As the core vehicle for preserving and transmitting traditional Chinese medicine（TCM） academic thought and clinical experience， the establishment of a robust quality evaluation system for TCM clinical case reports is a crucial component in the current standardization and modernization of TCM. Based on the practical experience of constructing the China Clinical Cases Library of Traditional Chinese Medicine by the China Association of Chinese Medicine， this study conducted a comprehensive analysis of critical challenges， including insufficient authenticity and unfocused evaluation criteria. It proposed a three-dimensional evaluation framework grounded in the structure-process-outcome logic， encompassing three dimensions of authenticity and standardization， characteristics and advantages， application and translational impact. This framework integrated 12 key evaluation indicators in a systematic manner. The model preserved the academic characteristics of TCM syndrome differentiation and treatment， while aligning with modern scientific research standards， achieving a balance between individualized TCM experience and standardized evaluation. Concurrently， this study provided theoretical foundations and methodological guidance for evaluating the quality of TCM clinical cases， contributing significantly to the inheritance of TCM knowledge， evidence-based practice， and the reform of talent evaluation mechanisms.

BACKGROUND:Bone tissue loss caused by tumors and trauma can have an adverse effect on postoperative rehabilitation.Therefore,scaffold materials are usually implanted during treatment.However,the existing implant materials are relatively simple and lack antibacterial properties.Early implantation may lead to iatrogenic autoinfection and have an adverse effect on osteogenesis.OBJECTIVE:To construct a KR-12-a5 polypeptide-nanohydroxyapatite-small intestinal submucosa composite scaffold and evaluate its feasibility as a material for promoting bone defect repair.METHODS:The small intestinal submucosa scaffold and the small intestinal submucosa scaffold containing 25,50,and 100 mg/mL nanohydroxyapatite(referred to as nHA-SIS scaffold)were prepared by 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide hydrochloride/N-hydroxysuccinimide cross-linking method.The appropriate scaffold was screened for subsequent experiments by mechanical property testing.The antibacterial properties of KR-12-a5 polypeptide solution against Staphylococcus aureus,Streptococcus gordonii,and Fusobacterium nucleatum were detected.The nHA-SIS scaffolds were immersed in 250,500,and 1 000 μg/mL KR-12-a5 peptide solutions for 24 hours,and then freeze-dried to obtain peptide-loaded nanohydroxyapatite-porcine small intestinal submucosa composite scaffolds(denoted as P-nHA-SIS scaffolds).The sustained-release properties of the three groups of scaffolds were characterized.The nHA-SIS scaffolds and the three groups of P-nHA-SIS scaffolds were co-cultured with Staphylococcus aureus,Streptococcus gordonii,and Fusobacterium nucleatum for 24 hours or 48 hours.The scaffolds with strong antibacterial ability were screened by live and dead bacteria staining and scanning electron microscopy for subsequent experiments.The degradation properties and water absorption rates of the uncross-linked small intestinal submucosa scaffolds,cross-linked small intestinal submucosa scaffolds,nHA-SIS scaffolds,and P-nHA-SIS scaffolds were characterized.The extracts of cross-linked small intestinal submucosal scaffolds,nHA-SIS scaffolds,and P-nHA-SIS scaffolds were co-cultured with MC3T3-E1 cells.CCK-8 assay and live-dead cell staining were performed.The effects of the extracts of the three scaffolds on the migration of MC3T3-E1 cells were detected by Transwell chamber assay.RESULTS AND CONCLUSION:(1)The elastic modulus and compressive strength of 25,50,and 100 mg/mL nHA-SIS scaffolds were higher than those of small intestinal submucosal scaffolds(P＜0.05),among which the elastic modulus and compressive strength of 25 mg/mL nHA-SIS scaffolds were the highest,and this group of scaffolds were selected for subsequent experiments to load peptides.(2)KR-12-a5 peptide had strong antibacterial activity against common bacteria in bone defects(Staphylococcus aureus,Streptococcus gordonii,and Fusobacterium nucleatum).The three groups of P-nHA-SIS scaffolds all had sustained release properties.With the increase of peptide mass concentration,the antibacterial property of P-nHA-SIS scaffold was enhanced.Among them,the P-nHA-SIS scaffold loaded with 500 μg/mL peptide had achieved a satisfactory antibacterial effect,and this group of scaffolds would be selected in the future.(3)The degradation rate of the three groups of cross-linked scaffolds was lower than that of the uncross-linked scaffolds,and the water absorption rate was greater than that of the uncross-linked scaffolds.P-nHA-SIS scaffolds could promote the proliferation and migration of MC3T3-E1 cells without affecting the activity of MC3T3-E1 cells.(4)The results show that P-nHA-SIS scaffolds have strong antibacterial properties and the ability to promote the proliferation and migration of MC3T3-E1 cells,and are expected to be used in bone defect repair.

BACKGROUND:Bone tissue loss caused by tumors and trauma can have an adverse effect on postoperative rehabilitation.Therefore,scaffold materials are usually implanted during treatment.However,the existing implant materials are relatively simple and lack antibacterial properties.Early implantation may lead to iatrogenic autoinfection and have an adverse effect on osteogenesis.OBJECTIVE:To construct a KR-12-a5 polypeptide-nanohydroxyapatite-small intestinal submucosa composite scaffold and evaluate its feasibility as a material for promoting bone defect repair.METHODS:The small intestinal submucosa scaffold and the small intestinal submucosa scaffold containing 25,50,and 100 mg/mL nanohydroxyapatite(referred to as nHA-SIS scaffold)were prepared by 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide hydrochloride/N-hydroxysuccinimide cross-linking method.The appropriate scaffold was screened for subsequent experiments by mechanical property testing.The antibacterial properties of KR-12-a5 polypeptide solution against Staphylococcus aureus,Streptococcus gordonii,and Fusobacterium nucleatum were detected.The nHA-SIS scaffolds were immersed in 250,500,and 1 000 μg/mL KR-12-a5 peptide solutions for 24 hours,and then freeze-dried to obtain peptide-loaded nanohydroxyapatite-porcine small intestinal submucosa composite scaffolds(denoted as P-nHA-SIS scaffolds).The sustained-release properties of the three groups of scaffolds were characterized.The nHA-SIS scaffolds and the three groups of P-nHA-SIS scaffolds were co-cultured with Staphylococcus aureus,Streptococcus gordonii,and Fusobacterium nucleatum for 24 hours or 48 hours.The scaffolds with strong antibacterial ability were screened by live and dead bacteria staining and scanning electron microscopy for subsequent experiments.The degradation properties and water absorption rates of the uncross-linked small intestinal submucosa scaffolds,cross-linked small intestinal submucosa scaffolds,nHA-SIS scaffolds,and P-nHA-SIS scaffolds were characterized.The extracts of cross-linked small intestinal submucosal scaffolds,nHA-SIS scaffolds,and P-nHA-SIS scaffolds were co-cultured with MC3T3-E1 cells.CCK-8 assay and live-dead cell staining were performed.The effects of the extracts of the three scaffolds on the migration of MC3T3-E1 cells were detected by Transwell chamber assay.RESULTS AND CONCLUSION:(1)The elastic modulus and compressive strength of 25,50,and 100 mg/mL nHA-SIS scaffolds were higher than those of small intestinal submucosal scaffolds(P＜0.05),among which the elastic modulus and compressive strength of 25 mg/mL nHA-SIS scaffolds were the highest,and this group of scaffolds were selected for subsequent experiments to load peptides.(2)KR-12-a5 peptide had strong antibacterial activity against common bacteria in bone defects(Staphylococcus aureus,Streptococcus gordonii,and Fusobacterium nucleatum).The three groups of P-nHA-SIS scaffolds all had sustained release properties.With the increase of peptide mass concentration,the antibacterial property of P-nHA-SIS scaffold was enhanced.Among them,the P-nHA-SIS scaffold loaded with 500 μg/mL peptide had achieved a satisfactory antibacterial effect,and this group of scaffolds would be selected in the future.(3)The degradation rate of the three groups of cross-linked scaffolds was lower than that of the uncross-linked scaffolds,and the water absorption rate was greater than that of the uncross-linked scaffolds.P-nHA-SIS scaffolds could promote the proliferation and migration of MC3T3-E1 cells without affecting the activity of MC3T3-E1 cells.(4)The results show that P-nHA-SIS scaffolds have strong antibacterial properties and the ability to promote the proliferation and migration of MC3T3-E1 cells,and are expected to be used in bone defect repair.

Objective To assess the efficacy of clear lens extraction combined with extended depth of focus(EDOF)intraocular lens(IOL)implantation in enhancing visual quality and concurrently opening peripheral angle structures in patients diagnosed with primary angle closure suspect(PACS)and presbyopia.Methods A total of 80 patients with PACS,presbyopia,and transparent lenses were enrolled and divided into two groups based on the type of implanted lens:a control group(n=46)and an experimental group(n=34).The control group underwent clear lens extraction followed by monofocal intraocular lens implantation,while the experimental group underwent clear lens extraction followed by extended depth of focus(EDOF)intraocular lens implantation.Preoperative and postoperative evaluations at 3 months included visual acuity,intraocular pressure,anterior segment structure,defocus curve,and Catquest 9SF-CN questionnaire scores.Adverse events were recorded to assess safety.Results Regarding the angular structure,after 3 months of treatment,results indicated significant increases in central ante-rior chamber depth,angle opening distance at 750 μ m,angle recess area at 750 μ m,trabecular-iris space area at 750 μm,and trabecular-iris angle at 750 μm in both groups compared to preoperative values(all P<0.01).However,no significant differences were observed between the two groups(all P>0.05).For the defocusing curve,visual acuity in the experimental group improved from+1.0 D to-4.0 D after 3 months of treatment(all P<0.05),while the control group showed improvements at+0.5 D,-0.5 D,-1.0 D,-2.0 D,-3.0 D,-3.5 D,and-4.0 D(all P<0.05).Postoperatively at 3 months,the experimental group exhibited superior visual acuity to the control group at-1.0 D to-4.0 D(all P<0.05).According to the Catquest 9SF-CN scale,scores in both groups significantly im-proved after 3 months of treatment(P<0.01),with the experimental group scoring higher than the control group(P<0.01).During the study,transient intraocular pressure elevation occurred in 7 patients(3 in the control group and 4 in the experimental group),but no serious adverse reactions were reported in either group.Conclusions In patients with pseudoexfoliation glaucoma combined with presbyopia,significant improvements in angle structures were observed following clear lens extraction.The implantation of an EDOF IOL notably enhanced postoperative visual quality compared to monofocal IOLs.

Objective:To analyze the effects of fertilization methods, quality of inner cell mass (ICM) and trophectoderm (TE) on the sex ratio at birth (SRB) during single blastocyst transfer cycles.Methods:5 367 single blastocyst transfer cycles in in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) of patients with successful pregnancy and delivery in Reproductive Medical Center of Zhanjiang Jiuhe Hospital from January 2010 to December 2022 were included in this retrospective cohort study. According to different types of embryos, the cycles were divided into fresh embryo group ( n=1 487, total population; n=1 258, ≤35 years old) and frozen-thawed embryo group ( n=3 880, total population; n=3 199, ≤35 years old). According to different fertilization methods, the cycles were divided into IVF group ( n=4 424, total population; n=3 667, ≤35 years old) and ICSI group ( n=943, total population; n=780, ≤35 years old). Chi-square test was used to analyze the differences of SRB among all the patients and the patients aged ≤35 years who underwent different embryo types and fertilization methods, and logistic regression was used to analyze the effects of ICM and TE ratings on SRB in each group of blastocysts. Results:There were 917 male infants (61.7%, 917/1 487) in the fresh embryo transfer group and 2 317 male infants (59.7%, 2 317/3 880) in frozen-thawed embryo transfer group. The SRB of the fresh embryo transfer group (160.9∶100) was slightly higher than that in frozen-thawed embryo transfer group (148.2∶100), but the difference was not statistically significant ( P=0.201). There were 2 732 male infants (61.8%, 2 732/4 424) in IVF group and 502 male infants (53.2%, 502/943) in ICSI group. The SRB of IVF group (161.5∶100) was significantly higher than that of ICSI group (113.8∶100), and the difference was statistically significant ( P<0.001). In female patients aged ≤35 years, the effects of different embryo transfer methods and different fertilization methods on SRB were consistent with the results of total population. Univariate logistic regression analysis showed that the SRB of patients with ICSI was lower than that of patients with IVF, except for 3-6AA. There were significant differences in SRB between ICSI cycles patients (88.8∶100; 72.8∶100; 156.1∶100) and IVF cycles patients (130.7∶100; 124.8∶100; 206.3∶100) when the blastocyst grade was 3-6BB ( OR=0.679, 95% CI: 0.516-0.896, P=0.006), 3-6AB( OR=0.583, 95% CI: 0.421-0.809, P=0.001) and 3-6BA OR=0.757, 95% CI: 0.585-0.979, P=0.034). Taking 3-6BB blastocysts as reference, the SRB of 3-6AA and 3-6BA blastocysts were higher (IVF: OR=1.527, 95% CI: 1.258-1.854, P<0.001; OR=1.579,95% CI: 1.341-1.859, P<0.001; ICSI: OR=2.566, 95% CI: 1.661-3.966, P<0.001; OR=1.758, 95% CI: 1.250-2.472, P=0.001). Compared with 3-6BA, the SRB of 3-6BC blastocysts was lower (IVF: OR=0.621, 95% CI: 0.447-0.862, P=0.004; ICSI: OR=0.442, 95% CI: 0.238-0.818, P=0.009). Taking 3-6AB as reference, the SRB of 3-6AA blastocysts was higher (IVF: OR=1.600, 95% CI: 1.307-1.958, P<0.001; ICSI: OR=3.130, 95% CI: 1.964-4.987, P<0.001). Conclusion:The SRB of fresh embryo group is slightly higher than that of frozen-thawed group in single blastocyst transfer cycles. Different fertilization methods can affect SRB, and the SRB in IVF is significantly higher than that in ICSI group. The quality of blastocysts can affect SRB, and blastocysts with higher quality TE have significantly increased SRB, while ICM quality have no significant effect on SRB.

Objective To explore the expression level of plasma miRNA in patients with swallowing and cognitive dysfunction after ischemic stroke and its correlation with the severity of dysfunction.Methods A retrospective analysis was conducted on the clinical data of 109 patients with ischemic stroke who were hospitalized in the First Affiliated Hospital of Guangxi Medical University and the First Affiliated Hos-pital of Fujian Medical University from January 2023 to March 2024.The expression levels of plasma miR-140-5p,miR-17-5p,and miR-103a-3p were detected by RT-qPCR.The swallowing function was evaluated by the Wada Drinking Water Test and the Functional Oral Feeding Scale,and the cognitive function of stroke pa-tients was evaluated by the modified Rankin Scale(mRS)classification.According to the mRS rating criteria,the patients were divided into the good functional outcome group(grade≤2,n=50)and the poor functional outcome group(grade≥3,n=59).Analyzed the correlation between miRNA expression levels and the degree of functional impairment,compared the clinical characteristics of patients with different mRS grades,and used the receiver operating characteristic(ROC)curve and the area under the curve(AUC)to analyze the efficacy of miRNA in predicting the functional outcome of mRS evaluation.Results The results of Spearman correla-tion analysis showed that the expression level of miR-17-5p was negatively correlated with the classification of the Wada Drinking Water Test(r=-0.317)and the classification of the Functional Oral Feeding Scale(r=-0.457,P<0.05).Compared with the good functional outcome group,the poor functional outcome group had a lower proportion of males,shorter disease course,and higher expression level of miR-103a-3p,the differ-ences were statistically significant(P<0.05).The results of ROC curve analysis showed that miR-103a-3p(AUC=0.709,95%CI:0.611-0.808)had the ability to distinguish functional outcomes in mRS evaluation.However,miR-140-5p(AUC=0.514,95%CI:0.405-0.624)and miR-17-5p(AUC=0.527,95%CI:0.414-0.637)did not have the ability.Conclusion The expression level of plasma miR-17-5p is related to the severi-ty of dysphagia in patients in the recovery period of ischemic stroke,and miR-103a-3p is helpful for judging the functional outcomes of patients in the recovery period of ischemic stroke.

Objective:To explore the causes and preventive measures of respiratory arrest following general anesthesia in children with obstructive sleep apnea （OSA）, in order to enhance the safety of OSA surgeries under general anesthesia. Methods:A retrospective analysis was conducted on the clinical and follow-up data of four pediatric cases that experienced respiratory arrest after general anesthesia for OSA at Shenzhen Hospital of Southern Medical University from March 2020 to March 2022. Results:All four children exhibited varying degrees of decreased blood oxygen saturation, cyanosis, and loss of consciousness after OSA surgery under general anesthesia, with one case experiencing respiratory and cardiac arrest. Through emergency rescue measures such as oxygen supplementation, suctioning, positive pressure ventilation, awakening, and cardiopulmonary resuscitation, all four children were stabilized. Follow-up after 2 to 6 months showed no complications. The main reasons for the occurrence are analyzed as: residual anesthetic drugs, characteristics of the OSA disease, and the unique aspects of the pediatric population. Conclusion:Children undergoing general anesthesia for OSA should be closely monitored for vital signs after surgery. If respiratory suppression occurs, active rescue measures should be taken to avoid serious consequences.
Humans ; Sleep Apnea, Obstructive/surgery* ; Anesthesia, General/adverse effects* ; Retrospective Studies ; Child ; Postoperative Complications/prevention & control* ; Male ; Female ; Child, Preschool

Nonunion of osteoporotic vertebral fractures (OVF), predominantly affecting the elderly, can lead to intractable pain, vertebral collapse, progressive kyphotic deformity, and neurological impairment, significantly compromising patients′ quality of life. There exists considerable debate on diagnosis and management of OVF, encompassing key issues such as clinical diagnosis and staging criteria for nonunion, surgical indications and procedure selection, and postoperative rehabilitation planning. Currently, there lacks standardized clinical guideline and expert consensus on the diagnosis and management of OVF nonunion in China. To address this gap, Minimally Invasive Surgery Group of Chinese Orthopedic Association, Osteoporosis Committee of Chinese Association of Orthopedic Surgeons, Prevention and Rehabilitation Committee for Osteoporosis of Chinese Association of Rehabilitation Medicine and Minimally Invasive Orthopedic Surgery Branch of China Association for Geriatric Care jointly organized domestic experts in spinal surgery, endocrinology, and rehabilitation to formulate the Clinical guideline for the diagnosis and treatment for nonunion of osteoporotic vertebral fractures ( version 2025), based on existing literature and clinical experience and adhering to principles of scientific rigor and practicality. The guideline provided 13 evidence-based recommendations encompassing diagnosis and treatment of OVF nonunion, aiming to standardize its clinical management.

Objective:To evaluate the feasibility, safety, and clinical outcomes of full-time full-endoscopic lumbar interbody fusion (FELIF) using a bladed retractor fusion channel (BRFC) system with reversed-mounting designed instruments compared to a tubular fusion channel (TFC).Methods:This retrospective study analyzed 101 cases of uniportal coaxial endoscopic lumbar interbody fusion performed between June 2018 and April 2023. Based on the type of fusion channel utilized, patients were divided into the TFC group (59 cases) and the BRFC group (42 cases). The BRFC technique involved neurological decompression, endplate preparation, and interbody fusion performed under full-time endoscopic monitoring with reversed-mounting designed instruments. Key parameters, including surgery duration, intraoperative estimated blood loss (IEBL), complication incidence, and interbody fusion rate (assessed by Bridwell criteria), were compared between the two groups. Clinical outcomes, including visual analog scale (VAS) scores for back and leg pain, Japanese Orthopaedic Association (JOA) scores, and Oswestry Disability Index (ODI), were recorded preoperatively, postoperatively, and at the final follow-up. Additionally, disc height at the fusion level was measured at one week postoperatively.Results:The mean follow-up duration was 42.9±12.1 months in the TFC group and 20.9±4.9 months in the BRFC group. No statistically significant differences were observed between the two groups in terms of surgery duration, IEBL, complication incidence, or interbody fusion rate (Grade 1 or 2 by Bridwell criteria) ( P>0.05). For single-level cases, the TFC group showed significantly better short-term clinical outcomes than the BRFC group at one week postoperatively, with JOA scores of 23(20, 25) versus 20(18, 23) ( Z=3.020, P=0.003) and ODI scores of 16%(11%, 21%) versus 28%(21%, 41%) ( Z=4.740, P<0.001). For double-level cases, the JOA score in the TFC group [23(20, 25)] was also significantly better than that in the BRFC group [20(18, 21)] ( Z=2.054, P=0.040) at one week postoperatively. However, at the final follow-up, all clinical indicators showed no significant differences between the two groups ( P>0.05). The disc height at the fusion level significantly increased at one week postoperatively compared to preoperative measurements in both groups ( P<0.05). However, the BRFC group demonstrated a significantly more recovery of disc height at one week postoperatively [(1.46±0.28) cm] compared to the TFC group [(1.17±0.20) cm] ( t=5.947, P<0.001). Conclusion:Full-time FELIF using the BRFC system and reversed-mounting designed instruments is a feasible, safe, and effective approach. However, its short-term clinical outcomes appear inferior to traditional FELIF using the TFC system.

Objective:To analyze the effects of fertilization methods, quality of inner cell mass (ICM) and trophectoderm (TE) on the sex ratio at birth (SRB) during single blastocyst transfer cycles.Methods:5 367 single blastocyst transfer cycles in in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) of patients with successful pregnancy and delivery in Reproductive Medical Center of Zhanjiang Jiuhe Hospital from January 2010 to December 2022 were included in this retrospective cohort study. According to different types of embryos, the cycles were divided into fresh embryo group ( n=1 487, total population; n=1 258, ≤35 years old) and frozen-thawed embryo group ( n=3 880, total population; n=3 199, ≤35 years old). According to different fertilization methods, the cycles were divided into IVF group ( n=4 424, total population; n=3 667, ≤35 years old) and ICSI group ( n=943, total population; n=780, ≤35 years old). Chi-square test was used to analyze the differences of SRB among all the patients and the patients aged ≤35 years who underwent different embryo types and fertilization methods, and logistic regression was used to analyze the effects of ICM and TE ratings on SRB in each group of blastocysts. Results:There were 917 male infants (61.7%, 917/1 487) in the fresh embryo transfer group and 2 317 male infants (59.7%, 2 317/3 880) in frozen-thawed embryo transfer group. The SRB of the fresh embryo transfer group (160.9∶100) was slightly higher than that in frozen-thawed embryo transfer group (148.2∶100), but the difference was not statistically significant ( P=0.201). There were 2 732 male infants (61.8%, 2 732/4 424) in IVF group and 502 male infants (53.2%, 502/943) in ICSI group. The SRB of IVF group (161.5∶100) was significantly higher than that of ICSI group (113.8∶100), and the difference was statistically significant ( P<0.001). In female patients aged ≤35 years, the effects of different embryo transfer methods and different fertilization methods on SRB were consistent with the results of total population. Univariate logistic regression analysis showed that the SRB of patients with ICSI was lower than that of patients with IVF, except for 3-6AA. There were significant differences in SRB between ICSI cycles patients (88.8∶100; 72.8∶100; 156.1∶100) and IVF cycles patients (130.7∶100; 124.8∶100; 206.3∶100) when the blastocyst grade was 3-6BB ( OR=0.679, 95% CI: 0.516-0.896, P=0.006), 3-6AB( OR=0.583, 95% CI: 0.421-0.809, P=0.001) and 3-6BA OR=0.757, 95% CI: 0.585-0.979, P=0.034). Taking 3-6BB blastocysts as reference, the SRB of 3-6AA and 3-6BA blastocysts were higher (IVF: OR=1.527, 95% CI: 1.258-1.854, P<0.001; OR=1.579,95% CI: 1.341-1.859, P<0.001; ICSI: OR=2.566, 95% CI: 1.661-3.966, P<0.001; OR=1.758, 95% CI: 1.250-2.472, P=0.001). Compared with 3-6BA, the SRB of 3-6BC blastocysts was lower (IVF: OR=0.621, 95% CI: 0.447-0.862, P=0.004; ICSI: OR=0.442, 95% CI: 0.238-0.818, P=0.009). Taking 3-6AB as reference, the SRB of 3-6AA blastocysts was higher (IVF: OR=1.600, 95% CI: 1.307-1.958, P<0.001; ICSI: OR=3.130, 95% CI: 1.964-4.987, P<0.001). Conclusion:The SRB of fresh embryo group is slightly higher than that of frozen-thawed group in single blastocyst transfer cycles. Different fertilization methods can affect SRB, and the SRB in IVF is significantly higher than that in ICSI group. The quality of blastocysts can affect SRB, and blastocysts with higher quality TE have significantly increased SRB, while ICM quality have no significant effect on SRB.