Agricultural carbon emissions in Zhejiang Province, China (2001-2020): changing trends, influencing factors, and has it achieved synergy with food security and economic development?

Given the huge carbon footprint of agricultural activities, reduction in agricultural carbon emission (ACE) is important to achieve China's carbon peaking and carbon neutrality goals, but it may affect agricultural food security and economic development. Therefore, it is important for scientific carbon reduction measures to understand the multi-year trends and the influencing factors of ACE, and clarify whether the process of ACE affects food security and economic development. This study analyzed the trends of total ACE and ACE caused by different agricultural carbon sources (ACS) from 2001 to 2020 in Zhejiang Province, then we revealed the main influencing factors of ACE based on the logarithmic mean Divisia index (LMDI) model and dissected the relationship between ACE and food security and economic development. Results show that the total ACE fluctuated from 6.10 Mt in 2001 to 3.93 Mt in 2020, and the process included a decrease in 2001-2003 and 2005-2020 and an increase in 2003-2005. The decrease in ACE, from 2001 to 2014, was mainly due to the decline in rice acreage, which contributed 90.38%; from 2014 to 2020, it was by the reduction in the use of fertilizer, diesel, and pesticide, which contributed 83.9%. As drivers, agricultural economic development effect and total population size effect drove 4.25 and 1.54 Mt of ACE, respectively. As inhibitors, planting structure effect, technology development effect, and population structure effect inhibited 3.12, 2.11, and 2.74 Mt of ACE, respectively. With the reduction of ACE, the agricultural economy continued to grow, but the food security situation was pessimistic, indicating that ACE reduction has achieved synergy with economic development, but not with food security.

Compensation mechanisms for fishermen quit fishing: A case of Jiangsu province, China.

The 'Ten-year Ban on Fishing' policy was designed by the Chinese government to protect the biodiversity of the Yangtze River basin. Fishermen are the ultimate implementers of the fishing ban policy. Therefore, a scientific compensation mechanism for fishers to stop fishing is the basis for ensuring the continuous implementation of the policy. First, we conducted a survey with 309 fishermen in eight cities along the Yangtze River in Jiangsu province. We also analyzed living conditions of fishermen before and after quitting fishing based on descriptive statistical analysis. Based on the theory of sustainable livelihood, a binary logistic regression model was used to analyze the relationship between fishermen's willingness to quit fishing and five types of livelihood capital (natural, material, human, financial, and social capital). The results showed that fishermen face severe livelihood sustainability issues after ceasing to fish and that their willingness to quit is closely related to the five types of livelihood capital. Based on this, and according to different age groups, this study constructed a compensation mechanism for retired fishermen from two aspects: monetary and social security compensation. The research results can provide a theoretical framework for other provinces in the Yangtze River basin to formulate a compensation system for fishermen.

Estimating the disutility of relapse in relapsing-remitting and secondary progressive multiple sclerosis using the EQ-5D-5L, AQoL-8D, EQ-5D-5L-psychosocial, and SF-6D: implications for health economic evaluation models.

BACKGROUND AND AIMS: Relapses are an important clinical feature of multiple sclerosis (MS) that result in temporary negative changes in quality of life (QoL), measured by health state utilities (HSUs) (disutilities). We aimed to quantify disutilities of relapse in relapsing remitting MS (RRMS), secondary progressive MS (SPMS), and relapse onset MS [ROMS (including both RRMS and SPMS)] and examine these values by disability severity using four multi-attribute utility instruments (MAUIs). METHODS: We estimated (crude and adjusted and stratified by disability severity) disutilities (representing the mean difference in HSUs of 'relapse' and 'no relapse' groups as well as 'unsure' and 'no relapse' groups) in RRMS (n = 1056), SPMS (n = 239), and ROMS (n = 1295) cohorts from the Australian MS Longitudinal Study's 2020 QoL survey, using the EQ-5D-5L, AQoL-8D, EQ-5D-5L-Psychosocial, and SF-6D MAUIs. RESULTS: Adjusted mean overall disutilities of relapse in RMSS/SPMS/ROMS were - 0.101/- 0.149/- 0.129 (EQ-5D-5L), - 0.092/- 0.167/- 0.113 (AQoL-8D), - 0.080/- 0.139/- 0.097 (EQ-5D-5L-Psychosocial), and - 0.116/- 0.161/- 0.130 (SF-6D), approximately 1.5 times higher in SPMS than in RRMS, in all MAUI. All estimates were statistically significant and/or clinically meaningful. Adjusted disutilities of RRMS and ROMS demonstrated a U-shaped relationship between relapse disutilities and disability severity. Relapse disutilities were higher in 'severe' disability than 'mild' and 'moderate' in the SPMS cohort. CONCLUSION: MS-related relapses are associated with substantial utility decrements. As the type and severity of MS influence disutility of relapse, the use of disability severity and MS-type-specific disutility inputs is recommended in future health economic evaluations of MS. Our study supports relapse management and prevention as major mechanisms to improve QoL in people with MS.

Can the water resources tax policy effectively stimulate the water saving behavior of social water users? A DSGE model embedded in water resources tax.

Whether the implementation of the water resources tax policy can stimulate the water-saving behavior of social water users is one of the important criteria for evaluating the implementation effect of the tax reform policy. Taking Hebei Province, the first tax reform pilot in China, as an example. A dynamic stochastic general equilibrium model (DSGE) with embedded water resources tax is constructed to simulate the persistent impact of water resources tax on water-saving objectives. The research shows that: (1) Water resources tax can effectively achieve the goal of water-saving and improve the utilization efficiency of water resources. (2) Levying water resources tax helps to improve the water-saving awareness of enterprises and residents. It can also encourage enterprises to optimize production structures. (3) Rational and efficient use of special water resources protection funds is the basis for ensuring the effective implementation of water resources tax. It can also improve the recycling capacity of water resources. The results show that the government should speed up formulating a reasonable water resources tax rate and accelerate the construction of water resources tax protection measures. To ensure the relatively steady state of water resources utilization and protection, and achieve the dual goals of sustainable economic development and sustainable use of water resources. The research results of this paper reveal the internal logic of the comprehensive impact of water resources tax on the economy and society and provide an important basis for the national promotion of tax reform policy.

Does green technology advancement and renewable electricity standard impact on carbon emissions in China: role of green finance.

Renewable energy growth should be accelerated in order to meet our goal of carbon neutrality and peak carbon emissions. Laws like the Renewable Electricity Standard (RES) are becoming increasingly important in producing renewable energy. Using green technology advancements is seen as balancing economic growth with environmental security. Though the connection between green technology advancements and CO2 emissions is poorly understood, empirical research is lacking, especially in developing countries. Climate change action now falls under a single overarching contract, signed in Paris on November 4, 2016. Global warming mitigation aims to keep temperature increases to no more than 2 °C above preindustrial levels. By 2060, China intends to reach carbon neutrality by developing green technologies (GTI). Because of these interconnections, this research explores the relationship between green technology innovation (GI) and renewable energy investment (REI) in selected Chinese provinces from 2005 to 2019. GI, REI, urbanization, industrial value-added, and income per capita were all considered in the STIRPAT model. We used a panel of chosen regions to test two relatively new panel estimation methods empirically: "continuously updated fully modified" (Cup-FM) and "continuously updated bias-corrected" (Cup-BC). According to our findings, urbanization and green technological developments positively impact CO2 emission reduction. The panel also finds that investments in renewable energy and the industrial sector fail to reduce pollution levels. A positive and negative coefficient of income per capita indicates that the inverted U-shaped EKC hypothesis is valid for the Chinese provinces. The results provide vital strategy insights and recommendations for the panel of experts and countries worldwide.

Measurement and driving factors of grey water footprint efficiency in Yangtze River Basin.

Water shortages and poor water quality have become an urgent problem that is constraining the sustainable development of China. Grey water has been found to bring greater stress on the water supply than freshwater consumption, and the grey water footprint (GWF) has received significant attention as a comprehensive indicator to assess wastewater pollution. In this study, we analysed the grey water footprint in the Yangtze River Basin from 2003 to 2017 and established a Logarithmic mean divisia index (LMDI) model to decompose the grey water footprint efficiency into six key factors. Our findings are as follows: (1) The average grey water footprint (AGWF) in the central regions was 40% higher than eastern region and 172% higher than western region; (2) Economic effects and capital deepening effects are the main factors affecting positive changes in grey water footprint efficiency; (3) Based on an analysis of the driving factors of greywater footprint efficiency in each province, we conducted a territorial classification according to the primary driving factors in each province. Our results reflect the spatial distribution characteristics of the influencing factors on the grey water footprint effect in the Yangtze River Basin and will enable the government to formulate relevant policies for each subregion.

Resource utilization and disaggregated cost analysis of bariatric surgery in the Australian public healthcare system.

OBJECTIVES: To present a comprehensive real-world micro-costing analysis of bariatric surgery. METHODS: Patients were included if they underwent primary bariatric surgery (gastric banding [GB], gastric bypass [GBP] and sleeve gastrectomy [SG]) between 2013 and 2019. Costs were disaggregated into cost items and average-per-patient costs from the Australian healthcare systems perspective were expressed in constant 2019 Australian dollars for the entire cohort and subgroup analysis. Annual population-based costs were calculated to capture longitudinal trends. A generalized linear model (GLM) predicted the overall bariatric-related costs. RESULTS: N = 240 publicly funded patients were included, with the waitlist times of ≤ 10.7 years. The mean direct costs were $11,269. The operating theatre constituted the largest component of bariatric-related costs, followed by medical supplies, salaries, critical care use, and labour on-costs. Average cost for SG ($12,632) and GBP ($15,041) was higher than that for GB ($10,049). Operating theatre accounted for the largest component for SG/GBP costs, whilst medical supplies were the largest for GB. We observed an increase in SG and a decrease in GB procedures over time. Correspondingly, the main cost driver changed from medical supplies in 2014-2015 for GB procedures to operating theatre for SG thereafter. GLM model estimates of bariatric average cost ranged from $7,580 to $36,633. CONCLUSIONS: We presented the first detailed characterization of the scale, disaggregated profile and determinants of bariatric-related costs, and examined the evolution of resource utilization patterns and costs, reflecting the shift in the Australian bariatric landscape over time. Understanding these patterns and forecasting of future changes are critical for efficient resource allocation.

Transmissive-detected laser speckle contrast imaging for blood flow monitoring in thick tissue: from Monte Carlo simulation to experimental demonstration.

Laser speckle contrast imaging (LSCI) is a powerful tool to monitor blood flow distribution and has been widely used in studies of microcirculation, both for animal and clinical applications. Conventionally, LSCI usually works on reflective-detected mode. However, it could provide promising temporal and spatial resolution for in vivo applications only with the assistance of various tissue windows, otherwise, the overlarge superficial static speckle would extremely limit its contrast and resolution. Here, we systematically investigated the capability of transmissive-detected LSCI (TR-LSCI) for blood flow monitoring in thick tissue. Using Monte Carlo simulation, we theoretically compared the performance of transmissive and reflective detection. It was found that the reflective-detected mode was better when the target layer was at the very surface, but the imaging quality would rapidly decrease with imaging depth, while the transmissive-detected mode could obtain a much stronger signal-to-background ratio (SBR) for thick tissue. We further proved by tissue phantom, animal, and human experiments that in a certain thickness of tissue, TR-LSCI showed remarkably better performance for thick-tissue imaging, and the imaging quality would be further improved if the use of longer wavelengths of near-infrared light. Therefore, both theoretical and experimental results demonstrate that TR-LSCI is capable of obtaining thick-tissue blood flow information and holds great potential in the field of microcirculation research.

Does health-related quality of life differ between people with relapse onset and progressive onset Multiple Sclerosis?

BACKGROUND: Multiple Sclerosis (MS) can be categorised as relapse onset MS (ROMS) and progressive onset MS (PROMS). We aimed to examine if health-related quality of life (in terms of health state utilities [HSUs] and dimensional scores) differed by onset type, in which health dimensions the differences were most pronounced, and whether these differences remained when stratified by disability severity. METHODS: We estimated HSUs and the unique composite 'super-dimension' and 'individual dimension' scores (crude, age, sex, disease duration and disease modifying therapies use adjusted; and stratified by onset type and disability severity) for a sample of 1577 participants in the Australian MS Longitudinal Study, using the Assessment of Quality of Life (AQoL)-8D. RESULTS: Adjusted mean overall HSU of PROMS was 0.55, 0.07 lower than ROMS. Adjusted mean physical and psychosocial super-dimension scores for PROMS were 0.51 and 0.28, 0.07 and 0.06 lower than for ROMS, respectively. For the individual health dimensions, the largest difference was seen in independent living (-0.12), followed by relationships (-0.07), and self-worth (-0.07). Whilst HSUs and dimensional scores were negatively associated with increasing disability severity in both onset types, estimates by disability severity did not differ between the two cohorts. CONCLUSIONS: Our study provides a comprehensive assessment of the effects of MS onset type on the overall and disability-severity specific HRQoL scores using a detailed preferentially sensitive AQoL-8D instrument. While overall HRQoL was substantially lower in PROMS than in ROMS, the mean HRQoL values for each disability level did not differ by onset type, indicating that future health economic models can use the same HSU inputs for both onset types.

Quantitative assessment of U.S. bulk power systems and market operations during the COVID-19 pandemic.

Starting in early 2020, the novel coronavirus disease (COVID-19) severely attached the U.S., causing substantial changes in the operations of bulk power systems and electricity markets. In this paper, we develop a data-driven analysis to substantiate the pandemic's impacts from the perspectives of power system security, electric power generation, electric power demand and electricity prices. Our results suggest that both electric power demand and electricity prices have discernibly dropped during the COVID-19 pandemic. Geographically diverse impacts are observed and quantified, while the bulk power systems and markets in the northeast region are most severely affected. All the data sources, assessment criteria, and analysis codes reported in this paper are available on a GitHub repository.

Few-Shot Learning by a Cascaded Framework With Shape-Constrained Pseudo Label Assessment for Whole Heart Segmentation.

Automatic and accurate 3D cardiac image segmentation plays a crucial role in cardiac disease diagnosis and treatment. Even though CNN based techniques have achieved great success in medical image segmentation, the expensive annotation, large memory consumption, and insufficient generalization ability still pose challenges to their application in clinical practice, especially in the case of 3D segmentation from high-resolution and large-dimension volumetric imaging. In this paper, we propose a few-shot learning framework by combining ideas of semi-supervised learning and self-training for whole heart segmentation and achieve promising accuracy with a Dice score of 0.890 and a Hausdorff distance of 18.539 mm with only four labeled data for training. When more labeled data provided, the model can generalize better across institutions. The key to success lies in the selection and evolution of high-quality pseudo labels in cascaded learning. A shape-constrained network is built to assess the quality of pseudo labels, and the self-training stages with alternative global-local perspectives are employed to improve the pseudo labels. We evaluate our method on the CTA dataset of the MM-WHS 2017 Challenge and a larger multi-center dataset. In the experiments, our method outperforms the state-of-the-art methods significantly and has great generalization ability on the unseen data. We also demonstrate, by a study of two 4D (3D+T) CTA data, the potential of our method to be applied in clinical practice.

Systematic Review of the Evolution of Health-Economic Evaluation Models of Osteoarthritis.

OBJECTIVE: To comprehensively synthesize the evolution of health-economic evaluation models (HEEMs) of all osteoarthritis (OA) interventions, including preventions, core treatments, adjunct nonpharmacologic interventions, pharmacologic interventions, and surgical treatments. METHODS: The literature was searched within health-economic/biomedical databases. Data extracted included OA type, population characteristics, model setting/type/events, study perspective, and comparators; the reporting quality of the studies was also assessed. The review protocol was registered at the International Prospective Register of Systematic Reviews (CRD42018092937). RESULTS: Eighty-eight studies were included. Pharmacologic and surgical interventions were the focus in 51% and 44% of studies, respectively. Twenty-four studies adopted a societal perspective (with increasing popularity after 2013), but most (63%) did not include indirect costs. Quality-adjusted life years was the most popular outcome measure since 2008. Markov models were used by 62% of studies, with increasing popularity since 2008. Until 2010, most studies used short-to-medium time horizons; subsequently, a lifetime horizon became popular. A total of 86% of studies reported discount rates (predominantly between 3% and 5%). Studies published after 2002 had a better coverage of OA-related adverse events (AEs). Reporting quality significantly improved after 2001. CONCLUSION: OA HEEMs have evolved and improved substantially over time, with the focus shifting from short-to-medium-term pharmacologic decision-tree models to surgical-focused lifetime Markov models. Indirect costs of OA are frequently not considered, despite using a societal perspective. There was a lack of reporting sensitivity of model outcome to input parameters, including discount rate, OA definition, and population parameters. While the coverage of OA-related AEs has improved over time, it is still not comprehensive.

Prospective assessment and risk factors of sleep disturbances in total hip and knee arthroplasty based on an Enhanced Recovery After Surgery concept.

PURPOSE: This study aimed to examine sleep quality and risk factors associated with sleep disturbance in patients undergoing total joint arthroplasty (TJA) managed with an enhanced recovery protocol from preoperatively until 12 weeks postoperatively in order to provide suggestions for improving the prevention and treatment of sleep disturbance in these patients. METHODS: The Chinese versions of the Pittsburgh Sleep Quality Index (CPSQI) and Epworth Sleepiness Scale (CESS) were used to evaluate sleep quality. Pain was measured by a visual analog scale (VAS). Neuropsychological status was also assessed, using the Center for Epidemiological Studies Depression Scale (CESD) and Zung Self-Rating Anxiety Scale (ZSAS). RESULTS: Of 107 patients (66% women), the prevalence of sleep disturbance was as high as 60% preoperatively. CPSQI score significantly increased postoperatively from baseline to 2 weeks before decreasing rapidly to a lower level than preoperative baseline. CESS scores of postoperative weeks 1 and 2 increased significantly compared with baseline and decreased significantly after 4 weeks, and a positive correlation was found between CESS and CPSQI score. VAS score significantly decreased from baseline over all time points in the postoperative period. A good sleeper group was more likely to suffer from severe sleep disturbance after surgery than a poor sleeper group with a bigger increase of CPSQI score. Multivariate logistic regression analysis indicated that pain and anxiety were risk factors associated with postoperative sleep disturbance. CONCLUSIONS: Sleep disturbance is highly prevalent among patients undergoing TJA. More attention and multimodal approaches with well-controlled pain, mental counseling, and possibly preemptive use of sleep medication may improve sleep quality in TJA patients to promote recovery.

Difference in Housing Temperature-Induced Energy Expenditure Elicits Sex-Specific Diet-Induced Metabolic Adaptations in Mice.

OBJECTIVE: The aim of this study was to test whether increased energy expenditure (EE), independent of physical activity, reduces acute diet-induced weight gain through tighter coupling of energy intake to energy demand and enhanced metabolic adaptations. METHODS: Indirect calorimetry and quantitative magnetic resonance imaging were used to assess energy metabolism and body composition during 7-day high-fat/high-sucrose (HFHS) feeding in male and female mice housed at divergent temperatures (20°C vs. 30°C). RESULTS: As previously observed, 30°C housing resulted in lower total EE and energy intake compared with 20°C mice regardless of sex. Interestingly, housing temperature did not impact HFHS-induced weight gain in females, whereas 30°C male mice gained more weight than 20°C males. Energy intake coupling to EE during HFHS feeding was greater in 20°C versus 30°C housing, with females greater at both temperatures. Fat mass gain was greater in 30°C mice compared with 20°C mice, whereas females gained less fat mass than males. Strikingly, female 20°C mice gained considerably more fat-free mass than 30°C mice. Reduced fat mass gain was associated with greater metabolic flexibility to HFHS, whereas fat-free mass gain was associated with diet-induced adaptive thermogenesis. CONCLUSIONS: These data reveal that EE and sex interact to impact energy homeostasis and metabolic adaptation to acute HFHS feeding, altering weight gain and body composition change.

Health state utilities for economic evaluation of bariatric surgery: A comprehensive systematic review and meta-analysis.

Health state utilities (HSUs) are health economic metrics that capture and assess health-related quality of life (HRQoL). They are essential in health-economic evaluations when calculating quality-adjusted life years. We investigated published studies reporting bariatric surgery-related HSUs elicited through direct or indirect (multiattribute utility instrument [MAUI]) patient-reported methods (PROSPERO registration number: CRD42019131725). Mean HSUs for different time points and HSU changes over time (where feasible) were meta-analysed using random-effects models. Of the 950 potentially relevant identified studies, n = 28 (2004-2018) qualified for data extraction, with n = 85 unique HSUs elicited mainly from the EQ-5D (88%). Most (75%) studies were published after 2013. The follow-up duration varied between studies and was often limited to 12 months. The pooled mean HSU was 0.72 (0.67-0.76) at baseline/presurgery (n = 18) and 0.84 (0.79-0.89) one-year postsurgery (n = 11), indicating a 0.11 (0.09-0.14) utility unit increment. EQ-5D showed the similar results. This positive difference can be partially explained by BMI and/or co-morbidities status improvement. This study provides a valuable summary of HSUs to future bariatric surgery-related cost-utility models. However, more well-designed higher-quality bariatric-related HSU studies are expected for future reviews to improve the available evidence. We suggest that researchers select an MAUI that is preferentially sensitive to the study population.

Hepatotoxicity assessment of Rhizoma Paridis in adult zebrafish through proteomes and metabolome.

Rhizoma Paridis hepatotoxicity is a risk factor limiting its extensive use in clinic, there is limited information available regarding the mechanism by which typical environmental levels of exposure can contribute to the onset of this disease. The adult zebrafish were exposed to Rhizoma Paridis at a sub-lethal concentration. The alterations in protein expression profiles and metabolite levels in the adult zebrafish liver, a popular model for toxicity assessment, exposed to the Rhizoma Paridis were observed. The result showed that Rhizoma Paridis exposure treatment caused an obvious toxic effect on the zebrafish liver, resulting in a significant change of the liver organization structure and various biochemical parameters. The hepatotoxicity of adult zebrafish liver induced by Rhizoma Paridis was mainly associated with lipid metabolism and energy metabolism disorder. Furthermore, oxidative stress injury, inflammation, and endoplasmic reticulum stress might also be involved in the hepatotoxicity. Our study facilitated the understanding of molecular signatures of toxic effects of Rhizoma Paridis causing liver injury to move away from the risk assessment based on in vivo animal experiments.

Bariatric surgery is a cost-saving treatment for obesity-A comprehensive meta-analysis and updated systematic review of health economic evaluations of bariatric surgery.

Demand for bariatric surgery to treat severe and resistant obesity far outstrips supply. We aimed to comprehensively synthesise health economic evidence regarding bariatric surgery from 1995 to 2018 (PROSPERO registration number: CRD42018094189). Meta-analyses were conducted to calculate the annual cost changes "before" and "after" surgery, and cumulative cost differences between surgical and nonsurgical groups. An updated narrative review also summarized the full and partial health economic evaluations of surgery from September 2015. N = 101 studies were eligible for the qualitative analyses since 1995, with n = 24 studies after September 2015. Quality of reporting has increased, and the inclusion of complications/reoperations was predominantly contained in the full economic evaluations after September 2015. Technical improvements in surgery were also reflected across the studies. Sixty-one studies were eligible for the quantitative meta-analyses. Compared with no/conventional treatment, surgery was cost saving over a lifetime scenario. Additionally, consideration of indirect costs through sensitivity analyses increased cost savings. Medication cost savings were dominant in the before versus after meta-analysis. Overall, bariatric surgery is cost saving over the life course even without considering indirect costs. Health economists are hearing the call to present higher quality studies and include the costs of complications/reoperations; however, indirect costs and body contouring surgery are still not appropriately considered.

Establishment of Neurobehavioral Assessment System in Tree Shrew SCT Model.

Tree shrews, possessing higher developed motor function than rats, were more suitable to study neurological behavior after spinal cord injury (SCI). Here, we established a feasible behavioral assessment method to detect the degree of ethology recovery in tree shrew subjected to spinal cord transection (SCT). Tree shrews were divided into normal group, sham group, and SCT group. The tree shrew in sham group was subjected to laminectomy without SCI, while the tree shrews in the SCT group were subjected to a complete SCT in thoracic 10 (T10). A novel neurobehavior assessment scale was established, in which, the behavior index including slow advancement, fast advancement, standing, shaking head, voluntary jump, lateral movement, and tail status, was determined, respectively. Meanwhile, magnetic resonance imaging (MRI) was applied to observe the structure of the spinal cord, and diffusion tensor imaging (DTI)-based white matter mapping was used to show the fibers of the spinal cord. As a result, a marked decrease in locomotor function and consciousness was seen in tree shrews with SCT, and the detection of MRI showed the collapsing of nerve fibers after SCT is completely cut and there is corresponding to the behavior change. Together, the present study provided a novel and feasible method that can be used to assess the neurobehavior in SCT model from tree shrews, which may be useful to the SCI translational study in future preclinic trial.

Effect of duration of gonadotropin releasing hormone agonist on the outcome of in vitro fertilization-embryo transfer in a short-acting long regimen.

Objective: To investigate the effect of the duration of gonadotropin releasing hormone agonist (GnRH-a) use on the outcome of in vitro fertilization and embryo transfer (IVF-ET) during the short-acting long-term hyperstimulation cycle. Methodology: Clinical data from 776 patients receiving controlled ovarian stimulation (COS) after short-term regimen downregulation were retrospectively analyzed. According to the duration of GnRH-a, the patients were divided into 3 groups: Group A, 14 days for GnRH-a; Group B, 15-17 days for GnRH-a; and Group C, >18 days for GnRH-a. The clinical data, treatment and clinical outcomes were compared among the groups. Results: There were no significant differences in fertilization rate, implantation rate, clinical pregnancy rate, abortion rate, ovarian hyperstimulation syndrome (OHSS) rate(P > 0.05). The total costs in group A were significantly less than those in group B and C(P < 0.001). The number of eggs and quality embryos generated in group A was significantly higher than that in groups B and C (P = 0.014, P = 0.005). Conclusions: In the short-acting GnRH agonist long protocol, satisfactory IVF-ET pregnancy outcome was obtained with the use of GnRH-a for 14 days under the premise of lowering the receptor-regulating standard. Excessive application of GnRH-a will affect the number of eggs and embryos and increase the cost of medical treatment.