％).男、女超声阳性率分别为6.41％和15.78％.臀位及羊水量少的新生儿超声检查阳性率分别为10.55％和13.00％.男、女左、右髋超声分度比较和男、女左髋、右髋、双髋超声检查比较显示,女婴、臀位、羊水量少、右髋发生DDH的风险高,差异有统计学意义(P＜0.05).第二阶段共筛选出符合超声初查和复查双条件的新生儿108例,初诊与复诊结果差异无统计学意义(P＞0.05).ROC曲线下面积为0.675(95％ CI:0.183～1.000).阳性预测值5.88％,阴性预测值98.90％.灵敏度及特异度的95％可信区间分别为50.00％ (95％ CI:1.26％ ～ 98.70％),84.90％(95％ CI:76.60％ ～91.10％).结论 超声进行新生儿髋关节DDH检查排除性诊断的意义大.运用髋关节临床及超声检查筛查新生儿DDH简便、安全,可早期发现可疑及异常病例,有利于门诊随访和早期干预.

患者女，25岁。因怀孕20周前来本院检查，停经后未曾进行过超声检查。本院超声检查：使用GE公司生产的730 Expert彩色超声诊断仪，探头频率为（2～9） MHz。孕妇常规采用仰卧位，首先测量胎儿双顶径、头围、腹围、股骨、肱骨、脐血流等参数，再按顺序扫查胎儿颅内结构、头面部、脊柱、胸腹腔、四肢以及胎盘、羊水和脐带等情况，并记录数据及适当存图。该胎儿双顶径48 mm，左侧股骨长34 mm，估计孕周20周3d。胎儿右下肢髋关节以下平面完全缺失（图1），脐带内见1条脐动脉和1条脐静脉，膀胱左侧脐动脉缺失，其他结构未见明显异常。超声诊断为胎儿右下肢缺失，单脐动脉。该病例本院住院引产后证实为右下肢缺失，单脐动脉。

患者女，28岁。因停经10周，自检尿人绒毛膜促性腺激素（HCG）（+）来院就诊。超声检查：子宫增大，宫腔内见1枚孕囊回声，大小46 mm×35 mm×48 mm，卵黄囊可见1枚，孕囊内见2枚胚胎回声，之一顶臀长27 mm，胎心可见；另一顶臀长14 mm（图1），胎心未见。超声提示：宫内早孕（双胎，胎儿1估计孕周9周4d；胎儿2胚胎停止发育，估计孕周7周5 d）。孕妇相隔21 d后再次就诊进行超声检查，超声所见：胎儿1双顶径21 mm，股骨长9 mm，胎心胎动可见，估计孕周13周2 d。另一胚胎顶臀长20 mm（图2），胎心未见。又过15 d后第3次来院复查，超声所见：胎儿1双顶径30 mm，股骨长14mm，胎心胎动消失，胎儿全身皮肤水肿。胎儿2顶臀长为30 mm（图3），胎心未见。超声诊断：双胎死亡。患者住院引产，因胎儿较小，仅见胎儿1,胎儿2混于胎盘中无法辨认。

胎儿泌尿系统异常发病率较高 , 严重者直接关系到围生儿的生存与预后 , 掌握不同阶段肾脏发育特征的动态观察 ,及早诊断胎儿泌尿系统异常 , 对指导优生优育有着重要意义.

目的探讨超声检测初诊2型糖尿病患者下肢动脉的临床意义.方法初诊2型糖尿病患者69例,根据有无临床症状分为有症状组49例(A组)和无症状组20例(B组),检测其髂股动脉、股浅动脉、(月国)动脉、胫前动脉和足背动脉的管径、IMT、斑块和血流频谱,与同龄的健康对照组(C组)比较.结果 (1)B组下肢动脉各段IMT界于A组和C组之间;与C组比较,A组患者下肢动脉各段、B组(月国)动脉段和足背动脉段IMT增加且差异有显著性(P＜0.05).(2)A组(月国)动脉段和足背动脉段微小斑块和斑块检出差异均无显著性(P＞0.05);(3)三组间下肢动脉内径和血流频谱比较差异均无显著性(P＞0.05).结论初诊2型糖尿病已存在早期动脉粥样硬化(IMT增厚、微小斑块形成)表现;无症状的B组的程度介于正常组C和有症状组A之间.

患者女,53岁.发现双小腿跟腱处肿块8年,逐渐增大,有酸胀感,无发热,有高脂饮食习惯,无外伤史.检查:无肥胖体征,双小腿跟腱处增粗,局部无红肿,皮肤粗糙,无皮疹和结节;可触及质地偏硬的肿块,表面不光滑,活动度差,有轻压痛.

Objective:To inv es tigate the usage of low extremity artery color Doppler imaging in elderly pati ents with type II diabetes mellitus (DM)and its clinical significance.Methods :The elderly patients with DM in our hospital accepted the ex-amination of l ow extremity artery color Doppler imaging from bottom to top.The inner caliber ,IMT,atheromatous plaques and blood flow spectrum of lower extremity artery w ere measured and compared with the control 's.Results:①The thickness of IMT and atheromatous plaques were thicker than the control group's(P0.01 ).②The check-out rates of marked narrow segments and occlusive segments in the low extremity artery in patients group were significantly higher than the c ontrol group's (12.64%vs3.19%and1.39%vs0,P0.01,respe ctively),the most of marked narrow segments and occlusive segments were locat ed in the small arteries under the knees(90.11%and91.30%,respectiv ely).③18.8%of non-symptoms patients had marked narrow and?or occlus ive arteries and the check-out rates of narrow segments and occlusive segment s in patients with symptoms were higher than the non-symptoms '.Conclusion: The tunica intima and plaque of low extremity artery in elderly patients with type II DM could be clearly displayed by the high resolving power B-mode ultras ound.The narrow extent and occlusive segments could be judged by united with C DFI and the measurement of frequency spectrum,the measurement was especiall y suitable for the small arteries under knees.