Objective:To evaluate the cumulative live birth rate (CLBR) and cost-effectiveness of fixed versus adjusted follicle-stimulation hormone (FSH) dosages in infertile women with different ovarian responses during their first assisted reproductive technology (ART) cycle.Methods:A retrospective real-world cohort study was conducted on 5 419 infertile women who underwent their first ART treatment at the Department of Reproductive Medicine of the First Affiliated Hospital of Nanjing Medical University between January 2013 and December 2017. All patients received an individualized starting dosage of gonadotropin. Based on whether FSH dosages were adjusted during controlled ovarian stimulation (COS), patients were divided into fixed-dosage group ( n=2 061) and adjusted-dosage group ( n=3 358). Clinical outcomes and FSH cost-effectiveness were compared between the two groups across different ovarian response groups, with CLBR as the primary outcome. Propensity score matching (PSM) and multivariable logistic regression were used to adjust for potential confounders. Results:FSH dosage adjustments were found in 62.0% (3 358/5 419) of cycles during COS. After PSM, baseline characteristics were comparable between the two groups (all P>0.05). After adjusting for confounders using multivariable logistic regression, FSH dosage adjustment was not significantly associated with CLBR ( OR=1.06, 95% CI: 0.94-1.20, P=0.332). Compared with the adjusted-dosage group, the fixed-dosage group showed no significant differences in CLBR in poor-, normal-, and high-responder groups (all P>0.05). The incidence of ovarian hyperstimulation syndrome (OHSS) did not differ significantly between the two groups ( P>0.05). In poor-, normal-, and high-responder groups, the total FSH dosages in the fixed-dose group [1 350 (375, 1 825) U, 1 200 (375, 1 500) U and 525 (375, 1 128) U, respectively] were significantly lower than those in the adjusted-dose group [1 875 (1 425, 2 294) U, P=0.001; 1 425 (450, 1 875) U, P<0.001; 600 (375, 1 425) U, P=0.020]. Similarly, average FSH costs in different ovarian response groups in the fixed-dosage group [4 725.0 (1 312.5, 6 387.5) yuan, 4 200.0 (1 312.5, 5 250.0) yuan and 1 837.5 (1 312.5, 3 947.3) yuan, respectively] were significantly lower than those in the adjusted-dosage group [6 562.5 (4 987.5, 8 028.1) yuan, P=0.001; 4 987.5 (1 575.0, 6 562.5) yuan, P<0.001; 2 100.0 (1 312.5, 4 987.5) yuan, P=0.020]. For normal-responders, the FSH cost per high-quality embryo in the fixed-dosage group [1 365.0 (875.0, 2 537.5) yuan] was significantly lower than that in the adjusted-dosage group [2 056.3 (1 268.8, 3 412.5) yuan, P<0.001]. Conclusion:FSH dosage adjustment during COS is not associated with CLBR or the incidence of OHSS. However, the fixed-dose group exhibited lower total FSH dosages and costs across different ovarian response populations. In the context of ART being covered by medical insurance, fixed FSH dosage may represent a more cost-effective ovarian stimulation protocol.

Objective:To evaluate the cumulative live birth rate (CLBR) and cost-effectiveness of fixed versus adjusted follicle-stimulation hormone (FSH) dosages in infertile women with different ovarian responses during their first assisted reproductive technology (ART) cycle.Methods:A retrospective real-world cohort study was conducted on 5 419 infertile women who underwent their first ART treatment at the Department of Reproductive Medicine of the First Affiliated Hospital of Nanjing Medical University between January 2013 and December 2017. All patients received an individualized starting dosage of gonadotropin. Based on whether FSH dosages were adjusted during controlled ovarian stimulation (COS), patients were divided into fixed-dosage group ( n=2 061) and adjusted-dosage group ( n=3 358). Clinical outcomes and FSH cost-effectiveness were compared between the two groups across different ovarian response groups, with CLBR as the primary outcome. Propensity score matching (PSM) and multivariable logistic regression were used to adjust for potential confounders. Results:FSH dosage adjustments were found in 62.0% (3 358/5 419) of cycles during COS. After PSM, baseline characteristics were comparable between the two groups (all P>0.05). After adjusting for confounders using multivariable logistic regression, FSH dosage adjustment was not significantly associated with CLBR ( OR=1.06, 95% CI: 0.94-1.20, P=0.332). Compared with the adjusted-dosage group, the fixed-dosage group showed no significant differences in CLBR in poor-, normal-, and high-responder groups (all P>0.05). The incidence of ovarian hyperstimulation syndrome (OHSS) did not differ significantly between the two groups ( P>0.05). In poor-, normal-, and high-responder groups, the total FSH dosages in the fixed-dose group [1 350 (375, 1 825) U, 1 200 (375, 1 500) U and 525 (375, 1 128) U, respectively] were significantly lower than those in the adjusted-dose group [1 875 (1 425, 2 294) U, P=0.001; 1 425 (450, 1 875) U, P<0.001; 600 (375, 1 425) U, P=0.020]. Similarly, average FSH costs in different ovarian response groups in the fixed-dosage group [4 725.0 (1 312.5, 6 387.5) yuan, 4 200.0 (1 312.5, 5 250.0) yuan and 1 837.5 (1 312.5, 3 947.3) yuan, respectively] were significantly lower than those in the adjusted-dosage group [6 562.5 (4 987.5, 8 028.1) yuan, P=0.001; 4 987.5 (1 575.0, 6 562.5) yuan, P<0.001; 2 100.0 (1 312.5, 4 987.5) yuan, P=0.020]. For normal-responders, the FSH cost per high-quality embryo in the fixed-dosage group [1 365.0 (875.0, 2 537.5) yuan] was significantly lower than that in the adjusted-dosage group [2 056.3 (1 268.8, 3 412.5) yuan, P<0.001]. Conclusion:FSH dosage adjustment during COS is not associated with CLBR or the incidence of OHSS. However, the fixed-dose group exhibited lower total FSH dosages and costs across different ovarian response populations. In the context of ART being covered by medical insurance, fixed FSH dosage may represent a more cost-effective ovarian stimulation protocol.

Chronic thromboembolic pulmonary hypertension is a serious pulmonary vascular disease with diagnostic and therapeutic challenges.As a non-invasive screening technique,lung ventilation/perfusion imaging plays a key role in the diagnosis,disease assessment and treatment decision-makings in patients with chronic thromboembolic pulmonary hypertension.This article comprehensively analyzes the application of lung ventilation/perfusion imaging in the diagnosis and evaluation of chronic thromboembolic pulmonary hypertension,and discusses its technical principles,advantages,and potential directions for future technical development.

Chronic thromboembolic pulmonary hypertension is a serious pulmonary vascular disease with diagnostic and therapeutic challenges.As a non-invasive screening technique,lung ventilation/perfusion imaging plays a key role in the diagnosis,disease assessment and treatment decision-makings in patients with chronic thromboembolic pulmonary hypertension.This article comprehensively analyzes the application of lung ventilation/perfusion imaging in the diagnosis and evaluation of chronic thromboembolic pulmonary hypertension,and discusses its technical principles,advantages,and potential directions for future technical development.

BACKGROUND: In lumbar spondylolisthesis patients with severe osteoporosis, screw is easily loose and pul s out during reposition, or loss of reduction and internal fixation failure easily occur after repair. Therefore, it is very important to elevate the intensity of pedicle screw fixation during repair. At present, few studies concern application of bone cement screw enhancement technology in lumbar spondylolisthesis patients with osteoporosis. OBJECTIVE: To investigate the clinical value of augmented pedicle screw with polymethylmethacrylate for lumbar spondylolisthesis accompanied with osteoporosis. METHODS: From June 2009 to June 2011, 27 patients suffering from lumbar spondylolisthesis accompanied with osteoporosis were included in this retrospective study. These patients received augmented pedicle screw with polymethylmethacrylate. The levels of disability and pain were evaluated by Oswestry Disability Index and visual analog scale. The internal fixation and fusion were evaluated by radiological findings. Al complications were recorded. RESULTS AND CONCLUSION: Al cases were fol owed up for 15-37 months. Oswestry Disability Index and visual analog scale scores were significantly better in final fol ow-up than that pre-treatment (P < 0.05). Imaging results revealed that bone cement tightly connected to bone interface. The position of screw and bone cement was good. Symptomatic bone cement leakage was not found. No fixation failure was detected during final fol ow-up. Al patients achieved interbody fusion. These results suggested that polymethylmethacrylate bone cement could increase the gripping force of the pedicle screw in osteoporotic vertebral body. It is safe and effective to treat spondylolisthesis accompanied with osteoporosis with augmented pedicle screws. Satisfactory fixation stability and interbody fusion can be obtained.

Objective To analyze the CT features of hepatic artery and morphology changes of the liver in patients with cavernous transformation of the portal vein (CTPV). Methods Thirteen patients of CTPV without malignant hepatic tumor or other diseases being able to cause changes of hepatic artery such as cirrhosis and hepatophyma were collected. CT data was analyzed, and the arterial and morphology changes of the liver were observed. Results Left and (or) right hepatic arteries were found dilated in 10 patients (76.92%), and unusual flake like enhancement was found in artery phase in 3 patients (23.08%). Atrophy-hypertrophy complex (AHC) could be found only in 1 patient (7.69%). Conclusion Dilatation of hepatic artery manifests more hepatic artery blood supply, while obvious AHC is hardly found in CTPV.

[Objective]To investigate the compatibility of tissue and cell in the three-dimensional porous bioactive glass/recombine human Bone Morphogenetic Protein-2 (BG /rhBMP2)materialscaffolds and provide a reference for improving the constitution of composite material.[Method]The material of BG and BG/rhBMP2 were cultured in vitro with rabbit osteoblasts respectively. The morphology and adhesion were examined by inverted microscope and scanning electron microscope, and the cell proliferation was detected by MTT assay. The composite materialscaffold were embeded in rabbit's muscle and incisions were observed. The specimens were harvested in 2, 4, 8 and 12 weeks respectively and examined by histology to evaluate the tissue response.[Result]The results showed the cells on BG and BG /rhBMP2 were good adhension and activity, the two materialscaffolds had no apparent inflammatory reaction in vivo. MTT assay showed the number of the cells in each group were significantly increased along with the culture time prolonged. The number of cells in the BG and rhBMP2 group was higher than that of the control group at different intervals, with a significant difference. The number of cells in the BG/rhBMP2 was not evidently higher than that of the BG with a significant difference.[Conclusion]The porous composite materialscaffold of BG/rhBMP2 has good biocompatibility with the hope to wide use in bone tissue engineering.

Objective To investigate the growth of rabbit osteoblast on the composite bioactive glass material scaffolds and to explore the experimental methods of optimized material scaffolds in bone tissue engineering. Methods The mesenchymal stem cells(MSCs) were separated and cultured from rabbit thigh marrow,and they were induced and differentiated into osteoblast by the revulsant.The change of typical appearance of the MSCs was investigated under microscope.The cytological characteristics of the MSCs were observed through cells activity and immunohistochemistry method.The osteoblast was cocultured with three various bioactive glasses respectively.The compatibility between the various bioactive glasses and osteoblast was compared by observation of the changes of the cells.Results The MSCs were successfully induced and cultured in the presence of the osteoblast revulsant.After inducement,these cells displayed osteoblast-like morphology.The bioactive glass composite scaffolds supported the attachment of cultured rabbit osteoblast.These cells proliferated faster on scaffolds with higher poriness of 90.20% and 94.50% than with lower poriness of 75.90%.Conclusion It is feasible to use bioactive glass composite scaffolds with proper poriness for bone tissue engineering.