玻璃化冷冻囊胚复苏移植与玻璃化冷冻胚胎复苏后继续培养至囊胚移植的妊娠结局比较

目的比较玻璃化冷冻囊胚复苏后移植与玻璃化冷冻胚胎复苏后继续培养至囊胚移植的临床妊娠结局。方法回顾性分析2013年1月至2014年12月在郑州大学第二附属医院生殖中心行玻璃化冷冻复苏后移植囊胚的不孕症患者134例(134个周期)的妊娠情况,其中卵裂期胚胎培养至囊胚冷冻复苏后移植者79个周期(A组),卵裂期胚胎冷冻复苏后继续培养至囊胚再移植者55个周期(B组)。比较2组患者临床妊娠率、着床率及早期流产率。结果 A组79个周期,复苏囊胚数151个,存活囊胚数133个,复苏率88.08%(133/151);获得可移植囊胚72个周期,妊娠周期46个,妊娠率为63.89%(46/72),着床率51.56%(66/128),早期流产率为15.21%(7/46)。B组55个周期227个胚胎,复苏存活170个胚胎,复苏率74.89%(170/227);其中45个周期共形成可移植囊胚93个,囊胚形成率为54.70%(93/170);获得妊娠周期23个,妊娠率为51.11%(23/45),着床率为36.56%(34/93),早期流产率13.04%(3/23)。A组囊胚复苏率高于B组卵裂期胚胎复苏率(P<0.05),且A组着床率显著高于B组(P<0.05),但2组临床妊娠率、流产率、异位妊娠率比较差异均无统计学意义(P>0.05)。结论玻璃化冷冻囊胚复苏移植能获得较高的着床率和妊娠率,囊胚可能是玻璃化冷冻胚胎的较好阶段。     

剩余胚胎继续培养囊胚的潜在价值

目的:探讨在新鲜周期中,经ⅣF/ICSI-ET、冷冻后的剩余胚胎在体外继续培养至囊胚的意义。方法:在新鲜周期中,将D3天发育的胚胎选择评分较高的进行移植,部分胚胎玻璃化冷冻保存后,所剩余的胚胎通过序贯微滴培养法在体外继续培养至囊胚阶段,将优质囊胚进行玻璃化冷冻。在未妊娠患者下一周期将其解冻、移植,比较同时期D3通过玻璃化冷冻解冻移植后的卵裂期胚胎与囊胚期胚胎的植入率、妊娠率、单胎率和多胎率。结果:422例不孕症患者D3天移植冷冻后剩余的胚胎1842枚形成囊胚437枚(23.72%),优质囊胚315枚(17.10%);将优质囊胚行玻璃化冷冻;其中42例患者的62枚囊胚在下一周期解冻后移植,其植入率(41.94%)极显著高于243例患者的536枚卵裂期胚胎解冻后移植的植入率(20.90%)(P<0.01);而妊娠率(54.76%)显著高于解冻后卵裂期胚胎的妊娠率(36.63%)(P<0.05);但是单胎率(71.26%vs 85.71%)和多胎率(28.74%vs 13.64%)无显著差异(P>0.05)。结论:囊胚体外培养可以筛选出具有发育潜能的剩余胚胎,最大限度地利用胚胎,从而提高可用胚胎数和临床妊娠率。     

囊胚期冷冻胚胎移植的临床应用探讨

目的探讨囊胚期冷冻胚胎移植的临床应用价值.方法对2002年10月～2003年12月在湘雅医院生殖医学中心接受囊胚培养并行囊胚期冷冻胚胎移植的病例进行分析,了解囊胚期与卵裂期冷冻胚胎解冻后的胚胎成活率、植入率及妊娠率.结果冷冻囊胚解冻后胚胎数、胚胎成活率、植入率和妊娠率与卵裂期冷冻胚胎无显著差别(P＞0.05),囊胚解冻后经15 h过夜培养,42枚中有22枚成活,其中8枚Ⅰ,Ⅱ级继续发育或囊胚腔扩张,3例获得妊娠,妊娠率为37.5%.结论囊胚期冷冻胚胎移植同样能达到卵裂期冷冻胚胎移植的临床效果,同时增加解冻与移植间隔时间可更好地选择冻融囊胚移植,对提高妊娠率可能有一定意义.     

冻融卵裂期胚胎复苏移植和冻融囊胚复苏移植的临床结局比较

目的 :比较Cryotop玻璃化冷冻的人类卵裂期胚胎、囊胚复苏移植的临床结局。方法 :回顾性分析2009年1月~2012年12月南京医科大学附属南京妇幼保健院生殖医学中心完成的1 307例玻璃化冷冻解冻移植周期,其中卵裂期胚胎复苏移植周期(A组)337例,冻融囊胚复苏移植周期(B组)970例。比较两组临床妊娠率、种植率、妊娠结局及新生儿情况等各项指标。结果:1 A组复苏率为86.42%,B组复苏率为83.71%,无显著统计学差异;2A组平均移植胚胎数(2.07±0.47)个显著高于B组(1.68±0.37)个;A组临床妊娠率及种植率(45.99%、27.32%)显著低于B组(54.95%、42.64%);3A组和B组的流产率、早产率、单胎率及多胎率分别为16.77%、25.24%、64.08%、35.92%和15.01%、25.34%、72.21%、27.29%,两组孕龄为(265.41±15.45)d和(264.46±16.12)d,两组均无明显统计学差异。A组异位妊娠率显著高于B组(3.23%vs 0.75%);4A组和B组巨大儿、生长受限及新生儿出生缺陷发生率分别为4.85%、1.94%、0.97%和7.36%、3.81%、1.36%,两组间无统计学差异。结论:卵裂期胚胎和囊胚行Cryotop玻璃化冷冻后冻融复苏率无统计学差异,冻融囊胚复苏移植周期具有更高的种植率、临床妊娠率和较低的异位妊娠率,而两组新生儿的流产率、早产率及出生缺陷率无明显差异。     

影响冻融胚胎复苏率和移植成功率因素分析

目的 探讨影响冻融胚胎复苏率和移植成功率的相关因素.方法 回顾性分析573个冷冻胚胎移植(FET)周期的临床资料,按冷冻前胚胎质量、胚胎发育时间、解冻后胚胎复苏程度和冷冻方法分别进行分组,分析不同分类各组间的胚胎复苏情况和(或)临床妊娠率差异.结果 冷冻当天胚胎中有优质胚胎者的临床妊娠率显著高于无优质胚胎者(31.8% vs 20.0%)(P<0.05).受精第2天冷冻者与受精第3天冷冻者的胚胎复苏率和临床妊娠率差异无统计学意义(79.1% vs 82.9%和25.5% vs31.2%)(P>0.05).解冻后完全移植100%卵裂球完整者和混合移植者的临床妊娠率显著高于完全移植部分卵裂球损伤者(36.7% vs 24.1%和29.2% vs 24.1%)(P<0.05).冷冻方法改进后的胚胎复苏率和全胚复苏率显著高于冷冻方法改进前(82.0% vs 66.3%和50.0% vs 27.5%)(P<0.05).结论 胚胎质量与胚胎复苏率和临床妊娠率密切相关,冷冻胚胎解冻后全胚复苏率与临床妊娠率正相关,冷冻过程中的操作细节是胚胎实验室保证冻融胚胎复苏、移植成功的重要因素.     

不同级别胚胎玻璃化冷冻时长对复苏周期 临床结局的影响

目的 探讨不同级别胚胎玻璃化冷冻时长对复苏周期妊娠结局的影响。方法 回顾性分析2016年1月至2021年12月在中国人民解放军联勤保障部队第九〇四医院生殖中心行玻璃化冷冻胚胎复苏移植的2210个周期,按胚胎级别分为4类：卵裂期1级、2级、3级胚胎及囊胚期胚胎;按时间分为6组：第1组≤180d（1122个周期）,第2组180~<360d组（507个周期）,第3组360~<720d组（216个周期）,第4组720~<1080d（195个周期）,第5组≥1080d（170个周期）,比较各组患者的基本情况、临床结局。结果 解冻卵裂期1级胚胎妊娠率、种植率随冷冻时间延长降低,其中第1组最高,分别为68.3%和70.7%（P<0.05）;解冻卵裂期2级胚胎随冷冻时间延长妊娠率、种植率比较,差异有统计学意义（P<0.05）,其中1、4、5组比较,差异有统计学意义（P<0.05）;解冻囊胚期胚胎妊娠率、种植率随冷冻时间延长降低,第1组最高,分别为66.7%和62.3%（P<0.05）;各组卵裂期及囊胚期胚胎活产率、流产率比较,差异无统计学意义（P>0.05）。结论 随着冷冻时间的延长,卵裂期优质胚胎及囊胚妊娠率、种植率有下降趋势;胚胎的短期冷冻（≤180d）可提高临床妊娠率;胚胎冷冻时间延长虽不影响活产率、流产率,但仍鼓励取卵后半年内择优移植。     

冻融周期囊胚移植的临床价值

目的：探讨冻融囊胚移植、冻融卵裂期胚胎复苏后行囊胚移植的临床价值。方法回顾性分析2012年9月至2013年8月在该院生殖医学中心接受冻融胚胎移植治疗患者共518个周期的临床资料,按移植冻融胚胎类型分为3组。A组：冻融囊胚移植,共129个周期;B组：卵裂期胚胎复苏后行囊胚培养后移植,共123个周期;C组（对照）：冻融卵裂胚移植,共266个周期。比较各组的临床结局及 A、B两组间新鲜周期胚胎和冻融周期的囊胚形成率和取消率。结果 A、B组的生化妊娠率、临床妊娠率和胚胎种植率（70．5％、61．2％、42．3％;67．5％、58．2％、40．2％）显著高于 C组（53．0％、42．5％、23．1％）（P＜0．05）;3组间流产率、异位妊娠率、多胎妊娠率差异无统计学意义（P＞0．05）。新鲜周期第3天优质胚胎与冻融胚胎复苏后的囊胚形成率（62．5％vs．57．7％）差异无统计学意义（P＞0．05）,均显著高于新鲜周期第3天非优质胚胎的囊胚形成率（20．3％）（P＜0．05）。结论冻融周期行囊胚移植可以获得较满意的临床结局;冻融卵裂期胚胎行囊胚培养后可获得较高的囊胚形成率和临床结局。     

慢速程序化冷冻人类扩张期囊胚的效果观察

目的：探讨慢速程序化冷冻在人类扩张期囊胚冷冻中的应用效果。方法收集2014年1~4月在本中心进行体外受精-胚胎移植(IVF-ET)或卵胞浆内单精子显微注射(ICSI)治疗的579个周期患者移植及冷冻后剩余的低质量胚胎(包括异常受精胚胎)发育成的扩张期囊胚87枚,用显微注射针刺穿囊胚腔使之皱缩,然后行程序化冷冻(囊胚组)。对照组为同期行程序化冻融的卵裂期胚胎。比较两组经冷冻复苏后的胚胎存活率。结果扩张期囊胚复苏率为80.46%,卵裂期胚胎复苏率为82.80%,两组比较差异无统计学意义(χ2=1.105, P>0.05)。结论扩张期囊胚经人工皱缩后行程序化冷冻行之有效,能明显提高囊胚的冷冻效率。     

冻融囊胚移植与冻融卵裂期胚胎移植临床研究对比

目的:探讨冻融囊胚和卵裂期胚胎移植与异位妊娠的关系。方法:回顾性分析自2008年9月至2011年5月在本生殖中心进行IVF-ET的患者,在新鲜周期失败后的下一周期中行冻融卵裂期胚胎和冻融囊胚,对比其移植冻融卵裂期胚胎和冻融囊胚的妊娠率和异位妊娠率。结果:两组患者的年龄(32.76±4.83vs31.85±4.14)和子宫内膜(8.96±1.75vs9.21±1.51)差异不显著(P>0.05);而冻融囊胚的妊娠率(48.2%vs34.8%)显著高于冻融卵裂期胚胎(P<0.05);但异位妊娠率冻融囊胚发生率是极显著低于冻融卵裂期胚胎。结论:冻融囊胚进行移植可以明显提高妊娠率,并且还能降低异位妊娠的发生,既往多次行IVF-ET治疗失败的患者或异位妊娠者建议行囊胚移植。     

玻璃化冷冻技术在人类胚胎中的应用价值

目的探讨玻璃化冷冻技术在人类胚胎中的应用价值。方法选择2014年3月~2016年2月在我院生殖中心做试管婴儿的264例不孕不育患者,经患者知情同意后,将实施体外受精-胚胎移植术患者卵裂期胚胎和囊胚符合冷冻标准的胚胎进行玻璃化冷冻保存。根据患者情况解冻胚胎移植,观察胚胎复苏后的临床妊娠效果。结果玻璃化冷冻74个周期,解冻胚胎149枚,解冻后存活胚胎147枚,存活率98.66%;种植胚胎56枚,种植率38.10%;临床妊娠42例(单胎27例,双胎14例,宫外孕1例),临床妊娠率为56.76%。结论玻璃化冷冻法是人类胚胎保存的优选方法,获得了理想的复苏率、种植率和妊娠率。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.