Background Age-related reproductive aging is a natural and irreversible physiological process, and delaying childbearing is increasingly common all over the world. Transplantation of mesenchymal stem cells (MSCs) is considered a new and effective therapy to restore ovarian function, but the relevant mechanisms remain unclear. Recently, it has been found that there is a local Renin-angiotensin system (RAS) in human ovary and it plays a key role. Methods After collecting follicular fluid from women who received oocyte retrieval for pure male factor infertility, the level of RAS components in it were detected, and the correlation analysis by linear regression. Then, the in vivo experiments on female C57BL/6 mice were designed to measure ovarian function, and the transcription and translation levels of RAS pathway were detected by molecular biology methods. Moreover, the role of RAS in regulating inflammation and oxidative stress in the co-culture system were explored in in vitro experiments on KGN cells. Results First, a total of 139 samples of analyzable follicular fluid were obtained. The local RAS of ovary, which is independent of systemic RAS (P > 0.05), is affected by age (Pearson r < 0, P < 0.05) and related to ovarian function, inflammation, oxidative stress indexes and assisted reproduction laboratory outcomes (P < 0.05). Next, the ovary/body weight of aging mice decreased significantly and serum sex hormones levels changed significantly (P < 0.01). The number of functional follicles decreased, while the atresia follicles increased (P < 0.05). After MSCs transplantation, all the above measures have been partially recovered (P < 0.05). Although several RAS components in aging ovary changed, MSCs only improved the expression level of AT1R (P < 0.05). Furthermore, the secretion ability and mitochondrial membrane potential of aging KGN cells decreased, while the intracellular ROS level and the aging cells ratio increased (P < 0.01). All the above measures have been partially recovered when co-cultured with MSCs (P < 0.05). After Ang(1-7) were added into the co-culture system, the above have been more significantly restored compared with Ang II (P < 0.05). Nevertheless, there was no statistical difference in estradiol level no matter which one was added (P > 0.05). Conclusions Together, our findings indicate that a novel possible mechanism to explain how stem cells restore age-related ovarian functional decline.

Background: the context and purpose of the study Methods: how the study was performed and statistical tests used Results: the main findings Conclusions: Age-related reproductive aging is a natural and irreversible physiological process, and delaying childbearing is increasingly common all over the world. Transplantation of umbilical cord-derived mesenchymal stem cells (MSCs) is considered a new and effective therapy to restore ovarian function, but the relevant mechanisms remain unclear. In recent years, it has been found that there is a local renin-angiotensin system (RAS) in human ovary and it plays a key role.In our research, local RAS of ovary, which is independent of circulating RAS, is affected by age and related to ovarian function. Furthermore, the in vivo(mice) and in vitro (KGN cells) experiments were designed to confirm that transplantation of MSCs improves age-related ovarian dysfunction by the local RAS. Together, our findings indicate that a novel possible mechanism to explain how stem cells restore age-related ovarian dysfunction.

Objective:To investigate the clinical effect of aspirin (ASA) combined with low molecular weight heparin (LMWH) in the treatment of recurrent spontaneous abortion (RSA). Methods:PubMed, Cochrane, Wanfang, CNKI, and other databases were searched to collect randomized controlled trials (RCT) of aspirin combined with LMWH in the treatment of RSA from the establishment of the database to July 31, 2023. The literature was screened, and the information was extracted according to the pre-established criteria. The Reviews Manager 5.4 software was used for data analysis. Results:A total of 10 RCTs containing 1865 patients with RSA were included in this study. Meta-analysis showed that the regimen of aspirin combined with LMWH treatment significantly increased the neonatal birth rate (P < .01); and the occurrence of preeclampsia was significantly reduced when compared with regimens such as aspirin alone (P = .02); there were no significant differences between the two groups in the incidence of preterm birth (P = .21), neonatal birth weight (P = .38), the incidence of a small amount of patient hemorrhage (P = .41) and fetal growth restriction (P = .93). Conclusion:The combination of aspirin and LMWH offers a clinically significant improvement in live birth rates and reduction in preeclampsia for RSA patients, suggesting a beneficial strategy for clinical practice and future research directions.

Objective: To investigate the association between the local renin-angiotensin system (RAS) in human follicular fluid (hFF) and age, ovarian function, in vitro fertilization (IVF) outcome. Design: Study on the correlation of non-intervention. Setting: Reproductive Medicine Center, First Affiliated Hospital of Soochow University. Sample: hFF of 139 women who received IVF simply because of their husband’s factors from January 2021 to February 2022. Methods: The correlation between age and RAS in hFF was analyzed by simple linear regression, and multivariate linear regression was used to further analyze the correlation between the RAS and IVF outcome. Main Outcome Measures: The levels of RAS components in hFF were measured, including Renin, ACE, ACE2, AngⅡ and Ang(1-7). Results: ①The influence of age on ACE-AngⅡ-AT1/2R axis was more significant than that on ACE2-Ang(1-7)-MAS axis in hFF; ②Provides evidence that gonadotropins mediate RAS activation of local ovarian follicles; ③It is still impossible to prove the effect of RAS on steroid hormone production, at least in ovarian follicles RAS cannot affect steroid hormones in the systemic circulation; ④Age and the level of RAS components in hFF have certain clinical value in predicting the number of oocyte retrieval and the rate of MⅡ maturation. Conclusions: The local RAS in ovarian follicles is affected by age and correlated with ovarian function and IVF outcome.

Recurrent miscarriage (RM), defined as three or more consecutive spontaneous miscarriages, affects many women of childbearing age. The pathological basis of RM is an imbalance in apoptosis, with the MDM2-p53 pathway playing a crucial role. In this study, we synthesized poly(6-acetoxyl-ε-caprolactone)-graft-(4-amino-benzimidazole) (PCCL-4-ABI) by modifying poly(6-acetoxyl-ε-caprolactone) (PCCL) with 4-amino-benzimidazole (4-ABI). The introduction of carboxyl and 4-ABI groups endowed the PCL backbone with fluorescence, pH responsiveness, and UCST responsiveness. The temperature-dependent release behavior of compound 1-loaded PCCL-4-ABI nanofluorescent materials was attributed to UCST transition. We successfully developed a novel nanofluorescent polymer drug delivery platform, PCCL-4-ABI@1, and evaluated its regulatory effects on p53 and MDM2 in trophoblast cells (HTR-8/SVneo). The results showed that the system loaded with low molecular weight heparin increased MDM2 and decreased p53 expression in a dose-dependent manner, thereby inhibiting trophoblast cell apoptosis. This study developed a biodegradable poly(ε-caprolactone) with UCST behavior, significant for the advancement of thermoresponsive fluorescent nanoparticle systems.

Background NIPT is becoming increasingly important as its use becomes more widespread in China. More details are urgently needed on the correlation between maternal risk factors and fetal aneuploidy, and how these factors affect the accuracy of prenatal aneuploidy screening. Methods Information on the pregnant women was collected, including maternal age, gestational age, specific medical history and results of prenatal aneuploidy screening. Additionally, the OR, validity and predictive value were also calculated. Results A total of 12,186 analysable karyotype reports were collected with 372 (3.05%) fetal aneuploidies, including 161 (1.32%) T21, 81 (0.66%) T18, 41 (0.34%) T13 and 89 (0.73%) SCAs. The OR was highest for maternal age less than 20 years (6.65), followed by over 40 years (3.59) and 35–39 years (2.48). T13 (16.95) and T18 (9.40) were more frequent in the over-40 group ( P < 0.01 ); T13 (3.62/5.76) and SCAs (2.49/3.95) in the 35–39 group ( P < 0.01 ). Cases with a history of fetal malformation had the highest OR (35.94), followed by RSA (13.08): the former was more likely to have T13 (50.65) ( P < 0.01 ) and the latter more likely to have T18 (20.50) ( P < 0.01 ). The sensitivity of primary screening was 73.24% and the NPV was 98.23%. The TPR for NIPT was 100.00% and the respective PPVs for T21, T18, T13 and SCAs were 89.92, 69.77, 53.49 and 43.24%, respectively. The accuracy of NIPT increased with increasing gestational age (0.81). In contrast, the accuracy of NIPT decreased with maternal age (1.12) and IVF-ET history (4.15). Conclusions ①Pregnant patients with maternal age below 20 years had higher risk of aneuploidy, especially in T13; ②A history of fetal malformations is more risky than RSA, with the former more likely to have T13 and the latter more likely to have T18; ③Primary screening essentially achieves the goal of identifying a normal karyotype, and NIPT can accurately screen for fetal aneuploidy; ④A number of maternal risk factors may influence the accuracy of NIPT diagnosis, including older age, premature testing, or a history of IVF-ET. In conclusion, this study provides a reliable theoretical basis for optimizing prenatal aneuploidy screening strategies and improving population quality.

Abstract Objective Retrospective analysis of maternal risk factors for fetal aneuploidy and evaluation of the clinical value of prenatal screening.Methods The information of pregnant women was collected, and the OR value, authenticity index and prediction value index were calculated.Results A total of 12,186 analysable karyotype reports were collected, and 372 cases(3.05%) of fetal aneuploidy were found, including T21 161 cases(1.32%), T18 81 cases(0.66%), T13 41 cases(0.34%), and SCAs 89 cases(0.73%). Maternal age <20 years old has the highest OR(6.65), followed by ≥40(3.59) and 35-39(2.48). History of fetal malformation has the highest OR(35.94), followed by IVF-ET(17.04) and RSA(13.08). The sensitivity of the preliminary screening was 73.24%, and the NPV was 98.23%. The TPR of NIPT was 100.00%, and the PPV for T21, T18, T13, and SCAs was 89.92%, 69.77%, 53.49%, and 43.24%. The reliability of NIPT and gestational age(0.81) are positively correlated, while had a negative correlation with maternal age(1.12) and the history of IVF-ET.Conclusion Our results support the correlation between maternal risk factors and fetal aneuploidy & reliability of screening. The above conclusions provide a reliable theoretical basis for developing prenatal screening strategies and improving reproductive health.

Abstract Background Previous studies have found that there is the local renin-angiotensin system (RAS) in human ovary, and it independently plays a regulatory role in ovarian function. Age-related reproductive aging is an inevitable process. To explore the relationship between RAS components in human follicular fluid (hFF) and age, ovarian function, so as to help clinical evaluation of oocyte quality and prediction of in vitro fertilization (IVF) outcome. Methods hFF of 139 women who received IVF simply because of their husband's factors from January 2021 to February 2022. The levels of RAS components in hFF were measured, including Renin, ACE, ACE2, AngⅡ and Ang(1–7). The correlation between age and RAS in hFF was analyzed by simple linear regression, and multivariate linear regression was used to further analyze the correlation between the RAS and IVF outcome. Results A total of 139 samples of analysable hFF were obtained in this study. It was found that there was a linear negative correlation between age and renin, ACE, AngⅡ, ACE/ACE2, AngⅡ/Ang(1–7) (Pearson's r < 0, P < 0.05), while the linear relationship with ACE2 and Ang (1–7) was not significant (P > 0.05). It was found that bFSH and bLH were correlated with age, ACE-AngⅡ-AT1/2R axis, ACE2-Ang(1–7)-MAS axis (P < 0.05), AFC was correlated with age, ACE2-Ang(1–7)-MAS axis (P < 0.05), and bAMH was only correlated with age (P < 0.01). There was no correlation between RAS and bE2, bP, bPRL, bT (P > 0.05). It was found that the number of oocyte retrieval and MⅡ maturation rate were correlated with age, renin, ACE-AngⅡ-AT1/2R axis and ACE2-Ang(1–7)-MAS axis (P < 0.05), and the rate of 2PN embryos, transplantable embryos, high-quality embryos were only correlated with age (P < 0.01). Conclusions ①The influence of age on ACE-AngⅡ-AT1/2R axis was more significant than that on ACE2-Ang(1–7)-MAS axis in hFF; ②Provides evidence that gonadotropins mediate RAS activation of local ovarian follicles; ③It is still impossible to prove the effect of RAS on steroid hormone production, at least in ovarian follicles RAS cannot affect steroid hormones in the systemic circulation; ④Age and the level of RAS components in hFF have certain clinical value in predicting the number of oocyte retrieval and the rate of MⅡ maturation.

目的:探讨瘢痕子宫再次妊娠不同分娩方式的近远期并发症.方法:选择2002年2月至2017年12月苏州大学附属第一医院妇产科收治的瘢痕子宫孕妇2617例,其中择期再次剖宫产2246例(ERCD组),阴道试产成功334例(VBAC组),阴道试产失败转急诊剖宫产37例(TOLAC失败组).对3组患者的妊娠结局及产后近远期并发症进行比较分析.结果:3组患者中,TOLAC失败组剖宫产患者并发症发生率最高(18.92％),其次是ERCD组患者(6.99％),而VBAC组患者并发症发生率最低(3.29％).VBAC组出现输血、产后发热和尿潴留的比例明显低于ERCD组(分别为0 vs 1.65％、1.20％ vs 4.14％、0.30％ vs 2.98％,P＜0.05);发生子宫破裂、输血、尿潴留、肠梗阻的比例低于TOLAC失败组(分别为0 vs 10.81％、0 vs 8.11％、0.30％ vs 5.41％、0 vs 5.41％,P＜0.05);TOLAC失败组发生子宫破裂、输血、肠梗阻的比例显著高于ERCD组(分别为10.81％ vs 0.31％、8.11％ vs 1.65％、5.41％vs 0.40％,P＜0.05);VBAC组的产妇发生腰痛、肠粘连、贫血、切口部位子宫内膜异位症的比例显著低于ERCD组(分别为0 vs 5.25％、0 vs 4.69％、2.80％ vs 7.93％、0 vs 3.91％,P＜0.05);3组均无新生儿重度窒息发生,TOLAC失败组轻度窒息发生率(8.11％)明显高于ERCD组(1.02％)和VBAC组(1.20％),差异有统计学意义(P＜0.05).TOLAC失败组1分钟及5分钟Apgar评分均低于ERCD组及VBAC组(1分钟:9.43±1.65分,9.92±0.38分,9.96±0.39分;5分钟:9.64±1.34分,9.98±0.28分,9.99-±0.10分),差异有统计学意义(P＜0.05),且随访发现,TOLAC失败组1例轻度窒息新生儿发生脑损伤,预后不佳.结论:瘢痕子宫再次妊娠患者,阴道试产成功的母儿并发症最小,择期再次剖宫产次之,试产失败转急诊手术者母儿并发症最高.瘢痕子宫患者在有条件的情况下可以在严密监护下试产,但是需要重视对试产失败患者的处理,以改善母儿结局.

目的:为探讨腔内三维彩超与子宫输卵管碘油造影两者对子宫畸形诊断的准确性与临床价值.方法:对39例经子宫输卵管碘油造影检查后诊断为子宫畸形的患者,进行腔内三维彩超检查,最后以宫腹腔镜或宫腔镜手术结果为标准以验证两者对子宫畸形判断的准确性.结果:39例子宫畸形病例中,经宫腹腔镜或宫腔镜验证后,子宫输卵管碘油造影漏诊5例,误诊7例,腔内三维彩超与手术对子宫畸形的诊断完全一致.结论:与子宫输卵管碘油造影相比,腔内三维彩超对子宫畸形的诊断具有更高的准确性,且有着经济,无创伤等多项优势,能提供更多关于子宫畸形的信息,具有更高的临床应用价值.

剖宫产术后瘢痕子宫再次妊娠的分娩方式是国内外学者研究的热点问题之一,我国剖宫产率呈逐年升高趋势,瘢痕子宫再次妊娠分娩方式的选择作为产科医师面临的难题日益突出.针对这一问题,本文综述了瘢痕子宫再次妊娠不同方式分娩的优缺点,影响瘢痕子宫阴道分娩成功的相关因素及研究进展情况.

目的 探讨国外文献报道的预测剖宫产史孕妇再次妊娠分娩方式的风险公式在国内的适用性. 方法 回顾性分析2002年2月至2012年2月于苏州大学附属第一医院妇产科126例有剖宫产史孕妇再次妊娠阴道试产的结局.利用Flamm、Grobman、Smith、Gonen公式分别进行风险计算及分析,比较公式计算理论值及实际情况.采用卡方检验、Fisher精确概率法和受试者工作特性(receiver operating characteristic,ROC)曲线进行统计学分析. 结果 以Flamm公式总分值1～7分分别为界对本组病例的结果进行统计学分析,仅以3和4分为界时,预测结果与实际结果一致(x2值分别为1.25和0.00,P均＞0.05).Grobman公式取界值为75％分析,尽管ROC曲线分析的临界值(74.51％)接近原文献(75％),但是统计学分析发现实际结果与原公式预测结果有较大差异(x2 =32.36,P＜0.01).Gonen公式计算按总分0～2、3～6和7～10分3组,各组剖宫产后阴道分娩的成功率分别为93.5％(29/31)、89.4％(59/66)和86.2％(25/29),差异无统计学意义(x2=0.267,P＞0.05).Smith公式预测时以临界值40％为界,未校正胎儿性别前,预测剖官产风险≤40％和＞40％者VBAC的实际成功率分别为91.6％(98/107)和14/18,预测结果与实际结果的差异无统计学意义(x2=0.70,P=0.40)；根据实际胎儿性别校正后,预测剖宫产风险≤40％和＞40％者的VBAC的实际成功率分别为91.1％(102/112)和10/13,差异亦无统计学意义(x2=0.05,P=0.82).ROC界值为39.65％,接近原文献的40％. 结论 4种公式比较,Smith公式更适合在本研究人群中用于预测其剖官产后再次妊娠阴道分娩的可行性.