Background Intractable postpartum hemorrhage (PPH) during cesarean section has been a significant concern for obstetricians. We aimed to explore the effectiveness and safety of a new type of uterine compression suture, the step-wise surgical technique of knapsack-like sutures for treating intractable PPH caused by uterine atony and placenta factors in cesarean section. Methods The step-wise surgical technique of knapsack-like sutures was established on the basis of the artful combination of vertical strap-like sutures and an annular suture-ligation technique. This novel surgical technique was applied to 34 patients diagnosed with PPH during cesarean section due to severe uterine atony and placental factors in our department. The hemostatic effects, clinical outcomes and follow-up visit results were all reviewed and analyzed. Results This new uterine compression suture successfully stopped bleeding in 33 patients, and the effective rate was 97.06%. Only 1 patient failed and was changed to use bilateral uterine arterial embolization and internal iliac artery embolization. The follow-up visits indicated that 33 patients restored menstruation except for 1 who was diagnosed with amenorrhea. The gynecological ultrasound tests of all the patients suggested good uterine involutions, and they had no obvious complaints such as hypogastralgia. Conclusions This step-wise surgical technique of knapsack-like uterine compression sutures can compress the uterus completely. It is a technique that can conserve the uterus and fertility function without special equipment in caesarean section for PPH, with the characteristics of being safe, simple and stable (3 S) with rapid surgery, reliable hemostasis and resident doctor to operation (3R).

Objective To analysis the hysteroscopy results of 2 123 female infertility patients in northern Shandong. Methods Retrospective analysis was performed on the case data of 2 123 female infertility patients in northern Shandong who underwent hysteroscopy in the Department of Reproductive Medicine of our hospital from January 2015 to December 2021 due to infertility (1 426 cases), adverse pregnancy history (448 cases), history of pregnancy failure assisted by IUI (61 cases) and history of pregnancy failure assisted by IVF (188 cases). The hysteroscopy results of patients with different types of infertility, age group, number of adverse pregnancies, and number of failed pregnancies assisted by IUI/IVF were compared. Results Among 1426 patients undergoing hysteroscopy due to infertility, 686 had abnormal results, with an abnormal rate of 48.11％. There were 428 cases of primary infertility, and 240 cases were abnormal, with an abnormal rate of 56.07％. There were 998 cases of secondary infertility, and 446 cases were abnormal, the abnormal rate was 44.69％ (P ＜0.05). The incidence of endometrial polyp, chronic endometritis and abnormal uterine development in primary infertility group was 21.73％, 21.73％ and 3.97％, respectively, which were higher than those in secondary infertility group (P ＜0.05). The incidence of intrauterine adhesions in secondary infertility group was 9.92％ higher than that in primary infertility group (P＜0.05). With the increase of age, the overall abnormal rate showed a downward trend (P＞0.05), and the abnormal rate of uterine development gradually decreased (P＜0.05). With the increase of infertility years, the overall abnormal rate gradually increased (P＜0.05). The abnormal rate of hysteroscopy increased gradually with the increase of the number of adverse pregnancies (P ＜0.05). With the increase of IUI-assisted pregnancy failure, hysteroscopy abnormality rate showed an increasing trend (P＞0.05). The abnormal rate of hysteroscopy decreased with the increase of transplant failure (P＞0.05). Conclusion The uterine abnormality rate of female infertility patients in northern Shandong is high, the overall abnormal rate of hysteroscopy is related to infertility factors, and the abnormal rate of uterine development is related to age. The duration of infertility is greater than or equal to 3 years, and the number of adverse pregnancies is greater than or equal to 3 times. Hysteroscopy is recommended.

多囊卵巢综合征(PCOS)是影响女性健康最常见的生殖内分泌疾病之一,也是辅助生殖助孕的一项重要指征.大量研究证实PCOS患者发生胰岛素抵抗(IR)、2型糖尿病、非酒精性脂肪肝和心血管疾病的风险显著升高,因此PCOS已成为影响患者终身健康的代谢性疾病.尽管IR并非PCOS的诊断标准,但PCOS患者中IR普遍存在且病理生理特征明显.雄激素在IR发生过程中具有双向调节效应,两者之间存在复杂的相互作用.骨骼肌是雄激素作用的靶器官,在维持代谢稳态中发挥关键作用,也是胰岛素介导葡萄糖利用的主要场所.近年来,骨骼肌代谢功能障碍在PCOS发病中的作用逐渐成为学界关注的焦点.分析PCOS女性骨骼肌代谢功能障碍的特征及可能的分子机制,或将为改善PCOS患者的代谢功能提供新的治疗思路.

Controlled ovarian hyperstimulation (COH) is an essential for in vitro fertilization-embryo transfer (IVF-ET) and an important aspect of assisted reproductive technology (ART). Individual starting doses of gonadotropin (Gn) is a critical decision in the process of COH. It has a crucial impact on the number of retrieved oocytes, the cancelling rate of ART cycles, and complications such as ovarian hyperstimulation syndrome (OHSS), as well as pregnancy outcomes. How to make clinical team more standardized and accurate in determining the starting dose of Gn is an important issue in reproductive medicine. In the past 20 years, research teams worldwide have explored prediction models for Gn starting doses. With the integration of artificial intelligence (AI) and deep learning, it is hoped that there will be more suitable predictive model for Gn starting dose in the future.

BACKGROUND:H19 is the first long noncoding RNA (lncRNA) found to be associated with gene imprinting. It is highly expressed in the embryonic stage and may have important regulatory effects on human embryonic development. We investigated the differences between the levels of H19 promoter DNA methylation in the chorionic villi of patients who experienced spontaneous abortion (SA) following in vitro fertilization embryo transfer (IVF-ET) and those of patients with a normal early pregnancy (NEP). We also analyzed the associated DNA methyltransferase (DNMT) activity. METHODS:Chorionic villus tissue from patients with SA and NEP were collected. The DNA methylation levels of two CpG islands in the promoter region of the H19 gene in the two groups were detected by bisulfite sequencing, and the mRNA expression of DNMTs was analyzed by real-time polymerase chain reaction. RESULTS:The sample size of each group was 32, and there were no significant differences in baseline data, including age, parity, and body mass index, between the two groups. Among the 7 CpG islands measured, the methylation rates of 3 CpG islands (CpG 1, 6, and 7) were significantly lower in the SA group than in the NEP group (P < 0.01). The methylation levels of the other 4 CpG islands were not significantly different between the two groups. There were no differences in the expression of DNMT1 between the two groups (P > 0.05), but DNMT3a and DNMT3b RNA levels were significantly lower in SA group than in the NEP group (P < 0.01). CONCLUSIONS:The lower H19 promoter DNA methylation levels found in the chorionic villi of patients with SA patients following IVF-ET may be explained by decreased expression of DNMT3a and DNMT3b.

目的 探讨术前行宫腔镜检查进行宫腔预处理对夫精人工授精(IUI)妊娠结局的影响.方法回顾性分析2017年1月至2021年10月首次于滨州医学院附属医院生殖医学科行IUI助孕的1 062个治疗周期的临床资料.选取其中女方双侧输卵管均通畅的964个周期纳入研究,按术前是否行宫腔镜检查分为观察组和对照组.观察组包括IUI术前行宫腔镜检查进行宫腔预处理的616个周期;对照组包括IUI术前未行宫腔镜检查的348个周期.分析两组患者的临床特征和助孕结局.结果 两组在年龄、不孕年限、基础促卵泡激素(bFSH)、基础黄体生成素(bLH)、抗穆勒氏管激素(AMH)、体重指数(BMI)、处理后前向运动精子总数、手术日内膜厚度、不孕类型占比、促排卵周期占比等方面的临床特征比较,差异均无统计学意义(P＞0.05).观察组临床妊娠率、异位妊娠率、活产率均高于对照组,差异均无统计学意义(P＞0.05).观察组流产率明显低于对照组,差异有统计学意义(P＜0.05).结论 双侧输卵管通畅的不孕症患者,IUI术前行宫腔镜检查进行宫腔预处理能够显著降低流产率,对提高活产率有积极的作用.

Objective:To investigate the expression and significance of E-cadherin and PCNA in rat PCOS model.Methods:Twelve 6-week-old SD clean grade female rats were randomly divided into two groups: letrozole treatment group（n=6）and normal control group（n=6）.Letrozole treatment group was given 1mg/kg of letrozole for intragastric modeling, while normal control group was given the same dose of solvent for intragastric modeling.After 21 days of continuous treatment, the rats were sacrificed by anesthetized dose, and the ovarian morphology was observed by HE staining.Immunohistochemical staining was used to detect the localization of E-cadherin and PCNA proteins, and Western blotting was used to detect the expression of E-cadherin and PCNA proteins.Results:In the control group, ovarian follicles at different stages of development were observed in the field of vision.In the letrozole treatment group, only a number of empty follicles of different sizes grew, and the number of inner granular cell layers was significantly reduced compared with that in the control group.E-cadherin and PCNA proteins were localized in cytoplasm and nucleus.Western blotting showed that the expression of PCNA protein in letrozole treatment group was significantly lower than that in the control group, and the expression of E-cadherin protein in letrozole treatment group was higher than that in the control group, with statistically significant differences（P＜0.05）.Conclusions:In the ovaries of PCOS model induced by letrozole, the expression of PCNA protein decreased and the expression of E-cadherin protein increased, which resulted in the decreased proliferation of ovarian granulosa cells.

目的 探讨腺病毒载体(Ad-DDAH2)转染大鼠脂肪干细胞(ADSCs)的可行性.方法 构建Ad-DDAH2-GFP质粒.原代培养大鼠ADSCs,流式细胞术检测免疫表型CD29、CD45、CD90表达情况.以不同滴度的Ad-DDAH2-GFP转染ADSCs,用荧光显微镜计数转染效率及细胞形态.通过RT-PCR及Western Blot检测DDAH2在ADSCs中的表达情况.结果 Ad-DDAH2-GFP重组腺病毒载体构建、包装成功,且病毒滴度达到2E+10PFU/ML.第4代ADSCs生长曲线呈现"S"形.细胞免疫表型CD29、CD90阳性率分别为(95.83±0.53)％、(91.32±0.27)％,CD45阳性率为(1.59±0.06)％,符合ADSCs免疫表型特征.当病毒感染复数值为80、100时,转染效率均可达到90％以上.但病毒感染复数值为100时,ADSCs出现明显细胞病理现象,因此病毒感染复数值为80被视为最佳感染复数,RT-PCR及Western Blot鉴定可见阳性扩增条带.结论 Ad-DDAH2-GFP重组腺病毒载体构建成功,可以高效转染大鼠ADSCs.DDAH2在mRNA及蛋白稳定长期表达,为后续体内实验奠定了实验基础.

目的 系统评价卵裂期和囊胚期胚胎移植的妊娠结局.方法 计算机检索PubMed、Embase、Medline和Cochrane library等外文数据库以及维普、中国生物医学文献数据库(CMB)、中国知网和万方数据库等国内数据库,自建库至2019年5月的所有文献,并通过人工阅读检索参考文献以及应用谷歌学术(Google Scholar)辅以检索,以避免文献漏检.2位研究者根据纳入及排除标准独立对文献进行筛选、资料提取和质量评价后,采用RevMan 5.3软件进行Meta分析.结果 共纳入21个随机对照试验(RC T),共3887个病例.与卵裂期胚胎移植比较,囊胚期胚胎移植可获得显著升高的临床妊娠率[RR=1.12,95％CI(1.04,1.20),P=0.002],而活产率[RR=1.14,95％CI(0.95,1.38),P=0.16]和多胎妊娠率[RR=1.09,95％CI(0.90,1.33),P=0.37]无显著性差异.囊胚期胚胎移植的周期取消率显著高于卵裂期胚胎移植[RR=2.52,95％CI(1.84,3.45),P<0.00001].亚组分析结果显示,患者预测指标和胚胎移植数量对临床妊娠率无显著影响(P>0.05).结论 囊胚期胚胎移植的临床妊娠率、周期取消率显著高于卵裂期胚胎移植,但活产率和多胎妊娠率与卵裂期胚胎移植无显著差异,患者预测指标和胚胎移植数目对临床妊娠率并无明显影响.受纳入研究数量和质量的限制,上述结论尚待开展更多高质量研究予以验证.