生长激素在IVF-ET周期子宫内膜发育不良患者中的应用

目的:探讨生长激素(growth hormone,GH)在体外受精-胚胎移植(in vitro fertilization-em-bryo transfer,IVF-ET)治疗中对子宫内膜发育不良者子宫内膜及临床结局的影响。方法:IVF-ET患者共67例,均由于子宫内膜发育不良而致IVF-ET种植失败,再次行IVF-ET治疗时随机分为研究组(加用GH治疗,32例)和对照组(未使用GH治疗,35例),统计分析患者的临床结局。结果:患者Gn用量、平均获卵数、受精率、优质胚胎率组间无统计学差异(P>0.05);研究组子宫内膜厚度、形态及子宫内膜和内膜下血流均较对照组有明显改善(P<0.01);研究组的胚胎种植率(31.4%)及临床妊娠率(39.5%)明显高于对照组(15.7%和19.8%)(P<0.01),早期流产率明显减低(14.6%vs 21.4%)(P<0.01)。结论:对内膜发育不良的患者进行IVF-ET治疗时加用GH可能是通过改善子宫内膜对胚胎的容受性,从而提高胚胎种植率及临床妊娠率,降低早期流产率。     

宫腔镜子宫内膜微刺激术后再次冻融胚胎移植的临床结局

目的探讨宫腔镜子宫内膜微刺激术对再次移植冻融胚胎患者临床结局的影响。方法选取2015年1月—2016年8月在本院行体外受精(IVF)助孕首次移植治疗失败的患者共281例,随机分为研究组(A组)和对照组(B组)。A组129例,月经干净后第3~7日进行宫腔镜子宫内膜微刺激术;B组152例,第2次移植前未行手术。统计分析冻融胚胎移植(FET)的妊娠结局。结果 (1)A、B两组间患者年龄、不孕年限、基础性激素、体质量指数、黄体酮转化日内膜厚度、移植胚胎数、优质胚胎率、异位妊娠率、多胎率、早期流产率相比较,差异无统计学意义(P0.05)。(2)A组的临床妊娠率和着床率分别是58.1%、34.0%,显著高于B组(47.4%、27.6%)(P0.05)。进一步运用多因素Logistic回归分析显示,宫腔镜子宫内膜微刺激术能够显著增加临床妊娠的几率(OR=1.50,95%CI=1.12~2.43),而对异位妊娠、多胎妊娠及早期流产的发生无明显影响。结论宫腔镜子宫内膜微刺激术属微创手术、并发症少,手术方便快捷,能更直观评价患者的宫腔内情况,并且通过对子宫内膜局部轻微刺激,改善内膜容受性,提高着床率、妊娠率,故宫腔镜子宫内膜微刺激术值得推广。     

IVF-ET失败者行宫腔镜检查的临床价值

目的:探讨IVF-ET失败者行宫腔镜检查的意义及其临床应用价值。方法:选取38例既往有IVF-ET失败史的患者行宫腔镜检查及手术(研究组),与同期常规行宫腔镜检查的不孕患者45例(对照组),就子宫内膜形态的不同表现类型临床结局等方面进行比较。结果:研究组宫腔内膜异常的发生率为84.21%,明显高于对照组的48.89%,其中宫腔粘连、子宫内膜不规则增生以及子宫内膜息肉的发生率均高于对照组(P<0.05)。研究组的32例于宫腔镜术后一年内再次行IVF/ICSI或冷冻胚胎移植术,17例获得临床妊娠。余6例术后至今未行IVF-ET,不避孕未孕。结论:宫腔镜检查、干预有利于改善子宫内膜的形态,提高临床妊娠率,可作为再次IVF前的常规筛查手段。     

生长激素对IVF-ET周期中子宫内膜的影响

目的:探讨生长激素在体外受精-胚胎移植(IVF-ET)治疗中对子宫内膜生长不良患者子宫内膜影响。方法:2005.01-2006.05期间由于子宫内膜发育不良而致IVF-ET种植失败68例,再次IVF-ET治疗中加用生长激素(GH)治疗者为研究组(37例),未使用GH治疗者为对照组(31例)。结果:二组在获卵数、优质胚胎率上有明显差别(P<0.05),而受精率、卵裂率无区别。研究组子宫内膜形态学及厚度均较对照组有明显改善,统计学有显著性差异(P<0.01)。研究组的胚胎种植率、临床妊娠率明显高于对照组(P<0.01),流产率明显减低。结论:对IVF-ET治疗中内膜发育不良的患者再次进行IVF-ET治疗时加用生长激素可促进子宫内膜发育,改善子宫内膜对胚胎的容受性,从而提高临床妊娠。     

搔刮术对子宫内膜形态不良患者体外受精-胚胎移植临床结局的影响

目的探讨搔刮术对子宫内膜形态不良患者IVF-ET周期临床结局的影响。方法 IVF-ET前自然周期阴式超声监测子宫内膜,卵泡晚期子宫内膜非三线征者共77例,随机分组：观察组（47例）在垂体降调节超促排卵周期月经第1～2天行子宫内膜搔刮术;对照组（30例）不做处理。比较两组患者的一般临床资料及治疗结局。结果两组的年龄、不孕因素及年限、用药量、移植胚胎数等比较差异无统计学意义（P〉0.05）,观察组的种植率（30.30%）及临床妊娠率（53.19%）显著高于对照组（分别为15.15%和30%）。观察组85.11%的患者搔刮术后卵泡晚期超声下子宫内膜形态得到改善。结论子宫内膜搔刮术能改善子宫内膜形态,提高周期临床妊娠率。     

探讨经期内膜厚度及早卵泡期内膜搔刮对冻融胚胎移植妊娠结局的影响

目的探讨经期内膜厚度与冻融胚胎移植(FET)妊娠结局的关系,并对经期内膜厚度7 mm的患者行早卵泡期子宫内膜搔刮,观察临床妊娠率,探讨内膜搔刮的时机及效果。方法回顾性分析本中心2014年11月—2016年11月期间行FET的1 363个周期,根据月经周期第4~5日内膜厚度分组:A组为内膜厚度3 mm;B组为内膜厚度3~5 mm;C组为内膜厚度5~7 mm;D组内膜厚度为7 mm;E组为宫腔分离、内膜不清(积液)。并对经期内膜厚度7 mm的患者,在胚胎移植周期月经第4~5日行早卵泡期内膜搔刮,比较各组间的一般情况及临床妊娠率。结果经期内膜厚度不同的5个组间患者的年龄、不孕年限、体质量指数(BMI)、移植胚胎数、FET内膜准备方式、双胎率及异位妊娠率均无统计学差异(均P0.05);5组的平均经期内膜厚度及组间内膜增幅差异有统计学意义(P0.05),经期子宫内膜厚度7 mm(A组、B组及C组)平均的内膜增幅较D组显著增加(P0.05);5组组间的临床妊娠率、胚胎着床率差异有统计学意义(P0.05);组间两两比较结果提示,D组的临床妊娠率、胚胎着床率较其他组显著下降(P0.005)。对经期内膜厚度7 mm的患者行早卵泡期内膜搔刮,搔刮组的临床妊娠率为68.29%(56/82),明显高于未搔刮组的53.26%(98/184),胚胎着床率(52.67%)显著高于未搔刮组(36.34%),差异皆有统计学意义(P0.05)。结论经期4~5 d内膜增厚(7 mm)影响FET妊娠结局,对其行早卵泡期内膜搔刮,可改善子宫内膜容受性,提高FET的临床妊娠率及胚胎着床率。     

宫腔镜在再次体外受精-胚胎移植前的应用价值

目的:探讨宫腔镜在助孕治疗失败后要求再次进行IVF-ET的患者中的应用价值。方法:回顾性分析曾行IVF-ET失败要求再次行IVF-ET患者159例,根据是否在第2次IVF-ET前接受宫腔镜检查分为A、B二组,根据宫腔镜检查情况再将A组分为宫腔形态正常组(A1组)与宫腔形态异常组(A2组),分析A组宫腔镜检查情况,并比较A1组、A2组和B组在重复IVF-ET周期中优质胚胎率、着床率、临床妊娠率。结果:A组53.8%宫腔形态正常,46.2%发现宫腔内微小病变,包括子宫内膜息肉、子宫内膜炎、宫腔轻度粘连、子宫黏膜下肌瘤、子宫内膜增殖和子宫内膜发育不良;A组临床妊娠率与着床率明显较B组高,A1组临床妊娠率和着床率较B组低,但无统计学差异;A2组临床妊娠率和着床率显著高于B组,P<0.05。结论:宫腔镜可以发现存在于宫腔内的微小病变;IVF-ET失败患者应放宽宫腔镜检查指征,以提高重复周期的临床妊娠率和着床率。     

剖宫产术后瘢痕子宫对再生育患者IVF-ET助孕结局影响的研究

目的:研究拟再生育不孕症人群中剖宫产术后瘢痕子宫对体外受精-胚胎移植(IVF-ET)妊娠结局的影响。方法:回顾性分析2011年12月至2017年7月就诊于厦门市妇幼保健院生殖医学科拟生育二孩接受IVF-ET助孕治疗的285例继发输卵管因素不孕症患者资料,按照生育第一孩的分娩方式将109例瘢痕子宫患者纳入研究组,将176例非瘢痕子宫患者纳入对照组;按照患者年龄分为高龄组(≥35岁)和低龄组(35岁);再将研究组按照胚胎移植距剖宫产术的时间分为≥10年组(50例)和10年组(59例),比较各组的妊娠结局。结果:两组患者年龄、不孕年限、移植胚胎数比较,差异无统计学意义(P0. 05)。研究组的临床妊娠率(42. 20%)、着床率(27. 40%)显著低于对照组(54. 55%、36. 14%),差异有统计学意义(P0. 05),两组间生化妊娠率、异位妊娠率及流产率比较,差异无统计学意义(P0. 05)。在35岁的低龄组中,研究组的临床妊娠率(41. 51%)和着床率(28. 51%)显著低于对照组(68. 11%、46. 04%),差异有统计学意义(P0. 05),两组生化妊娠率、异位妊娠率和流产率比较,差异无统计学意义(P0. 05);在≥35岁的高龄组中,研究组与对照组的生化妊娠率、临床妊娠率、着床率、异位妊娠率以及流产率比较,差异无统计学意义(P0. 05)。研究组中瘢痕子宫10年组的生化妊娠率(13. 56%)显著高于≥10年组(0%),差异有统计学意义(P0. 05)。结论:剖宫产术后瘢痕子宫是影响再生育人群IVF-ET妊娠结局的重要因素,降低了IVF-ET的临床妊娠率和着床率,其对IVF-ET临床妊娠率和着床率的影响与患者的年龄和剖宫产术距再孕的时间有关。     

不同降调节方案对子宫内膜异位症患者IVF-ET妊娠结局的影响

目的:探讨超长方案对子宫内膜异位症患者IVF-ET妊娠结局的影响。方法:回顾性分析79例(82个周期)子宫内膜异位症患者采用超长方案(42个周期)和常规长方案(40个周期)对IVF-ET妊娠结局的影响。结果:与常规长方案组相比超长方案组的获卵数(8.2vs10.7)、受精率(69.32%vs72.11%)、卵裂率(87.49%vs89.78%)无明显差异(P>0.05),但Gn总量(44.55支vs33.79支)、优质胚胎数(4.3vs5.8)、临床妊娠率(20.00%vs40.48%)、胚胎植入率(9.90%vs19.64%)等几项指标,超长方案组均显著增高(P<0.05)。结论:在IVF-ET超促排卵前,采用超长方案进行降调节能显著提高子宫内膜异位症患者IVF-ET的成功率。     

宫腔粘连分离术后冻融胚胎移植周期轻刮子宫内膜对改善妊娠结局的影响研究

目的探讨宫腔粘连分离术后子宫内膜轻刮术对冻融胚胎移植结局的影响。方法选择2011年1月至2014年12月在郑州大学附属洛阳中心医院行冻融胚胎移植(FET)的不孕症患者,在进入FET周期前宫腔镜检查确诊宫腔粘连(IUA),行宫腔镜下IUA分离术,术后复查宫腔镜显示宫腔形态正常行FET共277例。其中129例在FET前行子宫内膜轻刮术(治疗组),余148例未行子宫内膜轻刮术(对照组)。比较两组周期取消率及周期妊娠结局;将两组患者再分别分为轻度IUA组和中度IUA组,先比较治疗组和对照组内轻度和中度IUA患者的妊娠结局,再分别比较治疗组和对照组间轻度、中度IUA患者的妊娠结局。结果治疗组和对照组周期取消率差异无统计学意义[3.1%(4/129)vs.6.1%(9/148),P0.05]。治疗组临床妊娠率[48.0%(60/125)]高于对照组[33.1%(46/139)],差异有统计学意义(P0.05);治疗组胚胎着床率[25.2%(64/254)],高于对照组[17.8%(51/286)],差异有统计学意义(P0.05)。与轻度IUA患者比较,两组中度IUA患者胚胎着床率及临床妊娠率均降低(P0.05)。与治疗组中度IUA患者比较,对照组中度IUA患者临床妊娠率降低(P0.05)。流产率和宫外孕率两组间以及两组内比较差异均无统计学意义(P0.05)。结论子宫内膜轻刮术显著提高IUA术后患者子宫内膜容受性,尤其对中度IUA术后患者子宫内膜轻刮术可显著提高FET助孕周期妊娠率。     

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...