Objective To investigate feasibility and clinical application value of improved percutaneous transhepatic biliary internal-external drainage (PTBIED).Methods Consecutive patients from April 2007 to April 2010 with malignant obstructive jaundice were diagnosed by medical imaging or pathological confirmation whenever possible.The patients with proximal malignant biliary obstruction and intact inferior common bile ducts ＞ 3 cm in length,and a bilirubin of 70 μmol/L or higher,were included in the experimental group.The control group included patients with low malignant biliary obstruction,and those who met the criteria for the experimental group but refused to receive the altered method of PTBIED.The patients underwent traditional PTBIED in control group.The patients in the experimental group received the procedure as following:according to percutaneous transhepatic cholangiography,a biliary external drainage catheter was modified by adding side-holes.Then under fluoroscopic guidance,the loop tip of the modified biliary drainage catheter was positioned in the inferior common hepatic duct/common bile duct,while the additional side-holes were located in the expanded hepatic duct.Technical success rate,complications,hepatic function and white cell count (WBC) were recorded pre- and post-procedure.All patients were followed-up until death.A t-test was used to compare continuous variable data changes,the Chi-square test was used to compare categorical variable data in two groups,and survival time was assessed using the Kaplan-Meier method.Results Forty-six patients were included in the study,with 21 in the experimental group and 25 in the control group.The procedures were successfully performed in all patients in the two groups.There was no procedure-related death in the two groups.Symptoms were improved similarly after procedures in the two groups.The mean quantity of drained bile per day [experimental group (521 +136) ml/d,control group (606 + 159 ) ml/d,t =1.930,P ＞ 0.05],decrease of the serum total bilirubin after the procedures [ experimental group (87 ± 51 ) μmol/L,control group( 105 ± 66 ) μmol/L ( t =1.061,P ＞ 0.05 ) ] and the median survival time ( experimental group 7.7 months,control group 6.9 months,x2 =0.610,P ＞0.05 ) of the patients showed no statistically significant difference between two groups.The mean WBC amount of patients was higher after the traditional procedure [ ( 10.9 ±5.2) × 109/L] than before the procedure [ (7.8 ±2.9) × 109/L] in the control group ( t =3.606,P ＜ 0.05 ),but the converse change occurred in the experimental group [ pre-procedure (8.2 ± 3.4) × 109/L ],post-procedure [ (7.4 ± 2.6) × 109/L] ( t =2.649,P ＜ 0.05 ).No reflux of duodenal juice was observed in all patients of the experimental group,and 1 patient had infection of biliary tract.The reflux was observed in 11 patients of the control group after conventional PTBIED.Of them,8 patients had infection of biliary tract.Incidence rate of infection of biliary tract in the control group was higher than that in the experimental group( x2 =5.381,P ＜ 0.05 ).Conclusions Improved PTBIED is convenient and feasible,and compared with traditional PTBIED,it can reduce the complications of infection of biliary tract.

In order to optimize temperature monitoring, the mean of temperature measured by Copper-CuNi thermocouple (TC) was compared with the actual temperature. By the use of the temperature response curve of TC, the data from monitoring temperature were analyzed in regard to the depth of installation, the diameter of TC hole and the material of ablation electrode. The accuracy and real-time of TC with a depth of 3.5 mm were better than those of 2.5 mm or 3 mm, when TC was installed in the ablation electrode TC hole. However, the difference of real-time performance was not obvious. When TC was installed in different TC holes with diameter of 0.44 mm, 0.42 mm, 0.33 mm respectively, TC with the diameter of 0.33 mm TC hole was noted to be of higher accuracy and better real-time to response temperature, compared with others. In terms of material quality, the slope of platinum temperature response curve was greater than that of stainless steel, while the accuracy of sensor temperature changed inconspicuously. As a result, the monitoring device of temperature should be put to the heat source as nearly as possible. Also, platinum ablation electrode with better thermal conductivity should be chosen.
Catheter Ablation ; instrumentation ; methods ; Electrodes ; Equipment Design ; Humans ; Platinum ; Temperature

Objective To investigate the relationship between serum progesterone level at the day with human chorionic gonadotrophin (hCG) administration and pregnant outcome from in in-vitro fertilization-embryo transfer(IVF-ET). Methods From Mar. 2002 to Apr. 2007, 786 cycles with serum progesterone measurement on the day of hCG administration for final oocyte maturation in IVF were analyzed retrospectively in Reproductive Medicine Center in First Affiliated Hospital of Nanjing Medical University.All stimulations were down-regulated with gronadotrophin release hormone agonist (GnRH-a) in both long protocols and short protocols before gonadotrophin stimulation. When the thresholds of serum progesterone were set at 5.5, 6.0,6.5,7.0,7.5,8.0,8.5 and 9.0 nmol/L, respectively. If the level of progesterone was less than the thresholds, those patients were in lower progesterone group, on the contrary, more than the threshold value, those patients were in higher progesterone group. The laboratory results and the clinical outcomes between all patients at lower and higher progesterone group at different thresholds value were analyzed. Results The rate of normal fertilization, quality embryos, successful implantation, chemical pregnancy, clinical pregnancy and live birth did not exhibit remarkable difference between patients with higher and lower serum progesterone level at multiple thresholds on the day of hCG administration in the 786 cycles (P >0.05). However, when the thresholds of serum progesterone were at 8.5 and 9.0 nmol/L, early abortion rates of 27.3% (3/11) and 3/7 in higher progesterone group were significantly higher than 8.8% (26/297) and 8.6% (26/301) in lower progesterone group (P<0.05). And the total abortion rates of 3/7 in higher progesterone group were significantly higher than 11.0% (34/301) in lower progesterone group when the thresholds of serum progesterone were 9.0 nmol/L (P<0.05). Conclusions This study did not prove the correlationship between progesterone level at the clay with hCG administration and the probability of clinical pregnancy or live birth. However, early abortion rates or the total abortion rates were associated with higher progesterone level when the thresholds of serum progesterone were at 8.5 nmol/L or 9.0 nmoL/L.

Objective Using of cumulative live birth rate(CLBR)per oocytes retrieved cycle,to assess the clinical outcomes of in vitro fertilization or intracytoplasmic sperm injection(IVF/ICSI),and to explore impact factors on CLBR following utilization of all fresh and frozen embryos in one complete IVF/ICSI cycle using gonadotropin-releasing hormone(GnRH)agonist, GnRH-antagonist and clomiphene mild stimulation protocols. Methods Of the patients who underwent IVF/ICSI from January 1st, 2014 to December 31st, 2015 in the First Affiliated Hospital, Nanjing Medical University, a total of 6 142 oocytes retrieved cycles were included. The clinical and laboratory parameters of different ovarian stimulation protocols, and the effects of the age, number of oocytes retrieved and number of embryos available on the CLBR of each oocytes retrieved cycle were analyzed.Results The CLBR was 69.0%(2 004/2 906)in the GnRH-agonist protocol versus 67.4%(644/955)in the GnRH-antagonist protocol (P>0.05); the CLBR of clomiphene mild stimulation protocol was 53.2%(1 215/2 281),significantly lower than those of the other two protocols (all P<0.05). The CLBR significantly decreased with age increased. When divided into four groups according to the patients′ age, we found that CLBR were not statistically significant using three different protocols in the 20-25 years old group(all P>0.05).There was a strong association between the number of oocytes retrieved and embryos available on CLBR. CLBR rose significantly with an increasing number of oocytes up to 6, then the rising trend slowed down. Patients were categorized into four groups according to the number of oocytes retrieved,CLBR was significantly higher using GnRH-antagonist protocol (50.0%)than mild stimulation protocol(37.0%)in low ovarian responder(0-4 oocytes)group(P<0.05). The CLBR were no significant difference among three protocols in normal(10-15 oocytes)and high responders(≥15 oocytes)group(all P>0.05).The incidence rate of ovarian hyperstimulation syndrome in GnRH-agonist protocols(5.2%,152/2 906)were significantly higher than those of GnRH-antagonist(4.4%, 42/955)and clomiphene mild stimulation protocols(1.5%,34/2 281;all P<0.05).Conclusions CLBR is an important index to assess the clinical outcomes of IVF/ICSI. Age, number of oocytes retrieved and embryos available could affect CLBR obviously. According to the different age and ovarian response of patients, we should design ovarian stimulation protocols based on target oocytes number in order to get higher CLBR and reduce complications.

Objective To investigate the impact of dyslipidemia on in-vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) pregnancy outcome in patients with polycystic ovary syndrome (PCOS).Methods From July 2013 to March 2016,468 PCOS patients with antagonist protocol in IVF/ICSI of First Affiliated Hospital of Nanjing Medical University,cycles were divided into dyslipidemia group (108 cases) and normol blood lipids group (360 cases) according to the serum cholesterol,triglyceride (TG),high-density lipoprotein,low density lipoprotein levels.The general condition and clinical outcomes of the two groups were analyzed retrospectively,including the implantation rate,clinical pregnancy rate,live birth rate and the incidence of moderate to severe ovarian hyperstimulation syndrome (OHSS),etc.Besides,stratified analysis and multivariate logistic regression analysis were used to correct the impact of body mass index (BMI).Results (1) Comparing the based data of dyslipidemia group and normal blood lipids group:age,years of infertility,basic FSH,basic LH,basic estradiol and other indexes had no significant differences (all P＞0.05),but BMI of dyslipidemia group was significantly higher than normal blood lipids group [(25.0±3.0) versus (23.1±3.0) kg/m2],difference had statistical significance (P＜0.01).(2) The high score embryo rate,endometrial thickness on the day of hCG injection,progesterone and LH levels on the day of hCG injection,moderate to severe OHSS rate and miscarriage rate in the two groups did not exhibit remarkable differences (all P＞0.05).However,the number of dominant follicle,retrieved oocyte number,estrogen level on the day of hCG injection,implantation rate,biochemical pregnancy rate,clinical pregnancy rate and the live birth rate in dyslipidemia group were significantly less than those of normal blood lipids group (all P＜0.05),the dose of gonadotropin (Gn) and days of stimulation were significantly higher compared with the normal blood lipids group,there were significant differences statistically (all P＜0.05).(3) Stratified analysis showed that no matter in BMI＜24 or BMI≥24 kg/m2 group,the dose of Gn and days of stimulation were significantly higher in the dyslipidemia group than those of the normal blood lipids group,the difference was statistically significant (P＜0.05).However,the number of oocytes retrieved,estrogen level on the day of hCG injection had obvious downtrend,and the difference was statistically significant (P＜0.05) in BMI≥24 kg/m2 group.Multivariate logistic regression analysis found that,even after the correction of BMI,dyslipidemia still had negative impact on implantation rate,biochemical pregnancy rate,clinical pregnancy rate and the live birth rate (P＜0.05).(4) Further analysis of the different components of blood lipids in the clinical pregnancy group and unobtained pregnancy group revealed that the level of triglyceride (TG) in the unobtained pregnancy group was significantly higher than that in the pregnancy group,and the difference was statistically significant (P＜0.05);logistic regression analysis also showed that the increase of TG levels was negatively correlated with the clinical pregnancy rate of PCOS patients (P＜0.05).Conclusions PCOS patients combined with dyslipidemia have a higher BMI,and dyslipidemia increases the dosage of Gn,reduces the implantation rate,clinical pregnancy rate and live birth rate,especially the increase of TG level,which has adverse effects on IVF/ICSI outcome in patients with PCOS.