Objective:To explore the pregnancy outcomes of frozen-thawed embryo transfer (FET) after antibiotic treatment in patients with recurrent implantation failure (RIF) and chronic endometritis (CE).Methods:A retrospective cohort study was conducted to analyze 496 women with RIF undergoing hysteroscopy and endometrial biopsy before the next FET in Reproductive Medicine Center of Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology from January 2018 to December 2021. According to the pathological results of endometrial biopsy and subsequent treatment, the patients were divided into cured CE group (strong positive CD138 was converted to negative after antibiotic treatment, n=103), suspected CE group (weak positive CD138, n=76), non-CE group (negative CD138, n=230) and control group (hysteroscopy and diagnostic only, no CE-related histopathological screening, n=85). The pregnancy outcomes after FET were compared among the four groups. Results:The prevalence of CE in the patients with RIF was 25.5% (105/411), and the sensitivity of hysteroscopy for the diagnosis of CE was 55.2% and the specificity was 83.0%. The conversion rate of patients with CE was 86.7% (91/105) after 1 cycle of antibiotic treatment and 98.1% (103/105) after 2 cycles of treatment. After removing the confounding factors of age, ovarian reserve function, number of previous transfer cycles, number and type of embryos transferred in FET cycle, and number of high-quality embryos, multivariate regression analysis showed that the clinical pregnancy rate of the cured CE group improved significantly after antibiotic treatment ( OR=1.841, 95% CI: 1.123-3.020, P=0.029). Conclusion:Patients with RIF should be screened for CE, and if CE is diagnosed, pharmacological treatment is recommended prior to embryo transfer, which is beneficial to improve pregnancy outcomes in FET cycles.

目的:采用高效液相色谱-串联质谱法（HPLC-MS/MS）建立测定人血浆中尼洛替尼浓度的检测方法。方法:血样经甲醇除蛋白后，流动相分别为0.1%甲酸的甲酸铵缓冲液（A相）和0.1%甲酸的乙腈溶液（B相）梯度洗脱，Luna ? C 18 柱（20 mm×2.0 mm, 3μm）色谱柱分离，流速为0.6 ml·min -1 ;柱温35℃;电喷雾离子源（ESI）,正离子模式，多反应监测，离子对为m/z 530.1→m/z 288.9 （尼洛替尼）、m/z 502.3→m/z 394.1（伊马替尼-D8）。结果:尼洛替尼的线性范围为50～10 000 ng·ml -1 ,定量下限为50 ng·ml -1 ;日内及日间RSD均小于10%,尼洛替尼低、中、高浓度的提取回收率分别为98.5%,102.4%,103.3%。结论:本检测方法操作简单、灵敏度高、检测下限低、专属性强，适用于临床慢性髓系白血病（CML）患者血浆中尼洛替尼的检测。

目的:研究消化内镜故障成因以及对维修费用的影响,以为消化内镜故障处理和预防维护等工作的开展提供建议和参考.方法:收集某院消化内镜中心2020年10月至2021年10月的消化内镜故障维修数据,从故障现象、故障率、维修部位、维修等级、维修费用和维修配件更换等方面进行统计分析.采用SPSS 26.0进行统计学分析.结果:消化内镜故障现象主要为漏水问题(65.75％)、图像问题(35.62％)和角度问题(24.66％).在故障率方面,内镜整体故障率为0.16％,其中电子十二指肠镜的故障率最高,为0.83％.在维修部位方面,发生维修的部位多集中于先端部(82.19％)、弯曲部(79.45％)和插入部(78.08％).在消化内镜维修等级方面,86.30％的消化内镜维修等级为C级及以下.在维修费用方面,超声内镜单次维修费用均值最高(83256.00元),其次为电子结肠镜(33824.32元),再次为电子胃镜(22040.76元).在维修配件更换方面,更换较频繁的配件主要有橡皮(9.83％)、喷嘴(9.09％)和钳子管道(8.91％).钳子管道、软管组件、弯曲管、开关、导光软管、C盖、电气接口等配件的更换会显著影响消化内镜的维修费用,配件更换费用的增加会提高消化内镜的整体维修费用.结论:基于真实世界数据的消化内镜故障维修分析有利于降低消化内镜故障频率和维修成本,提高消化内镜使用效率.

Objective:To evaluate the clinical effect and pregnancy outcome of infertile patients with moderate and severe intrauterine adhesions by comprehensive treatment.Methods:Totally 148 infertile patients with moderate to severe intrauterine adhesions who were hospitalized in the Department of Reproductive Medicine of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from May 1, 2017 to May 1, 2018 were retrospectively analyzed. They were divided into two groups based on American Fertility Association (AFS) scoring: the moderate group (79 patients) with an AFS score of 5-8 and the severe group (69 patients) with an AFS score of 9-12. All patients received comprehensive treatment for intrauterine adhesions, including intrauterine adhesion decompression and postoperative adjuvant therapy, such as estrogen, physical barrier and biogels. Through case investigation, telephone and outpatient follow-up, the postoperative review of uterine cavity, menstruation and pregnancy outcomes were collected, and the follow-up time was 24-36 months after surgery.Results:1) Postoperative recovery of uterine cavity: 80.41% (119 cases of 148) patients with intrauterine adhesions had improved uterine cavity environment, and 65 of 79 moderate patients had significantly improved uterine cavity environment, the improvement rate was 82.28% (65/79). The uterine environment was significantly improved in 54 cases of 69 severe patients, the improvement rate was 78.26% (54/69). 2) Changes of postoperative intrauterine AFS score: postoperative AFS score of patients with moderate intrauterine adhesions decreased (4.10±0.21) points, and the difference was statistically significant ( P<0.001). AFS score of patients with severe intrauterine adhesions decreased (7.12±0.30) points after operation, and the difference was statistically significant ( P<0.001). 3) Improvement of menstruation after surgery: in the first 3 months after surgery, 72 patients with moderate intrauterine adhesions (91.14%) had improved menstruation. A total of 57 patients (82.61%) with severe intrauterine adhesions had improved menstruation. Three months after surgery, 52 patients (65.82%) with moderate intrauterine adhesions had better menses than before; a total of 41 patients (59.42%) with severe intrauterine adhesions had improved menstruation. 4) Pregnancy outcome: among 79 patients with moderate intrauterine adhesions, 44 cases were pregnant, of which 37 cases delivered live births (19 cases of natural pregnancy, 18 cases of assisted reproductive pregnancy), with a live birth rate of 84.09%. There were 33 pregnancies and 20 live births (15 natural pregnancies and 5 assisted pregnancies) in the patients with severe intrauterine adhesions, with a live birth rate of 60.61%. Conclusion:The comprehensive treatment of intrauterine adhesions can obviously improve the uterine environment of moderate and severe intrauterine adhesions, reduce AFS score, improve menstruation, increase pregnancy rate and improve pregnancy outcome.

Objective To observe the clinical efficacy and safety of Fuke Qianjin Capsules combined with goserelin in treatment of endometriosis. Methods Patients (200 cases) with endometriosis in Gong'an People's Hospital from May 2015 to December 2017 were randomly divided into control and treatment groups, and each group had 100 cases. Patients in the control group were subcutaneously implanted Goserelin Acetate Sustained-release Implant, once every four weeks, 3.6 mg/time. Patients in the treatment group were po administered with Fuke Qianjin Capsules on the basis of the control group, 2 grains/time, three times daily. Patients in two groups were treated for 24 weeks. After treatment, the clinical efficacy was evaluated, and sex hormone levels, serum markers, Kupperman scores, and VAS scores in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control group was 79％, which was significantly lower than 88％ in the treatment group, and there were differences between two groups (P<0.05). After treatment, E2, LH, and FSH in two groups were significantly decreased, and there were differences between two groups (P<0.05). And sex hormone levels in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P<0.05). After treatment, CA125 level in two groups were significantly decreased, but TNF-α and IL-6 levels in the treatment group were significantly decreased, and there were differences between two groups (P<0.05).And CA125, TNF-α, and IL-6 levels in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P<0.05). After treatment, Kupperman and VAS scores in two groups were significantly decreased, and there were differences between two groups (P<0.05). And Kupperman and VAS scores in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P<0.05). Conclusion Fuke Qianjin Capsules combined with goserelin in treatment of endometriosis can not only improve ovarian function, regulate the disorder of sex hormones, but also reduce inflammation, and improve the pain and menstrual status of patients, which has a certain clinical application value.

宫腔镜检查是不孕症(Infertility)诊疗的重要措施,可以直接观察子宫腔内的病灶,在宫腔镜的引导下对子宫内膜或病灶活检病理进行病理诊断,通过宫腔镜下的干预措施包括治疗局灶性子宫病变(息肉和小纤维瘤)和子宫腔成形术(粘连松解及纵隔切开)治疗不孕症,以及在宫腔镜指引下通过输卵管插管,再通近端梗阻的输卵管以潜在地提高生育力,使宫腔镜检查在治疗不孕症中的实用性显著提升[1].

目的 探讨胆管损伤性狭窄的原因,外科治疗以及疗效.方法 回顾性分析我院1987年至2007年损伤性胆管狭窄54例患者临床资料.结果 54例损伤处理后平均5.6个月内均不同程度的狭窄.对症治疗8例,内镜治疗7例,胆道探查5例,肝总管十二指肠侧侧吻合1例,胆总管空肠侧侧吻合1例,胆管空肠Roux-Y吻合32例.预后评估参照McDon分类,本组失访6例,随访48例中共43例(79.6%)(A＝35,B＝8)长期疗效良好,5例(9.2%)(C＝ 5)术后疗效差.结论 损伤性胆道狭窄首选胆管空肠Roux-Y吻合,其中胆管连续性尚存的低位早期狭窄也可选内镜治疗,效果良好.

目的 总结胰腺炎合并门静脉系统血栓的诊治经验.方法 回顾性分析2000年1月至2005年1月诊治的17例胰腺炎合并门静脉系统血栓患者的病因、临床表现和诊治方法.结果 9例非手术治疗患者随访1～3年,均未发生静脉曲张出血;7例行脾切除术患者,脾功能亢进症状消失,出血停止,均痊愈出院,未出现近期合并症;1例行内引流术患者术后未发生出血,脾功能亢进症状消失,未行二期脾切除术.结论 对于胰腺炎合并门静脉系统血栓若无出血和脾功能亢进症状,只需保守治疗和治疗原发疾病;脾脏切除术是胰腺炎诱发的门静脉系统栓塞合并上消化道出血的确切治疗措施。