人卵母细胞玻璃化冷冻技术在辅助生殖中的应用

目的:探讨人卵子玻璃化冷冻的可行性及临床应用价值。方法:回顾性分析2011年8月至2012年7月在取卵日因男方因素行卵子玻璃化冷冻的6例患者,解冻卵子后行卵胞浆内显微注射,记录卵子复苏、受精、卵裂及移植后妊娠情况。结果:6例患者共解冻卵子52枚,复苏卵子31枚,复苏率59.62%。对31枚卵子行ICSI,受精21枚,形成胚胎20枚。1例患者取消移植,5个移植周期共移植胚胎9枚,临床妊娠2例,临床妊娠率40%。结论:卵子的玻璃化冷冻是目前保存女性生育力的有效措施。     

1008个冷冻胚胎移植周期妊娠结局影响因素的分析

目的:探讨影响卵裂期冷冻胚胎移植妊娠结局的相关因素。方法:回顾性分析2011年1月至2014年12月在北京大学第一医院进行卵裂期冻胚移植的1008个周期,探讨患者年龄、不孕年限、不孕类型、内膜准备方式、内膜厚度及类型、受精方式、胚胎冷冻方法、辅助孵化、胚龄、移植胚胎数量及质量等对冷冻胚胎移植妊娠结局的影响。结果:1008个胚胎解冻周期,复苏胚胎2883个,存活2503个(86.8%),完成冻胚移植周期981个(97.3%),临床妊娠周期413个(42.9%),胚胎种植率23.6%,早期流产率14.0%。年轻患者、全胚冷冻后第一次冻胚移植、选择玻璃化冷冻方法、移植≥2枚胚胎尤其是≥2枚优质胚胎的冷冻胚胎移植妊娠率较高。结论:在诸多因素中,年龄、冷冻方法、是否全胚胎冷冻、移植胚胎数目及质量对冻胚移植妊娠结局影响显著。     

来源未见原核(0PN)卵裂期胚胎培养至囊胚的临床应用分析

目的:分析来源0PN卵裂期胚胎培养至囊胚后行冷冻复苏周期的临床妊娠结局,评价来源0PN囊胚的临床应用价值。方法:回顾性分析2014年3月至2016年9月在安徽省妇幼保健院生殖医学中心接受辅助生殖助孕治疗中40个来源0PN的卵裂期胚胎培养至囊胚的冷冻复苏周期,分析其临床妊娠及分娩结局情况。结果:40个完全来源0PN的囊胚复苏周期移植的临床妊娠率为45.0%(18/40),种植率为31.67%(19/60),随访截止时间至2016年9月,其中9例活产(5男4女),继续妊娠7例(8胎),2例流产(2胎),流产组织绒毛分析结果显示均异常。结论:患者行IVF-ET治疗后,可将来源0PN的卵裂期胚胎培养至囊胚给予冷冻,在没有来源2PN正常受精的卵裂期与囊胚时,患者可慎重选择来源0PN囊胚行复苏周期进行移植。     

胚胎冷冻保存时间对FET妊娠结局的影响

目的:探讨胚胎冷冻保存时间是否会对冻融胚胎移植(FET)周期妊娠结局造成影响。方法:回顾性分析本中心833个解冻移植周期,按冷冻保存时间分为Ⅰ组(90d);Ⅱ组(90~365d);Ⅲ组(366~730d);Ⅳ组(730d),比较组间临床妊娠结局情况。结果:四组的平均年龄及平均移植胚胎数均无显著性差异,各组间的临床妊娠率无显著性差异。结论:冷冻保存时间对FET妊娠结局无不良影响。     

玻璃化冻融卵裂期胚胎体外培养时间对妊娠结局的影响

目的:研究人卵裂期胚胎玻璃化冷冻复苏后的体外培养时间对妊娠结局的影响。方法:回顾性分析2016年1月1日至2016年11月30日在我中心进行冻融胚胎移植(frozen-thawed embryo transfer,FET)治疗的患者492个周期。根据胚胎解冻后是否过夜培养分为两组,A组为解冻后过夜培养组,共270个周期;B组为解冻当日移植组,共222个周期。根据过夜培养后胚胎是否生长,将A组继续分为三个亚组,A1组:全部胚胎均生长,共161例;A2组:部分胚胎生长,共89例;A3组:无胚胎生长,共20例。比较各组患者年龄、内膜厚度、移植胚胎数、胚胎复苏率、临床妊娠率及胚胎着床率。结果:A组与B组在患者年龄、内膜厚度、胚胎复苏率、移植胚胎个数、临床妊娠率和胚胎着床率等方面均无统计学差异(P0.05)。A1、A2、A3三组之间在患者年龄、内膜厚度、移植胚胎数及临床妊娠率等方面均无统计学差异(P0.05),但是A1组的胚胎复苏率(92.99%)显著高于A3组(83.64%)(P0.05),A1组的胚胎着床率(28.12%)分别显著高于A2组(19.53%)和A3组(13.04%)(P0.05)。结论:胚胎复苏后是否过夜培养并不影响妊娠结局,但是过夜培养后继续生长的胚胎具有更高的着床率。     

妇科恶性肿瘤患者治疗后性生活状况的研究

目的:研究妇科恶性肿瘤患者治疗后性生活状况及保留卵巢对性生活的影响。方法:对110例北京大学第一医院收治的妇科恶性肿瘤手术、放化疗后3个月以上的女性进行问卷调查,并比较保留卵巢组和卵巢缺失组间性生活状况的差异。结果:110例患者中子宫内膜癌31例、卵巢恶性肿瘤38例、宫颈癌41例,不同肿瘤治疗后女性性功能指数量表(FSFI)性欲评分中位数的差异具有统计学意义(P=0.042)。保留卵巢组与卵巢缺失组治疗后性生活恢复时间及FSFI各项评分的影响的差异均有统计学意义。结论:妇科恶性肿瘤患者治疗后性生活质量明显下降,保留卵巢对妇科肿瘤患者性生活恢复有重要意义,严格掌握卵巢切除适应症,重视对患者性健康教育,有助于提高患者性生活质量。     

液氮浅低温冷冻对皮肤血管影响的实验研究

进行了液氮浅低温冷冻对皮肤血管影响的实验研究,结果显示冷冻后真皮浅层血管显著扩张,数目增多（Ｐ＜００１）,尤以毛囊周围为显著。说明该方法主要通过改善毛囊及其周围的血液循环和组织代谢而促进了毛发生长,为临床采用该法治疗斑秃提供了理论依据     

影响降调节后激素替代周期冷冻胚胎移植结局的相关因素分析

目的分析可能影响降调节后激素替代周期冷冻胚胎移植结局的相关因素。方法选取2015年1月至2018年5月佛山市妇幼保健院诊治的150例经降调节后激素替代周期冷冻胚胎移植辅助生殖的患者作为研究对象。仔细阅览患者临床资料,记录其性别、年龄、不孕年限、不孕类型等一般情况,将种植失败者作为非临床妊娠组(n=91),种植成功者作为临床妊娠组(n=59),将可能影响降调节后激素替代周期冷冻胚胎移植结局的相关因素纳入,经χ~2检验与多项Logistic逐步回归分析检验,找出可能的高危因素。结果全部150例患者胚胎移植数量共301个,每个周期移植胚胎(2.01±0.45)个,胚胎着床率为22.92%,获得临床妊娠者59例,临床妊娠率39.33%;经χ~2检验与多项Logistic条件逐步回归分析检验证实,移植当天内膜厚度、胚胎移植数量、优质胚胎数量均可能是影响降调后激素替代周期冷冻胚胎移植结局的危险因素,差异具有统计学意义(P0.05),且以移植胚胎数量、优质胚胎数量影响较显著。结论降调节后激素替代周期冷冻胚胎移植中,移植胚胎数量越多、优质胚胎数量越多,临床妊娠率越高,同时移植结局还受到子宫内膜厚度的影响,故应根据患者子宫内膜厚度选择合适的移植日,以提高临床妊娠率。     

异体肾脏移植后患尖锐湿疣23例临床分析

尖锐湿疣(CA)的感染、临床特点及复发均与患者机体的细胞免疫有关1,2。异体肾脏移植患者长期应用免疫抑制剂,其免疫功能明显低下,患CA后更易复发。现将我科诊治的23例异体肾脏移植后CA患者的感染途径、临床特点及液氮冷冻治疗效果分析报道如下。临床资料23例异体肾脏移植后CA患者均为我科于2001年5月~2005年2月所诊治,根据典型临床表现,5%醋酸白试验阳性确诊。其中男15例,女8例,年龄19~56岁,平均39.9岁,病程10天~8个月,平均2个月;肾脏移植8个月~7年,平均4.5年。有6例男性患者有不洁性接触史,2例女性患者其丈夫有CA病史,共8例(34.78%)为…     

囊胚和卵裂期胚胎玻璃化冷冻解冻移植周期的妊娠结果分析

目的:比较囊胚和卵裂期胚胎玻璃化冷冻解冻后移植周期的妊娠结果。方法:回顾分析2014年1月至2014年12月在我院生殖医学中心行玻璃化冷冻解冻移植周期388个患者的妊娠情况,其中囊胚冷冻解冻165个移植周期(A组),卵裂期胚胎冷冻解冻223个移植周期(B组)。结果:A组和B组解冻存活率分别98.76%和96.74%,两组间无统计学差异(P>0.05);临床妊娠率、种植率和单胎率A组(68.48%、57.38%和76.10%)显著高于B组(68.48%、57.38%和59.37%);多胎率、双胎率和三胎率A组(23.01%、22.12%和0.88%)显著低于B组(40.62%、31.25%和9.37%,P<0.05);A组和B组的流产率分别为5.31%和6.25%,两组间无统计学差异。结论:囊胚和卵裂期胚胎玻璃化冷冻解冻均能获得较高的存活率、临床妊娠率和种植率,且囊胚玻璃化冷冻移植周期提高了临床妊娠率及种植率,同时降低了多胎率的发生。     

控制性卵巢刺激过程中卵巢慢反应1例分析

目前体外受精-胚胎移植(IVF-ET)技术为越来越多的不孕症患者所接受,是治疗不孕症的重要方法。控制性卵巢剌激(controlled ovarian stimulation,COS)方案能否获得数量适中且质优的卵母细胞及胚胎是影响IVF-ET成功率的关键因素。COS过程中如若出现卵巢慢反应,一旦处理不当,就会转变为卵巢低反应,导致获卵数少、临床妊娠率低,因此必须积极干预。本文通过对COS过程中出现卵巢慢反应的1例患者进行分析,探讨卵巢慢反应的临床特征、发生原因、治疗措施、转归及预防。     

Multiple primary cutaneous plasmacytomas.

BACKGROUND--Cutaneous plasmacytoma is an uncommon tumor and is mostly seen in the context of end-stage multiple myeloma. Only 20 cases of primary cutaneous plasmacytoma have been documented. A significant proportion of these patients went on to develop systemic disease with a poor prognosis. In a number of patients, however, the abnormal clone of plasma cells may arise in the skin and never progress to multiple myeloma involving the bone marrow. OBSERVATIONS--We describe a patient who developed multiple primary cutaneous plasmacytomas after a possible insect bite reaction. The monoclonality of the tumor cells is demonstrated using immunohistochemical techniques. He has been treated vigorously with chemotherapy and local radiotherapy and remains well 3 years after diagnosis. Bone marrow has been harvested for use as an autologous bone marrow transplant in the event of systemic relapse. CONCLUSIONS--Unlike previous reports of this rare entity, this case documents the monoclonality of tissue plasma cells with immunohistochemical techniques. As cutaneous plasmacytomas have been reported with an early significant mortality, unlike extramedullary plasmacytomas elsewhere, we have advocated combination chemotherapy and cryopreservation of uninvolved bone marrow for future autologous bone marrow transplantation should systemic myelomatosis develop in the patient.     

Fat transplantation for treatment of the senescent face

For more than a century, clinicians have attempted to utilize fat for the treatment of tissue deficiencies and contour abnormalities. Autologous fat transplantation for soft tissue augmentation has become increasingly popular in recent years. This has occurred as a result of the present authors' comprehension that the aging face is not simply as a result of gravity-induced ptosis, but also as a result of volume loss secondary to the atrophy of tissues. The popularity of tumescent liposuction has brought renewed interest and accessibility of fat for transplantation. Newer techniques and approaches to augmentation have provided more predictable and reproducible results. Fat augmentation has become an effective, safe, and reliable method for restoring volume and correcting the atrophy that accompanies senescence. In this review, the present authors describe their approach and technique of fat transplantation for the aging face.     

Andrologie bei onkologischen Erkrankungen

In dermato-oncological treatment there are many gonadotoxic interventions. Alkylating and hormonally active substances as well as gonadal irradiation, in particular, are known to have a fertilization-limiting effect in men. Since 2017 certified skin cancer centers in Germany therefore have the task to implement counselling on preservation of fertility. This is supported by the S2k guidelines on preservation of fertility in oncological treatment. Because recommendation of the various interventions from the dermato-oncological guidelines are dependent on the stage, the authors advocate at least the question “Is the desire to have children of interest to you?” when patients reach the appropriate stage. Fertility protection of men via cryopreservation of ejaculates or testicular tissue is then a simple and safe option. The procedure is standardized and usually available. In addition, the possibility of cryopreservation of testicular tissue from prepubertal male children and infants is now available via the new Androprotect project. If signs of hypogonadism occur during therapy, a treatment can be considered by weighing up the effects of testosterone but in this case it is important to take the anabolic and immunomodulating effects into account.     

Vitiligo surgery: A journey from tissues via cells to the stems!

Depigmented patches in vitiligo, a common dermatosis, cause a great psychological distress to the patients. Hence, apart from halting the disease process, the strategies to impart normal skin colour to these white patches carry an important role in the management of vitiligo. Surgical procedures are often required for stable vitiligo lesions not responding to medical therapies. It involves “shuffling” of melanocytes from the pigmented skin to the depigmented areas. During the last fifty years, the vitiligo surgery has evolved from tissue transplantation via cellular transplantation to reach a stage where the use of stem cells or immunomodulatory cells is contemplating. We would like to depict this wonderful journey of vitiligo surgery through this viewpoint.     

Surgical therapies, part III: melanocyte transplants

ABSTRACT: Melanocyte transplantation is currently the most effective treatment modality for patients who have stable depigmentation unresponsive to traditional medical therapies. Patient selection is extremely important since patients with active vitiligo or large areas of depigmentation will not respond well to this treatment method. This article discusses techniques available for harvesting and preparing donor tissue, preparing the depigmented recipient site, applying the melanocytes, and caring for the transplantation site postoperatively. Common complications and responses are also discussed. Many variations in the transplantation procedure exist, allowing practitioners to tailor the treatment to the facilities available and to individual patient needs. Melanocyte transplantation is becoming a more commonly utilized treatment option that is likely to increase in the future as medical therapies capable of halting the progression of vitiligo become available.     

Deceased organ donation for transplantation: Challenges and opportunities

Organ transplantation saves thousands of lives every year but the shortage of donors is a major limiting factor to increase transplantation rates. To allow more patients to be transplanted before they die on the wait-list an increase in the number of donors is necessary. Patients with devastating irreversible brain injury, if medically suitable, are potential deceased donors and strategies are needed to successfully convert them into actual donors. Multiple steps in the process of deceased organ donation can be targeted to increase the number of organs suitable for transplant. In this review, after describing this process, we discuss current challenges and potential strategies to expand the pool of deceased donors.     

女性生殖器结核不孕患者腹腔镜检查特点及临床疗效评估价值

目的探讨女性生殖器结核(FGT)不孕患者腹腔镜检查特点,分析其在临床疗效评估中的应用价值。方法选取2015年3月至2017年3月乌鲁木齐市妇幼保健院妇科收治的42例经病理学+腹水培养病原学+腹腔镜/宫腔镜确诊的FGT不孕患者作为研究对象。回顾性分析患者腹部异常症状、不孕以及月经改变等临床表现。对比不同结核类型和治疗效果腹腔镜特点情况。结果42例FGT不孕患者中输卵管结核25例、盆腔结核10例、卵巢结核3例、输卵管结核伴卵巢结核4例;患者的主要症状表现为月经不调、腹部压痛、下腹坠痛、腹部肿块、身体乏力和低热等。腹腔镜下的共性表现为组织粘连、有栗粒型结节、干酪样组织钙化等。治疗后随访1年无复发,患者生殖系统组织栗粒结节吸收、组织质地、颜色均逐渐恢复正常,自然受孕患者输卵管、卵巢病灶完全吸收,器官功能恢复正常。结论宫腔镜能够清晰显示FGT病灶的形态、大小等情况,在FGT诊断鉴别以及疗效评估中均有重要意义。     

From wound healing to modern tissue engineering of the skin. A historical review on early techniques of cell and tissue culture

The early precursors of modern techniques of keratinocyte transplantation and tissue engineering of the skin are reviewed, starting with histological research into the processes of wound healing and of skin transplantation in the 19th century and continuing with the introduction of cell and tissue culture techniques in early 20th century medicine. The later experimental and clinical application of this research in dermatology and plastic surgery is also explored.     

Artificial intelligence and kidney transplantation

Artificial intelligence and its primary subfield, machine learning, have started to gain widespread use in medicine, including the field of kidney transplantation. We made a review of the literature that used artificial intelligence techniques in kidney transplantation. We located six main areas of kidney transplantation that artificial intelligence studies are focused on: Radiological evaluation of the allograft, pathological evaluation including molecular evaluation of the tissue, prediction of graft survival, optimizing the dose of immunosuppression, diagnosis of rejection, and prediction of early graft function. Machine learning techniques provide increased automation leading to faster evaluation and standardization, and show better performance compared to traditional statistical analysis. Artificial intelligence leads to improved computer-aided diagnostics and quantifiable personalized predictions that will improve personalized patient care.