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With the development of assisted reproductive technology, there will be more and more complex conflicts of interest issues and challenges. This paper used clinical medicine, legal and ethical analysis of WAS syndrome gene mutation assisted reproductive technology cases, emphasized that the law is the bottom line of morality, strengthen the consulting duty of the ethics committee of reproductive medicine, and pointed out that medical staff must fully perform the obligation of notification, respect their autonomy and provide patients with best medical assistance.
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Objective:To investigate the safety of the Triple-P procedure in women complicated with severe placenta accreta spectrum disorders (PAS) and its influence on second pregnancy.Methods:From January 2015 to December 2017, the outcomes of the second pregnancy after the Triple-P procedure in 11 pregnant women complicated with PAS in the Third Affiliated Hospital of Guangzhou Medical University and the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed.Results:By December 2021, a total of 11 pregnant women who underwent the Triple-P procedure for PAS had a second pregnancy, with a median interval of 3 years (2-3 years). Of the 11 pregnant women, 7 delivered after 36 weeks of gestation. The median gestational age was 38 weeks, and 4 terminated within the first trimester. PAS recurred in 1 of 7 pregnant women (1/7) and was associated with placenta previa. All of the 7 pregnant women were delivered by cesarean section, with a median postpartum blood loss of 300 ml (200-450 ml), and only one pregnant woman required blood transfusion. None of the pregnant women were transferred to the intensive care unit, and there were no uterine rupture, bladder injury, puerperal infection, and neonatal adverse outcomes.Conclusion:Pregnant women who underwent the Triple-P procedure for severe PAS could be considered for second pregnancy with strictly management by an experienced multidisciplinary team, which may result in a good outcome.
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Objective:To analyze the correlation between peripheral blood lymphocyte subsets and unex-plained repeated implantation failure(URIF),and to investigate its predictive value for the diagnosis of URIF.Methods:A total of 156 patients with URIF who underwent treatment in the Department of Reproductive Medi-cine,The Second Affiliated Hospital of Kunming Medical University from October 1,2019 to December 1,2021 was selected as the URIF group.Meanwhile,age-matched 41 women with a history of healthy delivery in the past one year were selected as the control group.The percentages of peripheral blood lymphocyte subsets in the two groups were measured by flow cytometry,and the results were statistically analyzed.Receiver operating charac-teristic(ROC)curve was used to evaluate the predictive effect of lymphocyte subsets on URIF.Results:Com-pared with the control group,the percentage of CD3 + CD4 +[(34.03±7.26)%vs.(36.79±6.35)%,P = 0.017]、CD3 +HLA-DR +[(2.60±2.28)%vs.(3.60±2.39)%,P =0.017]、CD3 + CD16 + CD56 +[(1.24±1.04)%vs.(2.62±2.57)%,P<0.000]and CD4 +/CD8 +(1.37±0.48 vs.1.57±0.51,P =0.023)were sig-nificantly increased in URIF group,and were related to the increase of previous failure times to a certain extent.ROC analysis showed that CD3 + CD4 +>35.35%(AUC 0.624),CD3 + HLA-DR +>2.35%(AUC 0.669),CD3 +CD16 +CD56 +>1.86%(AUC 0.660)and CD4 +/CD8 +>1.26(AUC 0.628)could be used as an inde-pendent predictor for the diagnosis of URIF.Among the pair-wise combined indexes,CD3 + HLA-DR + combined with CD3 + CD16 + CD56 + had the highest prediction accuracy(AUC 0.739,Sensitivity 73.3%,Specificity 68.3%).The combination of the four indicators had the highest accuracy(AUC0.767,Sensitivity 68.6%,Specifici-ty 73.2%).Conclusions:There is immune dysfunction in patients with URIF,and the imbalance of peripheral blood lymphocyte subsets may be an important factor leading to embryo implantation failure.CD3 +CD4 +、CD4 +/CD8 +、CD3 +HLA-DR +and CD3 +CD16 +CD56 +could be used as independent indicators for the diagnosis of abnormal peripheral blood lymphocyte subsets in patients with URIF.The combination of them improves the accuracy of prediction,and it has a positive reference significance for dynamic monitoring and early intervention of URIF pa-tients in the process of assisted reproduction technology.
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Preeclampsia, a serious complication in pregnancy, is a "placental disease" in obstetrics. The growth and development of human and other mammalian embryos are closely related to the placenta. This review summarizes several models for studying preeclampsia including in vitro cell models, placental explants, organoid models, rodent models and primates models, contributing to a deeper understanding of placental development and related pregnancy disorders.
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Objective:To evaluate the effect of management mode based on WeChat platform on patients with mild to moderate chronic obstructive pulmonary disease (COPD).Methods:A total of 100 patients with mild to moderate COPD treated in the outpatient or ward of the Respiratory Department of Shangqiu First People′s Hospital from January 2019 to January 2020 were included. According to the randomization criteria singular number (observation group, control group), there were 50 cases in each group. The control group received routine outpatient treatment and health education follow-up, the observation group was enrolled into the WeChat management group of COPD based on the same treatment as the control group. Smoking cessation, eight-item Morisky Medication Adherence Scale (MMAS-8) score for inhaled drug compliance, chronic obstructive pulmonary disease assessment test (CAT) questionnaire score, 6 min walking distance (6MWD) and lung function [forced expiratory volume in the first second (FEV 1) and FEV 1%pred] were compared between 2 groups before and after six months intervention. Results:After intervention, the intervention follow-up was completed in 46 patients in the observation group and 35 patients in the control group, the rate of loss to follow-up in the observation group was lower than that in the control group (8% vs. 30%) ( P<0.05); The success rate of smoking cessation, the score of MMAS-8, the score of CAT, the FEV 1 and FEV 1%pred in the observation group were higher than those in the control group [82.4% vs 53.6%, (5.17±1.06) vs (4.55±0.94) points, (6.72±4.29) vs (9.37±4.54) points, (1.87±0.44) vs (1.64±0.41) L, (69.48±10.97) vs (64.46±8.25)%] (all P<0.05). There was no significant difference in 6MWD between the observation group and the control group [(401.5±92.3) vs (382.9±79.7) m] ( P>0.05). Conclusion:Management intervention based on WeChat platform can improve the smoking cessation rate and medication compliance of patients with mild to moderate COPD, so as to reduce the symptoms of dyspnea and delay the decline of pulmonary function.
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With the development of assisted reproductive technology, there will be more and more complex conflicts of interest issues and challenges. This paper used clinical medicine, legal and ethical analysis of WAS syndrome gene mutation assisted reproductive technology cases, emphasized that the law is the bottom line of morality, strengthen the consulting duty of the ethics committee of reproductive medicine, and pointed out that medical staff must fully perform the obligation of notification, respect their autonomy and provide patients with best medical assistance.
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Preeclampsia is a common gestational disease, involves multisystem disorder and carries risks for both mother and baby. Low-dose aspirin is the most comprehensive among the prevention candidates. The 2019 ACOG recommends the use of low-dose aspirin after 12 weeks of gestation as prevention if the patient has one or more of high-risk factors. WHO recommends calcium supplementation as one of strategy for prevention of preeclampsia, especially for the pregnant women who are likely to be low serum calcium or low calcium intake. Other medicines, antioxidants or sodium restriction are lack of evidence even present controversy. This paper highlights the latest guidelines, research findings and other new advances in preeclampsia prevention.
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Objective To establish the model of maternal high salt exposure and investigate the effects of maternal high salt exposure on growth and blood pressure in maternal and offspring.Methods At the age of 3 weeks (after weaning) female specific pathogen free (SPF) Sprague Dawley (SD) rats fed for 1 weeks,were randomly divided into three groups,including the high diet salt group (group H,8％ NaCl),low salt diet group (group L,0.26％ NaCl),and normal diet salt group (group N,0.5％ NaCl).Breeding started in feeding until 12 weeks of age,and the inverted microscope was used to see male sperm full view as the zeroth day of pregnancy.Pregnant,lactating,postpartum were grouped by the corresponding feed.Rats fed high salt group after weaning rats continued to high salt diet,denoted as HH group;maternal low salt group after weaning rats received continued low salt diet,denoted as LL group;normal saline group rats after weaning rats fed with normal feed to salt,denoted as NN group.Each period of maternal and offspring weight were measured with the electronic balance.Maternal and offspring's blood pressure was detected with Softron BP-2010A intelligent non-invasive blood pressure instrument (Japan) in different periods.SPSS19.0 software was used to analyze the data,including One-way ANOVA analysis,SNK,and LSD methods.Results High salt exposure,maternal postpartum 2 weeks,and the weight of H group were higher than that of L group,there were no difference in other different periods of maternal.In the offspring,in addition to 32 weeks of age,weight of HH group was lower than that of LL group;and at the age of 8 weeks and 24 weeks,HH group rats body weight was less than the NN group,the differences were statistically significant (P ＜ 0.05).After high salt exposure,after 3 weeks postpartum maternal blood pressure in H group was the highest (158.79 ± 1.87)mmHg.In the offspring,the blood pressure of 60 weeks in the HH group was the highest (162.50 ±2.11) mmHg.At the age of 8 weeks,9 weeks,10 weeks,11 weeks,7 days gestation,pregnant 14 days,1 weeks postpartum,2 weeks postpartum,3 weeks postpartum of maternal,and high salt group's blood pressure were higher than those in normal group,at the age of 9 weeks,10 weeks,11 weeks,7 days of pregnancy,postpartum 1 weeks,2 weeks postpartum,postpartum 3 weeks of high salt group's blood pressure was higher than the low salt group.In the offspring each period of HH group,the blood pressure was higher than that of NN group and LL group,and in the 28,32,36,44,48,and 52 weeks,blood pressure of LL was higher than that of NN group,the differences were statistically significant (P ＜ 0.05).Conclusions Maternal high salt exposure can affect the growth and development of offspring and lead to the occurrence of maternal and offspring hypertension,and with the high salt exposure time,blood pressure was gradually rising trend.
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Objective To establish the model of maternal high salt exposure and investigate the effects of maternal high salt exposure on growth and blood pressure in maternal and offspring.Methods At the age of 3 weeks (after weaning) female specific pathogen free (SPF) Sprague Dawley (SD) rats fed for 1 weeks,were randomly divided into three groups,including the high diet salt group (group H,8％ NaCl),low salt diet group (group L,0.26％ NaCl),and normal diet salt group (group N,0.5％ NaCl).Breeding started in feeding until 12 weeks of age,and the inverted microscope was used to see male sperm full view as the zeroth day of pregnancy.Pregnant,lactating,postpartum were grouped by the corresponding feed.Rats fed high salt group after weaning rats continued to high salt diet,denoted as HH group;maternal low salt group after weaning rats received continued low salt diet,denoted as LL group;normal saline group rats after weaning rats fed with normal feed to salt,denoted as NN group.Each period of maternal and offspring weight were measured with the electronic balance.Maternal and offspring's blood pressure was detected with Softron BP-2010A intelligent non-invasive blood pressure instrument (Japan) in different periods.SPSS19.0 software was used to analyze the data,including One-way ANOVA analysis,SNK,and LSD methods.Results High salt exposure,maternal postpartum 2 weeks,and the weight of H group were higher than that of L group,there were no difference in other different periods of maternal.In the offspring,in addition to 32 weeks of age,weight of HH group was lower than that of LL group;and at the age of 8 weeks and 24 weeks,HH group rats body weight was less than the NN group,the differences were statistically significant (P ＜ 0.05).After high salt exposure,after 3 weeks postpartum maternal blood pressure in H group was the highest (158.79 ± 1.87)mmHg.In the offspring,the blood pressure of 60 weeks in the HH group was the highest (162.50 ±2.11) mmHg.At the age of 8 weeks,9 weeks,10 weeks,11 weeks,7 days gestation,pregnant 14 days,1 weeks postpartum,2 weeks postpartum,3 weeks postpartum of maternal,and high salt group's blood pressure were higher than those in normal group,at the age of 9 weeks,10 weeks,11 weeks,7 days of pregnancy,postpartum 1 weeks,2 weeks postpartum,postpartum 3 weeks of high salt group's blood pressure was higher than the low salt group.In the offspring each period of HH group,the blood pressure was higher than that of NN group and LL group,and in the 28,32,36,44,48,and 52 weeks,blood pressure of LL was higher than that of NN group,the differences were statistically significant (P ＜ 0.05).Conclusions Maternal high salt exposure can affect the growth and development of offspring and lead to the occurrence of maternal and offspring hypertension,and with the high salt exposure time,blood pressure was gradually rising trend.
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Objective To investigate the role of neutrophils and their IgA Fc receptor CD89 in the occurrence of Henoch-Sch（o）nlein purpura (HSP),to evaluate their effects on vascular endothelial cell apoptosis,and to explore their mechanisms.Methods Peripheral blood neutrophils were isolated from 30 children with acute HSP and 9 age-matched healthy controls separately.After isolation of serum IgA by Jacalin affinity chromatography,IgA was purified by polypropylene dextran gel chromatography.Real-time fluorescence-based quantitative PCR (qPCR) and Western blot analysis were performed to determine the mRNA and protein expression of CD89 on neutrophils respectively,and flow cytometry was conducted to measure the expression of neutrophil activation marker CD11b.Human umbilical vein endothelial cells (HUVEC) were co-cultured with neutrophils isolated from patients with HSP (HSP group) and healthy controls (healthy control group) separately.Moreover,the HSP group were divided into 3 subgroups to be treated with serum IgA isolated from the HSP patients (HSP IgA group),monomeric IgA (mIgA group) and phosphate-buffered saline (blank control group) respectively.Then,flow cytometry was conducted to detect apoptosis of co-cultured HUVEC,and enzyme-linked immunosorbent assay (ELISA)to measure levels of interleukin-8 (IL-8) and tumor necrosis factor-alpha (TNF-α) in the supernatant of co-cultured cells.Results There was no significant difference in the mRNA expression of CD89 on neutrophils between the patients with HSP and healthy controls (P =0.98),but the protein expression of CD89 was significantly lower in the patients with HSP than in the healthy controls (0.60 ± 0.16 vs.0.83 ± 0.24,P =0.03).The expression of CD1 1b on neutrophils was significantly higher in the patients with HSP than in the healthy controls (1 880.25 ± 388.29 vs.1 109.25 ± 364.25,P ＜ 0.01).The apoptosis rate of co-cultured HUVEC was also significantly higher in the HSP group than in the healthy control group (37.44％ ± 5.49％ vs.17.14％ ± 4.45％,P ＜ 0.01).In addition,the H SP IgA group showed significantly higher apoptosis rate of cocultured HUVEC and levels of IL-8 and TNF-cα in the supematant compared with the mIgA group (all P ＜0.01) and blank control group (P ＜ 0.01,=0.01,=0.02,respectively).Conclusions Peripheral blood neutrophils in patients with HSP are activated,which can induce the apoptosis of vascular endothelial cells.HSP IgA can promote the neutrophil-mediated apoptosis of vascular endothelial cells and secretion of IL-8 and TNF-α,while mIgA may show a certain inhibitory effects.
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Objective To explore the related factors of fertilization failure after in-vitro fertilization and embryo transfer. Methods 150 patients were divided into total fertilization failure (TFF) group, low fertilization (LFR) group, and control (NFR) group according to fertilization rate. Semen was collected from the male pa-tients; the number, concentration, shape, and progressive motility of sperms were measured. Level of gACE was detected by Western blot. Logistic regression was used to explore the factors affecting fertilization rate. Results The fertilization rate and the concentration , progressive motility , and shape of sperms in were lower TFF group than in LFR group and NFR group (P < 0.05). Western blot proved that level of gACE group was higher in TFF than in LFR group and NFR group (P < 0.05). Logistic regression showed that the fertilization rate, the concen-tration , progressive motility , shape of sperms , and the level of gACE were all the independent risk factors for fertilization failure. Conclusions The concentration, progressive motility, and shape of sperms have impact on IVF. A lower expression of gACE in patients with lower fertilization rate can be used as a potential biomarker for predicting fertilization failure.
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Objective To evaluate the influence of pregnancy outcomes with different dosage of estradiol valerate in addition to progesterone for luteal supplementation in IVF-ET cycles. Methods From February 2011 to October 2012, 362 patients undergoing IVF-ET in the second affiliated hospital of Kunming Medical University were selected. The patients were randomly assigned into three groups. Since oocyte retrieval, all of them were injected luteal supplementation with progesterone in oil 60 mg/d, im. Group A as control group (112 cases) did not add with pentanoic acid estradiol;Group B for the experimental group (122 cases), added pentanoic acid estradiol 4 mg/d after embryo transfer;Group C for the experimental group (128 cases) added pentanoic acid estradiol 6 mg/d after embryo transfer. Finally the pregnancy outcome and implantation rate were compared for each group. Results There were no significant differences between group A and group B, group B and group C in the rate of embryos grow and pregnancy rate ( >0.05) . The embryo planting rate and pregnancy rate have significant difference between Group A and group C ( < 0.05) . Conclusion 6 mg/d fill estradiol valerate for luteal supplementation may improve implantation rate and pregnancy rate after IVF.