OBJECTIVETo explore the effects of different fertilization methods on the outcomes of elective blastocyst culture.

METHODSWe retrospectively analyzed the outcomes of elective blastocyst culture for 1 153 cycles of IVF and 205 cycles of ICSI performed between january 2009 and December 2012.

RESULTSA total number of 14 748 embryos in the IVF group and 2 655 embryos in the ICSI group underwent sequential blastocyst culture, with 7 871 blastocysts formed in the former and 1 210 in the latter. No cycles were canceled for no blastocyst formation in either of the two groups. The rates of quality embryos, blastocyst formation and embryo utilization were significantly higher in the IVF than in the ICSI group (64.77 vs 58.72%, 53.37 vs 45.57%, and 60.06 vs 52.17%, all P < 0.05), but the rates of implantation, clinical pregnancy and abortion showed no significant differences between the two groups (48.94 vs 51.43%, 49.03 vs 52.02%, and 11.69% vs 15.56, all P > 0.05).

CONCLUSIONWith the same inclusion criteria of selective blastocyst culture, IVF has a lower risk of cycle cancellation due to no blastocyst formation and therefore may effect higher rates of blastocyst formation and embryo utilization than ICSI. Our study suggested that appropriate inclusion criteria of selective blastocyst culture should be laid down according to different fertilization methods.

Adult ; Blastocyst ; Embryo Transfer ; Female ; Fertilization in Vitro ; methods ; Humans ; Pregnancy ; Retrospective Studies ; Sperm Injections, Intracytoplasmic

OBJECTIVEKawasaki disease (KD) is a kind of febrile disorder without definite etiology. The pathologic change of KD is characterized by nonspecific vasculitis, which mainly involves the coronary artery. Some patients may have coronary angioma formation, and some of them will result in the coronary narrowing or embolism. Notwithstanding that KD has been one of the most common causes for acquired heart diseases in childhood in addition to the rheumatic fever, the pathogenesis of the vascular damage remains unknown. This study was conducted to explore the pathophysiological role of cell adhesion molecules (P-selectin and E-selectin) on the endothelial lesions in KD, and to look for the evidence of direct relationship between the plasma levels of soluble cell adhesion molecules (P- and E-selectin) and the incidence of the coronary artery lesion (CAL).

METHODSSoluble P-selectin (PS), E-selectin (ES), thromboxane-B(2)(TXB(2)), 6-keto-PGF(1)alpha (6-KPGF(1)alpha) were measured in 36 patients with KD, 20 patients with febrile disease and 30 healthy children by using double antibody sandwich enzyme linked immunosorbent assay (ELISA) and radioimmunoassay. Patients with KD were separated into acute phase group, subacute phase group, recovery phase group, coronary artery lesion group (CAL), non-coronary artery lesion group (NCAL), intravenous immunoglobulin (IVIG) effective group (body temperature back to normal after 48 hours of using IVIG), and IVIG ineffective group.

RESULTSPlasma PS and ES levels in the acute phase group [(211 +/- 28 and 186 +/- 14) ng/ml], subacute phase group [(238 +/- 27 and 151 +/- 13) ng/ml] and recovery phase group [(198 +/- 21 and 1008 +/- 9) ng/ml] were significantly higher than those in the healthy group [(102 +/- 36 and 72 +/- 10) ng/ml, P < 0.01]. The plasma PS levels remained higher after the treatment, but in IVIG effective group, the PS and ES levels declined significantly (P < 0.01) compared with those in acute phase group. Plasma PS and ES levels of CAL group [(281 +/- 78 and 210 +/- 52) ng/ml] were significantly higher than those of NCAL group [(217 +/- 15 and 108 +/- 10) ng/ml, P < 0.01]. In contrast to 1 week after the treatment, the PS and ES in IVIG effective group at the time point of 2 weeks after the treatment decreased more significantly (P < 0.01). While the PS and ES in IVIG ineffective group remained higher at the time point of 2 weeks after the treatment, which showed no significant difference compared with those 1 week after the treatment (P > 0.05). One week after the treatment, the PS levels of IVIG effective and ineffective groups did not descend, and there was no significant difference in PS between these two groups at this time point. Two weeks after the treatment, the PS and ES in IVIG ineffective group remained higher than those in IVIG effective group, and there was a significant difference between them. The peak level of PS appeared in the subacute phase. TXB(2) levels of KD in acute phase group increased markedly, which were significantly higher than those of healthy group [(345 +/- 127 and 190 +/- 69) ng/L, P < 0.01]. There was no significant difference between subacute phase group and healthy group. No significant difference was found between CAL group and NCAL group (P > 0.05). The levels of TXB(2) declined quickly after the treatment. The 6-KPGF(1)alpha level in KD of acute phase group, subacute phase group and recovery phase group [(7.1 +/- 2.8, 10.8 +/- 3.7 and 11.3 +/- 4.0) ng/L, respectively] was significantly lower than that of healthy group [(17.7 +/- 5.8) ng/L, P < 0.01], and the levels did not recover to normal even 2 weeks after the treatment. There was no significant difference 6-KPGF(1)alpha levels between CAL group and NCAL group (P > 0.05). In the febrile group, PS and ES levels showed no significant differences compared with healthy children (P > 0.05). ES level of KD patients was significantly correlated with CRP levels (r = 0.79 P < 0.01). In febrile group, there was no significant correlation between ES and CRP. There was a significant correlation between PS and PLT levels in KD patients (r = 0.75 P < 0.01), and no significant correlation between PS and PLT levels in febrile patients.

CONCLUSIONThe increase of plasma PS and ES levels in KD acute phase and subacute phase might play an important role in the pathophysiology of the endothelial damage. E- and P-selectin may potentially be a predictor of CAL in patients with KD.

Child ; Coronary Artery Disease ; physiopathology ; Coronary Vessels ; physiopathology ; E-Selectin ; blood ; Endothelium, Vascular ; physiopathology ; Humans ; Mucocutaneous Lymph Node Syndrome ; blood ; physiopathology ; P-Selectin ; blood

BACKGROUND: Postoperative anticoagulant therapy after hip and knee arthroplasties has been included in the perioperative management guidelines. However, the application of anticoagulant drugs accompanies with the risk of bleeding. Routine coagulation tests provide limited information about the quality of clots because they identify only the first stage of clotting, while thrombelastography provides a comprehensive assessment of coagulation function. But its practicality remains controversial and the research for bleeding after joint replacement is little reported. OBJECTIVE: To explore the distribution of thrombelastography parameters (time to initial fibrin formation, clotting time, α angle, and maximum amplitude) and to analyze the correlation of the four parameters with postoperative blood loss, thereby providing guidance for improving the safety and effectiveness of anticoagulant therapy. METHODS: Totally 148 patients with detection of thrombelastogram after arthroplasty from August 2015 to March 2017 in Sun Yat-sen Memorial Hospital, Sun Yat-sen University were enrolled, including 76 cases of total hip arthroplasty and 72 cases of total knee arthroplasty. Thrombelastography data were collected on day 1 postoperatively, and the perioperative blood loss was calculated. Structural equation modeling of each group was constructed to investigate the relationship of four parameters and total blood loss. RESULTS AND CONCLUSION: (1) In the structural equation modeling of hip and knee arthroplasties, the root mean square error of approximation was less than 0.08, goodness-of-fit index, adjusted goodness-of-fit index, normed fit index and comparative fit index was all higher than 0.9, and Parsi-mony goodness-of-fit index was less than 2, so the theoretical model was matched with the data. (2) There was a correlation of postoperative hemorrhage with time to initial fibrin formation, clotting time, α angle, and maximum amplitude. (3) That is to say, thrombelastogram can be used as an efficient tool in predicting bleeding after hip and knee arthroplasties. Future study based on this research will further verify the correlation and provide more information for its clinical practice.

Objective To investigate the clinical efficacy of electroacupuncture and (or) massotherapy plus behavior therapy for cervical spondylosis.Methods Three hundred patients with cervical spondylosis were randomly allocated to three groups (A, B and C) by random number generated from calculator, 100 cases each. In addition to cupping and behavior therapy, group A received electroacupuncture; group B, massotherapy; group C, electroacupuncture and massotherapy. The clinical symptom and sign score was recorded in the three groups before and after treatment. The clinical therapeutic effects were compared.Results There were no statistically significant differences in the clinical control rate, marked control rate and total efficacy rate among the three groups after four and eight weeks of treatment and at the 4-month and 6-month follow-ups after treatment (P>0.05). In the three groups, there was a statistically significant difference in the clinical symptom and sign score between before treatment and after four and eight weeks of treatment or at the 4-month and 6-month follow-ups after treatment (P<0.01) and between after four weeks of treatment and after eight weeks of treatment or at the 4-month and 6-month follow-ups after treatment (P<0.01). There was no statistically significant differences in the clinical symptom and sign score among the three groups after four and eight weeks of treatment and at the 4-month and 6-month follow-ups after treatment (P>0.05). Conclusions Electroacupuncture and (or) massotherapy plus behavior therapy is an effective protocol for preventing and treating cervical spondylosis. It is characterized by simplicity, convenience, easiness and cheapness and can be provide for clinical application.

Objective To assess the level of sulfur dioxide(SO2) residues in sea shrimps on the market and to evaluate the health risk of the SO2 exposure of Wenzhou population by eating sea shrimp .Method SO2 residues in 246 sea shrimp samples collected from Wenzhou market from 2015 to 2016 were analyzed. The point assessment method was used to evaluate the risk of SO2 exposure for consumers,using the data of residents' consumption survey in 2008 in Zhejiang Province.Results The median of SO2 residual in the whole shrimp and the shrimp without shell were 20.05 mg/kg and 10.65 mg/kg respectively(P<0.05). The over-standard rate of SO2 for the whole shrimp and the shrimp without shell were 19.11% and 5.69%(P<0.05) respectively. The average exposure of SO2 in general population by eating the whole shrimp and the shrimp without shell were 0.0459 mg/kg BW and 0.0076 mg/kg BW respectively. However,the exposure of SO2 in high-consuming population (>P97.5) by eating the whole shrimp and the shrimp without shell were 0.1142 mg/kg BW and 0.0189 mg/kg BW respectively. The exposure level of SO2 in men were lower than in women. Conclusion The health risk of the SO2 exposure by eating sea shrimp in general population and high-consuming population is in a low level in Wenzhou.

Objective To investigate the knowledge, attitude, behavior about Dietary Guidelines for Chinese (2007) among elderly residents in 2 communities in Wenzhou City, and to exoplore the appropriate method for dietary intervention for elderly people. Methods A questionnaire survey was carried out in 784 people aged 50 years and above in two communities in Wenzhou from December, 2014 to January, 2015 about Dietary Guidelines for Chinese (2007) .The awareness of knowledge, attitude and behavior about nutrition were recorded, and multiple linear regressions were taken to evaluate the impression of knowledge. Results The awareness rate of knowledge was 58.28%, and the awareness about 'Which is the healthiest way to cook?' was the hot question (89.29%) while 'Which disease can be prevented by eating iodized salt?' was not (0.89%) . And 53.06% of respondents interested in nutrient knowledge, and 14.54% of them thought they had learned the knowledge about nutrition, and 39.54% of them thought knowledge had impact on health, and 76.53% of them would like to change their unhealthy dietary behavior. About 50.89% of respondents got knowledge about nutrition from TV or radio programs. Intake frequency about vegetables and fish were 88.01% and 62.63%respectively, while intake frequency about milk and milk products and beans and their products were 21.43% and 15.43%respectively. Multiple linear regression promoted that, female, a high degree of education, less number of offspring, people who had married, people whose income came from social insurance had positive impact on the awareness rate of knowledge. Conclusion The awareness rate of knowledge among elderly people was low, and intake frequency about milk and milk products and beans and their products were efficient. But they would like to change their unhealthy behavior. Long-term education about nutrition should be taken for elderly people.

Background: Approximately 15–20% cases of systemic lupus erythematosus (SLE) are diagnosed in children. There have been a few studies reporting the epidemiological data of pediatric?onset SLE (cSLE) in China, neither comparing the differences between cSLE and adult?onset SLE (aSLE). The aim of this study was to describe the impact of age of onset on clinical features and survival in cSLE patients in China based on the Chinese SLE Treatment and Research group (CSTAR) database. Methods: We made a prospective study of 225 cSLE patients (aged <16 years) and 1759 patients aged 16–50 years based on CSTAR registry. We analyzed initial symptoms, clinical presentations, SLE disease activity, damages, and outcomes of cSLE, as well as compared with aSLE patients. Results: The mean age of cSLE patients was 12.16 ± 2.92 years, with 187 (83.1%) females. Fever (P < 0.001) as well as mucocutaneous (P < 0.001) and renal (P = 0.006) disorders were found to be significantly more frequent in cSLE patients as initial symptoms, while muscle and joint lesions were significantly less common compared to aSLE subjects (P < 0.001). The cSLE patients were found to present more frequently with malar rash (P = 0.001; odds ratio [OR], 0.624; 95% confidence interval [CI ], 0.470–0.829) but less frequently with arthritis (P < 0.001; OR, 2.013; 95% CI, 1.512–2.679) and serositis (P = 0.030; OR, 1.629; 95% CI, 1.053–2.520). There was no significant difference in SLE disease activity index scores between cSLE and aSLE groups (P = 0.478). Cox regression indicated that childhood onset was the risk factor for organ damage in lupus patients (hazard ratio 0.335 [0.170–0.658], P = 0.001). The survival curves between the cSLE and aSLE groups had no significant difference as determined by the log?rank test (0.557, P = 0.455). Conclusions: cSLE in China has different clinical features and more inflammation than aSLE patients. Damage may be less in children and there is no difference in 5? year survival between cSLE and aSLE groups.

Objective This study aimed to investigate the potential relationship between urinary metals copper (Cu), arsenic (As), strontium (Sr), barium (Ba), iron (Fe), lead (Pb) and manganese (Mn) and grip strength. Methods We used linear regression models, quantile g-computation and Bayesian kernel machine regression (BKMR) to assess the relationship between metals and grip strength.Results In the multimetal linear regression, Cu (β=-2.119), As (β=-1.318), Sr (β=-2.480), Ba (β=0.781), Fe (β= 1.130) and Mn (β=-0.404) were significantly correlated with grip strength (P < 0.05). The results of the quantile g-computation showed that the risk of occurrence of grip strength reduction was -1.007 (95％ confidence interval:-1.362, -0.652; P < 0.001) when each quartile of the mixture of the seven metals was increased. Bayesian kernel function regression model analysis showed that mixtures of the seven metals had a negative overall effect on grip strength, with Cu, As and Sr being negatively associated with grip strength levels. In the total population, potential interactions were observed between As and Mn and between Cu and Mn (Pinteractions of 0.003 and 0.018, respectively).Conclusion In summary, this study suggests that combined exposure to metal mixtures is negatively associated with grip strength. Cu, Sr and As were negatively correlated with grip strength levels, and there were potential interactions between As and Mn and between Cu and Mn.

BACKGROUNDThrombolysis with recombinant tissue plasminogen activator (rt-PA) has gained international recognition, clinical outcomes following this thrombolytic therapy varied from patient to patient. Factors affecting clinical outcomes have not been well understood yet, so this retrospective case-control study aimed to investigate factors that may influence clinical outcomes of acute ischemic stroke treated with intravenous rt-PA.

METHODSOne hundred and one patients with acute ischemic stroke who received intravenous rt-PA thrombolysis within 4.5 hours from disease onset were included. Patients were divided into good or poor outcome group according to modified Rankin Scale (mRS) score, good outcome group: mRS score of 0-1; poor outcome group: mRS of 2-6. Stroke characteristics were compared between the two groups. Factors for stroke outcomes were analyzed via univariate analysis and Logistic regression.

RESULTSOf the 101 patients studied, patients in good outcome group (n = 55) were significantly younger than patients in poor outcome group (n = 46, (62.82 ± 14.25) vs. (68.81 ± 9.85) years, P = 0.029). Good outcome group had fewer patients with diabetic history (9.09% vs. 28.26%, P = 0.012), fewer patients with leukoaraiosis (7.27% vs. 28.26%, P = 0.005) and presented with lower blood glucose level ((5.72 ± 1.76) vs. (6.72 ± 1.32) mmol/L, P = 0.012), lower systolic blood pressure level ((135.45 ± 19.36) vs. (148.78 ± 19.39) mmHg, P = 0.003), lower baseline NIHSS score (12.02 ± 5.26 vs. 15.78 ± 4.98, P = 0.002) and shorter onset-to-treatment time (OTT) ((2.38 ± 1.21) vs. (2.57 ± 1.03) hours, P = 0.044) than poor outcome group. Logistic regression analysis showed that absence of diabetic history (odds ratio (OR) 0.968 (95% CI 0.941-0.996)), absence of leukoaraiosis (OR 0.835 (95% CI 0.712-0.980)), lower baseline NIHSS score (OR 0.885 (95% CI 0.793-0.989)), lower pre-thrombolysis systolic blood pressure (OR 0.962 (95% CI 0.929-0.997)), and lower blood glucose level (OR 0.699 (95% CI 0.491-0.994)) before thrombolysis were significantly associated with better outcome.

CONCLUSIONPatients with no history of diabetes, no leukoaraiosis, low blood glucose level, low systolic blood pressure level and low baseline NIHSS score before thrombolysis have a better outcome.

Aged ; Blood Pressure ; Case-Control Studies ; Female ; Fibrinolytic Agents ; therapeutic use ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Stroke ; drug therapy ; Thrombolytic Therapy ; Tissue Plasminogen Activator ; therapeutic use ; Treatment Outcome

BACKGROUNDCurrent risk stratification of idiopathic dilated cardiomyopathy (IDC) lacks sufficient sensitivity and specificity. The objective of this study was to investigate the predictive role of frontal QRS-T angles in IDC.

METHODSA prospective study with 509 IDC patients was performed from February 2008 to December 2013 in the Affiliated Drum Tower Hospital, Nanjing University School of Medicine. Baseline values and changes in QRS-T angles were recorded. Follow-up was conducted every 6 months. Analyses by Cox Proportional Hazards model were performed to evaluate the association between QRS-T angle and outcomes. The primary outcome of interest was all-cause mortality.

RESULTSDuring a median follow-up of 34 months, 90 of 316 patients with QRS-T angles >90° died compared to 31 of 193 patients with QRS-T angles ≤90° (hazard ratio [HR] =2.4, P < 0.001). Cardiac death was more prevalent in patients with a wide QRS-T angle (HR = 2.4, P < 0.001), similar to heart failure rehospitalization (HR = 2.5, P < 0.001). After adjustment for potential prognostic factors, the QRS-T angle was independently associated with all-cause mortality (HR = 2.5, P < 0.05), cardiac mortality (HR = 1.9, P < 0. 05), and heart failure rehospitalization (HR = 2.3, P < 0.01). Optimized therapy significantly narrowed the frontal QRS-T angle (100.9 ± 53.4° vs. 107.2 ± 54.4°, P < 0.001). The frontal QRS-T angle correlated well with established risk factors, such as left ventricular ejection fraction, brain natriuretic peptide, and New York Heart Association functional class.

CONCLUSIONSThe frontal QRS-T angle is a powerful predictor of all-cause mortality, cardiac mortality, and worsening heart failure in IDC patients, independent of well-established prognostic factors. Optimized therapy significantly narrows the QRS-T angle, which might be an indicator of medication compliance, but this requires further investigation.

Aged ; Cardiomyopathy, Dilated ; pathology ; physiopathology ; Electrocardiography ; Female ; Heart Failure ; pathology ; physiopathology ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Prognosis ; Prospective Studies ; Risk Factors