In vitro fertilization and embryo transfer(IVF-ET) technology is one of the important means to treat infertility in recent years,although it had made remarkable progress in the field of reproductive medicine,but IVF-ET pregnancy success rate is not very ideal,the reasons that influent the success of IVF-ET include both parents donor of various unfavorable factors and stimulate ovulation itself produces all sorts of malpractices,its influence factors are complicated.In recent years,how to reduce the adverse factors affecting IVF-ET,to improve the success rate of pregnancy of IVF-ET has become the hot topics in the study of domestic clinical intervention in IVF-ET,and the domestic research shown that the quality of the follicle and endometrial environment is the key to determine the success of IVF-ET.

Objective To investigate the effects of bevacizunab on the antioxidative function of human retinal pigment epithelium (RPE),in order to explore the possible mechanism of macular atrophy induced by the application of anti-vascular epithelial growth factor (VEGF) agents in age-related macular degeneration.Methods Human RPE cells were incubated in DMEM/F12 medium containing 0.25 g · L-1 bevacizumab and divided into 5 groups according to incubation period:0 hour(control),12 hours,24 hours,48 hours and 72 hours,and then the oxidative stress was induced by adding H2O2.Cell viability was measured by the CCK8 assay.MitoSox Red was used to determine mitochondrial reactive oxygen species (mtROS) production.Mitochondrial membrane potential was measured using the JC-1 assay.The expression levels of NOX4 and HO-1 were detected by RT-PCR and Western blot,respectively.Results CCK8 assay determination showed that the above treatment had no significant effect on cell viability,the cell viability of 0 hours,12 hours,24 hours,48 hours and 72 hours were (100.2 ±3.3)％,(99.2 ±2.7)％,(102.5 ±6.4)％,(103.9 ±3.7)％,(103.6 ±3.3)％,the difference was not statistically significant (P ＞ 0.05).Compared with the control group,the levels of mtROS increased at 12 hours,24 hours,48 hours and 72 hours,the difference was statistically significant (P ＜ 0.05).Mitochondrial membrane potential at 12 hours,24 hours,48 hours,72 hours were lower than the control group,the difference was significant,48 hours reached the lowest,72 hours significantly increased,but still lower than the control group.RT-PCR and western blot results demonstrated that the expression of NOX4 mRNA and protein increased at 12 hours,24 hours,48 hours and 72 hours,and reached the highest at 24 hours,then decreased significantly,but still higher than the control group,the difference was statistically significant (P ＜0.01).Compared with the control group,the expression of HO-1 mRNA decreased at 24 hours,48 hours and 72 hours,while the expression of HO-1 protein decreased at 48 hours and 72 hours,the difference was statistically significant (P ＜ 0.05).Conclusion The clinical concentration of bevacizumab can reduce the anti-oxidative function of RPE cells,which may be one of the causes of progressive macular atrophy after long-term anti-VEGF therapy.

Objective To probe the clinical value of three-dimensional speckle tracking echocardiography in evaluating the early ventricular myocardial dysfunction in breast cancer patients treated with anthracycline.Methods A group of 40 breast cancer postoperative patients were received a epirubicin-based chemotherapy.Conventional and 3D dynamic echocardiography were measured before chemotherapy and 2 cycles and 4 cycles after chemotherapy during 24 hours,and to compare the change of the parameters before and after the chemotherapy.Results Left ventricular global area strain(LVGAS),left ventricular global longitudinal strain(LVGLS),right ventricular global longitudinal strain(RVGLS),right ventricular global circular strain(RVGCS) and right ventricular global radial strain(RVGRS) were significantly lower after the chemotherapy than those before the chemotherapy,and negatively correlated to cumulative anthracycline dose,in which the area under the ROC curve of LVGAS was 0.897(P = 0.000).If-30.55% was selected as the diagnosis cut-off point,the sensitivity was 0.857,and the specificity was 0.917;some of right ventricular strain parameters were earlier than those of the left.Conclusions 3D-STI is useful to find the early left and right ventricular myocardial dysfunction in breast cancer patients treated with anthracycline and early access the subclinical cardiactoxicity,and right ventricular dysfunction may emerge earlier than the left,which can provide diagnosis basis to intervene timely for the clinical.

To explore the serum miR-338-5p expression characteristics in renal transplant recipients ,and the role of regulating BAFF signal ,then investigate its biological significance.Methods:Healthy volunteers were enrolled as control group.Serum miR-338-5p was detected by real-time PCR;soluble BAFF was detected by ELISA;anti-HLA-Ⅰantibody,anti-HLA-Ⅱ antibody and anti-MICA antibody were detected by liquid chip technology.SPSS17.0 software was applied.t-test was used to compare the means of two independent samples;Paired samples t-test was used to compare the means of two paired samples;Spearman method and Pearson method were used to analyse the correlation;P<0.05 was considered to be statistically significant.Results: Compared with healthy controls,serum miR-338-5p in renal transplant recipients decreased significantly (P<0.001),while serum BAFF increased significantly (P<0.01).Serum miR-338-5p levels within 1 year post-transplantation were significantly lower than that of more than 1 year post-transplantation (P<0.01);Serum miR-338-5p levels within 3 years post-transplantation were significantly lower than that of more than 3 years post-transplantation (P<0.01);To all research objects,serum miR-338-5p was significantly negatively correlated with serum BAFF (r=-0.51,P<0.001),and serum miR-338-5p was significantly negatively correlated with anti-HLA-Ⅱ antibody(r=-0.322, P<0.05);Serum miR-338-5p within 3 years was significantly negatively correlated with anti-HLA-Ⅱantibody (r=-0.423,P<0.05), and serum miR-338-5p within 3 years was significantly negatively correlated with anti-MICA antibody(r=-0.411,P<0.05);Serum miR-338-5p more than 3 years was significantly positively correlated with anti-MICA antibody(r=0.486,P<0.05),and Serum miR-338-5p more than 3 years was significantly positively correlated with anti-HLA & MICA antibody(r=0.578,P<0.01).Conclusion:miR-338-5p may directly or indirectly target BAFF signal ,and participate antibody mediated immune response by regulating its target genes and interfere with the long-term survival of transplanted renal.

Objective To compare the effects of different extracts of Rheum palmatum on weight and tissue structure of hypothalamusand and pituitary of adult female rats,and screen the main reproductive toxicity extract.Methods The water,chloroform,ethyl acetate,and n-butanol extracts and water-soluble substance of R.palmatum were prepared by polarity gradient extraction method.Female adult rats were randomly divided into blank control group,rhubarb water extract group,and different extracts groups.The dosage of all the groups was equivalent to 4.00 g/kg crude rhubarb.Rats were administered with extracts by gavage for 60 d.Body mass growth rate of rats were calculated before and after administration.The pathological changes of hypothalamic arcuate nucleus neurons and pituitary gonadal cell were observed with light microscope.Results Compared with the blank control group,the body mass growth rate of rhubarb water extract group was decreased (P ＜ 0.05),while those in the different extracts groups were increased (P ＜ 0.01);The hypothalamic arcuate nucleus neurons of rhubarb water extract group showed chromatin marginalization,nissl substance dissolving,fuzzy boundary of nuclear membrane,as well as hell cells,and the total number of adenohypophysis cells reduced and the cells arranged in irregular.However,there were no apparent pathologic changes in different extracts groups.Conclusion Rhubarb water extract administration by long-term dose can reduce weight growth rate and result in pathologic changes of hypothalamic arcuate nucleus and adenohypophysis,while the different extracts can increase weight growth rate significantly and have little effects on the organizational structure ofhypothalamic arcuate nucleus and adenohypophysis.

Objective To explore the hearing screening, and the change and outcome of hearing impairment of high risk infants. Meth-ods From March, 2015 to March, 2016, 336 high risk infants were screened with otoacoustic emissions (OAE), auditory brainstem response (ABR) and brainstem auditory evoked-potential (BAEP) 0-1, 3, 6, 12 months after born, respectively. Results Among the 336 high risk in-fants, 29 failed the examinations within the 1st month, 37 cases failed in the 3rd month, 27 cases recovered in the 9th month, and 7 cases re-covered in the 12th month, 3 cases were finally diagnosed as deafness (0.89%). Conclusion OAE, ABR combining with BAEP examination may obtain comprehensive diagnosis of hearing impairment for high risk infants, continuous listening comprehension monitoring can effec-tively dynamically observe the hearing impairment, changes and outcome of high risk infants.

Objective:To investigate the prevalence, risk factors and outcomes of diastasis recti abdominis (DRA) in multiparas after the second delivery.Methods:From June 2017 to September 2019, 300 multiparas with an average age of (31.7±4.0) years (26 to 43 years) after the second delivery were recruited at 6 weeks postpartum from two hospitals in Wenzhou. There were 171 multiparas with two natural births,36 multiparas with one natural birth and one caesarean delivery, and 93 multiparas with two caesarean deliveries. The interrectus distance (IRD) was measured with palpation at 6 weeks, 6 months and 12 months after delivery. Data on age, height, weight before pregnancy and delivery, baby′s birth weight, abdominal circumference before pregnancy and delivery, fetus number, delivery mode and occupation type were collected. Strength and endurance of abdominal muscle was assessed using manual muscle testing and curl-ups, low back pain was assessed using Oswestry disability index(ODI), urinary incontinence was assessed with International Consultation on Incontinence guestionnaire-incontinentia urinae (ICIQ-UI) short form (ICIQ-SF), and quality of life was assessed using 36-item short form health survey (SF-36).Results:Prevalence of DRA was 51.7%(155/300), 39.3%(116/295) and 27.7%(80/289) 6 weeks, 6 months and 12 months after delivery, respectively. Logistic regression analysis indicated that age ( OR=1.39, 95 %CI:1.02-1.91, P=0.38), abdominal circumference ratio ( OR=2.31, 95 %CI:1.23-4.33, P=0.01), twins ( OR=11.41, 95 %CI:2.15-60.76, P<0.01), and cesarean section ( OR=1.44, 95 %CI:1.06-1.95, P=0.02) were the risk factors of DRA at 12 months after delivery. At 12 months after delivery, the multiparas with DRA had weaker strength and endurance of abdominal muscle ( Z=-3.62, P<0.01; Z=-8.91, P<0.01), more serious low back pain ( Z=-2.10, P=0.04), and lower quality of life on physical health ( t=-3.34, P<0.01) than the multiparas without DRA. No difference in prevalence and severity of urinary incontinence and quality of life on psychological health was found when comparing multiparas with and without DRA (χ 2=0.66, P=0.42; Z=-1.18, P=0.24; t=0.91, P=0.36). Conclusion:Multipara after the second delivery has great likelihood for DRA.Age, abdominal circumference ratio, twins, and cesarean section are the risk factors of DRA. DRA is related to abdominal muscle dysfunction, low back pain, and quality of life.

Objective To study the time extended for getting emergency intervention in different modes of transportation and factors influencing the modes of transportation of patients with ST elevation myocardial infarction (STEMI).Methods A total of 564 consecutive patients with STEMI admitted from September 2013 to June 2016 were enrolled in the study.The clinical data about time consumed for getting emergency intervention and modes of transportation were collected.Results According to the mode of transportation,patients were divided into three groups:emergency care system (EMS) transportation group (n =96),self-transportation group (n =206) and referral group in which the patients were sent in from other hospitals (n =262).EMS transportation group had significantly shorter total ischemic time before emergency treatment than self-transportation group (229 rin vs.418 min,P ＜ 0.05) and referral group (229 min vs.512 rin,P ＜ 0.05),and significantly shorter length of pre-hospital time than self-arrival group (55 min vs.110 min;P＜0.05) and referral group (55 min vs.372 min;P＜0,05).The referral group had longer pre-hospital time and the self-transportation group had longer door-to-balloon time,but there was no difference in total ischemic time between the self-arrival and referral group (Z =-1.882,P =0.068).Multivariate logistic regression was used to analyze influence factors in mode of transportation:(1) patients characterized with high school or university education,profession of civil service,and their transportation distance more than 30 km were greater in number than referral group (P ＜ 0.05);(2) patients identified with senior middle school education,staff member of public sectors or company,their transportation distance less than 30 km,and with killip grade above Ⅱ were more likely to have EMS transport (P ＜ 0.05);(3) patients defined as businessmen without taking out new rural cooperative medical insurance,taking up transportation distance less than 80 km,and subjecting to killip grade Ⅰ had a higher proportion of individuals of this kind taking self-transportation (P ＜ 0.05).Conclusion Mode of transportation is an important factor that affects the time extended to get emergency intervention.Education level,occupation,medical insurance type,transportation distance,killip grade are associated with modes of transport.

Objective:To explore the effect of nursing based on Roy adaptation model on negative emotions and adverse reactions in patients with multiple myeloma during chemotherapy.Methods:Using the convenient sampling method, a total of 100 patients with multiple myeloma who were admitted to Zhoushan Hospital in Zhejiang Province from July 2017 to August 2019 were selected. They were divided into the control group and the observation group by lottery method, with 50 cases in each group. The control group was given routine nursing measures while the observation group was given nursing based on Roy adaptation model on basis of the control group. And patients in both groups were also given the same chemotherapy intervention.The incidence of negative emotions, chemotherapy compliance, nursing satisfaction and adverse reactions after nursing were compared between the two groups.Results:There were no statistically significant differences in the scores of anxiety and depression before nursing between the two groups ( P>0.05) . The scores of anxiety and depression of the two groups after nursing were lower than those before nursing, and the scores of the observation group after nursing were lower than those of the control group, and the differences were statistically significant ( P<0.01) . The incidence of adverse reactions after nursing in the observation group (12.00%, 6/50) was lower than that of the control group (48.00%, 24/50) , and the difference was statistically significant ( P<0.01) . In the observation group, the proportions of patients with good treatment compliance and nursing satisfaction were respectively 90.00% (45/50) and 96.00% (48/50) , which were higher than 64.00% (32/50) and 80.00% (40/50) in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Nursing based on Roy adaptation model on the basis of routine nursing can improve the adverse reactions of patients with multiple myeloma during chemotherapy, relieve their negative emotions and improve their compliance and nursing satisfaction, which is worthy of promotion and application.

Objective To investigate the effect of promoting natural delivery by implementing the systemic exercise and diet intervention for obstetric VIP primiparas during the middle and late pregnancy period . Methods From January 2011 to March 2012 , 97 primiparas were chosen as the intervention group in obstetric VIP clinic;at the same time, 274 cases of pregnant women were chosen as the control group from the general antenatal clinic of the hospital .Neither of the two groups of pregnant women had movement contraindication , and they all voluntarily made the decision for vaginal delivery .Pregnant women in the control group only accepted the general out-patient routine prenatal check-up and health guidance;while the pregnant women in the intervention group received the VIP systemic exercise and diet guidance in addition to the outpatient routine prenatal check-up and health guidance .The fetal presentation height before delivery , the degree of cervical dilation, the time of birth process, the amount of postpartum bleeding and the mode of delivery were compared within the two groups.Results The natural birth rate in the intervention group was 70.1%significantly higher than that of 35.8%in control group (χ2 =32.788, P<0.01).The descending level of fetal presentation in the intervention group was ( -0.65 ±1.15) cm, which was significantly lower than ( -1.12 ±1.10) cm in the control group (t=2.65, P<0.01).The total labor time and the first stage of labor time were (369.10 ± 166.82)min and (334.72 ±165.69) min, respectively, which were significantly shorter than (439.48 ± 177.93)min and (403.06 ±174.67)min in the control group (t=-2.57, -2.53;P<0.05).The weight of pregnant women before delivery and that of the neonates were (74.70 ±4.80) kg and (3 489.00 ±66.89) g, respectively, in the intervention group, and were (77.80 ±4.70)kg and (3 680.00 ±54.62)g, respectively, in the control group.The differences were significant (t=1.83, 1.12; P<0.05).Conclusions The VIP clinic provides the pregnant women with systemic exercise intervention and nutritional diet guidance , which result in decreasing the cesarean section rate , increasing the natural delivery rate , effectively shortening the time of labor process and reducing the amount of intrapartum bleeding .