Objective:Overweight and obesity are increasingly epidemic and negatively related to reproductive outcome.The aim of this study was to investigate the advantages of a modified ultra-long downregulation protocol on pre...Objective:Overweight and obesity are increasingly epidemic and negatively related to reproductive outcome.The aim of this study was to investigate the advantages of a modified ultra-long downregulation protocol on pregnancy outcomes of patients with high body mass index(BMI)undergoingin vitro fertilization(IVF)/intracytoplasmic sperm injection(ICSI),compared to the long protocol(LP).Methods:We retrospectively analyzed the clinical data of 3,920 infertile patients at the Reproductive and Genetic Hospital of Citic-Xiangya from January 2012 to December 2017 by propensity score matching(PSM).Patients were divided into two groups:modified ultra-LP(MULP)(n=1,960)and LP(n=1,960).Results:In the MULP group,live birth rate(52.65%vs.46.79%,P<0.001,odds ratio[OR]:1.784,95%confidence interval[CI]:1.563-2.036),clinical pregnancy rate(62.50%vs.57.91%,P=0.003,OR:1.211,95%CI:1.066-1.377),and implantation rate(53.24%vs.49.65%,P=0.004,OR:1.155,95%CI:1.048-1.272)were statistically significantly higher than those of the LP group.Moreover,the cycle cancellation rates(12.70%vs.15.15%,P=0.027,OR:0.815,95%CI:0.68-0.977),abortion rates(12%vs.14.8%,P=0.046,OR:0.785,95%CI:0.619-0.996),and ectopic pregnancy rates(1.06%vs.2.11%,P=0.04,OR:0.497,95%CI:0.252-0.98)were lower than those in the LP group.Conclusion:The modified ultra-long downregulation protocol improved the pregnancy outcomes in patients with high BMI undergoing IVF/ICSI treatment,providing a potential option for physicians when deciding an optimized ovary stimulation protocol for high BMI patients.展开更多
Objective: Postpartum hemorrhage(PPH) is a leading cause of maternal death. Although guidelines have been updated, those with detailed protocols are limited for nursing practice. This study aims at establishing an ear...Objective: Postpartum hemorrhage(PPH) is a leading cause of maternal death. Although guidelines have been updated, those with detailed protocols are limited for nursing practice. This study aims at establishing an early assessment and intervention protocol as a toolkit for PPH for midwives and obstetrical nurses.Methods: Employing the evidence-based method, a systematic Internet search of guidelines was conducted and appraisal of literatures was conducted with AGREE system and Oxman-Guyatt Overview Quality Assessment Questionnaire(OQAQ), according to which a protocol draft was therefore developed. Then, a two-round modified Delphi method was utilized to reach a consensus of the protocol built on best practices. Selection criteria for each intervention measure included consensus level with a threshold of 70%, mean of importance(M) >3.5, and coefficient of variation(CV) <0.25. Reliability of experts' opinion was calculated by positive coefficient and authoritative coefficient. Items without consistency were enlisted in the second-round consult. When all items met the selection criteria, the protocol would be finally formulated.Results: A 122-measure protocol was established, including prevention, assessment, and intervention of PPH. With a panel of 14 experts participated in the consult, the positivity coefficient was 0.93 and 1.00 for two rounds, respectively, and the authority coefficient was 0.88. After a two-round consult and revision of the draft, the final program was formulated, containing 5 first-level indexes and 14 second-level indexes with a total item of 120.Conclusions: The PPH protocol, based on high-quality evidences, was formulated with a two-round Delphi method, which can provide insight for midwives and obstetrical nurses to effectively deal with PPH.展开更多
As a result of the exponential growing rate of worldwide Internet usage, satellite systems are required to support broadband Internet applications. The transmission control protocol （TCP） which is widely used in the...As a result of the exponential growing rate of worldwide Internet usage, satellite systems are required to support broadband Internet applications. The transmission control protocol （TCP） which is widely used in the Internet, performs very well on wired networks. However, in the case of satellite channels, clue to the delay and transmission errors, TCP performance degrades significantly and bandwidth of satellite links can not be fully utilized. To improve the TCP performance, a new idea of placing a TCP spoofing proxy in the satellite is considered. A Novel Satellite Transport Protocol （NSTP） which takes advantage of the special properties of the satellite channel is also proposed. By using simulation, as compared with traditional TCPs, the on-board spoofing proxy integrated with the special transport protocol can significantly enhance throughput performance on the high BER satellite link, the time needed to transfer files and the bandwidth used in reverse path are sharply reduced.展开更多
Background The successful end-point of in vitro fertilization （IVF） treatment is for a woman to give live birth. This outcome is based on various factors including adequate number of retrieved eggs. Failure to recru...Background The successful end-point of in vitro fertilization （IVF） treatment is for a woman to give live birth. This outcome is based on various factors including adequate number of retrieved eggs. Failure to recruit adequate follicles, from which the eggs are retrieved, is called a ＂poor response＂. How to improve the clinical pregnancy rates of poor responders was one of the tough problems for IVF. Methods The study involved 51 patients who responded poorly to high dose gonadotropin treatment in their previous cycles at our reproductive center, between April 2010 and February 2012. The previous cycle （group A） received routine long protocol; the subsequent cycle （group B） received modified super-long down-regulation protocol. The primary outcome of the study was the number of oocytes fertilized. The increase in the pregnancy rate was the secondary outcome. Differences between the groups were assessed by using Student＇s t test and Z2 test where appropriate. Results The patients＇ average age was （36.64±3.85） years. The mean duration of ovarian stimulation cycles of the group A patients was longer than those of the group B patients. The total dose of follicle-stimulating hormone （FSH） was significantly lower in the subsequent cycle. The peak value of serum estradiol on human chorionic gonadotrophin （hCG） day was lower in group A as compared with group B. The number of metaphase II oocytes recovered was significantly higher in group B. The cleavage rate in group A was significantly lower than in group B, 49 patients in group B reached embryo transfer stage, while 46 patients in group A reached this stage. Patients in group B received significantly more embryos per transfer as compared with group A. More pregnancies and more clinical pregnancies with fetal heart activity were achieved in group B. Conclusions This comparative trial shows that poor responder women undergoing repeated assisted reproduction treatment using modified super-long down-regulation protocol achieve more oocytes, leading to higher fertilization rate, compared to women receiving routine long protocol. Our study also showed that clinical pregnancy rate was significantly improved.展开更多
基金the National Key Research and Development Program of China"Research on the ethics,policy and regulation framework of synthetic biology"(2018YFA0902400-03)Ministry of Education Humanities and Social Sciences Project of China“Research on intellectual property issues in the development of synthetic biology”(19YJA20022)Huazhong University of Science and Technology humanities and social science independent innovation major cross project"The institutional path of integrating the real world study into the rule of law in a healthy China"(2020WKZDJC020)。
基金support from the National Natural Science Foundation of China(grant No.81501328)。
文摘Objective:Overweight and obesity are increasingly epidemic and negatively related to reproductive outcome.The aim of this study was to investigate the advantages of a modified ultra-long downregulation protocol on pregnancy outcomes of patients with high body mass index(BMI)undergoingin vitro fertilization(IVF)/intracytoplasmic sperm injection(ICSI),compared to the long protocol(LP).Methods:We retrospectively analyzed the clinical data of 3,920 infertile patients at the Reproductive and Genetic Hospital of Citic-Xiangya from January 2012 to December 2017 by propensity score matching(PSM).Patients were divided into two groups:modified ultra-LP(MULP)(n=1,960)and LP(n=1,960).Results:In the MULP group,live birth rate(52.65%vs.46.79%,P<0.001,odds ratio[OR]:1.784,95%confidence interval[CI]:1.563-2.036),clinical pregnancy rate(62.50%vs.57.91%,P=0.003,OR:1.211,95%CI:1.066-1.377),and implantation rate(53.24%vs.49.65%,P=0.004,OR:1.155,95%CI:1.048-1.272)were statistically significantly higher than those of the LP group.Moreover,the cycle cancellation rates(12.70%vs.15.15%,P=0.027,OR:0.815,95%CI:0.68-0.977),abortion rates(12%vs.14.8%,P=0.046,OR:0.785,95%CI:0.619-0.996),and ectopic pregnancy rates(1.06%vs.2.11%,P=0.04,OR:0.497,95%CI:0.252-0.98)were lower than those in the LP group.Conclusion:The modified ultra-long downregulation protocol improved the pregnancy outcomes in patients with high BMI undergoing IVF/ICSI treatment,providing a potential option for physicians when deciding an optimized ovary stimulation protocol for high BMI patients.
基金supported by Nursing Research Program of Shanghai Nursing Association(No.2016SD-B03)
文摘Objective: Postpartum hemorrhage(PPH) is a leading cause of maternal death. Although guidelines have been updated, those with detailed protocols are limited for nursing practice. This study aims at establishing an early assessment and intervention protocol as a toolkit for PPH for midwives and obstetrical nurses.Methods: Employing the evidence-based method, a systematic Internet search of guidelines was conducted and appraisal of literatures was conducted with AGREE system and Oxman-Guyatt Overview Quality Assessment Questionnaire(OQAQ), according to which a protocol draft was therefore developed. Then, a two-round modified Delphi method was utilized to reach a consensus of the protocol built on best practices. Selection criteria for each intervention measure included consensus level with a threshold of 70%, mean of importance(M) >3.5, and coefficient of variation(CV) <0.25. Reliability of experts' opinion was calculated by positive coefficient and authoritative coefficient. Items without consistency were enlisted in the second-round consult. When all items met the selection criteria, the protocol would be finally formulated.Results: A 122-measure protocol was established, including prevention, assessment, and intervention of PPH. With a panel of 14 experts participated in the consult, the positivity coefficient was 0.93 and 1.00 for two rounds, respectively, and the authority coefficient was 0.88. After a two-round consult and revision of the draft, the final program was formulated, containing 5 first-level indexes and 14 second-level indexes with a total item of 120.Conclusions: The PPH protocol, based on high-quality evidences, was formulated with a two-round Delphi method, which can provide insight for midwives and obstetrical nurses to effectively deal with PPH.
文摘As a result of the exponential growing rate of worldwide Internet usage, satellite systems are required to support broadband Internet applications. The transmission control protocol （TCP） which is widely used in the Internet, performs very well on wired networks. However, in the case of satellite channels, clue to the delay and transmission errors, TCP performance degrades significantly and bandwidth of satellite links can not be fully utilized. To improve the TCP performance, a new idea of placing a TCP spoofing proxy in the satellite is considered. A Novel Satellite Transport Protocol （NSTP） which takes advantage of the special properties of the satellite channel is also proposed. By using simulation, as compared with traditional TCPs, the on-board spoofing proxy integrated with the special transport protocol can significantly enhance throughput performance on the high BER satellite link, the time needed to transfer files and the bandwidth used in reverse path are sharply reduced.
文摘Background The successful end-point of in vitro fertilization （IVF） treatment is for a woman to give live birth. This outcome is based on various factors including adequate number of retrieved eggs. Failure to recruit adequate follicles, from which the eggs are retrieved, is called a ＂poor response＂. How to improve the clinical pregnancy rates of poor responders was one of the tough problems for IVF. Methods The study involved 51 patients who responded poorly to high dose gonadotropin treatment in their previous cycles at our reproductive center, between April 2010 and February 2012. The previous cycle （group A） received routine long protocol; the subsequent cycle （group B） received modified super-long down-regulation protocol. The primary outcome of the study was the number of oocytes fertilized. The increase in the pregnancy rate was the secondary outcome. Differences between the groups were assessed by using Student＇s t test and Z2 test where appropriate. Results The patients＇ average age was （36.64±3.85） years. The mean duration of ovarian stimulation cycles of the group A patients was longer than those of the group B patients. The total dose of follicle-stimulating hormone （FSH） was significantly lower in the subsequent cycle. The peak value of serum estradiol on human chorionic gonadotrophin （hCG） day was lower in group A as compared with group B. The number of metaphase II oocytes recovered was significantly higher in group B. The cleavage rate in group A was significantly lower than in group B, 49 patients in group B reached embryo transfer stage, while 46 patients in group A reached this stage. Patients in group B received significantly more embryos per transfer as compared with group A. More pregnancies and more clinical pregnancies with fetal heart activity were achieved in group B. Conclusions This comparative trial shows that poor responder women undergoing repeated assisted reproduction treatment using modified super-long down-regulation protocol achieve more oocytes, leading to higher fertilization rate, compared to women receiving routine long protocol. Our study also showed that clinical pregnancy rate was significantly improved.
