Comparison of semen quality and outcome of assisted reproductive techniques in Chinese men with and without hepatitis B

In this study, we aimed to determine the effects of hepatitis B virus （HBV） infection on sperm quality and the outcome of assisted reproductive technology （ART）. A total of 916 men （457 HBV-positive and 459 HBV-negative） seeking fertility assistance from January 2008 to December 2009 at the Women＇s Hospital in the School of Medicine at Zhejiang University were analysed for semen parameters. Couples in which the men were hepatitis B surface antigen （HBsAg）-seropositive were categorized as HBV-positive and included 587 in vitrofertilisation （IVF） and 325 intracytoplasmic sperm injection （ICSI） cycles from January 2004 to December 2009; negative controls were matched for female age, date of ova retrieval, ART approach used （IVF or ICSI） and randomized in a ratio of 1：1 according to the ART treatment cycles （587 for IVF and 325 for ICSI）. HBV-infected men exhibited lower semen volume, lower total sperm count as well as poor sperm motility and morphology （P〈O.05） when compared to control individuals. Rates of two-pronuclear （2PN） fertilisation, high-grade embryo acquisition, implantation and clinical pregnancy were also lower among HBV-positive patients compared to those of HBV-negative patients after ICSI and embryo transfer （P〈0.05）; IVF outcomes were similar between the two groups （P〉0.05）. Logistic regression analysis showed that HBV infection independently contributed to increased rates of asthenozoospermia and oligozoospermia/azoospermia （P〈0.05） as well as decreased rates of implantation and clinical pregnancy in ICSI cycles （P〈0.05）. Our results suggest that HBV infection in men is associated with poor sperm quality and worse ICSI and embryo transfer outcomes but does not affect the outcome of IVF and embryo transfer.

Management of Cesarean Scar Pregnancy: A Case Series

Objective To survey effective treatment strategies for cesarean scar pregnancy(CSP). Methods The clinical data of 78 patients diagnosed with CSP from January 2010 to December 2013 were reviewed. Results Among these patients, 17 patients were first treated at our hospital; of them, 2 were misdiagnosed. The other 61 patients were referred from other hospitals; of them, 21 were initially misdiagnosed. There were 9 patients who were treated with laparotomy, 50 patients with curettage after uterine artery embolization(UAE) with or without local methotrexate(MTX) infusion, 10 patients with dilatation and curettage, 6 patients with transvaginal sonographic guided local intragestational MTX injection, and 3 patients with systemic MTX injection. All patients finally recovered. Patients with excessive vaginal hemorrhage underwent either emergency UAE treatment or laparotomy. These two treatments had similar success rates(81.82% vs. 100%, χ2 =0.289, P>0.05). Conclusions The accurate diagnosis of CSP is important. Curettage after UAE with or without local MTX infusion is a safe and effective method.

神经母细胞瘤干细胞转录因子的表达与意义

目的探索干细胞转录因子C-Myc、Sox2、Oct4、Klf4在儿童神经母细胞瘤(NB)的表达及其意义。方法选取河北医科大学第四医院儿科53例NB病理标本作为实验组。实验组又分为Ⅲ期组和Ⅳ期组;节细胞-神经母细胞瘤组和神经母细胞瘤组;术前有骨髓浸润化疗组和术前无骨髓浸润无化疗组。另选取10例严重肾盂积水患儿手术后残余的正常肾上腺组织作为对照组。采用免疫组织化学法检测各标本中C-Myc、Sox2、Oct4、Klf4的表达情况,分析化疗对其表达的影响及其与临床分期、病理类型、性别、年龄等病理参数的关系,并做相关性分析。结果 C-Myc、Sox2、Oct4、Klf4阳性率表达的比较:对照组和实验组差异有统计学意义(P<0.05);节细胞-神经母细胞瘤组和神经母细胞瘤组差异有统计学意义(P<0.05);术前化疗组和术前无化疗组差异有统计学意义(P <0.05);Ⅲ期组和Ⅳ期组差异无统计学意义(P>0.05);不同年龄、性别差异无统计学意义(P>0.05)。表达呈正相关的是:C-Myc和Sox2,C-Myc和Oct4。呈负相关的是:C-Myc和klf4,Sox2和Klf4,Oct4和Klf4。结论 C-Myc、Sox2、Oct4、Klf4可能参与了儿童NB的发生过程;C-Myc、Oct4和Klf4与儿童NB组织的分化程度相关,可能成为判断预后的指标;化疗药物对C-Myc、Sox2、Oct4、Klf4的表达有影响;Klf4与C-Myc、Sox2、Oct4在儿童NB的发生、发展过程中相互拮抗发挥作用;C-Myc、Sox2、Oct4、Klf4在NB组织中的表达与年龄、性别及临床分期无关。

Impact of COVID-19 pandemic on the pregnancy outcomes of women undergoing assisted reproductive techniques(ARTs):a systematic review and meta-analysis

The global outbreak of the coronavirus disease 2019(COVID-19) led to the suspension of most treatments with assisted reproductive technique(ART). However, with the recent successful control of the pandemic in China, there is an urgent public need to resume full reproductive care. To determine whether the COVID-19 pandemic had any adverse effects on female fertility and the pregnancy outcomes of women undergoing ART, a systematic review and meta-analysis was conducted using the electronic Chinese and English databases. Dichotomous outcomes were summarized as prevalence, and odds ratios(ORs)and continuous outcomes as standardized mean difference(SMD) with 95% confidence interval(CI). The risk of bias and subgroup analyses were assessed using Stata/SE 15.1 and R 4.1.2. The results showed that compared with women treated by ART in the pre-COVID-19 time frame, women undergoing ART after the COVID-19 pandemic exhibited no significant difference in the clinical pregnancy rate(OR 1.07, 95% CI 0.97 to 1.19;I^(2)=0.0%), miscarriage rate(OR 0.95, 95% CI 0.79 to1.14;I^(2)=38.4%), embryo cryopreservation rate(OR 2.90, 95% CI 0.17 to 48.13;I^(2)=85.4%), and oocyte cryopreservation rate(OR 0.30, 95% CI 0.03 to 3.65;I^(2)=81.6%). This review provided additional evidence for gynecologists to guide the management of women undergoing ART treatment during the COVID-19 pandemic timeframe.

Use of electroacupuncture and transcutaneous electrical acupoint stimulation in reproductive medicine:a group consensus

Abstract： With the rapid development of assisted reproductive technology, various reproductive disorders have been effectively addressed. Acupuncture-like therapies, including electroacupuncture （EA） and transcutaneous electrical acupoint stimulation （TEAS）, become more popular world-wide. Increasing evidence has demonstrated that EA and TEAS are effective in treating gynecological disorders, especially infertility. This present paper describes how to select acupoints for the treatment of infertility from the view of theories of traditional Chinese medicine and how to determine critical parameters of electric pulses of ENTEAS based on results from animal and clinical studies. It summarizes the principles of clinical application of EA/rEAS in treating various kinds of reproductive disorders, such as polycystic ovary syndrome （PCOS）, pain induced by oocyte retrieval, diminished ovarian reserve, embryo transfer, and oligosperrnia/ asthenospermia. The possible underlying mechanisms mediating the therapeutic effects of EA/TEAS in reproductive medicine are also examined.

American, European, and Chinese practice guidelines or consensuses of polycystic ovary syndrome: a comparative analysis

Polycystic ovary syndrome （PCOS） is the most common metabolic and endocrine disorder in women. However, there is no agreement concerning how to diagnose and treat PCOS worldwide. Three practice guidelines or consensuses, including consensus from the European Society of Human Reproduction and Embryology （ESHRE）/the American Society for Reproductive Medicine （ASRM） in Rotterdam, diagnosis criteria and consensus in China, and clinical practice guideline from the Endocrine Society （ES） in the United States are widely recognized. The present paper may provide some guidance for clinical practice based on a comparative analysis of the above three practice guidelines or consensuses.

A thermosensitive gel formulation of an empirical traditional Chinese prescription for treating cervical erosion

Cervical eropion,a pathological change associated with chronic cervicitis,is a common condition that is difficult to cure.M any pa tients particularly those with mild or medium infection and those preparing for pregnancy require a simple but effective medication.In this study,extracts of an empirical herbal prescription composed of six Chinese traditional drugs viz Cortex Phellodendri,Rhizoma Coptidis,Olibanum,Myrrha,borneol and catechu were formulated to facilitate intravaginal administration and improve efficacy.An extract of the first four components was formulated with borneol as a thermosensitive gel(TG)while an extract of catechu used to prepare a regular gel(CG)because of a chemical incompatibility.The optimized TG was prepared using poloxamer 407 and poloxamer 188.The CG was prepared using glycerin,carbopol and triethanolamine.The gels were characterized in vitro in terms of release of berberine(TG)and total catechins(CG)and in vivo in a rat model of cervical erosion.Trea tment by once daily application of the TG for 7 days followed by once daily application of the CG for 3 days produced a restoration of normal tissues.Gel formulation of the empirical Chinese traditional remedy appears to provide a promising treatment for cervical erosion.

Effects of body mass index on the outcomes of in vitro fertilization in Chinese patients with polycystic ovary syndrome: a retrospective cohort study

Objective: To investigate the effects of body mass index(BMI) on the outcomes of in vitro fertilization(IVF) in Chinese patients with polycystic ovary syndrome(PCOS). Methods: In the retrospective cohort study, a total of 1074 patients with PCOS undergoing IVF between April 2010 and May 2017 in two reproductive medicine centers, respectively in eastern China(Women's Hospital, School of Medicine, Zhejiang University, Zhejiang Province) and in southern China(Maternal and Child Health Care Hospital of Liuzhou, Guangxi Province), were included. The patients were divided into four groups according to the recommended Chinese BMI cut-off points: underweight(BMI<18.5kg/m^2), normal weight(18.5kg/m^2≤BMI<24.0kg/m^2), overweight(24.0kg/m^2≤BMI<28.0kg/m^2), and obese(BMI≥28.0kg/m2). The basic characteristics of the PCOS patients, the details of IVF treatment, and the pregnancy outcomes were collected. Main results: There were no significant differences among the normal weight, overweight, and obese PCOS patients undergoing IVF on the biochemical pregnancy rate, clinical pregnancy rate, miscarriage rate, live birth rate, or term delivery rate(P>0.05), although the overweight and obese PCOS patients required more gonadotropin(Gn)(P<0.001) as well as longer stimulation period(P<0.001), and got less retrieved oocytes(P<0.05) and fertilized oocytes(P<0.05). The underweight PCOS patients required less Gn(P<0.05) and achieved higher live birth rate and term delivery rate(P<0.05), compared with the normal weight PCOS patients. Conclusions: High BMI had no negative effects on the outcomes of IVF in Chinese patients with PCOS; however, the conclusion may seem a little limited due to the retrospective design and the potential bias.

Acupuncture for treating polycystic ovary syndrome:guidance for future randomized controlled trials

Objective： To provide guidance for future randomized controlled trials （RCTs） based on a review con- cerning acupuncture for treating polycystic ovary syndrome （PCOS）. Methods： A comprehensive literature search was conducted in October 2015 using MEDLINE, EMBASE, SCISEARCH, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Menstrual Disorders and Subfertility Group trials register, Allied and Complementary Medi- cine （AMED）, China National Knowledge Infrastructure （CNKI）, and the Wanfang databases. RCTs comparing either acupuncture with no/sham/pharmacological intervention or a combination of acupuncture and conventional therapy with conventional therapy in the treatment of PCOS were included in this review. A quality evaluation was performed for each of the included studies. Results： Thirty-one RCTs were included in the review and were divided into four categories according to the type of intervention used in the comparator or control group. Menstrual frequency, hor- mones, anthropometrics, insulin sensitivity, blood lipids, and fertility were used as the main measurements to assess the effects of acupuncture on the patients with PCOS. Thirty trials, except for one, showed an improvement in at least one of the indicators of PCOS after acupuncture treatment. However, normalizing the methodological and reporting format remains an issue. Conclusions： Based upon this review of current clinical trials concerning acupuncture for treating PCOS, we provide guidelines for better clinical trial design in the future.

Effects of pre-pregnancy body mass index and gestational weight gain on neonatal birth weight

To evaluate the effects of maternal pre-pregnancy body mass index （pre-BMI） and gestational weight gain （GWG） on neonatal birth weight （NBW） in the population of Chinese healthy pregnant women, attempting to guide weight control in pregnancy. A retrospective cohort study of 3772 Chinese women was conducted. The population was stratified by maternal pre-BMI categories as underweight （〈18.5 kg/m2）, normal weight （18.5-23.9 kg/m2）, overweight （24.0-27.9 kg/m2）, and obesity （〉28.0 kg/m2）. The NBW differences were tested among the four groups, and then deeper associations among maternal pre-BMI, GWG, and NBW were investigated by multivariate analysis. NBW increased significantly with the increase of maternal pre-BMI level （P〈0.05）, except overweight to obesity （P〉0.05）. The multivariate analysis showed that both pre-BMI and GWG were positively correlated with NBW （P〈0.05）. Compared with normal pre-BMI, underweight predicted an increased odds ratio of small-for-gestational-age （SGA） and decreased odds ratio for macrosomia and large-for-gestational-age （LGA）, and the results were opposite for overweight. With the increase of GWG, the risk of SGA decreased and the risks of macrosomia and LGA increased. In addition, in different pre-BMI categories, the effects of weight gain in the first trimester on NBW were different （P〈0.05）. NBW is positively affected by both maternal pre-BMI and GWG, extreme pre-BMI and GWG are both associated with increased risks of abnormal birth weight, and maternal pre-BMI may modify the effect of weight gain in each trimester on NBW. A valid GWG guideline for Chinese women is an urgent requirement, whereas existing recommendations seem to be not very suitable for the Chinese.

Fetal growth,fetal development,and placental features in women with polycystic ovary syndrome:analysis based on fetal and placental magnetic resonance imaging

Objective:Polycystic ovary syndrome(PCOS),a common endocrine-metabolic dysfunction in reproductive-aged women,may be involved in compromised pregnancy and offspring outcomes.This study aimed to investigate whether maternal PCOS affects fetal growth,fetal development,and placental features.Methods:This retrospective case-control study included 60 pregnant women with PCOS(PCOS group)and 120 healthy pregnant women without PCOS(control group).Fetal magnetic resonance imaging(MRI)was performed followed by an ultrasound examination and indications for imaging,including known or suspected fetal pathology,history of fetal abnormality in previous pregnancy or in a family member,and concern for placenta accreta.Fetal MRI images were analyzed for head cir-cumference(HC),abdomen circumference(AC),lung-to-liver signal intensity ratio(LLSIR,a prenatal marker of fetal lung maturity),lengths of liver and kidney diameters in fetuses,and placental relative signal intensity on T2-weighted single-shot fast spin echo(SSFSE)imaging(rSISSFSE),and placental relative apparent diffusion coefficient value(rADC).Data on height and weight of offspring were collected through telephone follow-up.Results:Compared to the control group,the PCOS group showed the following characteristics:(1)smaller biparietal diameter and femur length in fetuses(P=0.026 and P=0.005,respectively),(2)smaller HC in fetuses(evident after 32 weeks;P=0.044),(3)lower LLSIR and smaller dorsoventral length of liver in fetuses(evident before 32 weeks;P=0.005 and P=0.019,respec-tively),and(4)smaller placental thickness(evident before 32 weeks;P=0.017).No significant differences in placental rSISSFSE or rADC were observed between the groups(all P>0.05).No significant differences in height and weight of offspring during childhood existed between the groups(all P>0.05).Conclusions:There exist alterations of fetal growth,fetal development,and placental features from women with PCOS.

Heterochronic bilateral ectopic pregnancy after ovulation inductionHeterochronic bilateral ectopic pregnancy after ovulation induction

Ectopic pregnancy is identified with the widely-applied assisted reproductive technology （ART）. Bilateral ectopic pregnancy is a rare form of ectopic pregnancy which is difficult to be diagnosed at the pre-operation stage. In this paper, we presented an unusual case of heterochronic bilateral ectopic pregnancy after stimulated intrauterine insemination （IUI）, where there has been a delay of 22 d between the diagnoses of the two ectopic pregnancies. Literature was reviewed on the occurrence of bilateral ectopic pregnancy during the past four years in the MEDLINE database. We found 16 cases of bilateral ectopic pregnancy reported since 2008, and analyzed the characteristics of those cases of bilateral ectopic pregnancy. We emphasize that ovulation induction and other ARTs may increase the risk of bilateral ectopic pregnancy. Because of the difficulty in identification of bilateral ectopic pregnancy by ultraso- nography, the clinician should be aware that the treatment of one ectopic pregnancy does not preclude the occurrence of a second ectopic pregnancy in the same patient and should pay attention to the intra-operation inspection of both side fallopian tubes in any ectopic pregnancy case.

Towards a multidimensional scientific approach to improve clinical practices for infertility treatment

Polycystic ovary syndrome （PCOS） is the most common metabolic and endocrine disorder in women, leading to infertility. However, there is no general agreement concerning how to diagnose and treat PCOS. The Rotterdam consensus statement from the European Society of Human Reproduction and Embryology/American Society for Reproductive Medicine, the Chinese diagnostic criteria and consensus statement, and the clinical practice guideline from the Endocrine Society in the USA are widely recognized.

Herbal Medicines for Acute Kidney Injury: Evidence, Gaps and Frontiers

Acute kidney injury(AKI) is a major health threat worldwide. The literature on herbal intervention in AKI was searched from English and Chinese databases and reports were critically analyzed in terms of preventing AKI, promoting repair and regeneration, enhancing extrarenal clearance of uremic toxins, and preventing progression to chronic kidney disease(CKD). Altogether, 16 herbal formulae and a few extracts derived from individual herbs were reported to prevent or mitigate AKI in animal models induced by renal ischemia/reperfusion, cisplastin,gentamicin, glycerol, adenine, sepsis or physical exhaustion. Four formulae and six individual herbs were reported to accelerate recovery and/or to prevent CKD in established AKI animal models. Intrarectal herbal medicines, with or without simultaneous oral administration, were reported in six clinical trials and in an animal model to increase extrarenal clearance of uremic toxins. Additional 13 clinical trials reported oral or intravenous herbal interventions in AKI of different etiologies. Despite recurring problems, notably poor compliance with good practice guidelines for clinical trials and for authentication, naming and quality control of herbal materials, accumulating experimental data on the preventive effects of herbal medicines in AKI look encouraging and urge for better, definitive trials to guide clinical practice. Herbal enemas promoting extrarenal clearance of uremic toxins seem cost-effective, but better clinical evidence is certainly needed before any affirmative recommendation be made for AKI patients without access to dialysis. New frontiers, however, lie in those herbal remedies that promote repair/regeneration and prevent chronicity after AKI. Recent experimental data suggest that this may be possible.

Streptomycin inhibits electrophysiological changes induced by stretching of chronically infarcted rat hearts

Objective： To investigate stretch-induced electrophysiological changes in chronically infarcted hearts and the effect of streptomycin （SM） on these changes in vivo. Methods： Sixty Wistar rats were divided randomly into four groups： a control group （n=15）, an SM group （n=15）, a myocardial infarction （MI） group （n=15）, and an MI＋SM group （n=15）. Chronic MI was obtained by ligating the left anterior descending branch （LAD） of rat hearts for eight weeks. The in vivo blockade of stretch-activated ion channels （SACs） was achieved by intramuscular injection of SM （180 mg/（kg·d）） for seven days after operation. The hearts were stretched for 5 s by occlusion of the aortic arch. Suction electrodes were placed on the anterior wall of left ventricle to record the monophasic action potential （MAP）. The effect of stretching was examined by assessing the 90% monophasic action potential duration （MAPD90）, premature ventricular beats （PVBs）, and ventricular tachycardia （VT）. Results： The MAPD90 decreased during stretching in both the control （from （50.27±5.61） ms to （46.27±4.51） ms, P〈0.05） and MI groups （from （65.47±6.38） ms to （57.47±5.76 ms）, P〈0.01 ）. SM inhibited the decrease in MAPD90 during inflation （（46.27±4.51） ms vs. （49.53±3.52） ms, P〈0.05 in normal hearts; （57.47±5.76） ms vs. （61.87±5.33） ms, P〈0.05 in MI hearts）. The occurrence of PVBs and VT in the MI group increased compared with that in the control group （PVB： 7.93±1.66 vs. 1.80±0.86, P〈0.01; VT： 7 vs. 1, P〈0.05）. SM decreased the occurrence of PVBs in both normal and MI hearts （0.93±0.59 vs. 1.80±0.86 in normal hearts, P〈0.05; 5.40±1.18 vs. 7.93±1.66 in MI hearts, P〈0.01）. Conclusions： Stretch-induced MAPD90 changes and arrhythmias were observed in chronically infarcted myocardium. The use of SM in vivo decreased the incidence of PVBs but not of VT. This suggests that SACs may be involved in mechanoelectric feedback （MEF）, but that there might be other mechanisms involved in causing VT in chronic MI.

Women's health and Chinese integrative medicine

Researchers in the fields of obstetrics, gynecology, and Chinese integrative medicine （CIM） were invited to share their perspectives on the most recent studies.

The Role of Chinese Medicine in Cancer Care——a Critical Review

Traditional Chinese medicine(TCM) has been widely used in China and other East Asian countries for helping cancer patients. However, it is unavailable to most patients who are treated in NHS in UK, due to there is not enough evidence in using TCM in cancer patients, To try to establish the evidence base for using TCM in cancer patients management, the author reviewed the current available clinical reports to TCM treatment of cancer patients, mainly those of randomly assigned and controlled clinical trials(RCTs) with bigger samples, from maintaining the quality of life, enhancing immune system, remedying the side effects from radiotherapy and chemotherapy respectively, and to propose a role of TCM as an assistant therapy to the main therapies. We then concluded that TCM holds its unique value in maintaining good quality of life, and to help the patients through the operation, chemotherapy and radiotherapy to achieve better outcomes.

THE USE OF TRADITIONAL CHINESE MEDICINE FOR IN VITRO FERTILIZATION IN CHINA: CLINICAL EVIDENCE

In vitro fertilization(IVF),as an important assisted reproductive technology(ART),is chosen by over l,000,000infertile couples each year,which is linked to over 3,000,000babies bom worldwide.However,an IVF cycle may be unsuccessful.The success of IVF is not guaranteed,and patients often have to undergo more than one cycle of treatment before they are successful.IVF treatment