海藻糖在人类成熟卵母细胞玻璃化冷冻中初步应用

目的:探讨海藻糖在人类成熟卵母细胞玻璃化冷冻中的临床应用价值。方法:回顾性分析2014年1月至2015年12月在我院生殖中心行卵母细胞玻璃化冷冻的8例患者,解冻后行卵胞浆内单精子显微注射,记录存活、受精、卵裂及妊娠情况。结果:8例患者共解冻52枚胚胎,存活43枚,存活率82.69%,受精率67.44%,卵裂率89.66%;1例患者取消移植,7个移植周期获得临床妊娠3例,其中胚停1例,活产1例,继续妊娠1例。结论:海藻糖在人类成熟卵母细胞玻璃化冷冻中的临床应用可获得较好的临床结局。     

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。     

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(P>0.05)。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(P>0.05),但是A1组的胚胎复苏率(92.99%)显著高于A3组(83.64%)(P<0.05),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%)(P<0.05)。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。     

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。     

卵子玻璃化冷冻技术在辅助生殖中的临床应用

目的研究并探讨卵子玻璃化冷冻技术在辅助生殖中的可行性和应用价值。方法选取2013年3月至2017年1月深圳市人民医院诊治的卵巢功能衰退、接受放化疗手术以及患有盆腔疾病行卵子玻璃化冻融术后行卵母细胞内单精子注射的72例患者作为研究对象,设为观察组;另外选取深圳市人民医院72例同期内行新鲜卵子ICSI的患者作为对照组。比较两组患者的受精率、流产率以及妊娠患者的胚胎情况。结果行卵子玻璃化冷冻的患者与行新鲜卵子ICSI的患者其受精和流产情况之间差异无统计学意义(P0.05);同时,观察组患者的卵裂率、优质胚胎数以及临床妊娠情况等与行新鲜卵子ICSI的对照组患者之间差异亦无统计学意义(P0.05)。结论卵子玻璃化冷冻技术在提高患者妊娠率、辅助生殖中具有较好效果,有助于保存女性生育能力。     

低评分胚胎发育潜能的研究

目的:探讨低评分胚胎体外囊胚培养的发育潜能.方法:将 IVF/ICSI周期中第3天的低评分胚胎进行体外囊胚培养,观察胚胎发育情况,将形成的致密桑葚胚和囊胚进行玻璃化冷冻,并进一步观察这些冷冻胚胎冻融后的临床结局.结果:613周期中2058枚低评分胚胎进行囊胚培养后共获得753枚囊胚和13枚致密桑葚胚,囊胚形成率为36.59%;共冻胚322枚,冷冻胚胎率为15.65%;其中有低胚冷冻的周期为220,冷冻周期拥有率为35.89%;54例冻融有低胚移植周期中有18例临床妊娠,临床妊娠率为33.33%.结论:将低评分胚胎进行体外囊胚培养,可以筛选出具有发育潜能的胚胎,提高胚胎利用率和累计妊娠率.     

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。     

单囊胚冻融周期中囊胚冷冻时期及冻融后囊胚再次扩张程度对临床结局的影响

目的:分析比较第5天(Day 5)、第6天(Day 6)的冻融单囊胚移植对妊娠结局的影响,探讨不同发育天数囊胚对冻融后胚胎的发育潜能和临床结局的影响,以及囊胚解冻后的扩张程度对临床结局的影响。方法:回顾性分析2012年10月至2014年10月在我院生殖中心行冻融单囊胚移植的患者211例,根据冷冻时间不同分为Day 5冷冻组(n=113)和Day 6冷冻组(n=98),比较两组患者的临床妊娠率,胚胎种植率和早期流产率。根据囊胚解冻后2小时囊腔的扩张程度分为:部分扩张组(n=54)、完全扩张组(n=105)、孵出组(n=52),比较三组患者的临床妊娠率,胚胎种植率,早期流产率。结果:Day 5冷冻组的临床妊娠率(63.72%)和种植率(63.72%)均显著高于Day 6冷冻组(46.94%,46.94%)(P<0.05),Day 5冷冻组的流产率(13.89%)低于Day 6冷冻组(17.39%);冻融后部分扩张组的临床妊娠率(40.74%)和种植率(40.74%)均显著低于完全扩张组和孵出组的临床妊娠率(60.95%、61.54%)和种植率(60.95%、61.54%),三组的流产率依次递减但无统计学差异分别为(18.18%、15.63%、12.50%)。结论:Day 5囊胚较Day 6囊胚具有更好的发育潜能,解冻后可获得更好的妊娠结局;冻融后囊胚腔的扩张程度越好,其发育潜能越高,显著改善妊娠结局。     

ICSI周期卵子成熟度对胚胎发育与临床结局的影响

目的:研究卵胞浆内单精子注射(ICSI)周期中卵子成熟度对受精、胚胎发育以及临床结局的影响。方法:收集我院从2012年3月至2013年12月,新鲜周期中未成熟卵子(MⅠ或GV)占获卵数50%及以上的ICSI周期为A组(n=33);2012年9月至12月,新鲜周期中未成熟卵子小于获卵数的20%为ICSI周期为B组(n=138)。比较两组胚胎的受精率、正常受精率、多核率、优质胚胎率、临床妊娠率和种植率。结果:A组(n=33)获卵261枚,成熟卵子118枚;其中受精率80.51%,正常受精率72.88%,多核率6.78%,优质胚胎率47.37%,妊娠率30.30%,种植率19.30%;B组(n=138)获卵1330枚,成熟卵子1146枚,其中受精率89.97%,正常受精率86.39%,多核率1.13%,优质胚胎率61.64%,妊娠率59.42%,种植率40.88%。A组受精率、正常受精率、临床妊娠率、种植率均显著低于B组(P<0.05),而多核率显著高于B组(P<0.05)。结论:ICSI周期中,未成熟卵子比例过高可能影响胚胎的发育潜能及临床结局。     

睾丸精子卵母细胞浆内注射治疗梗阻性无精子症所致不育的临床体会

目的:探讨睾丸精子单精子卵母细胞浆内注射(ICSI)治疗梗阻性无精子症所致的男性不育的疗效,以完善辅助生殖技术。方法:选男性不育症夫妇905例分成两组:ICSI组和TESE+ICSI组。ICSI组自行排精后精液内可以找到正常形态活精子的少精症患者行ICSI治疗共863例,TESE+ICSI组经附睾抽吸取精失败而睾丸切开后可找到形态正常活精子的梗阻性无精子症患者用睾丸内精子行ICSI治疗共42例,两组患者的女方均给予超促排卵用药后获取卵母细胞。结果:ICSI组863周期,获得卵子9650个,其中成熟卵母细胞7879个,ICSI7879个,移植808个周期,妊娠256例,妊娠率为31·68%。TESE+ICSI组42周期,获得卵子567个,其中成熟卵母细胞479个,ICSI479个,移植42个周期,妊娠20例,妊娠率为47·60%。对两组的受精率、优质胚胎获得率、临床妊娠率进行比较及统计学分析,TESE+ICSI组的受精率稍低于ICSI组(P<0·05),而两组的优质胚胎获得率及临床妊娠率无显著差异(P>0·05)。结论:睾丸切开取精子进行ICSI治疗同样能够得到较高的受精率、优质胚胎获得率和临床妊娠率。     

New fillers for the new man

ABSTRACT:  Two new collagen-based lidocaine-containing dermal fillers, ArteSense™/ArteFill™ (Artes Medical, San Diego, CA) and Evolence® (Colbar LifeScience Ltd., Herzliya, Israel), have proved to be of particular interest to men, many of whom seek a long-lasting or permanent correction. ArteFill™ has been available in the United States since 2006, and it is expected that Evolence® will reach the American market in 2008. The properties of the two products will be described, and experience based on the administration of many hundreds of syringes of both products by a Canadian dermatologist will be detailed here, with tips and precautions to optimize patient outcomes.     

Outcomes and adverse effects of ablative vs nonablative lasers for skin resurfacing: A systematic review of 1093 patients

It is generally believed that ablative laser therapies result in prolonged healing and greater adverse events when compared with nonablative lasers for skin resurfacing. To evaluate the efficacy of ablative laser use for skin resurfacing and adverse events as a consequence of treatment in comparison to other modalities, a PRISMA‐compliant systematic review (Systematic Review Registration Number: 204016) of twelve electronic databases was conducted for the terms “ablative laser” and “skin resurfacing” from March 2002 until July 2020. Studies included meta‐analyses, randomized control trials, cohort studies, and case reports to facilitate evaluation of the data. All articles were evaluated for bias. The search strategy produced 34 studies. Of 1093 patients included in the studies of interest, adverse events were reported in a total of 106 patients (9.7%). Higher rates of adverse events were described in nonablative therapies (12.2% ± 2.19%, 31 events) when compared with ablative therapy (8.28% ± 2.46%, 81 events). 147 patients (13.4%) reported no side effects, 68 (6.22%) reported expected, transient self‐resolving events, and five (0.046%) presented with hypertrophic scarring. Excluding transient events, ablative lasers had fewer complications overall when compared with nonablative lasers (2.56% ± 2.19% vs 7.48% ± 3.29%). This systematic review suggests ablative laser use for skin resurfacing is a safe and effective modality to treat a range of pathologies from photodamage and acne scars to hidradenitis suppurativa and posttraumatic scarring from basal cell carcinoma excision. Further studies are needed, but these results suggest that ablative lasers are a superior, safe, and effective modality to treat damaged skin.     

Genetic alterations in RAS‐regulated pathway in acral lentiginous melanoma

Studies integrating clinicopathological and genetic features have revealed distinct patterns of genomic aberrations in Melanoma. Distributions of BRAF or NRAS mutations and gains of several oncogenes differ among melanoma subgroups, while 9p21 deletions are found in all melanoma subtypes. In the study, status of genes involved in cell cycle progression and apoptosis was evaluated in a panel of 17 frozen primary acral melanomas. NRAS mutations were found in 17% of the tumors. In contrast, BRAF mutations were not found. Gains of AURKA gene (20q13.3) were detected in 37.5% of samples, gains of CCND1 gene (11q13) or TERT gene (5p15.33) in 31.2% and gains of NRAS gene (1p13.2) in 25%. Alterations in 9p21 were identified in 69% of tumors. Gains of 11q13 and 20q13 were mutually exclusive, and 1p13.2 gain was associated with 5p15.33. Our findings showed that alterations in RAS‐related pathways are present in 87.5% of acral lentiginous melanomas.     

Self‐resolving superficial primary cutaneous mucormycosis in a 7‐week‐old infant

A 7‐week‐old girl, born at 30 weeks' gestational age, presented to clinic for evaluation of a crop of vesicular lesions that were noted after removal of a bandage that had been in place for 4 days. A punch biopsy of the lesion revealed fungal elements that were later identified as Rhizopus spp. The lesion began to self‐resolve, and no further treatment was needed, with full resolution of the lesion by 1 month after presentation. Clinicians should be aware of the variable presentations of mucormycosis and consider fungal infection in the differential diagnosis when evaluating vulnerable patients with skin eruptions.     

Multiple New-Onset Subcutaneous Nodules of the Upper Extremity Digits: Giant Cell Tumor of Tendon Sheath and Lipoma

A black woman with the concurrent onset of two subcutaneous nodules located on the digits of her upper extremities is described. Initially, a single systemic disorder was considered; yet, the lesions differed in morphology and consistency. Microscopic examination of the nodules showed a giant cell tumor of tendon sheath and a lipoma. Although Occam's “razor” suggests that multiple lesions in the same person are more likely to represent variable manifestations of a single disorder than several different diseases in that individual, the simultaneously appearing lesions in this patient represented two different conditions.