超促排卵周期HCG日与取卵日雌激素水平与妊娠的相关性研究

目的:探讨超促排卵周期中血清雌激素(E2)水平的变化及其与妊娠的关系.方法:选择201 1年1月至2012年10月在我中心行IVF-ET(包括ICSI)治疗的516例不孕患者,按妊娠结局将患者分为妊娠组与非妊娠组.回顾分析患者注射HCG日与取卵日的血清E2水平,计算两日E2差值(⊿E2)与取卵日E2值的比值,并对此比值与妊娠结局进行相关性分析.结果:在超促排卵周期中,妊娠组与非妊娠组患者的⊿E2与取卵日E2值的比值差异显著(1.45±0.89 vs 1.44±1.54,P＜0.05).此比值与妊娠率呈负相关(r=-0.824,P＜0.05).结论:在控制性超排卵治疗中,⊿E2与取卵日E2值的比值可作为预测助孕结局的指标,此比值越大,越不利于妊娠结局.     

IVF中三种促超排卵方案效果的比较

目的：探讨IVF中最佳促超排卵方案。方法：将IVF对象随机分为3组。BFh组：23例126个周期,按BFh长方案（Buserelin／FSH／hCG）进行;Chh组：13例14个周期,以CC／hMG／hCG方案进行;Fhh组：55例57个周期,按FSH／hMG／hCG方案进行。结果：每周期平均促性腺激素（Gn）用量BFh组为18．62±5．95支;Chh组16．57±5．70支;Fhh组25．56±8．08支。每周期获成熟卵子数分别为10．23±5．80个;6．07±3．22个;10．96±6．45个。Gn用量BFh组与Chh组差异无显著性（P＞0．05）,但取到的卵子数,差异有显著性（P＜0．05）。BFh组与Fhh组比较,BFh组Gn用量少于Fhh组（P＜0．05）,但取到的卵子数差异无显著性（P＞0．05）,且BFh组无过早的LH峰出现,另二组则各有1例过早的出现内源性LH峰。结论：IVF中BFh方案是较为理想的促起排卵方案。     

自交联透明质酸钠凝胶预防中重度宫腔粘连分离手术后再粘连的前瞻性、随机、阴性对照临床研究

目的 评价自交联透明质酸钠凝胶预防中重度宫腔粘连分离手术后再粘连的有效性和安全性.方法 前瞻性、多中心、随机、阴性对照临床研究;对2011年11月至2012年11月中南大学湘雅三医院等医院符合入组标准的宫腔粘连患者,根据美国生育学会(AFS)宫腔粘连评分分级标准进行宫腔镜下的术前诊断分级,中重度宫腔粘连患者纳入本研究.随机入组120例患者(试验组和对照组各60例),对试验组患者在宫腔镜粘连分离术后应用Foley球囊导尿管结合自交联透明质酸钠凝胶防止术后再粘连;对照组患者在宫腔镜粘连分离术后只用Foley球囊导尿管防止术后再粘连.在术后3个月时进行第2次宫腔镜检查,再次对宫腔粘连进行分级.主要评价指标:术后3个月时防止宫腔粘连的有效率.次要评价指标:对宫腔粘连累及范围、粘连类型、月经模式的得分进行手术前后和组间比较.结果 完成本研究的患者共111例,其中试验组55例、对照组56例.试验组自交联透明质酸钠凝胶防止术后宫腔粘连的有效率(76％,42/55)明显高于对照组(48％,27/56),两组比较,差异有统计学意义(P=0.000 9).试验组应用自交联透明质酸钠凝胶显著减少了AFS总分,试验组为(2.1±1.1)分,对照组为(3.7±2.5)分,两组比较,差异有统计学意义(P=0.000 8);并对宫腔粘连累及范围得分[试验组(1.3±0.5)分,对照组(1.7±0.8)分]和月经模式得分[试验组(0.8±1.1)分,对照组(1.4±1.1)分]均有明显改善(P=0.037 8、0.0004).试验组应用自交联透明质酸钠凝胶减少了术后再粘连(中度和重度)的发生率,试验组术后3个月时中重度宫腔粘连的发生率为13％(7/55),而对照组为38％(21/56),两组比较,差异有统计学意义(P=0.000 6).未发生与材料相关的不良事件和并发症.结论 自交联透明质酸钠凝胶能够有效减少中重度宫腔粘连分离手术后的再粘连发生率并降低粘连严重程度,有利于改善患者的月经情况.     

改良GnRH-a长方案在控制性促排卵中的应用

目的探讨改良GnRH—a/FSH/hMG联合长方案在控制性促排卵中的应用以及国产阿拉瑞林在此方案中的使用。方法以回顾性分析的方法对174例改良GnRH-a长方案和48例超短方案控制性促排卵的资料进行回顾性分析。结果 改良GnRH—a/FSH/hMG联合长方案在FSH/hMG用药天数、用药量、取卵数、移植数、冻存胚胎数、hCG丑内膜厚度、临床妊娠率、种植率、流产率、OHSS发生率等方面与短方案组相比差异均无显著性(P>0.05),其中流产率明显低于超短方案组。结论改良国产阿拉瑞林/FSH/hMG联合长方案是一种简单、经济、有效的控制性促排卵方案,值得在IVF—ET周期中推广。     

The clinical significance of the poor correlation of cervical dysplasia and cervical malignancy with referral cytologic results.

OBJECTIVE: We prospectively studied the diagnostic utility of our Bethesda system-based cervical cytology screening program with colposcopy and biopsy as the criterion standard. STUDY DESIGN: We prospectively collected and studied the correlation of cytologic, colposcopic, and histologic data in women referred for colposcopic examination because of "nonnormal" cytologic results or other risk factors. RESULTS: We found that 771 of 5585 initial colposcopic visits yielded high-grade (cervical intraepithelial neoplasia II or worse) biopsies (13.8% prevalence); 13 showed invasive cancer (0.23% prevalence). Only 132 of 771 cases of high-grade dysplasia (17%) and 5 of 13 cases of invasive cancer (38%) followed Papanicolaou smears suggesting high-grade intraepithelial lesions or cancer, with 77% being discovered after "minor" Papanicolaou smear abnormalities. High-grade disease or cancer was confirmed in 1 of 2 high-grade or cancer Papanicolaou referrals and in 1 of 11 referrals with atypical squamous cells of undetermined significance. CONCLUSION: Papanicolaou smears, especially those that are low grade, should not be equated with histologic sampling in association with poor cytohistopathologic correlation. Most high-grade dysplasias and cancers occur in women with either minor Papanicolaou smear abnormalities or visible lower genital tract lesions or both. Colposcopy for women with any "nonnormal" screening result is feasible.     

A prospective,randomised, investigator-blind,controlled, clinical study on the clinical efficacy and tolerability of two highly purified hMG preparations administered subcutaneously in women undergoing IVF

Abstract

The aim of this multicentre, prospective, randomised, investigator blind, controlled clinical trial was to evaluate the clinical efficacy and tolerability of a highly purified human menopausal gonadotrophin (hMG) preparation (Merional-HG) when administered to patients undergoing controlled ovarian stimulation (COS) for in-vitro fertilisation (IVF) procedure enrolled in hospital departments.

One hundred fifty-seven patients were randomised in two parallel groups: 78 started COS with Merional-HG and 79 with Menopur. Results of the study showed that both highly purified hMG preparations were equivalent in terms of number of oocytes retrieved (primary endpoint: 8.8?±?3.9 versus 8.4?±?3.8, p?=?0.54). In the patients treated with Merional-HG, we observed a higher occurrence of mature oocytes (78.3% versus 71.4%, p?=?0.005) and a reduced quantity of gonadotrophins administered per cycle (2.556?±?636?IU versus 2.969?±?855?IU, p?<?0.001). Fertilisation, cleavage, implantation rates and the number of positive β-human chorionic gonadotrophin (hCG; pregnancy) tests and the clinical pregnancy rate were comparable in the two groups. Both treatments were well tolerated. In conclusion, the results of this study support the efficacy and safety of Merional-HG administered subcutaneously for assisted reproduction techniques. Efficiency of Merional-HG appears to be higher due to reduced quantity of drug used and the higher yield of mature oocytes retrieved.     

A prospective randomized clinical trial comparing 150 IU and 225 IU of recombinant follicle-stimulating hormone (Gonal-F*) in a fixed-dose regimen for controlled ovarian stimulation in in vitro fertilization treatment

OBJECTIVE: To compare fixed daily doses of the recombinant FSH (rFSH) Gonal-F (150 IU vs. 225 IU) for ovarian stimulation in IVF-ET. DESIGN: Single-center prospective, randomized study. Assisted conception unit of a university hospital.One hundred twenty-four women aged 23-41 years participated in the study. Exclusion criteria were as follows: FSH of >10 IU/L, polycystic ovarian syndrome, one ovary or previous ovarian surgery, previous poor response to ovarian stimulation, or ovarian hyperstimulation syndrome (OHSS). INTERVENTION(S): Randomized to commence 150 IU or 225 IU of Gonal-F per day without dose alterations during treatment. MAIN OUTCOME MEASURE(S): Number of oocytes retrieved and total rFSH dose. RESULT(S): More oocytes were retrieved in women aged or=33 years), the number of oocytes retrieved in the two groups were similar. No significant differences were found for fertilization rate, number of embryos formed and cryopreserved, and pregnancy rates between the two groups. The total rFSH dose used was higher in the 225-IU group (2,595.0 +/- 510.0 vs. 1,897.5 +/- 457.5 IU). The cancellation rate due to insufficient ovarian response was higher in the 150-IU group (15.0% vs. 3.3%). All cases of ovarian hyperstimulation syndrome (n = 4) occurred in the 225-IU group. CONCLUSION(S): Two hundred twenty-five IU is more effective than 150 IU in younger women but requires a higher total dose of Gonal-F. The use of 225 IU in older women did not result in a higher oocyte yield, suggesting that 225 IU of rFSH does not compensate for the age-related decline in the number of follicles available for stimulation.     

The evolving role of ultrasound in obstetrics/gynecology practice.

The value of ultrasound examinations depends heavily on the preparation of the personnel carrying out the examination and the technical capabilities of the equipment they use. Only well-organized regional or national programs are able to provide high level, cost-effective care based on certification of quality. Such certification must include the training of professionals, the definition of competence levels, accreditation of laboratories and the establishment of professional protocols. Together, these factors can guarantee the standard of care and provide legal protection for practitioners. It is worth carrying out routine screening in each pregnancy because the majority of abnormalities occur in pregnancies with low risk. Abnormalities detected on screening cases and the examination of high risk groups should be referred to higher level centers. Here, appropriate technical background and qualified personnel are present to provide cost-effective care. At the same time, necessary invasive interventions can also be performed. A minimum of three screening tests should be performed during pregnancy. The first should be performed at the fetal age of 10-14 weeks to detect abnormalities and pathological conditions in early pregnancy. The second one has to be performed between the fetal ages of 18 and 22 weeks to assess detailed fetal anatomy and rate of development. The third should be performed between the fetal age of 30 and 34 weeks to assess fetal anatomy, rate of development, placentation and circulation. It is worth considering a fourth screening at approximately 36-38 weeks to assess the intrauterine condition of the fetus and determine the appropriate method of delivery. Finally, besides improving the standard of living, education, and hygienic conditions in developing countries, developed countries also have to help improve the standard of pregnancy care. Within this context, the dissemination of diagnostic ultrasound must be given special emphasis.     

Effects of propolis on inflammation markers in patients undergoing hemodialysis: A randomized,double-blind controlled clinical trial

Background and aimsSeveral studies have been performed in vitro and in animals showing that propolis (a resin made by bees) has excellent anti-inflammatory properties, but no study has been performed in patients with chronic kidney disease (CKD) on hemodialysis (HD). The present study aimed to evaluate the effects of propolis supplementation on inflammatory markers in patients with CKD on HD.MethodsThis is a longitudinal, double-blind, placebo-controlled trial with patients randomized into two groups: propolis (4 capsules of 100 mg/day containing concentrated and standardized dry EPP-AF® green propolis extract) or placebo (4 capsules of 100 mg/day containing microcrystalline cellulose, magnesium stearate and colloidal silicon dioxide) for two months. Routine parameters were analyzed using commercial kits. The plasma levels of inflammatory cytokines were evaluated by flow luminometry.ResultsForty-one patients completed the follow-up, 21 patients in the propolis group (45 ± 12 years, 13 women, BMI, 22.8 ± 3.7 kg/m²) and 20 in the placebo group (45.5 ± 14 years, 13 women, BMI, 24.8 ± 6.8 kg/m²). The obtained data revealed that the intervention with propolis significantly reduced the serum levels of tumour necrosis factor α (TNFα) (p = 0.009) as well as had the tendency to reduce the levels of macrophage inflammatory protein-1β (MIP-1β) (p = 0.07). There were no significant differences in the placebo group.ConclusionShort-term EPP-AF® propolis dry extract 400 mg/day supplementation seems to mitigate inflammation, reducing the plasma levels of TNFα and MIP-1β in patients with CKD on HD. This study was registered at clinicaltrials.gov (NCT04411758).     

小儿慢性乙型肝炎干扰素治疗引起的抗纤维化效应

目的观察儿童慢性乙型肝炎（CHB）应用α-干扰素（IFN-α）治疗引起的抗纤维化效应。方法30例小儿CHB应用IFN-α治疗24周以上,且停药后随访36周,其中5例治疗前后均行肝活体组织检查。所有患儿均在治疗前、治疗后24周和36周,应用放射免疫法检测患儿血清肝纤维化标志物：透明质酸（HA）、层连蛋白（LN）、Ⅳ型胶原（Ⅳ-C）。结果应用IFN-α治疗前（0周）、治疗后24周和36周,小儿CHB血清肝纤维化标志物HA值分别为（243.6±70.5）ng/mL、（145.2±51.6）ng/mL、（85.1±40.3）ng/mL;LN值分别为（180.5±61.3）ng/mL、（102.7±40.6）ng/mL、（62.8±32.6）ng/mL;Ⅳ-C值分别为（137.1±48.6）ng/mL、（108.9±40.3）ng/mL、（70.5±30.7）ng/mL,治疗后血清肝纤维化标志物较治疗前显著下降（P〈0.05）。肝活体组织病理检查显示,治疗后肝组织纤维化分期比治疗前有明显降低（P〈0.01）。结论IFN-α在治疗小儿CHB时,不仅有抗病毒作用,在改善肝纤维化方面,也具有一定疗效。     

3种超促排卵方案对卵巢窦卵泡数不同患者体外受精-胚胎移植结局的影响

目的:通过研究卵巢窦卵泡数(AFC)与不同超促排卵方案对IVF-ET妊娠结局的影响,探讨更合理的促排卵方案.方法:选取2010年4月至10月在山东中医药大学第二附属医院生殖中心行IVF-ET的291例患者,291个周期,按卵巢AFC将患者分为3组:5～10个(A组,69例),10～15个(B组,134例)及15～20个(C组,88例).患者分别采取GnRH-a长方案(a方案)、GnRH-a短方案(b方案)和GnRH-ant(c方案)方案行促排卵治疗,其中A组中20例患者行a方案,28例行b方案,21例行c方案;B组中48例患者行a方案,57例行b方案,29例行c方案;C组中29例患者行a方案,37例行b方案,22例行c方案.比较3组患者分别采用3种促排卵方案治疗后的Gn量、HCG日LH、P、E2水平、获卵数、优质胚胎率、周期取消率、妊娠率.结果:A、C组患者行3种方案治疗的获卵数、优质胚胎数、周期取消率及临床妊娠率均无显著差异(P＞0.05).B组患者中行a方案治疗者的HCG日P水平显著低于行b、c方案者(P＜0.05),临床妊娠率显著高于行b、c方案者(P＜0.05);行b方案治疗者的LH、E2水平显著高于a、c方案者(P＜0.05).结论:AFC为5～10个及15 ～ 20个的患者,采用GnRH-a长方案、GnRH-a短方案和GnRH-ant方案的妊娠结局无显著差异;AFC为10 ～15个的患者,采用GnRH-a长方案超促排卵的临床效果较好.     

Serum and plasma determination of angiogenic and anti-angiogenic factors yield different results: The need for standardization in clinical practice

Objective.?The importance of an anti-angiogenic state as a mechanism of disease in preeclampsia is now recognized. Assays for the determination of concentrations of soluble vascular endothelial growth factor receptor (sVEGFR)-1, sVEGFR-2, placental growth factor (PlGF) and soluble endoglin (sEng) have been developed for research and clinical laboratories. A key question is whether these factors should be measured in plasma or serum. The purpose of this study was to determine if there are differences in the concentrations of these analytes between plasma and serum in normal pregnancy and in preeclampsia.

Methods.?Samples of maternal blood were obtained by venipuncture and collected in EDTA (lavender top) and serum collection tubes (red top). A standard laboratory procedure was implemented for the centrifugation, aliquoting and storage of samples. Plasma and serum from 70 women with normal pregnancies and 34 patients with preeclampsia were assayed for sVEGFR-1, sVEGFR-2, PlGF and sEng by ELISA. Nonparametric paired tests were used for analyses.

Results.?A significant difference between plasma and serum concentration was observed for sVEGFR-1 and sVEGFR-2 in normal pregnancy, and for sVEGFR-1, sVEGFR-2, PlGF and sEng in women with preeclampsia.

Conclusion.?The concentrations of sVEGFR-1, sVEGFR-2, PlGF and sEng when measured in maternal plasma and in serum are different. Therefore, the matrix used for the assay (serum versus plasma) needs to be considered when selecting thresholds for predictive studies and interpreting the growing body of literature on this subject.     

控制性超促排卵对不孕妇女血脂代谢及血清瘦素的影响

目的:探讨控制性超促排卵(COH)对不孕妇女血脂代谢及血清瘦素的影响。方法:接受体外授精-胚胎移植不孕妇女48例,以自身自然周期为对照,比较自然周期与促排卵周期在不同时间点血清高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、胆固醇(TG)、甘油三酯(TC)、瘦素(LEP)、雌二醇(E2)及孕酮(P)水平的变化,分析COH过程中血脂各因子及LEP的变化规律。结果:自然周期和促排卵周期血脂各指标无明显波动(P0.05);HDL变化与雌激素水平呈正相关,LDL、TG、TC变化趋势与雌激素水平呈负相关;在自然周期LH出峰日LEP均值水平出现高峰,且明显高于相应自然周期月经第2天的LEP水平(P0.05);COH周期HCG注射日LEP均值水平亦出现高峰,且明显高于促排卵周期月经第2天的LEP水平(P0.05);血清LEP与血清E2呈正相关(P0.05)。结论:短时间应用COH治疗对不孕女性脂代谢无不良影响。     

A pilot randomized controlled clinical trial of dance practice for functionality in autistic children and adolescent with all levels of need support

ObjectiveThis study addressed dance practice intertwining communication, functional independence and social behavior in autistic children and adolescents with all levels of need support.DesignA pilot randomized clinical trial with seventy-two participants between 8 and 15 years old were assessed for eligibility.SettingTheater rehearsal room and mental health clinic.InterventionsDance group (n = 17) or control group (n = 19), 24 sessions, once a week, lasting 40 min.Main outcome measuresThe Autism Behavior Checklist (ABC), Autistic Screening Questionnaire (ASQ), Childhood Autism Rate Scale (CARS), Functional Independence Measure (FIM), and World Health Organization Disability Assessment Schedule (WHODAS, version 2.0, to assess mothers’ functioning) were applied at two time points: baseline and end-point.ResultsDifferences between dance and control groups were significant at post-intervention for communication (mean difference: 1.31; 99.8%CI: 0.29, 2.32, p < 0.001, d = 0.93); social cognition (mean difference: 1.01; 99.8%CI: 0.13, 1.89, p < 0.001, d = 0.82); autistic behavior (mean difference: 11.82; 99.8%CI: 17.33, −6.31, p < 0.001, d = 1.45).ConclusionsIn this preliminary study, the findings provide ways of communication and social interaction through dance practice by autistic children and adolescents with all levels of support needs. Research on neurodiversity is needed to understand its feasibility and the lifestyle appropriation.     

多囊卵巢综合征患者C-反应蛋白、血脂与临床内分泌特点相关性研究

目的通过对多囊卵巢综合征(PCOS)患者和年龄、体重相匹配的正常妇女进行C-反应蛋白(CRP)、血脂的检测寻找多囊卵巢综合征妇女易患心血管疾病的风险因素。方法64例PCOS和20例年龄、体重匹配的正常健康妇女进行体重指数(BMI)计算、葡萄糖耐量试验(OGTT)、血清胰岛素(INS)、血脂和CRP的测定,比较肥胖、非肥胖;胰岛素抵抗、非胰岛素抵抗;高雄激素、雄激素正常的血脂、C-反应蛋白血中水平。结果PCOS患者总胆固醇(CHO)、CRP明显高于正常对照组,而高密度脂蛋白(HDL)却低于对照组;肥胖的PCOS患者CHO、CRP明显高于非肥胖PCOS患者和对照组,PCOS患者超敏C-反应蛋白(SCRP)水平高于对照组,肥胖的PCOS患者高密度脂蛋白(HDL)低于非肥胖PCOS患者和对照组;胰岛素抵抗的PCOS患者CRP、甘油三酯(TG)明显高于非胰岛素抵抗的PCOS患者,而HDL却低于非胰岛素抵抗者,SCRP高于对照组;高雄激素PCOS患者血清CRP、SCRP水平明显高于雄激素正常组,高雄激素PCOSTG高于雄激素正常组和对照组,而HDL却低于这两组。CRP与肥胖关系最为密切。结论PCOS患者的心血管疾病的风险不是某一个因素决定的,而是多种代谢异常综合作用的结果。肥胖、胰岛素抵抗、高雄激素均是PCOS患者易患心血管疾病的风险因素,但是肥胖与CRP的关系更为密切。