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Objective To investigate the current status,evolving hotspots,and emerging trends in the field of human re-source allocation research in public hospitals,both domestically and internationally,to provide a reference for future research di-rections in China.Methods CiteSpace was used to conduct a visual analysis of the research literature on human resource alloca-tion in public hospitals based on China National Knowledge Infrastructure(CNKI)and the Web of Science(WOS).The analysis encompassed co-authorship,institutional collaboration,keyword co-occurrence and clustering,and burst detection.Results A total of 1 417 Chinese articles and 981 international articles were included.Domestic research in this field focused more on healthcare reform and management,resource allocation,hierarchical diagnosis,and treatment,and informatization and efficiency improvement.On the contrary,international research primarily centered on the employee satisfaction,healthcare system quality,work environment and medical staff.Future trends in domestic research included cost reduction,efficiency enhancement,and a greater emphasis on public welfare in public hospitals,while international research was beginning to explore the influence of polit-ical concepts in this field.Conclusion Compared to international research,domestic research needs to further improve its theo-retical and localized understanding,broaden its research scope,explore the interdisciplinary collaboration opportunities,and delve into research directions such as the application of artificial intelligence and automation technology in healthcare services,management of a diverse workforce,and innovative management techniques and applications.
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Objective:To investigate the association between serum sex hormone-binding globulin (SHBG) and non-alcoholic steatohepatitis (NASH).Methods:In this cross-sectional study, a total of 371 middle-aged and young obese patients who were hospitalized and underwent liver puncture in Nanjing Drum Tower Hospital from January 2016 to April 2021 were included. The population was divided into control group ( n=43) and non-alcoholic fatty liver disease (NAFLD) group ( n=328) based on the non-alcoholic fatty liver disease activity score. Subjects in NAFLD group were further divided into non-alcoholic fatty liver (NAFL) ( n=60), uncertain-NASH ( n=172), and NASH ( n=96). Serum SHBG was tested in patients with NAFLD who were divided into three subgroups according to tertiles. The liver pathological characteristics in different SHBG level subgroups were compared. The risk factors of NASH were analyzed by logistic regression. The prediction model of NASH noninvasive diagnosis was established by forward stepwise regression, and the diagnostic value of non-invasive model for NASH was evaluated by receiver operating characteristic (ROC) curve. Results:The median age in patients were (32±10) years old with a body mass index of (39.16±6.58) kg/m2, including 236 females (63.6%). Serum SHBG level [ M ( Q1, Q3)] in NAFLD group was significantly lower than that in control group [16.90 (11.43, 23.00) vs. (23.45 (15.40, 31.22) mmol/L, P<0.05], and progressively diminished in NAFL, uncertain-NASH and NASH subgroups [(22.24±10.47), (20.57±19.58), (15.80±8.74) mmol; P for trend<0.05]. Compared with the high-leveled SHBG subgroup, the steatosis score (2.09±0.80 vs. 1.51±0.72, P<0.01) and lobular inflammation score (1.10±0.68 vs. 0.85±0.68, P<0.05) were significantly higher in the low-leveled SHBG group. Multivariate logistic regression analysis indicated that lower serum SHBG level was an independent risk factor for NASH ( OR=2.527, 95% CI: 1.296 to 4.928, P<0.05). The area under ROC curve of SHBG combined with aspartate aminotransferase in predicting NASH in NAFLD patients was 0.752 (95% CI: 0.696 to 0.809). Conclusion:Low serum SHBG level is associated with NASH.
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Objective To determine the association of subclinical hypothyroidism (SCH) with body composition (measured by body impedance analysis) and insulin resistance (IR) in overweight/obese patients with polycystic ovary syndrome (PCOS).Methods A retrospective analysis was conducted of the clinical records of 109 overweight or obese [body mass index (BMI) ≥ 24 kg/m2] PCOS patients who visited the Department of Endocrinology and Fertility Center of Nanjing Drum Tower Hospital between April 2013 and April 2016 for menstrual disorder or infertility and were referred to receive weight management.24 of the patients had SCH,and 85 had euthyroid (EU).We determined the body composition of the patients with Biospace Inbody 720 body composition analyzer,measured the patients' serum lipid profiles,conducted in each patient the 75 g oral glucose tolerance test and the insulin release test,and calculated the homeostasis model assessment of insulin resistance (HO-MA-IR) indices.Results Patients with SCH and autoimmune thyroiditis (AIT) accounted for 22.02％ and 24.36％ of the total.The obesity level [(145.19±13.75)％ vs.(153.31±18.15)％,t=-2.032,P=0.045],VFA [(132.48±20.85) cm2vs.(147.35±24.26) cm2,t=-2.730,P=0.007],body fat (BF) [(31.91±5.88) kgvs.(35.43±6.89) kg,t=-2.274,P=0.025],body fat percentage (BFP) [(40.92±3.701)％ vs.(43.07±4.26)％,t=-2.241,P=0.027],body mass index (BMI) [(30.49±2.88) kg/m2 vs.(32.19±3.81) kg/m2,t=-2.026,P=0.045] and waist circumference (WC) [(98.34±7.13) cm vs.(102.86±8.74) cm,t=-2.324,P=0.022] of SCH group were significantly lower than those of euthyroid,with significant statistical difference.The levels of serum thyroid hormone (TSH) in patients with EU were positively correlated with the degree of obesity,the BF,the BFP,the BMI and the hip circumference (P=0.019,0.042,0.005,0.019,0.039),but not with the VFA (t=1.797,P=0.076).There were no statistically significant differences (P＞ 0.05) between patients with SCH and those with EU in their HOMA-IR indices,insulin levels,blood glucose,blood lipid,and ratio of IR (defined as HOMA-IR ≥2.69).Conclusions Obesity related body composition parameters were lower in PCOS patients with SCH than in those with EU.However,there was no significant difference between the two groups in blood lipid level and the ratio of IR.TSH levels in the EU group were correlated with the BMI and the BFP,but not with the VFA.A larger sample is needed to identify how and why thyroid hormones may affect the body composition and glycolipid metabolism of females with PCOS.
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Objective To establish and validate the ascites volume forecast model of ascites puncture drainage operation with ultrasound measuring for 6 positions in patients with ovarian hyperstimulation syndrome (OHSS),including front of the uterus,Douglas pouch,right iliac fossa,left iliac fossa,hepatorenal recess and spleen kidney fossa.Methods Fifty patients received ultrasonographic measurement (measurement group) and then underwent ascites puncture drainage operation within 6 h.Three scatter diagrams of actual ascites volume (Y;ml) and key position ascites depth summation (X;mm),height correlation coefficient and surface area correlation coefficient were drawn.The simple and practical regression equation with better correlation was used to be the one verified.Then 100 subsequently HSS patients were enrolled in verrification group.Forecast ascites volume calculated with above-mentioned regression equation and actual ascites volume was analyzed with Bland-Altm an method and paired t test.Results Regression equation obtained with the scatter diagram was Y=-256.554 + 10.452X (R2 =0.577),which could be simplified as Y=10.5X-250.0.The limit of consistency between forecast ascites volume and actual ascites volume was (-1 314.02,1 560.48) ml,and the bias was 123.23 ml.The difference between forecast ascites volume and actual ascites volume was not statistically significant (t=-1.684,P=0.096).Conclusion The simplified equation is Y=10.5X-250.0 to forecast ascites volume caused by OHSS,therefore guiding clinical work.
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Objective Three-dimensional(3D) automated ultrasonic volume measurement is becoming favorable in clinical application and turns to be an important direction .The article was to evaluate the consistency of two-dimensional (2D) and three-di-mensional ultrasonography in the diameter measurement of single follicle . Methods 438 single folliculars were respectively meas-ured by the same sonographer in 2D and 3D ultrasonic measurement.2D diameter, 3D mean diameter and 3D virtual ball diameter of every single follicle were recorded , and Bland-Altman method were used to evaluate the consistency of the results by these two meth-ods. Results In the consistency analysis on the diameter measurement of single follicle by 2D and 3D mean diameter measurment methods, d equaled -1.06 mm, and 95% LoA range covered the range of -4.82 mm to 2.70 mm.95% CI of 95% LoA range,-5.21 mm to 3.08 mm, was beyond the settings of clinical acceptable error limit range , -3.56 mm to 1.44 mm, showing poor consis-tency.Likewise, in the research of the consistency in the measurement of 2D diameter and 3D virtual ball diameter in the diameter measurement of single follicle , d equaled -0.07 mm , and 95%LoA range covered the range of -3.11 mm to 2.98 mm.95%CI of 95%LoA range, -3.43 mm to 3.29 mm, was beyond the settings of clinical acceptable error limit range , -2.57 mm to 2.43 mm, showing poor consistency . Conclusion 2D and 3D ultrasound measurements in the diameter measurement of single follicle are not consistent.However, considering the objectivity and accuracy of the results , 3D ultrasonography still has an advantage over 2D ultra-sonography , which can provide more acurate aid for assisted reproductive technology .
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Objective The CYP19 gene product enzyme aromatase mediates the conversion of the androgen testosterone to es -tradiol.The aim of this study is to investigate whether the CYP19A1 gene single nucleotide polymorphism (SNP) is associated with the susceptibility to polycystic ovary syndrome (PCOS) and serum hormone levels. Methods We conducted a case-controlled study, which included 373 PCOS patients and 313 healthy controls.We genotyped SNP rs2899470 in the subjects using the polymerase chain re-action-restriction fragment length polymorphism ( PCR-RFLP) method and analyzed the frequencies of genotypes and alleles as well as the association of different genotypes with age , menarchal age, body mass index (BMI), and serum levels of hormones. Results The gen-otypic distributions of rs2899470 GG, TG, and TT in the PCOS women were 44.5%, 49.6%, and 5.9%, respectively, significantly dif-ferent from 39.3%, 48.6%, and 12.1%in the healthy controls (P=0.013).The frequency of the G allele was 69.3%in the former, remarkably higher than 63.6%in the latter (P=0.025).The rs2899470 genotypic frequencies were associated with the serum E 2/T lev-els in the PCOS patients. Conclusion SNP rs2899470 in the CYP19A1 gene is associated with the susceptibility to PCOS , and so is the genotype of rs2899470 with serum E2/T levels, which may be attributed mainly to the reduced activity of aromatase .
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Nanobody is a kind of antibody from camel, which misses light chain. Nanobody has the same antigen binding specificity and affinity as mAb. Moreover, because of its small molecular weight, high stability and easy preparation, nanobody has great value of biomedical applications. In this study, we successfully prepared highly pure antiEGFR nanobody in E.coli using genetic engineering techniques. Cell proliferation assay (CCK-8 assay) and migration experiments (cell scratch test and Transwell assay) indicated that the recombinant antiEGFRnano can significantly inhibit the proliferation and migration of endometrial cancer cells. These results provide a new way of thinking and methods for EGFR-targeted therapy of endometrial cancer.
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Objective To investigate the effect of different amplification methods and probes with various length on the results of comparative genomic hybridization (CGH) analysis of pre-implanted single blastomere and to establish the basis for preimplantation genetic diagnosis.Methods Twenty blastomeres of embryo at 6-8 cells stage were randomly divided into A and B group with 10 in each.Twenty peripheral blood lymphocytes from a healthy man were similarly divided into C and D group with 10 in each.Degenerate oligonucleotide primed polymerase chain reaction (DOP-PCR) was used to amplify whole genomic DNA in group A and C,and multiple displacement amplification (MDA) was used in group B and D for whole genome amplification (WGA).The specificity of resultant products was confirmed by amplification of TBX1 gene exon 2.CGH was performed respectively with 250-750 bp and 750-2000 bp probes prepared from the amplified whole genomic DNA.The result of CGH was verified by sex-determining region of Y (SRY).Results (1) Nine of the 10 samples in group A and all in group C were amplifiable by DOP-PCR,but there were multiple non-specific bands in the amplification of TBX1 exon 2 when WGA products were used as templates.When 250～750 bp probe was used in CGH,1 of the 5 blastomeres was failed and another one had different karyotype from that analyzed by SRY.(2) All samples in group B and D were successfully amplified by MDA,and the non-specific bands were significantly less in the amplification of TBX1 exon 2.All 5 blastomeres were successful in CGH with the 250～750 bp probe.Moreover,the karyotype was in agreement with that of SRY.(3) When 750 ～ 2000 bp probe was used,the CGH results were suboptimal.Conclusions In WGA of single blastomere,MDA is superior to DOP-PCR in the stability and specificity.The karyotype image detected by CGH with the 250～750 bp probe is clear and homogenous.
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<p><b>OBJECTIVE</b>To evaluate percutaneous epididymal sperm aspiration (PESA) and testicular sperm extraction (TESE) in the diagnosis and treatment of azoospermia.</p><p><b>METHODS</b>We examined 385 azoospermia patients using the techniques of PESA and TESE.</p><p><b>RESULTS</b>Of the total number of the azoospermia patients, 64 (16.62%) had sperm in the epididymis and 45 (11.69%) in the testis. Intracytoplasmic sperm injection (ICSI) was applied to 64 of the patients with sperm in the epididymis or testis. The pregnancy rate after the embryo transfer was 39.07%.</p><p><b>CONCLUSION</b>PESA and TESE, as an effective therapy for azoospermia, can further the classification of azoospermia and provide chances of procreation to azoospermia patients with partial obstruction.</p>
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Adulte , Humains , Mâle , Azoospermie , Diagnostic , Thérapeutique , Séparation cellulaire , Méthodes , Épididyme , Biologie cellulaire , Injections intracytoplasmiques de spermatozoïdes , Méthodes , Testicule , Biologie cellulaire , Résultat thérapeutiqueRÉSUMÉ
<p><b>OBJECTIVE</b>To evaluate the impact of the concentration of circulating luteinizing hormone (LH) in the late-follicle phase on the outcome of in vitro fertilization for normogonadotrophic women.</p><p><b>METHODS</b>Intracytoplasmic sperm injection treatment was conducted in 432 consecutive cycles of normogonadotrophic women. A stimulation protocol with mid-luteal gonadotropin-releasing hormone (GnRH) agonist down-regulation and ovarian stimulation with follicle stimulating hormone (FSH) was used in all cycles. hMG was added when a follicle of > or = 14 mm was present (FSH + hMG group), not in the control group (FSH-alone). LH and oestradiol concentration in the serum on hCG day were detected. Based on LH levels, patients in the FSH + hMG group were again divided into four subgroups: LH < or = 1, 1 < LH < or = 2, 2 < LH < or = 3, and 3 < LH < or = 10 IU/L.</p><p><b>RESULTS</b>Oestradiol concentration on the day of hCG injection in the FSH + hMG group was higher than that in the FSH-alone group [(3435.51 +/- 2029.01) pg/ml vs (2620.62 +/- 1604.80) pg/ml, P < 0.05]. More embryos were transferred in the FSH-alone group than in the FSH + hMG group [(2.77 +/- 0.45) vs (2.22 +/- 0.46), P <0.001]. Fertilization rate, implantation rate, and clinical pregnancy rate were similar between the FSH-alone group and the FSH + hMG group (77.52% vs 78.31%, 41.42% vs 41.68%, 64.56% vs 62.64%, P > 0.05), as well as among the four subgroups of the FSH + hMG group (P > 0.05).</p><p><b>CONCLUSION</b>The adding of suitable amount of hMG and physiologically limited LH concentration in the late-follicle phase have no negative effect on the outcome of in vitro fertilization/intracytoplasmic sperm injection for normogonadotrophic women.</p>
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Adulte , Femelle , Humains , Régulation négative , Oestradiol , Sang , Fécondation in vitro , Hormone folliculostimulante , Utilisations thérapeutiques , Phase folliculaire , Hormone de libération des gonadotrophines , Hormone lutéinisante , Sang , Induction d'ovulation , Résultat thérapeutiqueRÉSUMÉ
<p><b>OBJECTIVE</b>To review the treatment results of intracytoplasmic injection of epididymal and testicular sperm obtained from 50 azoospermic patients from January 2003 to May 2004.</p><p><b>METHODS</b>Sperm was retrieved by percutaneous epididymal sperm aspiration (PESA) or testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI) was performed. The rates of successful sperm retrieval, fertilization, implantation and pregnancy were analysed and evaluated.</p><p><b>RESULTS</b>In the PESA, TESE and ejaculation groups, the number of M II oocytes suitable for ICSI were 286, 360 and 1569 respectively. The difference of fertilization rates among the three groups was not significant (74.8%, 75.2% vs 77.5%, P>0.05). No difference was seen in the implantation and clinical pregnancy rates of the TESE group from the ejaculation group (29.87% vs 29.54%; 48.15% vs 52.60%, P>0.05). However the implantation and clinical pregnancy rates were higher in the PESA group compared with the TESE and ejaculation groups (50.85% vs 29.87%, 29.54%; 68% vs 48.15%, 52.60%, P<0.05). In the PESA group, 17 clinical pregnancies were achieved including 9 ongoing pregnancies, and 6 live deliveries and 2 miscarriages. While in the TESE group, 13 clinical pregnancies were achieved including 4 ongoing pregnancies, 7 live deliveries and 2 miscarriages.</p><p><b>CONCLUSION</b>ICSI with PESA and TESE is an effective method to treat azoospermia.</p>
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Adulte , Femelle , Humains , Mâle , Adulte d'âge moyen , Grossesse , Azoospermie , Thérapeutique , Épididyme , Issue de la grossesse , Études rétrospectives , Injections intracytoplasmiques de spermatozoïdes , Méthodes , TesticuleRÉSUMÉ
<p><b>OBJECTIVE</b>To investigate the main correlative factors affecting the pregnancy rate of intrauterine insemination (IUI) by means of analyzing 186 patients and 216 cycles of IUI.</p><p><b>METHODS</b>Comparisons were made between different pregnancy rates from five respects: infertility reasons, stimulation and natural cycles, different protocols for stimulating ovulation (CC group, CC + hMG group, hMG group), two methods for semen treatment (swim-up and gradient centrifugal), and insemination time (endometrial thickness and E2 levels at the day of hCG injection, and times of IUI).</p><p><b>RESULTS</b>The pregnancy rates resulting from male and cervix factors (29.82%, 25.00%) were significantly higher than those from other factors. There were few statistical differences in the pregnancy rates between stimulation and natural cycles (19.54% vs 16.67%), between the three different protocols for stimulating ovulation (CC 6.50%, CC + hMG 14.28%, hMG 22.30%), between gradient centrifugal and swim-up methods (20.13% vs 16.13%) and between one-time IUI and two-time IUI (19.73% vs 17.39%) (P > 0.05). However, the pregnancy rates were statistically correlated with the endometrial thickness at the day of hCG injection and different E2 levels of the follicles over 14 mm in diameter (P < 0.05).</p><p><b>CONCLUSION</b>IUI is of more applied value for infertility caused by male and cervix factors. With these factors in view, to choose the most suitable insemination time is the key to increasing pregnancy rate.</p>
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Femelle , Humains , Mâle , Grossesse , Oestradiol , Sang , Insémination artificielle , Méthodes , Taux de grossesse , Facteurs tempsRÉSUMÉ
Objective To evaluate effects of different laparoscopic procedures for hydrosalpinx on ovarian responses to superovulation induction during in vitro fertilization-embryo transfer(IVF-ET).Methods A total of 65 patients with infertility derived from hydrosalpinx underwent 67 cycles of IVF-ET from January 2002 to January 2005.Before the IVF-ET,the patients were given bilateral laparosocpic salpingectomy(Group A,n=47,48 cycles) or laparosocpic proximal tubal ligation and distal tubal salpingostomy(Group B,n=18,19 cycles).Another 58 patients with proximal tubal occlusion without hydrosalpinx were simultaneously included for 58 cycles of IVF-ET(Group C).Results The fertilization rates,cleavage rates,implantation rates,and clinical pregnancy rates were 85%?21%,95%?17%,49%(55/113),and 79%(38/48) in the Group A,83%?17%,98%?7%,47%(21/45),and 68%(13/19) in the Group B,and 81%?22%,92%?16%,41%(57/140),and 66%(38/58) in the Group C,respectively,without statistically significant difference among the 3 groups(F=0.48,P=0.620;F=1.22,(P=0.297);?~2=1.691,P=0.429;?~2=2.471,P=0.291).The doses of gonadotrophin,the duration of stimulation,and the number of retrieved oocytes were 29.4?10.3 vials,9.4?1.7 d,and 11.4?5.6 in the Group A,24.7?7.7 vials,9.0?1.8 d,and 12.8?6.1 in the Group B,and 28.4?8.8 vials,9.1?1.8 d,and 11.4?5.3 in the Group C,respectively,without statistically significant difference among the 3 groups(F=1.77,P=0.174;F=0.52,P=0.593;F=0.51,P=0.599).Conclusions Laparosocpic salpingectomy or laparosocpic proximal tubal ligation with distal tubal salpingostomy for hydrosalpinx does not impair ovarian responses to the superovulation induction.Both of the procedures may be considered for the treatment of hydrosalpinx prior to IVF-ET.
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Objective To evaluate the tension-free herniorrhaphy for groin hernia with defect of the entire posterior wall. Methods Fifty-four patients underwent tension-free repair for groin hernia with defect of posterior wall of the groin canal by one of two kinds of prosthesis, Bard Mesh PerFix Plug in 8 cases, Bard Mash in 2 cases and Gore-Tex Micromesh in 44 cases, under epidural anesthesia. Results Inguinal groin hernia of entire posterior wall defect was diagnosed when the defect of the posterior wall was larger than 4 cm in length. Operations were all successful in patients with pimary hernia and recurrent hernia. The mean postoperative follow up was 12.8 months with no recurrence. Conclusions The two tension-free herniorrhaphies for this type of groin hernia were safe and effective.