Simultaneous type III congenital esophageal atresia and patent ductus arteriosus in a low-weight patient: A case report

BACKGROUND We report a low-birth-weight child(1.8 kg)with neonatal type III congenital esophageal atresia(CEA)combined with symptomatic patent ductus arteriosus(PDA).After comprehensive evaluation,esophageal anastomosis was performed on postnatal day 11 after excluding surgical contraindications,and arterial catheter ligation was performed at the same time.Concurrent surgery for CEA combined with PDA has not been clearly reported in the literature.CASE SUMMARY We report a 6-day-old female child with type III CEA and PDA.The patient presented with foam at the mouth after birth,cough and shortness of breath after feeding.At another hospital,she was considered to have neonatal pneumonia,neonatal jaundice and congenital heart disease and transferred to our hospital.After iodine oil radiography of the esophagus and echocardiography we con-firmed diagnosis of CEA and PDA.The diameter of the PDA was 8 mm,with obvious left to right shunting.We performed right rear extrapleural orificium fistula ligation and esophageal anastomosis,and ligation of PDA via left axilla straight incision after 5 d of hospitalization.The operations were successful,and the incision healed after 12 d,and the patient was discharged.We re-examined the patient 1 mo after surgery.She did not vomit when she ate rice flour.Esophageal angiography showed no stricture of the anastomotic stoma.The patient weighed 3.2 kg.CONCLUSION For CEA patients with multiple risk factors,comprehensive,timely and accurate diagnosis and evaluation,and early treatment may improve prognosis.

Theoretical study on the pressurization characteristics of disc-seal single screw pump used in high viscosity oily sludge conveying field

The disc-seal single screw pump(DSSP)used in the field of high viscosity oily sludge transport has a huge advantage.However,there is no research on the pressurization characteristics of the DSSP at present,which makes its application limited.In view of this,the pressurization process mathematical model of the DSSP was established based on the geometric model of the pump.By using this model,the pressurization characteristics of DSSP and the influence of working parameters on the pressurization process were studied combined with the principle of back-flow pressurization.Analysis results show that the instantaneous pressurization process could be realized mainly depending on the reflux pressurization from the outlet chamber to the pressurization chamber when the screw rotor rotating angle is located at-5°to+5°.The pressure in the pressurization chamber will increase with the increase of working parameters which include inlet pressure,outlet pressure,screw rotation velocity and dynamic viscosity of fluid medium in the area of flow-back pressurization.The screw rotation velocity and the viscosity of the conveying medium have significant effects on the peak pressure in the pressurization chamber,and the peak pressure in the pressurization chamber is proportional to the screw rotation velocity and the dynamic viscosity coefficient of the conveying medium.The proportional coefficient between the peak pressure and the screw rotation velocity is 6.29×10~4.The proportional coefficient between the peak pressure and the dynamic viscosity of the conveying medium is 6.28×10~6.

Perinatal complications and live-birth outcomes following assisted reproductive technology: a retrospective cohort study

Background:With the development of assisted reproductive technology(ART)and its increasing success rate in the mainland of China,more attention has been paid to the safety of ART.In this study,we explored the associations between conception by ART and pregnancy/perinatal complications,and neonatal outcomes compared with similar outcomes following spontaneous conception.Methods:This retrospective cohort study of pregnancies over a 3-year period(2013-2015)was performed at Beijing Obstetrics and Gynecology Hospital,Beijing,China.Subjects were divided into two groups:conception by ART(n=2256)or spontaneous conception(n=6768).According to different fertilization modes,the ART group was divided into in vitro fertilization(IVF,n=1873)and intracytoplasmic sperm injection(ICSI,n=383)subgroups.The ART group was also divided into two different embryo transfer methods;fresh embryo transfer(ET,n=1583)and frozen embryo transfer(FET,n=673)subgroups.Pregnancy complications,perinatal complications,and neonatal outcomes of the enrolled subjects were investigated and analyzed by univariate analysis and multivariate logistic regression.Results:After adjustment for maternal age,gravidity,parity,maternal education,smoking,alcohol consumption,and body mass index(BMI),pregnancies conceived by ART were associated with a significantly increased incidence of gestational diabetes mellitus(GDM;OR 1.88,95%CI 1.56-2.27),gestational hypertension(OR 2.18,95%CI 1.83-2.60),and intrahepatic cholestasis of pregnancy(ICP)(OR 2.79,95%CI 2.15-3.64),compared with spontaneous conception.These associations were similar for the singleton group.In the twin group,only the incidence of ICP was significantly higher than in controls.We found that pregnancies conceived by ART were associated with perinatal complications,including placental abruption(OR 2.14,95%CI 1.33-3.45),premature rupture of membranes(PROM;OR 1.24,95%CI 1.06-1.45),postpartum hemorrhage(OR 2.89,95%CI 2.33-3.59)and polyhydramnios(OR 2.01,95%CI 1.29-3.16).The singleton group had a similar result with placental abruption,but not with fetal membranes ruptures before labor and polyhydramnios.There were no significant differences in the incidence of these perinatal complications in the twin group.Some neonatal outcomes,including preterm labor(OR 4.29,95%CI 3.84-4.80)and low birth weight(OR 1.72,95%CI 1.42-2.08),were more likely to occur with singleton births after ART.However,there were no significant differences for these outcomes from twin pregnancies.Perinatal complications and neonatal outcomes were consistent between the IVF and ICSI subgroups.The FET and ET subgroups showed a similar increase in complications,except for the incidence of placental abruption.After taking into account the effects of parity,birth plurality and maternal age,the ART group still exhibited increased maternal and neonatal complications,although some differences narrowed or disappeared.Conclusions:This retrospective cohort study demonstrated that patients who underwent ART were at increased risk of several adverse pregnancy outcomes compared with women who conceived spontaneously.These complications may be attributed in part to the relatively high multiple pregnancy rate after ART.Elective single embryo transfer should be promoted in China to reduce the obstetrical risks of ART pregnancy.Singletons of ART pregnancy exhibited increased maternal and neonatal complications as well,suggesting that underlying infertility or other maternal or parental factors may contribute to the adverse outcomes.

电针和经皮穴位电刺激技术在生殖医学中的应用:专家共识（英文）

本文从传统针刺治疗不孕症的选穴依据与现代电针/经皮穴位电刺激技术的相关原理着手,从最优刺激参数选择、穴位辨证、疗程与治疗次数的确定及基本原理等方面阐述了电针/经皮穴位电刺激技术在多囊卵巢综合症、取卵镇痛、卵巢储备功能降低、胚胎移植以及男性少/弱精症等生殖领域中的具体应用。首次对电针/经皮穴位电刺激技术在生殖领域优势病种中的应用进行了系统的分析和总结,在最优刺激参数选择、穴位辨证、疗程与治疗次数的确定等方面提出了一系列专家共识,并为临床实践提供了指导意见和理论依据。

Epidemiological Survey and Risk Factor Analysis of Recurrent Spontaneous Miscarriages in Infertile Women at Large Infertility Centers

Background：A higher frequency of spontaneous miscarriage has been observed in infertile couples,and there is a higher prevalence of infertility among patients with a history of recurrent spontaneous miscarriages （RSMs;〉2 miscarriages）.This study aimed to determine the proportion of infertile patients with RSM and examine risk factors associated in patients with RSM being treated with assisted reproductive technologies.Methods：This cross-sectional observational study was conducted at six reproductive medicine centers in three cities of China.Data of 751 patients with at least one spontaneous miscarriage were analyzed.Demographic data and etiological factors associated with infertility were compiled and compared between patients with a single spontaneous miscarriage （SSM） and those with RSM.Results：Two hundred （26.6%,95% confidence interval [CI]：23.50-29.95%） patients experienced RSMs and 551 （73.4%） had a single miscarriage.The odds of RSM increased with increasing age （odds ratio [OR] =1.06）,uterine disorders （OR =2.09）,endocrine disorders （OR =2.48）,and immune disorders （OR =2.98）.Higher education level,masters or above,and a pelvic cavity disorder were associated with lower risk of RSM （OR =0.27 and 0.46,respectively）.Late spontaneous miscarriages were more frequent in patients with RSM than in those with a SSM （31.5% vs.14.2%,respectively,P 〈 0.001） and were associated with a history of uterine cavity procedures （OR =2.095） and cervical factors related to infertility （OR =4.136,95% CI：1.012-16.90）.Conclusions：Compared to patients with only a SSM,the conditions of patients with RSM are more complicated.To increase the success rate of assisted reproductive technology,factors including uterus cavity adhesion,cervical relaxation,endocrine disorders,and immune disorders should be treated before assisted reproduction is initiated.These data may provide treatment guidance for infertile patients with a history of RSM.

Effect of Dandelion Extracts on the Proliferation of Ovarian Granulosa Cells and Expression of Hormone Receptors

Background： In the current society, infertility related to age has become a social problem. The in vitro fertilization （IVF） success rate in women with poor ovarian response （POR） is very low. Dandelion extract T-1 （DE-T1） is an effective component of the extract from the leaves and stems of Traxacum officinale, which is one of the medicines used in some patients with POR, but its molecular mechanism remains unclear. Methods： Following IVF, ovarian granulosa cells （GCs） of sixty patients were extracted and divided into normal ovarian response （NOR） and POR groups. GCs were cultured in a dose-dependent and time-dependent manner with DE-TI, proliferation of GCs was determined by Cell Counting Kit-8 assay, and mRNA levels of insulin-like growth factor 1 receptor （IGF-1R）, luteotropic hormone receptor （LHR）, follicle-stimulating hormone receptor （FSHR）, LHR, and CYP19A1 （aromatase） were determined by quantitative polymerase chain reaction. Progesterone and estradiol （E2） concentrations were determined by enzyme-linked immunosorbent assay. Results： The cell viability gradually increased with the progressive increase in the DE-T1 concentration. Compared with the control group （without DE-T1）, the mRNA expressions of FSHR, LHR, IGF-IR, and CYPIgAI were upregulated after the addition of DE-T l, especially in the 2.5% DE-T 1 group （P 〈 0.01 ）. The expression of IGF- 1R was upregulated approximately 25 times （24.97 ± 4.02 times） in the POR group with 2.5% DE-T1. E2 and progesterone levels increased with the increasing DE-T1 concentration. There were highly significant differences in the E2 and progesterone secretion between the NOR and POR groups （P 〈 0.01）. Conclusion： DE-TI may promote steroid hormone synthesis by promoting GC proliferation and upregulating GC receptor expression, thereby improving ovarian endocrine function.

Hydrogen-rich Water Exerting a Protective Effect on Ovarian Reserve Function in a Mouse Model of Immune Premature Ovarian Failure Induced by Zona Pellucida 3

Background：Premature ovarian failure （POF） is a disease that affects female fertility but has few effective treatments.Ovarian reserve function plays an important role in female fertility.Recent studies have reported that hydrogen can protect male fertility.Therefore,we explored the potential protective effect of hydrogen-rich water on ovarian reserve function through a mouse immune POF model.Methods：To set up immune POF model,fifty female BALB/c mice were randomly divided into four groups：Control （mice consumed normal water,n =10）,hydrogen （mice consumed hydrogen-rich water,n =10）,model （mice were immunized with zona pellucida glycoprotein 3 [ZP3] and consumed normal water,n =15）,and model-hydrogen （mice were immunized with ZP3 and consumed hydrogen-rich water,n =15） groups.After 5 weeks,mice were sacrificed.Serum anti-M＆#252;llerian hormone （AMH） levels,granulosa cell （GC） apoptotic index （AI）,B-cell leukemia/lymphoma 2 （Bcl-2）,and BCL2-associated X protein （Bax） expression were examined.Analyses were performed using SPSS 17.0 （SPSS Inc.,Chicago,IL,USA） software.Results：Immune POF model,model group exhibited markedly reduced serum AMH levels compared with those of the control group （5.41 ± 0.91 ng/ml vs.16.23 ± 1.97 ng/ml,P =0.033） and the hydrogen group （19.65 ± 7.82 ng/ml,P =0.006）.The model-hydrogen group displayed significantly higher AMH concentrations compared with that of the model group （15.03 ± 2.75 ng/ml vs.5.41 ± 0.91 ng/ml,P =0.021）.The GC AI was significantly higher in the model group （21.30 ± 1.74%） than those in the control （7.06 ± 0.27%）,hydrogen （5.17 ± 0.41%）,and model-hydrogen groups （11.24 ± 0.58%） （all P 〈 0.001）.The GC AI was significantly higher in the model-hydrogen group compared with that of the hydrogen group （1 1.24 ± 0.58% vs.5.1 7 ± 0.41%,P =0.021）.Compared with those of the model group,ovarian tissue Bcl-2 levels increased （2.18 ± 0.30 vs.3.01 ± 0.33,P =0.045） and the Bax/Bcl-2 ratio decreased in the model-hydrogen group.Conclusions：Hydrogen-rich water may improve serum AMH levels and reduce ovarian GC apoptosis in a mouse immune POF model induced by ZP3.

Hysterectomy in the Second Trimester of Pregnancy after In vitro Fertilization-embryo Transfer： A Case Report and Analysis of Its Risk Factors

In vitro fertilization-embryo transfer （IVF-ET） is an effective method and an elective procedure to treat infertility caused by various factors, for example, endometriosis, tubal obstruction, and polycystic ovary syndrome. However, this technique leads to a higher rate of complications and are therefore always iatrogenic such as ovarian hyperstimulation syndrome, thrombosis, multiple pregnancy, adnexal torsion, pelvic inflammatory disease （PID）, which may threaten fetal or maternal well-being during the whole pregnancy.

Monochorionic Triplet Gestation after in Vitro Fertilization

To the Editor： Although multifetal pregnancies are common, monozygotic triplets （MZTs） remain a relatively rare occurrence. MZT gestations present patients and physicians with a dilemma because the continuation of the pregnancy can seriously threaten the health of both the mother and fetuses, while selective fetal reduction carries the risk of losing all the fetuses and is associated with a high risk of obstetric complications, especially prematurity （〉90%）. Here, we present two cases of MZT after in vitro fertilization （IVF）.