克龄蒙联合坤泰胶囊治疗卵巢早衰对患者血清性激素水平的影响观察

目的 探究克龄蒙联合坤泰胶囊治疗卵巢早衰对患者血清性激素水平的影响。方法 选取96例卵巢早衰患者,按照随机数字表法分为对照组与研究组,每组48例。对照组接受克龄蒙治疗,研究组在对照组基础上接受坤泰胶囊治疗。比较两组临床疗效、血清性激素水平及不良反应发生率。结果 研究组临床治疗总有效率97.92%高于对照组的81.25%(P<0.05)。研究组不良反应发生率略高于对照组,但差异无统计学意义(P>0.05)。治疗前,两组促黄体生成素(LH)、雌激素(E₂)、卵泡刺激素(FSH)水平比较,差异无统计学意义(P>0.05);研究组治疗后LH、FSH水平低于对照组,E₂水平高于对照组(P<0.05)。结论 对卵巢早衰患者实施克龄蒙联合坤泰胶囊治疗可以有效改善性激素水平,提高治疗效果,且治疗安全性有保障。     

三种促排卵方案对卵巢储备力低下患者助孕效果比较

目的:探讨卵巢储备力低下患者行体外受精/卵胞浆内单精子显微注射-胚胎移植(IVF/ICSI-ET)助孕时较理想的超促排卵方案。方法:将302例行IVF/ICSI-ET助孕的卵巢储备力低下患者分为3组:微刺激方案组(A组,98例)、黄体期促排卵方案组(B组,62例)和超短方案组(C组,142例),比较3组的一般情况、周期取消率、总促性腺激素释放激素(Gn)使用天数(Gn天数)、人绒毛膜促性腺激素(HCG)日血雌二醇(E_2)、促黄体生成素(LH)、孕酮(P)及子宫内膜厚度、平均获卵数、受精率、形成胚胎率、优质胚胎率、临床妊娠率、生化妊娠率。结果:A组的周期取消率均明显高于B、C两组(P0.05);A组的总Gn天数最短,C组的总Gn天数最长(P0.05);A组的HCG日子宫内膜厚度低于B、C组,但差异无统计学意义;A组的HCG日E_2水平、平均获卵数均低于B、C两组,C组的HCG日LH水平均低于A、B两组(P0.05)。3组的一般情况、正常受精率、成胚率、优胚率、临床妊娠率、生化妊娠率均无统计学差异。结论:超短方案可能是较好的卵巢储备力低下超促排卵方案,同时黄体期促排卵亦不失为一种新的有效促排卵方案。     

安宫黄体酮和来曲唑联合Gn超促排卵在卵巢储备减退患者IVF/ICSI-FET中应用效果的比较

目的:比较安宫黄体酮(MPA)联合促性腺激素(Gn)超促排卵与来曲唑微刺激促排卵在卵巢储备功能减退(DOR)患者体外受精及冻融胚胎移植(FET)中的应用效果。方法:回顾分析730周期拟行体外受精助孕的DOR的不孕症患者的临床资料,380周期行MPA联合Gn促排卵(MPA组),350周期行来曲唑联合Gn促排卵(来曲唑组)。观察两组的周期取消率、Gn天数、Gn剂量、性激素水平、获卵数、可利用胚胎数、优胚率和FET妊娠率、种植率、流产率和活产率。结果:MPA组患者的Gn使用时间、Gn使用总量、优胚率均显著高于来曲唑组(P0.05),而HCG日LH水平、HCG日P水平、可用胚胎数显著低于来曲唑组(P0.05)。两组的获卵数、成熟卵数、受精卵数、卵裂数比较,差异均无统计学意义(P0.05)。MPA组患者的FET种植率和临床妊娠率均显著高于来曲唑组(P0.05)。两组患者的流产率、异位妊娠率和活产率比较,差异均无统计学意义(P0.05)。结论:与来曲唑联合Gn促排卵比较,MPA联合Gn促排卵对于DOR患者可有效抑制早发LH峰,减少提前排卵发生,能获得可观的临床妊娠率,值得临床应用推广。     

人工黄体期促排卵在卵巢储备功能低下患者中的应用

目的:比较微刺激方案与人工黄体期促排卵方案在卵巢储备功能低下患者体外受精-胚胎移植(l VF-ET)周期中的应用效果,探讨人工黄体期促排卵在卵巢储备功能低下患者中的价值。方法:回顾分析2014年4月至2015年3月在焦作市妇幼保健院生殖中心行IVF助孕的210周期,比较氯米芬微刺激方案组和人工黄体期促排卵方案组的一般资料、促排卵情况、获卵数、取消周期率、2PN率、可利用胚胎率及冷冻胚胎移植妊娠结局等。结果:两组患者的年龄、基础FSH水平及窦卵泡数等比较,差异无统计学意义(P0.05)。与微刺激组比较,人工黄体期促排卵组的Gn天数及Gn总量较多,差异有统计学意义(P0.05)。人工黄体期促排卵组的HCG日E2及P水平均明显高于微刺激组,而LH水平明显低于微刺激组,差异均有统计学意义(P0.05)。人工黄体期促排卵组的获卵数及优胚数较微刺激组多,差异有统计学意义(P0.05)。两组胚胎解冻后妊娠率无明显差异(P0.05)。结论:对于卵巢储备功能低下的患者,人工黄体期促排卵方案可取得较高的获卵数及可利用胚胎数,解冻移植后可获得较满意的临床妊娠结局,提示人工黄体期促排卵方案可为卵巢储备功能低下的患者争取更多的妊娠时机。     

脱氢表雄酮在卵巢储备功能低下高龄患者体外受精/卵胞质内单精子注射-胚胎移植中的应用研究

目的探讨口服脱氢表雄酮(DHEA)辅助治疗在卵巢储备功能低下(DOR)高龄患者体外受精/卵胞质内单精子显微注射-胚胎移植(IVF/ICSI-ET)中的临床疗效。方法选取行IVF/ICSI助孕治疗的DOR患者152例,所有患者均行2次及以上助孕周期,前一周期为未加用药周期(治疗前组),本次为用药周期(治疗后组),进行自身用药前后对照分析。比较口服DHEA后卵巢储备功能的变化情况,同时比较是否加用DEHA患者IVF/ICSI-ET的临床治疗参数、实验室参数及临床结局。结果 (1)口服DHEA后患者血清抗苗勒管激素(AMH)、硫酸脱氢表雄酮(DHEA-s)、睾酮(T)及窦卵泡计数(AFC)较用药前升高,卵泡刺激素(FSH)较前下降,差异有统计学意义(P0.05);(2)治疗后组h CG注射日E2及孕酮(P)水平、获卵数、受精率、可移植胚胎数、胚胎种植率及临床妊娠率高于治疗前组,Gn总用量、Gn使用时间、周期取消率低于治疗前组,差异有统计学意义(P0.05)。结论 DOR的高龄患者在进入IVF/ICSI周期前口服DHEA可改善其卵巢储备功能及助孕结局。     

卵巢低反应专家共识

卵巢低反应(POR)是卵巢对促性腺激素(Gn)刺激反应不良的病理状态。POR诊断标准满足以下3条中的2条即可:1高龄(≥40岁)或存在卵巢反应不良的其它危险因素;2前次IVF周期卵巢低反应,常规方案获卵数≤3个;3卵巢储备下降[窦卵泡数(AFC)5~7个或抗苗勒管激素(AMH)0.5~1.1μg/L]。其病因主要与年龄、遗传和免疫因素、环境因素等有关。在IVF助孕中建议采用常规的Gn RHa长方案、Gn RHa短方案和Gn RHA方案进行促排卵,也可采用非传统的微刺激方案、自然周期方案等方法。另外,使用生长激素(GH)、雄激素(A)、雌激素、口服避孕药(OC)等及中医中药来预处理有利于患者治疗结局的改善。     

IVF周期中非多囊卵巢患者基础睾酮值对卵巢功能的预测

目的：研究体外受精胚胎移植（IVF-ET）周期中患者基础睾酮（T）值的水平,探讨其与卵巢反应性之间的关系。方法：回顾分析2011年5月至2012年7月于我中心行第一周期IVF长方案控制性促排卵（COH）助孕的1413例患者。根据基础T值分为A组（T≤20ng/dl,473例）和B组（T〉20ng/dl,940例）。比较两组患者的基础T值与卵巢反应性之间的关系。结果：两组患者的体重指数（BMI）、基础FSH水平、基础LH水平、窦卵泡数、Gn天数、Gn总量、〉14mm卵泡数、获卵数、HCG日内膜厚度（cm）、优质胚胎数、冷冻胚胎数均差异显著（P〈0.05）。基础T水平与卵巢反应性、HCG日〉14mm卵泡数及Gn总用量呈正相关性。结论：基础T值能预测患者的卵巢功能及COH中Gn用量。     

来曲唑微刺激方案和短方案对卵巢低反应助孕的临床研究

目的:探讨卵巢低反应助孕患者在进行体外受精/卵细胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)治疗中来曲唑(LE)微刺激方案和短方案的应用.方法:回顾性分析进行IVF/ICSI-ET治疗的卵巢低反应患者共206个周期.按治疗方案分短方案组(97周期)和微刺激组(109周期),分别比较两组患者的一般情况、促排卵情况及妊娠结局等.结果:短方案组的促性腺激素(Gn)用量、Gn刺激天数、HCG注射日雌激素(E2)值、≥16 mm卵泡数等均高于微刺激组,差异有统计学意义(P＜0.05).而两组成熟率、正常受精率、卵裂率、周期取消率、生化妊娠率及临床妊娠率比较,差异无统计学意义(P＞0.05),但微刺激组的优质胚胎率显著高于短方案组(P＜0.01).结论:来曲唑微刺激方案是卵巢反应低下患者较理想的促排卵方案.     

长效促性腺激素释放激素激动剂用于体外受精-胚胎移植中降调节后延迟卵巢启动时间的探讨

目的:探讨体外受精-胚胎移植(IVF-ET)中应用半量长效促性腺激素释放激素激动剂(GnRHa)降调节后,延迟超促排卵(COH)启动时间对实验室和临床结局等的影响。方法:将IVF中207个周期分为3组,使用不同剂型的GnRHa和COH的启动时间。结果:常规组的取消周期数最多(P<0.01)。COH启动日,延迟组和对照组之间E2、LH水平高于常规组(P均<0.01)。HCG注射日,对照组的E2水平最高;延迟组和对照组中LH水平高于常规组(P均<0.01),刺激天数和Gn用量少于常规组(P均<0.005);获卵数、受精率、可移植胚胎数、临床妊娠率、胚胎种植率和MⅡ期卵子高于常规组(P均<0.05)。结论:延迟COH启动时间可减少卵巢刺激时间、Gn用量,增加获卵数、成熟卵子数,可移植胚胎数和胚胎种植率,提高IVF的妊娠率。     

卵巢反应低下患者辅助生殖技术促排卵方案的对比分析

目的:通过比较卵巢反应低下(POR)患者在进行辅助生殖技术(ART)治疗中几种促排卵方案的治疗结局,探讨针对POR患者经济有效、个性化的促排卵方案。方法:回顾性分析行体外受精/卵细胞浆内单精子注射(IVF/ICSI)治疗的POR患者共302个周期,按不同促排卵方案分为4组:超短方案组(43个周期),短方案组(30个周期),氯米芬联合尿促性素微刺激方案组(CC+HMG组,62个周期),卵泡期尿促性素联合甲羟孕酮方案组(HMG+MPA组,167个周期)。对4组患者的促排卵情况、周期取消情况及每起始周期的临床结局进行比较。结果:(1)4组患者ART周期中Gn天数、Gn用量、药费、扳机日优势卵泡数、获卵率、性价比比较,差异有统计学意义(P0.05);其中,超短方案组的Gn天数最长,Gn用量最多;短方案组扳机日优势卵泡数最多,完成1次治疗周期的药费最贵,相对取得1个可移植胚胎的性价比最差;CC+HMG组的Gn天数最短、Gn用量最少,但扳机日优势卵泡数最少,获卵率也最低;HMG+MPA组药费最低,获卵率最高,性价比最好。(2)在取消周期方面,4组间因异常受精及未受精、未卵裂、无可移植胚胎、无优质胚胎而取消周期的差异无统计学意义(P0.05)。CC+HMG组及超短方案组的未获卵周期率高于短方案组及HMG+MPA组(P0.05)。(3)4组方案每起始周期的临床妊娠率、着床率比较,差异无统计学意义(P0.05)。HMG+MPA组的流产率低于CC+HMG组(P0.05);HMG+MPA组每起始周期的继续妊娠率高于超短方案组与CC+HMG组(P0.05)。结论:卵泡期HMG+MPA方案可能是POR患者的一种经济的、有效的、有利于患者的促排卵方案。     

miRNAs小鼠哮喘模型中的作用初探

目的 探讨小鼠哮喘模型中miRNAs的差异表达情况.方法 将24只BALB/c小鼠随机分为正常对照组、卵清蛋白处理组、地塞米松治疗组各8只,使用血细胞分析仪检测每组肺泡灌洗液中嗜酸性粒细胞(EOS)、嗜中性粒细胞(NEU)、巨噬细胞(MAC)和淋巴细胞(LYM)的表达情况,通过ELISA的方法 检测每组肺泡灌洗液中白细...     

Role of ultrasound in the management of diabetes in pregnancy

The purpose of this review is to discuss the established role of ultrasound (US) in the management of pregnancy complicated by diabetes mellitus (DM), as well as new developments with regard to the use of US in this situation. We choose to explore the role of US in pregnancy complicated by DM in three areas:

(1) Role of US in estimation of fetal weight.

(2) Role of US in diagnosis of congenital malformation.

(3) Role of US in monitoring diabetic pregnant patients.     

Increase in incidence of gastroschisis in the South West of England in 1995

Objective To describe the incidence of gastroschisis and to identify possible aetiological factors.
Design A retrospective case review study.
Setting The South West Region of England.
Population All known cases of gastroschisis were identified from the regional fetal medicine, ultrasound, pathology and neonatal surgery databases. Datasets to be collected were agreed prospectively and included demographic, past medical, family and obstetric information for all pregnancies conceived between January 1987 and December 1995.
Results In the first eight years the incidence was 1.61 10,000 but in 1995 a highly statistically significant rise to 4.4/ 10,000 was found (   P = 0.0009  ). The increased incidence was not associated with changes in maternal age, proportion of primigravidae, use of tobacco or illicit drugs, conception while taking the oral contraceptive pill, or an increase in the number of teenage pregnancies. The median maternal age at last menstrual period for pregnancies with gastroschisis was 20.4 years which was much younger than the national average of 28 years. Thirty-seven percent of these conceptions occurred during the first quarter of the year compared with the expected 25%.
Conclusions The incidence of gastroschisis has risen to a higher level than previously reported which, despite a marked association with young maternal age at conception, is not due to an increase in the teenage pregnancy rate. As the average length of inpatient stay in the neonatal intensive care unit for cases with this malformation is approximately four weeks, the rise has considerable cost implications. The increasing incidence may also offer opportunities to determine the cause of gastroschisis.     

Challenges in the Practice of Sexual Medicine in the Time of COVID-19 in China

BackgroundIn March 2020, the World Health Organization declared coronavirus disease 2019 (COVID-19), which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a pandemic. Currently, data on changes in sexual behavior during the COVID-19 outbreak are limited.AimThe present study aimed to obtain a preliminary understanding of the changes in people's sexual behavior, as a result of the pandemic, and explore the context in which they manifest.MethodsA convenience sample of 270 men and 189 women who completed an online survey consisting of 12 items plus an additional question were included in the study.OutcomesThe study outcomes were obtained using a study-specific questionnaire to assess the changes in people's sexual behavior.ResultsWhile there was a wide range of individual responses, our results showed that 44% of participants reported a decrease in the number of sexual partners and about 37% of participants reported a decrease in sexual frequency. Multiple regression analysis showed that age, partner relationship, and sexual desire were closely related to sexual frequency. In addition, we found that most individuals with risky sexual experiences had a rapid reduction in risky sexual behavior.Clinical ImplicationsThe current findings contribute to identifying another potential health implication associated with the COVID-19 pandemic and report preliminary evidence of the need to provide potential interventions for the population.Strength & LimitationsThis study is the first to perform a preliminary exploration of sexual behavior during the COVID-19 outbreak. The generalizability of the results is limited, given that only a small convenience sample was used.ConclusionDuring the height of the COVID-19 outbreak, overall sexual activity, frequency, and risky behaviors declined significantly among young men and women in China.Li W, Li G, Xin C, et al. Challenges in the Practice of Sexual Medicine in the Time of COVID-19 in China. J Sex Med 2020;17:1225–1228.     

Effectiveness of Antihypertensive Drugs in the Treatment of Hypertension in Pregnancy

The purpose of this open, prospective, randomized, comparative study was to examine the effectiveness of atenolol, a cardioselective beta₁ blocker, alphamethyldopa, an alpha-adrenergic antagonist, and ketanserin, a serotonin receptor antagonist, in the treatment of 90 patients (N–30 each) with severe chronic hypertension (ChH) during pregnancy or severe pregnancy-induced hypertension, with or without proteinuria in either case.

Arterial blood pressure (BP) for each drug group was analyzed at the onset of treatment, weekly for three weeks, and at the end of pregnancy. After one week of treatment a significant drop in BP was observed in the three groups of patients. Thereafter BP remained stable until the end of gestation, when a slight increase in BP was observed, especially in the group of patients treated with ketanserin.

No significant difference was observed between the groups in mean birthweight and perinatal morbidity and mortality. No adverse effects from the drugs on the fetus or newborn were observed. No significant difference was observed among the three drugs in their antihypertensive effect. However, given the relatively small numbers of patients studied, definitive statements regarding the relative efficacy and safety of alphamethyldopa, ketanserin and atenolol cannot be made. Thus, additional, larger controlled trials of these agents are required.     

Seroprevalence of TORCH infections in women of childbearing age in Croatia

During 2005–2009, a seroepidemiological study was carried out in Croatia to define the population susceptible to common TORCH agents among pregnant and non-pregnant women of childbearing age. The IgG seroprevalence was 29.1% forT. gondii, 94.6% for rubella, 75.3% for cytomegalovirus (CMV), 78.7% for herpes simplex virus type 1 (HSV-1), and 6.8% for HSV-2. Acute toxoplasmosis and CMV infection (positive IgM antibodies with low IgG avidity) were documented in 0.25% and 0.09% women, respectively. IgM prevalence was 1.2% for both HSV-1 and HSV-2. None of the participants showed acute rubella infection. Seropositivity to T. gondii and HSV-2 varied significantly between age groups (p?=?0.001 and p?=?0.036, respectively). Women residing in rural regions showed a significantly higher seroprevalence rate for T. gondii, CMV, and HSV-1 than urban women (T. gondii: 44.0% vs. 25.4%, p?<?0.001; CMV: 85.0% vs. 73.1%, p?=?0.018; HSV-1: 86.0% vs. 76.4%, p?=?0.041).     

细胞自噬在子宫腺肌病发病机制中作用的研究进展

子宫腺肌病(adenomyosis)作为女性常见疾病之一,其常见症状如痛经、经量过多对患者生活质量造成严重影响,常并发贫血甚至休克,子宫腺肌病还可导致不良妊娠及不孕症。子宫腺肌病保守治疗效果较差、较易复发,部分患者需接受手术治疗。子宫腺肌病的发病机制目前尚不明确,近年也逐渐成为妇科领域的研究热点。细胞自噬(autophagy)作为调节细胞生长代谢的重要生理机制,其在包括肿瘤在内的众多疾病的发生、发展中发挥着重要作用。近年细胞自噬在子宫腺肌病发生、发展及转归方面的作用日益引起关注,针对两者之间关系的研究也越来越多。总结自噬在子宫腺肌病中作用的最新相关研究进展,并对自噬在子宫腺肌病治疗中的潜在作用进行探讨。     

广州地区6493例女性生殖道人乳头状瘤病毒检测结果分析

目的了解广州地区妇女生殖道人乳头状瘤病毒感染状况和基因亚型分布。方法 2006年10月至2010年2月,采用核酸分子快速导流杂交基因芯片分型技术(HybriMax)对广州地区6493例女性进行人乳头状瘤病毒检测,并对HPVDNA亚型、感染率和年龄分布进行分析。结果 6493例女性中检出HPV阳性1947例,阳性率为29.99%。阳性感染者中,单一型感染最多,为1436例,占73.75%,其中高危单一型感染者1143例,占58.71%,低危单一型感染者293例,占15.05%;混合型感染者511例,占26.25%,主要为双重感染,占19.41%。15个与宫颈癌密切相关的HPV高危亚型阳性率为25.24%,6个低危亚型HPV感染阳性率为7.98%。排在前十位的亚型分别是HPV52(25.22%)、HPV58(14.20%)、HPV16(13.56%)、HPV6(9.76%)、HPV11(8.32%)、HPV53(7.70%)、HPV33(6.73%)、CP8304(6.68)、HPV68(6.63)、HPV18(6.52%)。在各年龄组中,小于20岁女性感染率最高,为52.5%,各年龄组HPV感染差异有统计学意义...