Objective To investigate the clinical pregnancy outcomes of laparoscopic treatment for different degrees of tubal adhesion and tubal distal occlusion.Methods Clinical information of 41 infertile patients from April 2001 to December 2005 was reviewed.According to the extent of tubal and pelvic lesion,the patients were classified as stage Ⅰ in 10 patients,stage Ⅱ in 10,stage Ⅲ in 17,and stage Ⅳ in 6.After a diagnosis was made by hysterosalpinggography(HSG),all the patients received a salpingostomy and adhesionlysis under laparoscope.Results No abnormal findings were detected by hysteroscopy and bilateral tubes were patent after operation in all the 41 patients.The 10 patients at stage Ⅰ were followed up for 12~21 months.Four of them got pregnant in six months and 1 got pregnant in 1 year because of intermittent separation,all the 5 patients being intrauterine pregnancy.The 8 patients at stage Ⅱ were followed up for 12~26 months.Three patients got pregnant,including intrauterine pregnancy in 1 and ectopic pregnancy in 2.The pregnancy occurred at 15,16,and 26 months after operation,respectively.The 17 patients at stage Ⅲ were followed up for 3~48 months.Four had pregnancy,at 3,4,12,and 14 months after operation,respectively,including intrauterine pregnancy in 1 and ectopic pregnancy in 3.The 6 patients at stage Ⅳ were followed up for 12~36 months and no pregnancy was observed.Among the 12 patients with pregnancy,8 got pregnant within 12 months and 3 at 13~18 months after operation,the pregnancy rate within 18 months being 91.7%(11/12). Conclusions Clinical pregnancy outcomes are related with the degree of tubal lesion and adnexal adhesion.Patients at stage Ⅰ~Ⅱ have better pregnancy outcomes than patients at stage Ⅲ~Ⅳ.

Objective To evaluate the efficacy and safety of transvaginal hydrolaparoscopic ovarian drilling for treatment of the polycystic ovary syndrome(PCOS)in clomiphene citrate-resistant infertile women.Methods Between February 2008 and November 2008,11 clomiphene citrate-resistant anovulatory women with PCOS mean age:(29.3?3.7)years,mean body mass index:(24.3?8.3)kg/m2] were enrolled in this study.Transvaginal hydrolaparoscopy using a F5 bipolar needle was performed on the patients to create 5-15 holes with a free length of 0.8 cm and a diameter of 0.2 mm in each ovary(electrocoagulation time 10-15 sec).Results A mean of(17?6)holes were made in both the ovaries in the patients.No surgical complications occurred.The levels of LH,FSH,and androstenedione dropped from(14.7?4.5)IU/L,(7.1?6.4)IU/L,and(12.2?4.4)nmol/L to(10.5?3.7)IU/L,(6.4?1.7)IU/L,and(8.9?3.0)nmol/L(t=2.389,P=0.027;t=1.007,P=0.326;and t=2.104,P=0.048)respectively after the operation.The patients were followed up for 2 to 9 months,during the period 6(54.5%)patients recovered spontaneous menstruation,among which 3 recovered ovulatory cycles(27.3%)and 2(18.2%)had spontaneous pregnancy.In the other 8 patients who didn't recover spontaneous menstruation,5 cases received CC or FSH(one of them was pregnant after the treatment);1 case was not pregnant though received IVF;and 2 are still in follow-up.Conclusions Transvaginal hydrolaparoscopic ovarian drilling is safe and effective for clomiphene citrate-resistant infertile women.

Objective To investigate the effects of laparoscopic management of hydrosalpinx on outcomes of in vitro fertilization and embryo transfer(IVF-ET).Methods A total of 53 patients with hydrosalpinx undergoing IVF-ET from 2002 to 2005 were divided into three groups: ①Untreated Group included 17 patients who were given no interventions for hydrosalpinx prior to IVF-ET;②Preoperative Group included 17 patients undergoing laparoscopic treatment of hydrosalpinx prior to IVF-ET;③Postoperative Group had 19 patients who had experienced a history of unsuccessful IVF-ET treatment cycles and received laparoscopic management of hydrosalpinx prior to subsequent IVF-ET cycles.Results The pregnancy rates in fresh IVF cycles,the pregnancy rates in frozen cycles,the mean pregnancy rates per transfer,and the accumulative rate of live fetuses were 15.8%(3/19),10.5%(2/19),13.2%(5/38),and 17.6%(3/17) in the Untreated Group,36.8%(7/19),23.1%(3/13),30.3%(10/32),and 41.7%(8/17) in the Preoperative Group,and 16.7%(2/12),58.3%(14/24),44.4%(16/36),and 73.7%(14/19) in the Postoperative Group,respectively.The pregnancy rates in frozen cycles,the mean pregnancy rates per transfer,and the accumulative rate of live fetuses were all significantly higher in the Postoperative Group than in the Untreated Group(?~2=10.374,P=0.001;?~2=8.903,P=0.003;?~2=11.305,P=0.001,respectively).The mean pregnancy rates per transfer and the accumulative rate of live fetuses in the Preoperative Group tended to higher than those in the Untreated Group(?~2=3.377,P=0.066;?~2=3.360,P=0.067).Conclusions Hydrosalpinx is associated with poor IVF-ET outcomes.Laparoscopic management for hydrosalpinx prior to IVF-ET improves the pregnancy rate of IVF-ET.

Objective To compare clinical effects among three techniques of multifetal pregnancy reduction(MFPR) guided by transvaginal ultrasonography through vaginal approach.Methods Under the guidance of transvaginal B-ultrasonography,99 cases of multiple pregnancy following assisted reproductive technique underwent three different methods of embryo reduction: drug injection directly to the pregnancy sac(Drug Group),simple embryonic bud aspiration(Aspiration Group),and combined use of drug and aspiration(Combination Group).Results The gestational age at the procedure ranged 41~88 days(mean,58.9?8.7 days).The success rate of the procedure on one session was 100%(99/99).Short-term outcomes included 3 cases of abortion(3.0%).On continuing follow-up observations in 73 cases,the incidences of abortion and premature delivery were 11%(8/73) and 12%((9/73)),respectively.No statistical differences were seen among the three groups in rates of abortion,premature delivery,and full-term delivery(?~2=1.131,P=0.889).In the Aspiration Group,however,the exposure time to B-ultrasound and the operative time were significantly shorter than those in the other two groups.The gestational age at the procedure was 61.7?8.2 days in the Drug Group,48.8?2.7 days in the Aspiration Group,and 56.7?7.2 days in the Combination Group,respectively,with significant differences between the Aspiration Group and other two groups(F=19.36,P=0.000).The number of embryos reduced was associated with pregnancy outcomes: the abortion rate was remarkably higher in patients receiving the reduction of more than two embryos than only one embryo(?~2=6.415,P=0.040).Conclusions Ultrasound-guided multifetal pregnancy reduction is a safe,effective and microinvasive procedure.It is recommended that simple embryonic bud aspiration be used for multifetal pregnancy before 7 gestational weeks,combined use of drug injection and aspiration for multifetal pregnancy at 7~9 gestational weeks,and drug injection to the pregnancy sac for multifetal pregnancy after 9 weeks.

Objective To study the clinical application of laparoscopy combined with hysteroscopy to female infertility.Methods From January 2007 to March 2008,145 cases of female infertility were examined and treated by laparoscopy combined with hysteroscopy in our hospital.We analyzed the clinical records of the patients to determine the value of the method.Results By using laparoscopy combined with hysteroscopy,136 cases of pelvic disease(93.8%,136/145) were detected in this series.The most common causes of infertility were pelvic inflammation(58.6%,85/145) and endometriosis(29.0%,42/145).The incidence rate of pelvic inflammation in secondary infertility patients was significantly higher than in those with primary infertility(P

Objective To predict the genes that affect endometrial receptivity through the differential expression of microRNA (miRNA) in eutopic endometrial tissues during implantation window in patients with endometriosis infertility. Methods Among infertile patients that received treatments at the Center for Reproductive Medicine,Peking University Third Hospital between May and December 2013, patients with endometriosis infertility were selected as endometriosis group (among the selected 17 cases, there were 6 cases with follicular phase endometrium and 11 cases with implantation window phase endometrium), and patients with tubal factor infertility were selected as control group (among the selected 19 cases, there were 7 cases with follicular phase endometrium and 12 cases with implantation window phase endometrium). (1)Implantation window phase endometrium was selected from 3 cases in each group. Using miRNA and mRNA joint gene sequencing and database for forecast results, as well as using the negative regulatory relationship between miRNA and mRNA, the intersection of target gene that negatively correlates with miRNA expression were obtained. The co-expression network of miRNA-mRNA wae constructed. Combined with the genes associated with endometrial receptivity found through bioinformatics method, the miRNA with core regulatory functionwas found. (2) Expand sample size to 14 cases for endometriosis group and 16 cases for control group.Reverse transcription (RT)-PCR technique was utilized to detect the expression of miR-142-5p, miR-146a-5p and miR-543 in endometrial tissues, and verify miRNA microarray results. Results (1) miRNA and mRNA microarray screening results showed that, among the endometrial tissues of patients with endometriosis infertility and with implantation window phase, 6 differentially expressed miRNA were indentified, among which miR-142-5p, miR-146a-5p, miR-1281, miR-940, miR-4634 showed significantly enhanced expression and miR-543 showed significantly inhibited expression. Sixty-three differentially expressed mRNA were indentified, among which 58 mRNA such as CADM1, IL-10RA, ITGAL and LPAR5 had significantly enhanced expression. Five mRNA such as HLA-DRB1,3,4,5 and SOHLH2 showed significantly inhibited expression. Thirty-six taget genes were found in consideration of negatively correlated miRNA expression with the genes, miRNA-mRNA co-expression network were constructed. The miR-543 was found at the core of the network. Targetscan and other database predicted that miR-142-5p, miR-146a-5p and miR-543 could act on various types of endometrial receptivity molecular corresponding marker genes such as HOX10, ITGAV, ITGB3, OPN, LIF, ESR, PGR, CDH1 and MMP. (2) RT-PCR test showed that the average levels of expression of miR-142-5p and miR-146a-5p in implantation window phase endometrium in endometriosis group were 8.3 ± 10.6 and 1.9 ± 0.8 respectively;the average levels of that in control group were 1.1±0.6 and 0.9±0.4, respectively. The difference was statistically significant (P=0.027, P=0.015), and was consistent with results from miRNA microarray test. The expression of miR-543 in tissues of follicular phase endometrium in endometriosis group (2.3±1.0) was significantly higher than that in control group (1.0 ± 0.4), and the difference was statistically significant (P=0.008). However, when comparing the expression of miR-543 implantation window phase endometrium in endometriosis group (1.2±0.6) with that in control group (1.5 ± 1.0), the difference was not statistical significant (P=0.890). Conclusions There are multiple differential expressions of miRNA in the implantation window phase endometrium tissues of endometriosis infertility patients, among which miR-142-5p and miR-146a-5p show significantly enhanced expression and may affect embryo implantation by acting on a variety of endometrial receptivity marker molecules. The expression of miR-543 in implantation window phase endometrium of endometriosis infertility patients is lower than that in the follicular phase, forewarned changes in the pattern of cyclic variation of miR-543, and may be the reason for affecting endometrial receptivity.

Objective To assess the vaIue of speckle tracking imaging (STI) in quantifying the regional myocardial strain in systemic lupus erythematosus (SLE) group.Methods ① Sixty subjects were divided into SLE group and normal group.High frame rate two-dimensional images were recorded from the apical two-chamber view,long-axis view and four-chamber view of the left ventricle (LV).Peak systolic strain of each view of 18 segments were measured by automated functional imaging (AFI) software of 2-DSE.All parameters were compared between the two groups.② Twenty cases were randomly taken from the normal group.The same observer at different times and two observers measure the strain of left ventricular respectively.The results of the measurement between the two groups were compared with unpaired t test and its relevance was analyzed using Pearson's correlation analysis.ResultsLeft ventricular two-dimensional longitudinal strain gradually increased from the base to apex in the normal group.There were statistically differences between the apical segments and the basal,middle segments of every left ventricular wall (P＜0.05).The same wall segment time to peak myocardial systolic peak strain was consistent.Left ventricular two-dimensional longitudinal strain gradually increased from the base to apex in the SLE group,except for the anterio-septal and anterior wall [ (-18.7±4.2)％,(-16.3±9.4)％,(-18.1±10.5)％ vs (-19.0±9.0)％,(-18.6±7.9)％,(-17.7±1.4)％ ].There was no statistically significant difference between the apical segments and the basal,middle segments of every left ventricular wall(P＞0.05).All parameters of S were significantly higher in the normal group than those of the SLE group.The difference was statistically signoficant (P＜0.05).The time to peak systolic peak strain of every segments was not consistent.The results from the same observer at different times and peak systolic myocardial strain measurements by the two observers were correlated well(P＜0.01).Conclusion The myocardial function assessment by STI technology in the SLE patients is significantly different from that of the normal control:SLE patients with left ventricular myocardial damage can be manifested as reduced regional myocardial systolic peak strain.

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 6832 fresh IVF/intracytoplast single sperm injection (ICSI) cycles and 5659 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.

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.MethodsFrom 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.ResultsAge,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 (14934±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 ).ConclusionIn 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.

Objective: To learn the epidemiological characteristics of fall mortality among the elderly people in Taizhou，and to provide basis for intervention strategies of fall in the elderly. Methods: Data of fall mortality among residents aged 60 years or over in Taizhou from 2016 to 2018，collected from Zhejiang Chronic Disease Surveillance Information Management System，was used for analysis of time，population and geographical characteristics of fall deaths. The epidemic trend of fall mortality in the elderly was described by annual percentage change（APC）. Results: From 2016 to 2018，3 699 cases of fall death in Taizhou were reported，the crude and standardized mortality were 116.90/100 000 and 97.88/100 000. The standardized mortality of fall in women was 106.11/100 000，which was higher than 90.13/100 000 in men（P<0.05）. The standardized mortality of fall in rural residents was 131.20/100 000，which was higher than 28.15/100 000 in urban residents（P<0.05）. The mortality of fall in residents aged 65-69 years from 2016 to 2018 showed an upward trend（APC=4.20%，P<0.05），while the mortality trend of fall in other age groups was not statistically significant（P>0.05）. Conclusion Fall was the first cause of injury death in the elderly aged 60 years or over in Taizhou. Females and rural residents have relatively higher fall mortality.