Enhancing the scope of in vitro maturation for fertility preservation: transvaginal retrieval of immature oocytes during endoscopic gynaecological procedures.

STUDY QUESTION: Could in vitro maturation (IVM) following transvaginal oocyte retrieval during gynaecological surgery (IVM-surgery) be an effective and safe strategy for fertility preservation? SUMMARY ANSWER: IVM-surgery on unstimulated ovaries is a novel option that can be considered for fertility preservation for women requiring gynaecological surgery, but more research is needed to identify appropriate patients who may benefit and to determine the cost-effectiveness of such an approach. WHAT IS KNOWN ALREADY: IVM followed by oocyte/embryo cryopreservation has been useful as a safe reproductive strategy for some infertile women. STUDY DESIGN, SIZE, DURATION: This prospective cohort study comprised 158 consecutive women with polycystic ovary syndrome (PCOS) who underwent laparoscopy or hysteroscopy for other reasons and had concomitant transvaginal oocyte retrieval followed by IVM between 2014 and 2016. PARTICIPANTS/MATERIALS, SETTING, METHODS: A total of 158 women with anovulatory PCOS who underwent IVM-surgery in our infertility centre were recruited for this study. Matured IVM oocytes obtained from these women were either freshly fertilized and subsequently frozen at the blastocyst stage (fresh oocyte group, n = 46) or the oocytes were frozen (frozen oocyte group, n = 112) for fertility preservation followed by later thawing for insemination and cleavage embryo transfer (ET) (n = 33). The following outcomes were then evaluated: embryological data, clinical pregnancy rate, live birth rate (LBR), neonatal outcomes, post-operative complications and post-operative ovarian function. MAIN RESULTS AND THE ROLE OF CHANCE: Among all the women who underwent IVM-surgery, the clinical pregnancy rate and LBR per initiated IVM cycle were 9.5% (15/158) and 6.9% (11/158), respectively. Women (40.6%, 20/33) who underwent the procedure with frozen-thawed oocytes (oocyte survival rate, 83.0%) obtained a high quality of cleaved embryos. In the fresh oocyte group, the clinical pregnancy rate and LBR per ET cycle were 69.2 and 53.8%, respectively. In the frozen oocyte group, the clinical pregnancy rate and LBR per ET cycle were 28.6 and 19.1%, respectively. No adverse neonatal outcomes were recorded. IVM-surgery was not associated with post-operative complications, a longer hospital stay, or impaired ovarian function. LIMITATIONS, REASONS FOR CAUTION: Because of the small sample size and the low utilization rate and cost-effectiveness per retrieval, the present findings should be interpreted with caution, and further studies are needed for the long-term follow-up of live births. WIDER IMPLICATIONS OF THE FINDINGS: This strategy can also help patients with normal ovulation to obtain available oocytes and embryos for cryopreservation and subsequent use. STUDY FUNDING/COMPETING INTEREST(S): This research was supported by the Joint Research Fund for Overseas Natural Science of China (No. 31429004), the National Key Research and Development Program of China (No. 2017YFC1002000, 2017YFC1001504, 2016YFC1000302), the Ministry of Science and Technology of China Grants (No. 2014CB943203), the Chinese Society of Reproductive Medicine Fund (No. 16020400656) and the National Natural Science Foundation of China (No. 81300456). All the authors have nothing to disclose in terms of conflicts of interest. TRIAL REGISTRATION NUMBER: chictr-ONC-17011861.

A novel causative factor of injury: Severe burns related to fires and explosions of lithium-ion batteries of electric motorcycles.

Severe burns related to fires and explosions of lithium-ion batteries of electric motorcycles have not been reported to date. We retrospectively studied 419 patients admitted to our burn intensive care unit from January 2016 to December 2021. Of these 419 patients, 26 (22 male, 4 female; median age, 42 years) had burns related to lithium-ion battery fires and explosions, and all of their injury characteristics were similar to those of traditional flame burns. Lithium-ion battery-related burns were the eighth most common cause of burn injuries among all hospitalized patients. The 26 patients comprised 10 unemployed and 16 employed individuals. Twenty-three patients were injured at home during the battery charging process, and three were injured outdoors (one by a fire while the electric motorcycle was stationary and the others two by a fire while riding the motorcycle). The burn sites were distributed over the whole body; the burn area ranged from 10 % to 100 % of the total body surface area, and the burn depth ranged from superficial second-degree burns to third-degree burns. Twenty-three patients had inhalation injuries, and ten underwent prophylactic tracheostomy and intubation. Multiple operations were required for wound repair. Although convenient, lithium-ion electric motorcycles can also cause severe burns. To prevent these injuries, we must increase public safety awareness and education, develop new battery energy storage systems and battery management systems, and ensure the safety of batteries. Consumers should be aware of the potential dangers of lithium-ion batteries and comply with related security measures.

[Influence of duration of gonadotropin administration on the clinical outcome of in vitro fertilization embryo transfer].

OBJECTIVE: To investigate the influence of duration of gonadotropin (Gn) administration on the clinical outcome of in vitro fertilization embryo transfer (IVF-ET). METHODS: A total of 3 221 cycles of short protocol or antagonist protocol in our center from January 2012 to December 2012 were included in the retrospective study. According to the different duration of Gn administration, all patients were divided into group A (≤7 days, n=58) and group B (>7 days, n=3 163). The different clinical parameters, such as age, duration of infertility, body mass index (BMI), basis estradiol (E2), follicle-stimulating hormone (FSH), the number of antral follicle, the number of oocytes, endometrium thickness, fertility rate, good quality embryo rate, impatation rate and clinical pregnancy rate were compared between the two groups. RESULTS: There was no significant difference in age, duration of infertility, BMI, basis E2, FSH, the number of antral follicle between the two groups. The number of oocytes in group A was fewer than that in group B [(8.2±5.6)vs.(12.1±8.3), P=0.009]; endometrium thickness on the day of HCG in group A was thinner than that in group B [(9.9±2.1) mm vs.(10.4±1.6) mm,P=0.002]. There was no significant difference in fertility rate, good quality embryo rate, impatation rate and clinical pregnancy rate (36.2% vs. 33.6%, P>0.05). There was no significant difference in clinical pregnancy rate between the two groups in short protocol (33.3% vs. 27.2%, P>0.05). In the same way, there was no significant difference in clinical pregnancy rate between the two groups in antagonist protocol (37.5% vs. 36.6%, P> 0.05). CONCLUSION: Although short duration of gonadotropin administration in short protocol and antagonist protocol has association with fewer number of oocytes, it may not affect the outcome of IVF-ET.

[Comparison of gonadotropin releasing hormone agonist long protocol and gonadotropin releasing hormone antagonist protocol in infertile women].

OBJECTIVE: To compare the clinical outcomes of GnRH agonist (GnRH-a) long protocol and GnRH antagonist (GnRH-ant)protocol in vitro fertilization (IVF)-embryo transfer (ET) cycles, and to explore the optimized protocol for infertile women. METHODS: From June 2010 to June 2012, 2 444 infertile women underwent their IVF cycles in Peking University Third Hospital, which were divided into 1 706 GnRH agonist long protocol and 738 GnRH antagnist protocol groups. The data of the general demographic, treatment and clinical outcome were compared between the two groups. RESULTS: The age, body mass index(BMI), infertile duration, antral follicle count (AFC) did not reach statistical difference, the level of estradiol on the day of HCG: injection was higher in GnRH agonist group [(10 595±7 368)pmol/L vs. (9 087±7 035) pmol/L], and the mean length of stimulation was longer in GnRH agonist group[(12.5±1.8) d vs.(9.4±1.7) d], The dose of Gn [(3 107±1 377) IU vs. (2 084±903)IU]was higher in GnRH agonist group. The number of ovum was 13.4±6.6 in GnRH agonist group and 11.8±6.4 in GnRH antagonist group. Those clinical parameters all reached statistical difference (P<0.05). The number of the transfer embryos, fertilization rate, and cleavage rate did not reach statistical difference, but the number of the embryos was 5.6±4.5 in GnRH agonist group and 5.1±4.3 in GnRH antagonist group,reached statistical difference (P<0.05). The abortion rate, embryonic death rate, ectopic pregnancy rate, preterm labor rate, postterm pregnancy rate, fatal malformations rate showed no statistical difference, but the GnRH agonist long protocol had higher pregnancy rate (44.0% vs. 38.3%), and higher term pregnancy rate (64.2% vs. 56.9%) compared with GnRH antagonist protocol, thus those parameter reached significant difference (P<0.05). CONCLUSION: Compared with GnRH-antagnist protocol, GnRH agonist long protocol had higher pregnancy rate and better pregnancy outcome.

[Analysis of clinical factors affecting pregnancy rate of intrauterine insemination].

OBJECTIVE: To analyze the factors affecting clinical pregnancy rate of intrauterine insemination in Center of Reproductive Medicine, Peking University Third Hospital, to guide clinical treatment. METHODS: In the study, 5 167 intrauterine insemination cycles were retrospectively analyzed from May 2011 to October 2012 in our reproductive center. The data were collected, the single-factor was analyzed with χ2 test, and the multi-factor was analyzed with Logistic regression with a significant level of 0.05. RESULTS: The cycle clinical pregnancy rate was 12.8%, which decreased with the increase of the female age and infertile duration. The clinical pregnancy rate was low when the sperm density was less than 1×10(6)/mL. In the ovulation group, the clinical pregnancy rate was higher than the natural group. The group with more than 2 dominant follicles had higher clinical pregnancy rate as compared with the single dominant follicle group. The clinical pregnancy rate was the highest in the third cycle but decreased after the fourth cycle. The clinical pregnancy rate was higher in cervical factors, sexual dysfunction, and polycystic ovary than in the group with other reasons. CONCLUSION: The female age, infertile duration, ovarian stimulation and follicle number, cause of infertility were the main factors affecting clinical pregnancy outcome; the sperm density, and cycle numbers have influence too; the insemination timing, and frequency have little effect.

[Combined efficacy of parecoxib and incisional ropivacaine infiltration on pain management after diagnostic hysteroscopy and laparoscopy].

OBJECTIVE: To evaluate the combined effect of premedication of parecoxib sodium and local infiltration of ropivocaine on postoperative shoulder pain and incisional pain in patients undergoing diagnostic hysteroscopy and laparoscopy. METHODS: In the study, 60 patients undergoing elective diagnostic hysteroscopy and laparoscopy were randomly allocated to two groups (each with 30 patients). The patients in group 1 were premedicated with 40 mg parecoxib sodium (diluted with 2 mL normal saline), and 0.5% ropivacaine (20 mL) were infiltrated around the incision site before establishment of CO2 pneumoperitoneum. The patients in group 2 received 2 mL normal saline intraveniously before anesthesia induction, and infiltration of 0.5% ropivacaine 20 mL were also applied as group 1. After anesthetic withdrawal, the patients' postoperative anesthesia recovery time and the time point of opening eyes on verbal command were noted. The intensities of postoperative shoulder pain and incisional pain were evaluated at 0, 2, 4, 8, 12, 24, and 48 h after surgery. The postoperative analgesic requirement was met by administration of tramadol. RESULTS: Compared with group 2, the incidence of postoperative shoulder pain was less in group 1 (37% vs. 67%, P=0.020), and the occurence of severe pain was lower (4 vs. 11, P=0.037). The numerical rating scales (NRS) of right shoulder pain of group 1 were significantly reduced than those of group 2 at 12 h postoperatively [0 (0, 2) vs. 0 (0, 8), P=0.012]. Left shoulder pain did not appear at 0 h and 2 h in both groups, while at 12 h and 24 h postoperatively, the NRS scores of group 1 were lower than those of group 2 [0 (0, 1) vs. 0 (0, 8), P=0.026; 0 (0, 4) vs. 2 (0, 9), P=0.014]. The dynamic and static abdominal pain scores of group 1 were significantly decreased than those of group 2 in post-anesthesia care unit (PACU) after surgery (P=0.001, P=0.005). The NRS scores of static abdominal pain of group 1 were significantly reduced than those of group 2 at 12 h and 24 h postoperatively (P=0.042, P=0.029). More patients in group 2 needed tramadol within 24 h postoperatively (8 vs. 0, P=0.002). CONCLUSION: Premedication of parecoxib sodium combined with local infiltration of ropinvocaine before incision could significantly reduce the postoperative shoulder pain and incisional pain as well as reduce opioid consumption in patients undergoing diagnostic hysteroscopy and laparoscopy.

Evolution and interaction relationship of "eco-economy" dual grid pattern in Lingwu City, Ningxia, China.

Strengthening ecological network construction is an important measure to improve urban ecological environment and protect biodiversity. With Lingwu City of Ningxia as an example, based on remote sensing and social and economic data, we comprehensively analyzed the "double network" (ecological network and social and economic landscape) pattern and their relationship by using morphological spatial pattern analysis, Linkage Mapper, and improved gravity model. The results showed that land use/cover changed dramatically from 2000 to 2020 in Lingwu City. The area of sandy land and grassland decreased sharply, that of forest and construction land increased, and industrial zones expanded rapidly. The connectivity and stability of "dual network" were improved. The intensive areas of human activities were distributed in urban area, oasis agricultural areas, and Ningdong energy industrial zone. The ecological source areas and ecological corridors were mainly distributed in the middle of the nature reserve, while some extended to the other three functional areas. The transportation corridor presented an "H" pattern that was dense in oasis agricultural area and Ningdong energy industrial zone, and connected between the two regions. The "double network" were centered around their respective functional area spaces and had interwoven distributions. The trend of the "double network" changed from conflict to coordinated situation, with obvious zoning and interaction in space. The oasis agricultural area and Ningdong energy industrial area destroyed the eco-logy in the early stage and improved that in the later stage. In the future, it is necessary to strengthen the coordination between ecological protection and social and economic development, which could improve ecological quality by combining measures such as improving the quality of ecological sources and corridors, constructing ecological nodes, and repairing ecological disturbance points.

[Comparison of GnRH antagonist fixed protocol and GnRH agonists long protocol in infertile patients with normal ovarian reserve function in their first in vitro fertilization-embryo transfer cycle].

OBJECTIVE: To compare the clinical outcomes of gonadotropin-releasing hormone (GnRH) antagonist (GnRH-ant) fixed protocol with GnRH agonist (GnRH-a) long protocol in infertile patients with normal ovarian reserve function in their first in vitro fertilization-embryo transfer (IVF-ET) cycle, and to explore the feasibility and advantage of GnRH antagonist protocol performed in normal responders. METHODS: From January 2011 to June 2011, 771 infertile women with normal ovarian reserve function underwent their first IVF or intracytoplasmic sperm injection (ICSI) cycles in Peking University Third Hospital, which were divided into 245 cycles in GnRH-ant fixed protocol group (GnRH-ant group) and 526 cycles in GnRH-a long protocol group (GnRH-a group). The data of general demographic, treatment and clinical outcome were compared between two groups. RESULTS: Age, infertile duration, body mass index (BMI), baseline serum follicle-stimulating hormone (FSH) and estradiol levels between two groups did not reached statistical difference (P > 0.05). The level of estradiol was (12 289 ± 6856) pmol/L in GnRH-ant group and (14 934 ± 8007) pmol/L in GnRH-a group at day of hCG injection. The mean length of stimulation was (10.3 ± 1.2) days in GnRH-ant group and (12.8 ± 1.6) days in GnRH-a group. The dose of gonadotropin was (2013 ± 607) U in GnRH-ant group and (2646 ± 913) U in GnRH-a group. The number of ovum was 15 ± 7 in GnRH-ant group and 17 ± 8 in GnRh-a group. Those clinical parameter all reached statistical difference (P < 0.05). The number of embryo was 7 ± 4 in GnRH-ant group and 8 ± 5 in GnRH-a group, the rate of clinical pregnancy was 40.9% (94/230) in GnRH-ant group and 45.6% (216/474) in GnRH-a group, the rate of implantation was 26.1% (128/490) in GnRH-ant group and 30.9% (307/994) in GnRH-a group, the rate of continuing pregnancy was 38.7% (89/230) in GnRH-ant group and 42.6% (202/474)in GnRH-a group, those parameter did not reach statistical difference (P > 0.05). The rate of moderate or severe ovarian hyperstimulation syndrome was 2.4% (6/245) in GnRH-ant group and 4.2% (22/526) in GnRH-a group, which did not show significant difference (P > 0.05). CONCLUSION: In the first IVF or ICSI cycle of the patients with normal ovarian reserve function, the fixed GnRH-ant protocol could get the same satisfied clinical outcome, and it is more economic, convenient and safer compared with low dose depot GnRH-a long protocol.

Influence of follicle-stimulating hormone receptor (FSHR) Ser680Asn polymorphism on ovarian function and in-vitro fertilization outcome: a meta-analysis.

BACKGROUND: A common follicle-stimulating hormone (FSH) receptor (or FSHR) polymorphism Ser680Asn (rs6166) was found to be associated with altered ovarian response in women undergoing in-vitro fertilization. To further investigate such an association, a meta-analysis was conducted. METHODS: A PubMed literature search was conducted to identify all cohort studies investigating such a relationship. The following parameters-basal FSH levels, total FSH doses, oocytes retrieved, and pregnancy rates-were used to evaluate the ovarian function, its response to exogenous FSH and in-vitro fertilization and intracytoplasmic sperm injection outcome. RESULTS: A total of 1421 cases were collected from eight studies. Of them, a significantly lower basal FSH level was observed in patients harboring Asn/Asn (NN) genotype than those carrying the Ser/Ser (SS) genotype both in Asian (WMD: -2.57 mIU/ml, 95% CI: -2.96 to -2.19, P<0.0001) and Caucasian retrospective groups (WMD: -1.86 mIU/ml, 95%CI: -2.07 to -1.66, P<0.0001) with no heterogeneity. Moreover, carriers of the SS tended to require greater FSH doses than NN (WMD: -268.82IU, 95% CI: -561.28 to 23.63, P=0.07). Other parameters, such as oocytes retrieved and pregnancy rate, were not significantly different between the groups. CONCLUSION: Carriers of the SS variant have slightly higher basal FSH levels, tending to require higher doses of exogenous FSH for stimulation.

Evaluation of the tissue damage of porcine ovaries after bipolar drilling under transvaginal hydrolaparoscopy--an in vitro experiment.

OBJECTIVE: To evaluate the tissue damage of in vitro porcine ovarian drilling in saline solution mimicking transvaginal hydrolaparoscopy (THL). STUDY DESIGN: In vitro ovarian drilling with different current and activation time was applied on fresh porcine ovaries, 15 ovaries in each group and 2 punctures in each ovary. Drilling using 5-Fr bipolar needle was performed in saline solution mimicking THL, while saline solution rinsing the ovaries after monopolar electrocoagulation. RESULTS: The monopolar drilling caused more tissue damage than the bipolar needle in saline (p < 0.01). The ratio of the damage of monopolar electrocoagulation (40 w, 3s) over that of bipolar diathermy in saline solution (70 w, 15 s) was 7.4 [(16.74 +/- 1.30) mm(3)/(2.27 +/- 0.49) mm(3)]. In the bipolar groups, the 70 w power set (15s and 20 s) caused significantly more tissue damage than the 50 w ones (p < 0.05), and the amount of damage was not stimulation time dependent (p > 0.05). CONCLUSION: The tissue damage caused by monopolar electrocoagulation with 40 w for 3 s was about seven times of that caused by 5-Fr bipolar one in saline with 70 w for 15 s . In THL drilling using a 5-Fr bipolar electrode, the current is more crucial than stimulation time.

[Effects of different fertilizations upon serum HCG level of IVF versus ET in early pregnancy].

OBJECTIVE: To compare the serum HCG levels in pregnant women of routine IVF versus ICSI during fresh transplantation cycles so as to explore whether ICSI influenced the serum HCG levels. METHODS: A total of 934 IVF pregnant cycles during March 2005 to September 2006 were divided into 7 groups: biochemical pregnancy (A), first-trimester miscarriages (B), ectopic pregnancy (C), single-pregnancy (D), twin-pregnancy (E), triplet-pregnancy (F) and heterotopic pregnancy (G). The median of serum HCG level at Days 14 and 21 was calculated among 7 groups. RESULTS: The serum HCG value was lower by ICSI than that by IVF only in biochemical pregnancy group at Day 14 (P = 0. 032). CONCLUSION: ICSI is associated with relatively low HCG values in the biochemical pregnancies at Day 14 after embryo transplantation. There is no statistical difference of HCG level for clinical pregnancy between IVF and ICSI.

[Comparison of multiple pregnancy rate following transfer of frozen-thawed or fresh embryos and analysis of related factors].

OBJECTIVE: To compare the multiple pregnancy rates of frozen-thawed embryos transfer (FET) or fresh embryos transfer, analyze the factors related to multiple pregnancies after IVF and study pregnancy rates with different number of embryos transferred in FET cycle. METHODS: A retrospective analysis was performed upon multiple pregnancies from 1235 and 1561 clinical pregnancies conceived by FET or fresh embryo transfers. RESULTS: No correlation was found between fresh or cryopreserved embryos transfer and multiple pregnancy rates. There were significant effects of woman's age, number of embryos transferred and stage of embryos upon multiple pregnancy rates. When the same number of cleavage-stage embryos was transferred to women with the same age, twin pregnancy rate or triplet pregnancy rate was the same between FET and fresh cycles. Triplet pregnancy rate with three embryos transferred was significantly higher than that of two embryos transferred. In women under 35 years old, the pregnancy rate with two embryos transferred reached 36.1%. CONCLUSION: Frozen-thawed embryos or fresh embryos transfer has no effect upon the multiple pregnancy rate. Women under 35 years old can achieve acceptable pregnancy rates when two cryopreserved embryos are transferred. It is helpful to reduce the triplet pregnancy rate.

[Clinical analysis of 12,491 cycles treated in embryo transfer program].

OBJECTIVE: To analyze the clinical outcomes of patients treated with in vitro fertilization and embryo transfer (IVF-ET) and influence factors of pregnancy rate. METHODS: We retrospectively analyzed the clinical data of 12,491 cycles, including 6,832 fresh IVF/intracytoplast single sperm injection (ICSI) cycles and 5,659 frozen embryo transfer (FET) cycles from 2005 to 2007. RESULTS: The clinical pregnancy rate per cycle was 32.99% (2254/6832) in fresh embryo transfer program, and the live birth rate was 25.75% (1394/5413); the early pregnant loss rate was 9.36% (211/2254), and the prenatal defect rate was 1.45% (25/1722). Through analysis of these patients' basic data, we found that the patients' age, causes for infertility, egg retrieval and cycle number affected the pregnancy rate. Using logistic regression method, we found that patients' age was the most important factor affecting pregnancy outcome. In FET cycles, the clinical pregnancy rate was 38.08% (2155/5659), significantly higher than fresh embryo transfer cycles. CONCLUSIONS: IVF-ET treatment is a safe and effective method for infertility couples. However, the female age and poor ovarian response are the main factors affecting pregnancy rate. Thawed embryo transfer can increase the accumulated pregnancy rate effectively.

Human trophoblast cell during first trimester after IVF-ET differs from natural conceived pregnancy in development and function.

OBJECTIVE: To explore the differences of the trophoblast cell function in first trimester between natural pregnancy and pregnancy after IVF-ET therapy. METHODS: 102 cases with twin to singleton fetal reduction after IVF-ET treatment from July 2010 to August 2013 in Peking University Third Hospital were involved in analysis, and eight specimens were obtained from this group. 10 natural-pregnancy cases undergoing artificial abortion with unwanted pregnancy were recruited as control. Semi-quantitative immunohistochemical method was used to detect the expression of EGFR, Bcl-2, tubulin-α, metallothionein and AFP in villi in both groups. RESULTS: Of the 102 cases, 14 cases (13.73%) were aborted. Preterm birth occurred in seven cases (7.86%). Low birth weight occurred in three patients (3.37%), and extremely low birth weight occurred in four cases (4.49%). The expression of EGFR, tubulin-α, Bcl-2, and metallothionein in the IVF-ET group was significantly lower than that in the control group (P<0.05). However, AFP expression was significantly higher in IVF-ET group than in control group (P<0.05). In IVF-ET group, the miscarriage case had weaker EGFR, tubulin-α, and metallothionein expression than full-term pregnancy; the early preterm labor case had weaker Bcl-2, tubulin-α, and metallothionein expression; and velamentous cord insertion case had weaker tubulin-α expression. CONCLUSIONS: The trophoblast cell function of IVF-ET group in first trimester is different from control group in proliferation, invasion, apoptosis and vascular development, and optimal pregnancy outcome depends on the self-healing balance of trophoblast cells.

[Quantitative evaluation of resource and environment pressure in Qinghai Province, China based on footprint family]. / 基于足迹家族的青海省资源环境压力定量评估.

In order to effectively evaluate the influence of human activities on the resource and environment, this paper constructed an resource and environment pressure evaluation system based on footprint family, and calculated the ecological footprint, carbon footprint, water footprint, and resource and environment pressure in Qinghai Province. The results showed that from 1990 to 2013, the ecological footprint per capita in Qinghai Province increased from 1.32 hm2 to 3.32 hm2, and biological capacity per capita decreased from 2.33 hm2 to 2.07 hm2. Since 2006 there was ecological deficit. However, the biomass surplus existed during 1990-2013. The carbon footprint per capita increased from 5.82 t to 15.85 t, which had been more than 7.93 times of the target to address climate change. The water footprint per capita decreased from 967.67 m3 to 732.05 m3. Since 1990, the ecological pressure was at low grade (1b), greenhouse gas (GHG) emissions pressure was enhanced from low grade (1b) to above-average grade (2b), the water pressure was at very low grade (1a), the resource and environment pressure increased from very low grade (1a) to low grade (1b). The rate of contribution of ecological pressure and water resource pressure to resources and environment pressure gradually decreased, whereas, the rate of contribution of GHG emission pressure to resources and environment pressure gradually increased. The resource and environment pressure had spatial heterogeneity. In 2013, it was at very high grade (3b) in Xining City, at above-average grade (2b) in Haidong City, at below-average grade (2a) in Haixi State and atvery low grade (1a) in the rest regions. The main resource and environment pressure source also had obvious spatial heterogeneity. In future, differentiation strategies should be taken in the decompression progress.

[Expression of telomerase and telomerase associated-regulation protein and proliferating cell nuclear antigen in ovarian epithelial tumors].

OBJECTIVE: To investigate expression and significance of hTERT, telomerase associated-regulation protein (TRAP) and proliferating cell nuclear antigen (PCNA) in ovarian epithelial tumors. METHODS: 106 specimens of ovarian epithelial tumors and their clinical history were collected, including 54 cases of malignancy, 33 borderline cases and 19 benign tumor cases. Immunohistochemical staining for hTERT, TRAP and PCNA were performed. Follow-up information was obtained for 45 of 87 cases (malignancy in 54 and borderline malignancy in 33). RESULTS: The expression of hTERT was significantly different between benign (4/19) and borderline (90.9%, 30/33) cases, benign and malignant (94.4%, 51/54) cases (P < 0.001), as was the expression of TRAP between benign (4/15) and malignant (77.8%, 28/36) cases (P < 0.001). The expression of hTERT and TRAP was not higher in stage III, IV ovarian cancer patients than in stage I and II (P > 0.05, P > 0.3). The expression of PCNA between benign (6.9 +/- 5.9)% and borderline (26.4 +/- 17.8)% cases, benign and malignant (51.8 +/- 22.1)% cases, and borderline and malignant cases were different, and were statistically significant (P < 0.01, P < 0.001, P < 0.05). 33 cases of borderline malignancy are all survive. In 54 cases of malignancy, 35 of them have metastasis (64.8%), including 5 cases of lymph nodes metastasis. 4 of them died (7.4%). CONCLUSIONS: The expression of hTERT and TRAP is associated with the malignant degree of ovarian cancer, but does not correlate with stage. The expression of TRAP resembles hTERT, which may be a new tumor-associated gene. Telomerase activity is positively associated with PCNA.

Efficacy of local aspiration in the conservative treatment of live interstitial pregnancy coexisting with live intrauterine pregnancy after in vitro fertilization and embryo transfer.

BACKGROUND: Heterotopic pregnancy (HP) is defined as a pregnancy in which one or more embryos is viably implanted in the uterus while the other is implanted elsewhere as an ectopic pregnancy. The occurrence of HP rises dramatically with the increased use of assisted reproductive technology. HP of interstitial pregnancy is one special situation which needs more concern. Here we evaluate the efficacy of local aspiration and instillation of hyperosmolar glucose in the treatment of live interstitial pregnancy complicated with live intrauterine pregnancy after in vitro fertilization and embryo transfer. METHODS: Five female patients were diagnosed with live interstitial pregnancies complicated with intrauterine pregnancies. They were treated with transvaginal ultrasound-guided aspiration of interstitial pregnancy and instillation of hyperosmolar glucose at the Center for Reproductive Medicine of Peking University Third Hospital from January 1st, 2008 to May 30th, 2011. RESULTS: Gemmule embryos in all 5 cases were aspirated successfully and there was no abdominal hemorrhage, threatened abortion or infection in any of the cases. The sac of interstitial pregnancy continued to progress after aspiration and stopped growing between 11 to 20 weeks. By the 30th week of pregnancy, 80% of the interstitial masses had disappeared. Four cases have delivered and one is still in on-going pregnancy. All of the four cases underwent cesarean section and there were nothing special detected in the corner of the uterus. CONCLUSION: Local aspiration and instillation of hyperosmolar glucose may be an effective way to treat live interstitial pregnancy when coexisting with a live intrauterine pregnancy.

Effects of tumor necrosis factor-alpha on porcine oocyte meiosis progression, spindle organization, and chromosome alignment.

OBJECTIVE: To evaluate the effects of tumor necrosis factor-alpha (TNF-alpha) on porcine oocyte maturation, spindle dynamics, and chromosome alignment. DESIGN: Controlled, prospective study. SETTING: University hospital and IVF research laboratory. ANIMAL(S): Ovaries collected from slaughtered prepubertal gilts. MAIN OUTCOME MEASURE(S): Oocyte maturation rate and cytoskeleton distribution. MATERIALS AND METHOD(S): Immature porcine oocytes (GV) were exposed to TNF-alpha at a concentration of 0 (as a control), 1, 5, 10, 100, 200, or 600 ng/mL in M199 medium. Oocytes were cultured for 24 hours to the pre-MI stage or 44 hours to the MII stage. After in vitro maturation for 44 hours, the rates of GV oocytes reaching MII stage were assessed, and MII oocytes were fixed for further examination of the cytoskeleton and the chromosomal distribution. RESULT(S): The TNF-alpha concentration at 5 ng/mL decreased the porcine oocyte maturation rate compared with the control after culture for 44 hours, whereas exposure to 10 or 100 ng/mL TNF-alpha resulted in a significant increase in the frequency of defective spindles or abnormal microfilament distribution. Exposed to 200 ng/mL, TNF-alpha caused a significantly higher abnormality rate of chromosome alignment when compared with the controls. CONCLUSION(S): Exposure of porcine oocytes to an elevated TNF-alpha concentration clearly caused a reduction in their maturation from GV stage to MII stage and increased the proportion of oocytes with abnormal chromosome alignment and cytoskeleton structure.

Comparison of the major malformation rate of children conceived from cryopreserved embryos and fresh embryos.

BACKGROUND: Cryopreserved embryo transfer has become indispensable in reproductive technology. More and more children are conceived from frozen-thawed embryo transfer (FET). The risk of birth defects associated with frozen-thawed embryo transfer has been evaluated and conflict results are obtained. The aim of this study was to compare the rate of major malformations in children conceived from cryopreserved embryos with that of children from fresh embryos. METHODS: A retrospective analysis was performed on children conceived from frozen-thawed embryos and fresh embryos between January 2005 and December 2008 at the Reproduction Center of the Third Hospital, Peking University. The major malformation rates were compared between two groups for all children, as well as singletons or twins, separately. The frequencies of different subtypes of malformations classified according to different organ system were also compared. RESULTS: Thirty-four of 3125 children from cryopreserved embryos had a major malformation. The malformation rate was 1.09%, which was comparable to that for children after fresh embryos transfer (1.53% (55/3604), OR: 0.71, 95%CI; 0.46-1.09). The malformation rate was also similar when the analysis was limited to children from cryopreserved embryos resulted from in vitro fertilization (IVF) (1.39%) and fresh IVF (1.3%). However, children from cryopreserved embryos resulted from intracytoplasmic sperm injections (ICSI) had much lower malformation rate than from fresh ICSI (0.63% vs.1.83%, OR: 0.34, 95%CI: 0.16-0.75). No difference was found in the incidence of major malformations in singletons from cryo ICSI (0.73%) and fresh ICSI (1.9%), or from cryo IVF (1.49%) and fresh IVF (1.67%). Similar malformation rate was found in multiples from cryo ICSI (0.52%) and fresh ICSI (1.76%), or cryo IVF (1.30%) and fresh IVF (0.90%). The distribution and risk of the subtype of malformations, such as cardiovascular, gastrointestinal, neural tube, urogenital, musculoskeletal and facial abnormalities was not different between the cryo group and fresh group. CONCLUSIONS: The major malformation rate is similar between fetuses/children conceived from cryopreserved embryos and those from fresh embryos. Large prospective and long-term follow-up studies are needed to get exact results concerning the birth defects of the children born after cryopreserved embryos.