By analyzing the physiological and psychological state of the children conceived by different assisted reproduction techniques,studies confirm that the current assisted reproductive technology is safe,and there is no adverse effect on the physiological and psychological state of offspring.However,the high multiple pregnancy rate caused by assisted reproductive technology can affect the growth and psychological state of the children conceived by different assisted reproduction techniques,which is to be resolved.

Objective To analysis newborn stage and long-term physiological and neuropsychological development in children born after assisted reproductive technology(ART),and to evaluate the safety of ART.Methods Eighty-four 6-month-old to 6-year-old children born after ART performed from January 1st,2006 to June 30th,2011 in Reproduction Center of Fuzhou General Hospital were taken as ART group; and 84 matched children born after spontaneous conception were as control group.The physiological and neuropsychological states of these children in their newborn stage and 6-month-old to 6-year-old duration were compared with Chi-square or t test.Results There was no statistical difference in childbearing age of mothers,the prevalence of gestational diabetes mellitus and hypcrtensive disorder complicating pregnancy,delivery mode,living environment,parents' education level,newborn birth length,birth weight,the rate of premature birth,low birth weight,asphyxia and hospitalized to neonatal intensive care unit between two groups (P＞0.05).In ART group,the incidence of growth retardation and abnormal social life skills was 6.0 ％ (5/84) and 1.2 ％ (1/84),and no statistical difference were found comparing with control guoup [4.8％(4/84) and 1.2％(1/84),x2 =0.12 and 0.00,P＞0.05],neither the developmental quotient (95.9±6.1 vs 94.8±5.1,t=1.25,P=0.21).Twins had higher rates of preterm birth [41.8％ (33/79) vs 10.1％(9/89),x2 =22.37,OR=6.38,95％CI:2.81-14.50,P=0.00],low birth weight [51.9％(41/79) vs 6.7％(6/89),x2=42.35,OR=14.93,95％ CI:5.84-38.16,P=0.00],asphyxia [10.1 ％ (8/79) vs 1.1 ％(1/89),x2 =6.69,OR=9.92,95％ CI:1.21～81.15,P=0.01],hospitalized to neonatal intensive care unit [36.7 ％ (29/79) vs 14.6 ％ (13/89),x2 =10.90,OR =3.39,95％CI:1.61-7.14,P=0.00] and growth retardation [11.4％(9/79) vs 0.0％(0/89),x2=10.71,RR=0.11,P=0.00] than singleton.Conclusions ART has no negative effects on children's physical and neuropsychological development.It could increase the incidence of twins,so that it might increase the incidences of preterm labor and low birth weight,which might affect the long-term physical and neuropsychological development of the offspring.

Objective:To evaluate the adjuvant role of the eCura scoring system in selecting appropriate treatment strategies after non-curative endoscopic submucosal dissection (ESD) of early gastric cancer (EGC) patients.Methods:The clinicopathological data of 110 EGC patients who underwent non-curative ESD at Fujian Provincial Hospital from January 2015 to June 2019 were retrospectively analyzed. According to the eCura score, patients were divided into three lymph node metastasis (LNM) risk groups: low-risk group (79 cases), middle-risk group (22 cases), and high-risk group (9 cases). The receiver operator characteristic (ROC) curve analysis was used to test the diagnostic efficacy of eCura scoring system in predicting LNM. Logistic regression analysis was used to explore the influence of risk stratification of eCura scoring system on LNM. Kaplan-Meier method was used to evaluate cancer survival rate, which was then compared with log-rank test.Results:Thirty-five patients underwent additional standard surgery after ESD, including 22 in the low-risk group, 8 in the middle-risk group, and 5 in the high-risk group. Among them, 5 cases had LNM, including 1 case in the low-risk group and the middle-risk group respectively and 3 cases in the high-risk group. The area under the ROC curve was 0.857 (95% CI: 0.697-0.952, P=0.001), and when the cut-off value of the eCura score was set at 3, the Yuden index reached the maximum value of 0.7, with the corresponding sensitivity and specificity of 80% and 90%, respectively. Logistic regression analysis showed that the probability of LNM in the middle-risk group was about 3.00 times (95% CI: 0.17-54.57, P=0.458) as high as that in the low-risk group, and the probability of LNM in the high-risk group was about 31.50 times (95% CI: 2.14-463.14, P=0.012) of that in the low-risk group. The follow-up time was 12 to 58 months, and the median follow-up time was 40 months. There were 10 cases of recurrence, including 4 cases in the low-risk group, 3 cases in the middle-risk group and 3 cases in the high-risk group, of which 2 cases in the low-risk group were from those of additional standard surgery after ESD, and the remaining 8 cases were from those who did not receive additional standard surgery after ESD. Kaplan-Meier survival curve analysis showed that the survival rate of patients with additional surgery in the low-risk group was similar to that of patients without ( P=0.319), and the survival rate of patients with additional surgery in the middle-risk group was also similar to that of patients without ( P=0.296). The survival rate of patients with additional surgery in the high-risk group was significantly higher than that of those without ( P=0.013). Conclusion:The eCura scoring system can assist the selection of treatment strategies after non-curative resection of EGC, and can accurately predict the risk of subsequent LNM and recurrence. Close follow-up may be an acceptable option for patients with low risk of LNM, and additional standard surgical treatment may be more conducive to improving the prognosis in patients with high risk of LNM.

Objective:To evaluate the safety and long-term efficacy of endoscopic resection of gastric stromal tumors with a diameter of >2-4 cm.Methods:The clinical data of 307 patients, who underwent endoscopic or surgical resection and pathologically confirmed to be gastric stromal tumors with a diameter ≤4 cm in Fujian Provincial Hospital, Jinshan Branch of Fujian Provincial Hospital or Fujian Geriatric Hospital from January 2014 to December 2019, were collected. The propensity score matching (1∶1) was performed for the cases with the tumor size of >2-4 cm.Then the incidence of adverse events related to the operation and clinical outcomes were compared between 41 patients in the endoscopic group and 41 patients in the surgical group.Results:Compared with the surgical group, the median operation time in the endoscopic group was significantly shorter (58.0 min VS 108.0 min, Z=-4.789, P<0.001), and the median hospitalization cost was significantly lower (22.7 thousand yuan VS 42.0 thousand yuan, Z=-7.164, P<0.001). There were no significant differences in postoperative fasting time or postoperative hospitalization time between the two groups ( P>0.05). Complications occurred in 7 cases (17.1%) in the endoscopy group, including 5 cases of postoperative acute infection, 1 case of postoperative perforation, and 1 case of postoperative bleeding; all 9 cases (22.0%) in the surgical group developed postoperative acute infection. There was no significant difference in the overall incidence of complications between the two groups ( χ2=0.311, P=0.577). Tumors in both groups were completely removed with negative resection margins. The follow-up time of the endoscopy group was 34.3±15.6 months, and that of the surgical group was 42.2±20.2 months. No recurrence or distant metastasis was observed during the follow-up period in the two groups. Conclusion:Endoscopic resection of large gastric stromal tumor (range>2-4 cm) is safe and effective in the long term, which can be used as one of the methods for gastrointestinal stromal tumors.

Objective:To investigate the clinical characteristics of carotid webs and prevention measurements of cerebral ischemic stroke caused by carotid webs.Methods:The clinical data of three patients with carotid webs admitted to our hospital from October 2017 to January 2019 were retrospectively studied, and publications (208 patients with carotid webs) reported from January 1, 2014 to June 30, 2019 in PubMed, Embase, Wanfang and CNKI databases were collected. The demographic and clinical characteristics of carotid webs and secondary prevention measurements of ischemic stroke caused by carotid webs were analyzed.Results:A total of 211 patients with carotid webs were enrolled, including 68 male (32.2%) and 143 female (67.8%), with an median age of 48 years. Prevalence of risk factors for cerebrovascular disease reported in 148 patients was as follows: hypertension ( n=43, 29.1%), dyslipidemia ( n=19, 12.8%), diabetes mellitus ( n=14, 9.5%), and smoking ( n=12, 8.1%); 89.8% of carotid webs(44/49) caused mild stenosis of carotid artery (stenosis degree<50%). In secondary stroke prevention, the recurrence rate of stroke patients treated with anticoagulation plus antiplatelet was obviously lower than that of patients treated with antiplatelet alone (11.1% vs. 49.3%). No ischemic stroke or surgical complications were noted in 23 patients underwent carotid endarterectomy and 54 patients underwent carotid stent implantation during the mean follow-up period of 12 months (one-60 months) and 11 months (3-144 months), respectively. Conclusions:Carotid web may be a vital risk factor for cryptogenic stroke. Anticoagulation plus antiplatelet is superior to antiplatelet alone in preventing stroke recurrence. Carotid endarterectomy and carotid stent implantation may be the perfect choices for carotid web patients with high risk of stroke recurrence.