Effects of growth hormone in down-regulating hormone replacement cycle on the outcome of frozen-thawed embryo transfer北大核心CSCD

Objective To analyze whether the application of growth hormone (GH) in the frozen-thawed embryo transfer (FET) cycle can improve the pregnancy outcome of patients. Methods The retrospective cohort study including 1042 FET cycles was carried out between January 2015 to July 2018 in Reproductive Medicine Center, the Fourth Hospital of Hebei Medical University. According to medication before transfer, all patients were divided into GH group (group A ) and no GH group (group B). The pregnancy outcomes were compared between the two groups in aged patients (≥35 years), polycystic ovary syndrome (PCOS) patients and repeated implantation failure (RIF) patients. Results In group A, the maternal age [(31.1±4.5) years old] and the clinical pregnancy rate [67.1% (114/170)] were higher than those in group B [(30.1±4.4) years old, 57.5% (501/872)] (P=0.010, P=0.020). There were no significant differences in the implantation rate, the clinical pregnancy rate, the abortion rate and the live birth rate between group A and group B in aged patients (all P>0.05). In PCOS patients, the live birth rate in group A [65.8% (25/38)] was significantly higher than that in group B [42.3% (96/227)] (P=0.007). In the RIF patients, the implantation rate [37.3% (57/153)], the clinical pregnancy rate [50.5% (46/91)] and the live birth rate [37.4% (34/91)] in group A were significantly higher than those in group B [23.0% (115/501), 29.1% (92/316), 21.8% (69/316)] (P<0.001, P<0.001, P=0.003). Conclusion For the aged patients, adding GH could not improve pregnancy outcomes. The application of GH in PCOS patients could increase the live birth rate. For the RIF patients, the application of GH could increase the implantation rate, the clinical pregnancy rate and the live birth rate. © 2021 Chinese Medical Journals Publishing House Co.Ltdg. All rights reserved.     

Comparison of the early follicular long-term protocol and antagonist protocol in unexplained infertility patients北大核心CSCD

Objective To investigate the clinical effects and pregnancy outcomes of the early follicular long-term protocol and antagonist protocol in the treatment of unexplained infertility patients. Methods From January 2018 to January 2019, 642 cases of unexplained infertility patients with early follicular long-term protocol and antagonist protocol in in vitro fertilization/ intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) were collected using the clinical assisted reproductive technologies management system software database of the Department of Reproductive Medicine of the First Affiliated Hospital of Nanjing Medical University. Patients were divided into early follicular long-term protocol (n=283) and antagonist protocol (n=359) groups. The clinical outcomes of the two groups were analyzed retrospectively, including the implantation rate, the clinical pregnancy rate, and the live birth rate. Furthermore, the pregnancy outcomes of different age and body mass index (BMI) patients were further analyzed. Results 1) The BMI in the antagonist protocol group was higher than that in early follicular long-term protocol group [(22.17±2.96) kg/m2vs. (21.68±2.29) kg/m2, P=0.018]. The other based data did not exhibit remarkable difference between the two groups (P>0.05). 2) The starting dosage of gonadotropin (Gn) in early follicular long-term protocol group was less than that of antagonist group [(149.74± 36.24) IU vs. (177.97±38.85) IU, P<0.001]. While the total duration and dosage of Gn used in early follicular long-term protocol group were significantly higher than those in antagonist group [(11.93± 2.26) d vs. (8.86±1.45) d, P<0.001; (1 908.35±632.36) IU vs. (1 638.57±497.23) IU, P<0.001). The cleavage embryo implantation rate, the clinical pregnancy rate and the live pregnancy rate in fresh cycle in early follicular long-term protocol group were significantly higher than those in the antagonist group [57.14% (152/266) vs. 39.53% (68/172), P<0.001; 66.48% (121/182) vs. 51.72% (60/116), P=0.011; 59.89% (109/182) vs. 40.52% (47/116), P=0.001]. The incidence of moderate and severe ovarian hyperstimulation syndrome between the two groups were not statistically different (P>0.05). Multivariate logistic regression analysis showed that different protocols and age were both risk factors for clinical pregnancy and live birth of cleavage embryo transfer [2.261 (95% CI=1.333-3.836), P=0.002; 0.928(95% CI=0.869-0.991), P=0.026; 2.598(95% CI=1.535-4.397), P<0.001; 0.906(95% CI=0.849-0.967), P=0.003]. 3) In patients under 35 years old, the clinical pregnancy rate and the live birth rate in early follicular long-term protocol group were higher than those of the antagonist group, but there was no statistical difference (all P>0.05). The fresh embryo cycle implantation rate, the clinical pregnancy rate and the live birth rate of 35-39 years old patients in the early follicular long-term protocol group were higher than those in the antagonist group, but there was no statistical difference (all P>0.05). 4) In normal BMI group, the implantation rate, the clinical pregnancy rate and the live birth rate in early follicular long-term protocol group were significantly higher than those in the antagonist group [55.71% (122/219) vs. 37.82% (45/119), P=0.002; 63.58% (96/151) vs. 46.99% (39/83), P=0.014; 58.94% (89/151) vs. 39.76% (33/83), P=0.005]. In the overweight population, the implantation rate and the clinical pregnancy rate in early follicular long-term protocol group were significantly higher than those in the antagonist group [68.09% (32/47) vs. 43.40% (23/53), P=0.013; 81.25% (26/32) vs. 57.14% (20/35), P=0.034], but there was no statistically significant difference in the live birth rate (P>0.05). Conclusion Compared with the antagonist protocol, early follicular long-term protocol for unexplained infertility patients may achieve higher clinical pregnancy outcomes in IVF fresh cycle, but it could increased the duration of descending, the duration and dosage of Gn used. © 2021 Chinese Medical Journals Publishing House Co.Ltdg. All rights reserved.     

Comparative analysis of perinatal outcome of intracytoplasmic sperm injection and frozen-thawed embryo transfer between donor and autologous oocytes北大核心CSCD

Objective To investigate the obstetric outcomes of intracytoplasmic sperm injection and frozen-thawed embryo transfer (ICSI-FET) between donor and autologous oocytes. Methods A retrospective cohort study was conducted to analyze the clinical data of pregnant patients who underwent ICSI-FET in the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from June 2016 to January 2020. Totally 73 patients with donor oocytes, and 550 patients who used autologous oocytes in the same period, and the patients were matched at 1∶3 with propensity score matching (PSM), then there were 47 patients in donor group and 131 patients in autologous group. The general conditions and obstetric outcomes were compared among donor group and autologous group. Multivariate logistic regression and linear regression were applied to analyze the factors affecting perinatal complications. Results The bilateral antral follicle count (3.08±4.78) and basal estradiol level [(71.55±45.29) pmol/L] in donor group were significantly lower than those in autologous group [14.95±6.42, (132.84±74.89) pmol/L, all P<0.001]. The birth weight of singleton in donor group [(2 916.48±537.55) g] was lower than that in autologous group [(3 326.67±503.43) g], and there was significant difference (P<0.001). There were no significant differences in premature birth rate [21.28% (10/47) vs. 16.03% (21/131), P=0.416] and incidence of hypertensive disorder complicating pregnancy [12.77% (6/47) vs. 7.63% (10/131), P=0.448] between donor group and autologous group, but both of them had an increasing trend in donor group. Oocyte-donated ICSI-FET reduced the birth weight of singleton (MD=-388.225, 95% CI= -625.914-150.537, P=0.002). Conclusion The perinatal outcome of oocyte-donated ICSI-FET is relatively safe, but the birth weight of singleton is lower than that of self-oocyte ICSI-FET. © 2022 Chinese Journal of Endocrine Surgery. All rights reserved.     

Clinical analysis for pregnancy outcome of previous TORCH infection patients evolved with in vitro fertilization/intracytoplasmic sperm injection-embryo transfer北大核心CSCD

Objective To investigate the influence of previous TORCH infection on pregnancy outcome of in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ ICSI-ET). Methods A retrospective cohort study was carried out for infertile female patients who underwent IVF/ICSI-ET treatment from May 2016 to May 2018 at Department of Obstetrics and Gynecology, Reproductive Medicine Center, the Second Affiliated Hospital, Air Force Military Medical University. IgM and IgG in serum have been detected for cytomegalovirus (CMV), herpes simplex virus (HSV), rubella virus (RV) and Toxoplasma (TOX) by enzyme-linked immunosorbent assay (ELISA). Patients with IgM negative and IgG positive [IgM(-), IgG(+)] were assigned as the previous infection, while IgM-negative and IgG-negative [IgM(-), IgG(-)] were assigned as negative control. Four groups of CMV [1984 IgG(+) cases vs. 421 IgG(-) cases], HSV [1535 IgG(+) cases vs. 344 IgG(-) cases], RV [1795 IgG(+) cases vs. 261 IgG(-) cases] and TOX [75 IgG(+) cases vs. 2111 IgG(-) cases] were investigated for general data and pregnancy outcome of IVF/ICSI-ET. Results There were no significant differences between previous infection and negative control at age, body mass index (BMI), infertility duration, basal follicle-stimulating hormone (FSH) and anti-Müllerian hormone (AMH) levels among four groups (all P>0.05). The number of oocytes retrieved (9.68±4.33, 10.04±3.99, 10.41±4.33), fertilization rate [82.01% (1627/1984), 82.74% (1270/1535), 82.95% (1489/1795)], clinical pregnancy rate [53.20% (1055/1984), 51.66% (793/1535), 52.98% (951/1795)] and live birth rate [50.25% (997/1984), 38.96% (598/1535), 40.33% (724/1795)] in CMV, HSV, and RV IgG positive groups were significantly lower than those in the negative control [10.18±4.41, 10.58±3.54, 11.08±3.90, P=0.032, P=0.021, P= 0.018; 86.46% (364/421), 87.21% (300/344), 88.12% (230/261), P=0.028, P=0.043, P=0.035; 58.4% (246/421), 58.14% (200/344), 60.54% (158/261), P=0.049, P=0.030, P=0.022; 55.58% (234/421), 46.51% (160/344), 47.89% (125/261), P=0.047, P=0.010, P=0.021]. However, the biochemical pregnancy rate [9.47% (188/1984), 9.12% (140/1535), 10.53% (189/1795)] and the miscarriage rate [10.48% (208/1984), 9.97% (153/1535), 10.97% (197/1795)] in CMV, HSV, and RV IgG positive groups were higher than those in the negative group [6.18% (26/421), 5.81% (20/344), 6.51% (17/ 261), P=0.031, P=0.047, P=0.044; 7.13% (30/421), 6.10% (21/344), 6.51% (17/261), P=0.036, P= 0.026, P=0.027]. There were no significant differences in the number of oocyte retrieved, fertilization rate, clinical pregnancy rate and live birth rate between the TOX IgG positive group and the negative control (all P>0.05). Conclusion Previous infections of CMV, HSV and RV may be the reason for the fewer number of oocyte retrived and lower fertilization rate, clinical pregnancy rate and live birth rate for patients undergoing IVF/ICSI-ET treatment. Previous infections of CMV, HSV and RV cause the higher biochemical pregnancy rate and miscarriage rate. The previous TOX infection has no infection on IVF/ICSI-ET pregnancy outcome. © 2022 Chinese Journal of Endocrine Surgery. All rights reserved.     

Analysis of relative factors and prediction model for optimal ovarian response in patients with follicular phase long-acting long protocol北大核心CSCD

Objective To explore the relative factors for best ovarian response in patients undergoing assisted reproductive technology with follicular phase long-acting long protocol, and to establish a Nomogram prediction model of ovarian response. Methods This retrospective cohort study analyzed the clinical data of 1289 patients who received assisted reproductive treatment in the Center for Reproductive Medicine of Fujian Maternity and Child Health Hospital from July 1, 2018 to July 30, 2019. According to the number of oocytes retrieved, there were 164 cases in the low ovarian response group (≤5 oocytes retrieved), 891 cases in the normal ovarian response group (the number of retrieved oocytes was >5, and ≤18), and 234 cases in the high ovarian response group (>18 oocytes retrieved). Independent factors affecting ovarian reactivity were screened by logistic regression, which were the model entry variables, and a Nomogram prediction model was established based on the regression coefficients in the model. Results There were statistically significant differences in age, anti-Müllerian hormone (AMH) level and antral follicle count (AFC) among the three groups [32.43±3.99, 31.48±3.89, 29.91±3.73; (2.53±1.90) μg/L, (3.79±2.20) μg/L, (5.94±3.12) μg/L; 10.24±3.10, 14.50±3.29, 19.81±3.44; all P<0.001]. There were no significant differences in body mass index (BMI), duration of infertility and causes of tubal infertility (all P> 0.05). The initial dosage of gonadotropin (Gn) used for ovarian hyperstimulation among the three groups was statistically different [(182.62±53.96) U, (166.79±48.20) U, (159.13±43.92) U, P<0.001], while the duration of Gn used and clinical pregnancy rate had no significant differences (all P>0.05). Multifactorial stepwise aggression analysis showed that female age [0.93(0.90-0.96), P=0.007], AFC [1.07(1.03-1.09), P=0.001], AMH [1.29(1.20-1.39), P=0.001], basal follicle-stimulating hormone [0.79(0.73-0.86), P=0.001], luteinizing hormone value [1.11(1.06-1.23), P=0.010], initial dosage of Gn used [1.00(1.00-1.01), P=0.003], total dosage of Gn usd [1.00(0.99-1.00), P=0.001] and the presence or absence of diagnosis of endometriosis [0.63(0.47-0.86), P=0.001] and polycystic ovary syndrome [0.30(0.22-0.91), P=0.030] were independent factors for the occurrence of different ovarian responses during ovarian hyperstimulation. The prediction model of ovarian reactivity was constructed based on the above factors, and the accuracy of predicting the optimal ovarian response state was 95%. The above model was verified with 306 patients' data from August 1, 2019 to October 30, 2019 in this center, and the predicted ovarian response (number of oocytes obtained) of a total of 279 patients was consistent with the actual situation, with a coincidence degree of 91.2%. The consistency index of the model was 0.71. Conclusion We screened out the relevant factors affecting ovarian response in patients undergoing assisted reproductive technology with follicular phase long-acting long protocol, and established a Nomogram prediction model of ovarian response, which could effectively, intuitively and visually predict ovarian reactivity in hyperstimulation. © 2022 Chinese Medical Journals Publishing House Co.Ltd. All rights reserved.     

Effects of Baduanjin combined with limb function exercise on trunk control and living ability of stroke patients with hemiplegiaCSCD

Objective To explore the effect of Baduanjin combined with limb function exercise on trunk control and living ability of stroke patients with hemiplegia. Methods From September 2019 to March 2021, a total of 86 stroke patients with hemiplegia admitted into the First Affiliated Hospital of Zhengzhou University who met the inclusion criteria were selected and divided into the control group and the experimental group with 43 cases in each group according to the random number table method. The control group was given limb function exercise, while the experimental group was given Baduanjin combined with limb function exercise, and the intervention time was 6 weeks. The Trunk impairment scale (TIS), Berg balance scale (BBS), Fugl‑Meyer assessment of motor function (FMA), Barthel index (BI) scores and the thicknesses of transverse abdominis and multifidus muscle were compared between the two groups before and after the intervention. Results After the intervention, the TIS, BBS, FMA and BI scores of the experimental group were significantly higher than that of the control group [(19.52±2.68) vs (16.78±2.51) points, (43.19±5.03) vs (35.62±4.89) points, (71.24±7.39) vs (59.26±6.35) points, (69.52±6.81) vs (62.31± 6.46) points], the thickness of transversus abdominis and multifidus were significantly greater than that in the control group [(2.76±0.39) vs (2.39±0.35) mm, (24.37±1.69) vs (23.67±1.45) mm] (all P< 0.05). Conclusion Baduanjin combined with limb function exercise can improve the trunk control ability, balance function, motor function and daily life ability of stroke patients with hemiplegia. © 2021 Journal of Clinical Otorhinolaryngology Head and Neck Surgery. All rights reserved.     

Influencing factors of post stroke cognitive impairment in patients with acute ischemic stroke and their correlation with cognitive scoresCSCD

Objective To analyze the influencing factors of post stroke cognitive impairment (PSCI) and their correlation with cognitive scores in patients with acute ischemic stroke. Methods In this cross‑section study, 36 patients diagnosed with acute ischemic stroke and post stroke cognitive impairment (PSCI) admitted to the Department of Vascular Neurology of Beijing Tiantian Hospital Affiliated to Capital Medical University from June 1, 2022 to September 30, 2022 were selected as the PSCI group. And one to one matching was performed for patients without PSCI (PSNCI group) with an age±1 year and same gender admitted to the hospital during the same period (as control, 36 cases). Basic clinical data of the two groups were collected, the laboratory and imaging examinations were completed. Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment Scale (MoCA) were used for cognitive evaluation by neuropsychologists. Hypothesis testing was used to compare the differences in basic data, laboratory tests and lesion sites between the two groups. Multi‑factor conditional logistic regression was performed to analyze the influencing factors of PSCI, and Spearman correlation analysis was carried out to analyze the correlation between influencing factors of PSCI and the cognitive scores. Results Compared with those in PSNCI group, the proportion of patients with stroke/transient ischemic attack history, hyperhomocysteinemia (HHcy), apolipoprotein E(ApoE) ε4 carriers and the ratio of temporal lobe and thalamus infarction were higher in PSCI group (41.7% vs 13.9%, 36.1% vs 2.8%, 30.6% vs 5.6%, 22.3% vs 2.8%, 25.0% vs 5.6%), the MMSE and MoCA scores were lower in PSCI group [16.50 (8.25, 19.00) vs 28.00 (27.00, 30.00), 10.00 (4.25, 14.50) vs 27.00 (25.00, 28.00)] (all P<0.05). Logistic regression analysis showed that HHcy was a positive correlation factor for PSCI (OR=2.342, 95%CI= 1.186-4.622, P=0.014). Spearman correlation analysis showed that MMSE (r=-0.415) and MoCA (r= -0.417) scores were negatively correlated with homocysteine (Hcy) (both P<0.05). Conclusion HHcy is an important factor affecting the occurrence and development of PSCI in patients with acute ischemic stroke, and Hcy level is negatively correlated with cognitive scores in those patients. © 2022 Chinese Medical Journals Publishing House Co.Ltd     

重症急性胰腺炎预防性抗真菌治疗的临床研究

目的 探讨应用预防性抗真菌治疗是否可以降低重症急性胰腺炎(SAP)患者真菌感染的发生率及病死率.方法 选择2008年1月至2009年12月收治的40例存在真菌感染高危因素的SAP患者,按随机数字表法分为预防组和对照组,每组20例.对照组应用常规治疗,预防组除常规治疗外,应用氟康唑预防性抗真菌治疗.比较两组住院时间、真菌感染发生时间、真菌感染发生率以及病死率.结果 预防组与对照组比较,住院时间缩短[(40.3±15.4)d比(46.5±18.5)d],真菌感染发生时间较晚[(24.5±14.3)d比(14.5±12.7)d],真菌感染发生率低[15.0%(3/20)比35.O%(7/20)],病死率低[10.0%(2/20)比25.0%(5/20)],差异均有统计学意义(P<0.05).结论 SAP患者预防性抗真菌治疗,缩短住院时间,延缓真菌感染发生时间,降低真菌感染发生率及患者病死率.

Abstract：

Objective To investigate whether prophylactic antifungal treatment will reduce the incidence of fungal infection(FI)and the mortality in severe acute pancreatitis(SAP).Methods Forty consecutive patients with SAP admitted from January 2008 to December 2009 were divided into prevention group and control group with 20 cases each by random digits table.The patients in prevention group underwent routine therapy plus intravenous fluconazol as prophylactic antifungal treatment,while routine therapy only in control group.The length of hospital stay,the time when FI occurred,the incidence of FI and mortality were compared with each other.Results Compared with control group,the length of hospital stay wag shorter[(40.3±15.4)d vs.(46.5±18.5)d],the time when FI occurred was slewer[(24.5±14.3)d vs. (14.5±12.7)d],the incidence of FI[15.0%(3/20)vs.35.0%(7/20)]and the mortality [10.0%(2/20)vs. 25.0%(5/20)]were lower in prevention group,there were significant differences between the two groups(P<0.05).Conclusion Prophylactic antifungal treatment can shorten the hospital stay,delay the FI occurrence,reduce the incidence of FI and the mortality in patients with SAP.     

亚低温治疗急性呼吸窘迫综合征患者对炎性反应影响及肺保护作用的研究

Objective To explore the effect of mild hypothermia on inflammation status,lung function protection and clinical prognosis in patients with acute respiratory distress syndrome (ARDS).Methods All of 56 patients with ARDS were randomly divided into two groups: trial group (29 patients,treatment with mild hypothermia) and control group (27 patients, treatment with common practice). The following parameters including tumor necrosis factor (TNF)-α,interleukin (IL)-6 and C reactive protein (CRP), oxygenation index, SOFA evaluation and injury of lungs evaluation were detemined before treatment and at the 3rd, 7th day after treatment, and survival rates and adverse reaction in 28 days also were observed.Results After treatment, the levels of TNF-α ,IL-6 and CRP were decreased significantly, and oxygenation index, the scores of SOFA evaluation and injury of lungs evaluation were improved significantly in trial group than those in control group (P<0.05 ). The survival rate in trial group was higher than that in control group after treatment of 28 days [65.5%(19/29) vs 51.9%(14/27)]. The courses of mechanical ventilation and staying in ICU in trial group were shorter than those in control group [(11.9±3.6)d vs (17.0±5.1)d,(14.1±4.2)d vs (21.5±7.7)d](P<0.05). Conclusion Mild hypothermia can effectively attenuate inflammation disorder, improve damaged lung function and prognosis in patients with ARDS.     

亚低温治疗急性呼吸窘迫综合征患者对炎性反应影响及肺保护作用的研究

Objective To explore the effect of mild hypothermia on inflammation status,lung function protection and clinical prognosis in patients with acute respiratory distress syndrome (ARDS).Methods All of 56 patients with ARDS were randomly divided into two groups: trial group (29 patients,treatment with mild hypothermia) and control group (27 patients, treatment with common practice). The following parameters including tumor necrosis factor (TNF)-α,interleukin (IL)-6 and C reactive protein (CRP), oxygenation index, SOFA evaluation and injury of lungs evaluation were detemined before treatment and at the 3rd, 7th day after treatment, and survival rates and adverse reaction in 28 days also were observed.Results After treatment, the levels of TNF-α ,IL-6 and CRP were decreased significantly, and oxygenation index, the scores of SOFA evaluation and injury of lungs evaluation were improved significantly in trial group than those in control group (P<0.05 ). The survival rate in trial group was higher than that in control group after treatment of 28 days [65.5%(19/29) vs 51.9%(14/27)]. The courses of mechanical ventilation and staying in ICU in trial group were shorter than those in control group [(11.9±3.6)d vs (17.0±5.1)d,(14.1±4.2)d vs (21.5±7.7)d](P<0.05). Conclusion Mild hypothermia can effectively attenuate inflammation disorder, improve damaged lung function and prognosis in patients with ARDS.     

快速康复方案在肛肠外科围手术期的临床研究

目的 研究快速康复方案在肛肠外科围手术期的安全性及有效性.方法 将169例结直肠、肛管恶性肿瘤围手术期患者按随机数字表法分为快速康复治疗方案组(观察组)86例与传统治疗方案组(对照组)83例,比较两组患者术后开始下床活动时间、首次肠道排气时间、停止静脉输液时间、住院时间、治疗费用及术后并发症的发生情况.结果 观察组术后首次肠道排气时间(33.6±12.9)h,停止静脉输液时间(4.5±1.3)d,住院时间(5.6±1.2)d,治疗费用(1.5±0.3)万元,对照组分别为(81.7±20.1)h、(7.4±1.6)d、(8.9±2.7)d、(1.6±0.4)万元,两组比较差异均有统计学意义(P＜0.01或＜0.05);观察组术后并发症的发生率[5.8%(5/86)]明显低于对照组[16.9%(14/83)](P＜0.05).结论 快速康复方案在肛肠外科围手术期的应用安全、有效、有益.

Abstract：

Objective To study the safety and efficacy of fast track program in anorectal surgery perioperative period. Methods One hundred and sixty-nine cases of rectal cancer were divided into the study group of 86 patients with fast track program, and the control group of 83 patients with traditional programs by random digits table. Both groups were compared from the time out of bed, the first intestinal discharge time,intravenous fluids stopping time,length of hospital stay,total cost of treatment and the incidence of postoperative complications. Results The study group compared with the control group: the first intestinal discharge time [(33.6 ± 12.9) h vs. (81.7 ± 20.1) h], intravenous fluids stopping time [(4.5 ±1.3) d vs.(7.4 ± 1.6) d],and length of hospital stay [(5.6 ± 1.2) d vs.(8.9 ±2.7) d],the total cost of treatment [(15 000 ± 3000) yuan vs. (16 000 ± 4000) yuan], the differences were statistically significant (P ＜ 0.01 or ＜ 0.05),and had less incidence of postoperative complications in study group than that in control group [5.8% (5/86) vs. 16.9% (14/83)], the difference was statistically significant (P ＜ 0.05).Conclusions Fast track program in anorectal surgery perioperative period is safe and effective, beneficial,conducive to rehabilitation of patients.     

糖皮质激素对重症肌无力患者外周血T淋巴细胞Fas表达的影响

目的 探讨糖皮质激素治疗重症肌无力(MG)与Fas介导的细胞凋亡的关系.方法 选择17例MG患者,其中6例接受糖皮质激素治疗(糖皮质激素治疗组),11例未接受糖皮质激素治疗(无糖皮质激素治疗组);另选择同期健康自愿献血者13例作为健康对照组,采用流式细胞技术检测三组外周血T淋巴细胞表面CD4、CDs及Fas的表达.结果 糖皮质激素治疗组外周血T淋巴细胞表面CD4-CD8+表达高于健康对照组[(36.75±11.56)%比(26.31±9.00)%],CD4-CD8-表达低于健康对照组[(30.56±9.72)%比(42.96±11.54)%],差异有统计学意义(P=0.027、0.018);糖皮质激素治疗组外周血T淋巴细胞表面CD4-CD8+表达高于无糖皮质激素治疗组[(36.75±11.56)%比(25.24±7.63)%],差异有统计学意义(P=0.019).糖皮质激素治疗组外周血T淋巴细胞表面Fas+、CD8+Fas+表达高于健康对照组[(46.10±7.13)%比(31.22±13.00)%,(62.86±12.29)%比(45.59±11.50)%],差异有统计学意义(P=0.006、0.003).糖皮质激素治疗组CD8+Fas+表达高于无糖皮质激素治疗组[(62.86±12.29)%比(50.84±8.31)%],差异有统计学意义(P=0.034).结论 糖皮质激素治疗对MG患者外周血T淋巴细胞亚群分布具有影响.Fas介导的细胞凋亡可能是糖皮质激素治疗MG的机制之一.

Abstract：

Objective To investigate the relation between Fas-mediated apoptosis and glucocorticoid treatment in myasthenia gravis (MG). Methods In 17 patients with MG, 6 patients received glucocorticoid treatment (glucocorticoid treatment group),and 11 patients were treated without glucocorticoid (nonglucocorticoid treatment group). Meanwhile, 13 healthy cases were selected as healthy control group. CD4,CD8 and Fas expressions in peripheral blood T lymphocyte were detected by flow cytometry in three groups and analyzed. Results The percentage of CD4-CD8+ cells in peripheral blood T lymphocyte in glucocorticoid treatment group was significantly higher than that in healthy control group[(36.75 ± 11.56)% vs. (26.31 ±9.00)%, P = 0.027], while the percentage of CD4-CD8- cells was significantly lower [(30.56 ± 9.72)% vs.(42.96 ± 11.54)%, P =0.018]. The percentage of CD4-CD8+ cells in peripheral blood T lymphocyte in glucocorticoid treatment group was significantly higher than that in non-glucocorticoid treatment group [(36.75 ± 11.56)% vs. (25.24 ±7.63)% ,P =0.019]. The percentages of Fas+ and CD8 +Fas+ cells in peripheral blood T lymphocyte in glucocorticoid treatment group were significantly higher than those in healthy control group[(46.10 ± 7.13)% vs. (31.22 ± 13.00)%, P=0.006; (62.86 ± 12.29)% vs. (45.59 ±11.50)%, P = 0.003]. The percentage of CD8+ Fas+ cells in peripheral blood T lymphocyte in glucocorticoid treatment group was significantly higher than that in non-glucocorticoid treatment group [(62.86 ± 12.29)%vs (50.84 ± 8.31 )%, P = 0.034]. Conclusions Glucocorticoid treatment may have influence on peripheral blood T lymphocyte subsets in patients with MG. Fas-mediated apoptosis may be involved in the mechanism of glucocorticoid treatment in MG.     

血清降钙素原在社区获得性肺炎诊断与病情判断中的价值

Objective To estimate the influence of abnormal glucose metabolism during pregnancy and family history of cardio-cerebrovascular disease and/or diabetes on umbilical C-peptide concentrations. Methods Chesed 85 pregnant women who had prenatal examination and their newborns as the subjects. Thirty-six newborns of mothers with gestational diabetes mellitus, impaired glucose tolerance or diabetes mellitus with pregnancy and 49 newborns of mothers with normal glucose tolerance were randomly chosed as the control group. All newborns were also classified according to whether their maternal grandparents had history of diabetes and/or cardio-cerebrovaacular disease. Therefore, there were four groups in this study: 25 newborns in group A were of diabetic mothers and positive family history, 11 newborns in group B were of diabetic mothers but negative family history, 9 newborns in group C were of mothers with normal glucose tolerance but positive family history, 40 newborns in group D were of mothers with normal glucose tolerance and negative family history. The blood samples of umbilical veins were collected at the time of delivery. Umbilical C-peptide levels of the four groups were measured by radioimmunonssay. Results The umbilical C-peptide concentrations of newborns in group A, B, C, D were (2.22±1.52), (1.44±0.63), (1.13± 0.34), (1.31±0.69) μg/L respectively, the umbilical C-peptide concentrations of newborns in group A were elevated compared to those of other three groups (F=5.11, P=0.003), and there were no significant differences in C-peptide levels of newborns between the three groups (group B vs C P=0.499, group B vs D P=0.694, group C vs D P=0.642). Conclusion Special attention should be given to newborns of diabetic mothers and whose maternal grandparents have history of diabetes and/or cardio-cerebrovascular disease.     

辅助生殖技术后输卵管间质部妊娠 10 例临床分析

Objective： This is ten cases report of the interstitial pregnancy after assisted reproductive technology （ART）. Methods：Ten cases of the interstitial pregnancy after IVF/ICSI-ET in our center, from July 2011 to July 2013, were retrospectively analyzed. Clinical features and related risk factors were summarized. Results：Ten patients aged （32.9±3.7）years, with the tubal-related operation history, accepted IVF/ICSI treatment due to their tubal factors. Four cases had a history of ectopic pregnancy. Nine patients had been transferred 2 embryos in their ART cycles,and only 1 case transfered a single embryo. As for clinical manifestations,6 cases were firstly suspected for ectopic pregnancy by B ultrasound, 1 case suffered from abdominal pain ,1 case had a small amount of vaginal bleeding,and the other 2 cases were complained of abdominal pain and vaginal bleeding. After diagnosed, eight patients underwent direct operation,one case successfully received MTX treatment while another one case underwent operation after her unsuccessful MTX treatment. Conclusions：The interstitial pregnancy after IVF/ICSI was possibly related to abnormal function of fallopian tube after the tubal-related operation, especially tube resection or the proximal tubal occlusion. The number of transferred embryos should be controlled in those IVF/ICSI patients with high-risk factors,while B ultrasound monitoring after transplantation and health education should be added so as to reduce the adverse outcome of the interstitial pregnancy after ART. [ABSTRACT FROM AUTHOR]     

Influence of airway mucus plugs on patients with bronchial asthma and its managementCSCD

Objective To explore the influence of airway mucus plugs on patients with bronchial asthma and its management. Methods In this cross‑sectional study, from January 2020 to June 2022, 100 patients who were diagnosed with asthma and underwent chest CT examination in the Outpatient Department of Peking University Third Hospital were included. The chest CT results and medical history, pulmonary function, fractional exhaled nitric oxide (FeNO), blood routine, total allergen IgE, Aspergillus fumigatus M3 allergen‑specific IgE antibody test results were collected. According to the results of chest CT, the asthma patients were divided into group with mucus plugs and those without mucus plugs. Distribution of airway mucus plugs and the mucus plug scores based on lung segments were calculated. The relationships of mucus plugs with medical history, pulmonary function [These included before and after the bronchodilation test, forced vital capacity percent of predicted value (FVC%pred), forced expiratory volume in one second percent of predicted value (FEV1%pred), FEV1/FVC, peak expiratory flow percent of predicted value (PEF% pred), maximal mid‑expiratory flow percent of predicted value (MMEF%pred), maximal expiratory flow at 25%, 50%, 75% of vital capacity remaining percent of predicted value (MEF25%pred, MEF50%pred, MEF75%pred)], FeNO, and peripheral blood eosinophil (Eos) counts were analyzed. The logistic regression model was used to analyze whether airway mucus plug was a risk factor for asthma exacerbation, and the corresponding intervention strategies were explored. Results Among the 100 patients with asthma, 24 cases were in the mucus plug group and 76 cases were in the non‑mucus plug group. The distribution of mucus plug was more common in the lower lungs (30.53% and 9.16% in the lower and upper lobe of left lung, respectively; 29.01%, 14.50% and 16.80% in the lower, middle and upper lobe of right lung, respectively). The average score of mucus plug was (4.42±3.12) points. The body mass index (BMI), the number of visits to a doctor due to asthma exacerbations, FeNO, peripheral blood Eos counts in the mucus plug group were higher than those in the non‑mucus plug group [(24.95±4.34) vs (23.22±2.91) kg/m2, 0(0, 1) vs 0(0, 0), 97(37, 169) vs 31(18, 59) ppb (1 ppb=1×10‑9), 0.41(0.15, 0.70) vs 0.18(0.09, 0.37)×109/L](all P<0.05), and FVC% pred, FEV1%pred, FEV1/FVC, PEF% pred, MEF50%pred, MEF25%pred, MMEF% pred, MEF75%pred were lower than those in the non‑mucus plug group [(87.49±19.32)% vs (97.34± 14.24)%, (76.49±19.58)% vs (91.07±18.33)%, (72.44±10.91)% vs (79.48±8.13)%, (82.36±24.46)% vs (93.83±18.27)%, (53.03±24.81)% vs (75.75±27.15)%, (46.47±22.92)% vs (64.09±25.90)%, (50.28±23.73)% vs (74.53±26.80)%, (71.30±27.55)% vs (89.92±26.82)%] (all P<0.05). In the group with mucus plug, the airway mucus plug score was positively correlated with the patient′s body weight and the number of peripheral blood Eos counts at enrollment (r=0.413, 0.478; all P<0.05), and negatively correlated with FVC%pred and FEV1%pred (r=-0.576, -0.465; all P<0.05). Logistic regression analysis showed that airway mucus plug score was a risk factor for acute asthma attack (OR=1.269, 95%CI: 1.031-1.562; P=0.024). Conclusions Asthma patients have a high incidence of airway mucus plug, which is related to the level of Eos inflammation and body size. Airway mucus plugs can promote airflow obstruction and acute exacerbation of asthma. In clinical practice, appropriate asthma management policies can be formulated for airway mucus plugs to delay the progression of asthma and reduce the number of acute attacks. © 2023 Chinese Journal of Health Management. All rights reserved.     

Diagnostic value of vascular endothelial growth factor combined with β-human chorionic gonadotropin for suspected ectopic pregnancy

Objective To explore the diagnostic values of vascular endothelial growth factor (VEGF) and p -human chorionic gonadotropin( β -hCG) for early ectopic pregnancy. Methods The serum levels of VEGF and β-hCG were measured in 109 patients with suspected ectopic pregnancy by ELISA and RIA respectively, receiver operating characteristic (ROC) curvers were established, the diagnostic values of VEGF and β -hCG for ectopic pregnancy were analyzed. Results One hundred and nine patients with suspected ectopic pregnancy were diagnosed in the end: 62 cases with ectopic pregnancy and 47 cases with intrauterine pregnancy. The levels of VEGF in ectopic pregnancy were significantly higher than those in intrauterine pregnancy (P ＜ 0.05), but the levels of β -hCG were significantly lower than those in intrauterine pregnancy (P ＜ 0.05). The areas under ROC curves of VEGF were 0.87, the areas under ROC curves of β -hCG were 0.71. In VEGF ＞ 140 ng/L for diagnosis of ectopic pregnancy, the sensitivity and specificity were 75.8% (47/62) and 80.9% (38/47) respectively. In β-hCG ＜ 1200 U/L for diagnosis of ectopic pregnancy, the sensitivity and specificity were 64.5%(40/62) and 61.7%(29/47) respectively. The sensitivity and specificity of combined detection of VEGF and β -hCG were 80.6%(50/62) and 57.4%( 27/47) respectively. Conclusions The diagnostic values of VEGF are better than those of β -hCG. The combined detection of VEGF and β -hCG can increase the rate of early diagnosis and shorten observation time.     

含橄榄油脂肪乳剂在肝叶切除患者术后肠外营养中的应用

Objective To assess the safety and efficacy of an olive oil-based lipid emulsion for parenteral nutrition in patients after hepatectomy.Methods Thirty-one postoperative patients with elective hepateetomy were randomized to receive isonitrogenous,isocalorie parenteral nutrition over 6 days after liver lobectomy(48-72hours)with either olive oil-based lipid emulsion(study group,n=15)or standard soybean oil emulsion(control group,n=16).The liver function and plasma protoins were assessed using peripheral venous blood collected before surgery,one day after surgery,and 7 days after surgery.The safety profiles of emulsion supports and postoperative rehabilitation were also assessed.Results The preoperative serum levels of total bilirubin,direct bilirubin,alanine amiotransferase,aspartate aminotransferase,alkaline phosphatase,total protein,albumin,and prealbumin were comparable between the two groups(all P>0.05).Although the Postoperative safety profile and liver function were not significantly different between two groups(all P>0.05),plasma total proteins,albumin,and prealbumin returned to the normal levels significantly faster in the study group than in control group[(57.57±9.84)g/L vs.(47.76±6.53)g/L,P=0.000;(31.29±3.11)g/L vs.(26.34±4.87)g/L,P=0.000;(0.188±0.059)g/L vs.(0.103±0.037)g/L,P=0.000]on the 7th Postoperative day,and the Postoperative hospital stay was also significantly shorter in the study group[(13.1±1.2)d vs.(15.2±1.1)d,P=0.041].The incidence of postoperative complications in study group and control group was 26.7%and 31.3%.respectively.Conclusions Treatment with the new olive oil-based lipid emulsion is weU tolerated in hepatectomy patients.It can speed up plasma proteins recovery and may shorten postoperative hospital stay,although it does not remarkably decrease the incidence of postoperative complications.     

慢性乙型肝炎肝组织损伤的相关因素研究

Objective To study the expression of adiponectin and α-smooth muscle actin (α-SMA) in liver from the patients of chronic hepatitis B(CHB) overlapped non-alcoholic fatty liver disease( NAFLD), and to explore the mechanism of CHB patients with NAFLD. Methods 94 patients of CHB overlapped NAFLD (case group)underwent liver biopsy, 119 cases of patients with CHB alone (control group) as control, the fasting venous blood sample was taken for liver biochemical and virological indicators. Liver biopsy specimens were immunohistochemically stained for histology, adiponectin and α-SMA, and integral absorbance. Results The serum ALT, total cholesterol, triglyceride, low density lipoprotein cholesterol and fasting glucose levels in case group were significantly higher than that in control group (Z = 3.425,4.488,4.858、2.265, P < 0.05) .There was no significant difference in HBV DNA viral load and HBeAg between the two groups( Z = 0.825, χ2 = 0.323, P > 0.05). In case group, adiponectin expression was no significant correlation with steatosis, inflammation and fibrosis(r = 0.032, -0.107, -0.133, P>0.05); however, in control group adiponectin was negatively related to inflammation and fibrosis(r= -0.223, -0.259,P<0.05). In case group,α-SMA expression was significant correlation with inflammation and fibrosis( r = 0.323,0.355, P < 0.05). In control group, its expression was no correlation with inflammation and fibrosis( r = 0.172,0.155, P > 0.05). Conclusions The occurrence of NAFLD is mainly related to metabolic factors and no relation with viral factors. Adiponectin is not directly related to liver injury of patients of CHB overlapped NAFLD. α-SMA may be important indicator of liver injury,and NAFLD may promote the progress of liver injury in patients with CHB.     

Investigation and analysis of psychological stress of assisted reproduction patients after COVID-19 epidemic北大核心CSCD

Objective To analyze the psychological stress of infertile patients after COVID-19 epidemic and its related factors by Chinese version of the perceived stress scale (CPSS). Method The basic information, reproductive history, impact of the epidemic, psychological status of patients undergoing assisted reproductive technology at the General Hospital of Northern Theater Command from March 29, 2021 to April 29, 2021 were collected by questionnaire. According to CPSS, group comparison and correlation analysis were used to explore factors related to patients' psychological stress. Results A total of 251 valid questionnaires were received. The average CPSS score of the patients was 22.43±7.07. During the epidemic, about 33.86% (85/251) of the infertility patients postponed the fertilization plan; there were significant differences in the psychological stress among patients of different genders, occupations, and postponed fertilization plans at different stages of fertilization (P=0.001, P=0.005, P=0.002). There was no significant difference in CPSS score between infertile patients who delayed treatment or not (P>0.05). Correlation analysis showed that the perceived stress of patients was negatively correlated with their age, income, and delay duration (r=-0.192, P=0.002; r=-0.323, P=0.001; r=-0.282, P=0.009). Among all patients who delayed treatment, patients with higher CPSS score would restart treatment sooner; most of the infertile patients knew little about the vaccine. Conclusion The COVID-19 epidemic has caused a certain impact on the psychological pressure of infertile couples who accepted treatment in our hospital. The psychological care for infertile patients is particularly important. In the future, in order to dispel the doubts of infertile patients about the vaccine, we should pay attention to the correct scientific promotion of the COVID-19 vaccine during the treatment process. © 2020 Chinese Medical Journals Publishing House Co.Ltd. All Rights Reserved.     

联合应用子宫输卵管造影和B超监测卵泡治疗不孕症的疗效观察

Objective To observe the therapeutic effect on the infertilitas feminis combining hysterosalpingography (HSG) and B ultraphonic monitor for the follicle. Methods Five hundred and eighty-four patients with infertility were divided into two groups by random digits table: control group with 292 patients received the combined optimized treatment, and study group with 292 patients received the combined optimized treatment and optimizing fallopian tube to be pregnant. All patients received the HSG while the patients of the study group received the B ultraphonic monitor for the dominant follicle besides. Results The intrauterine gestation rate in the study group was higher than that in the control group [ 40.07% (117/292) vs. 19.86% (58/292)] (P ＜0.01),and the eccyesis rate was lower than that in the control group [29.79% (87/292) vs. 51.37%(l50/292)](P＜0.01). The eccyesis rate in fallopian tube incompletely unobstructed [74.36% (58/78)] was higher than that in hydrosalpinx [ 38.96% (30/77)] , salpingemphraxis [38.24% (104/272)] and fallopian tube unobstructed[28.66%(45/157)](P＜0.01). Conclusions HSG can detect and imply the situation of the fallopian tube of the infertilitas feminis women, and B ultraphonic can monitor the follicular development to catch the dominant follicle. Combining these two detection and guiding sexual life can raise the intrauterine gestation rate. It should be widely use in clinic.