OBJECTIVES: To evaluate the strategies and outcomes of assisted reproductive technology (ART) for fertility preservation and promotion in women with malignant tumors, and to analyze ART outcomes across different tumor types. METHODS: We conducted a retrospective analysis of female patients who underwent ART for fertility preservation or treatment at the Reproductive Center of the Women's Hospital, Zhejiang University School of Medicine, between January 1, 2018, and December 31, 2023. A total of 163 ART-aided pregnancy patients with malignant tumors were included in the case group, among which 6 patients underwent embryo cryopreservation for fertility preservation before radiotherapy or chemotherapy. Additionally, 11 unmarried women underwent oocyte cryopreservation due to borderline ovarian tumors, ovarian cancer, breast cancer, or hematological malignancies. The control group was selected from women without a history of malignant tumors who received ART treatment during the same period, using propensity score matching at a ratio of 1∶2, resulting in 326 cases. Data were collected through the reproductive medical record system and telephone follow-up (as of October 31, 2024). Baseline characteristics, controlled ovarian hyperstimulation parameters, laboratory indicators, and pregnancy outcomes were compared between case and control groups and among patients with different tumor types, and the tumor recurrence of the patients was followed up. RESULTS: Patients in the case group had significantly lower ovarian reserve (AMH, AFC) and a higher proportion of diminished ovarian reserve compared to the control group (all P<0.01). Regarding the ovulation induction protocol, the proportion of patients using the minimal stimulation protocol in the case group was significantly higher than that in the control group (29.45% vs. 12.88%, P<0.01), and the total dosage of gonadotropins used was lower (P<0.01). In terms of assisted reproductive outcomes, there were no statistically significant differences between the two groups in the number of retrieved oocytes, number of high-quality embryos, fertilization rate, cumulative pregnancy rate, cumulative live birth rate, or miscarriage rate (all P>0.05). However, the number of oocyte retrieval cycles and embryo transfer cycles required to achieve a live birth outcome in the case group were significantly higher than those in the control group (both P<0.05). Subgroup analysis showed that there were no significant differences in cumulative pregnancy rate and live birth rate among patients with different tumor types (thyroid cancer, reproductive system tumors, breast cancer, lung cancer). Nevertheless, lung cancer patients had the lowest ovarian reserve and required the most oocyte retrieval cycles due to their older age; breast cancer patients had a relatively lower fertilization rate partially because some of them were complicated with male factors. A follow-up of 154 tumor patients (with a follow-up rate of 88.5%) revealed that 6 patients (4.20%) had tumor recurrence, and 1 breast cancer patient died due to tumor recurrence. None of the 11 unmarried patients who had undergone oocyte cryopreservation had used the cryopreserved oocytes for assisted pregnancy yet, and 1 patient who had undergone fertility preservation died due to tumor recurrence. CONCLUSIONS Women of reproductive age with malignant tumors are at risk of diminished fertility. ART can effectively preserve and promote fertility, enabling favorable pregnancy and live birth outcomes. It is recommended to initiate a multidisciplinary assessment promptly prior to radiotherapy/chemotherapy and formulate an individualized ART regimen for fertility preservation or promotion, so as to achieve reproductive goals or safeguard future fertility potential.

OBJECTIVE: The study investigates the performance parameters of a nebulizer for pressurized intraperitoneal aerosol chemotherapy (PIPAC). METHODS: Laser diffraction spectroscopy was used to measure the median droplet diameter ( D ₅₀) and spray angle during the steady-state aerosol phase. RESULTS: The minimum droplet diameter of aerosol was achieved when using a nozzle of 0.2 mm diameter and 0.07 mm thickness. The nebulizer could not produce steady-state aerosol when the liquid flow rate was less than or equal to 0.3 mL/s. When the liquid flow rate was greater than or equal to 0.5 mL/s, as the working pressure increased, the median particle size gradually decreased and the spray angle gradually increased. When the pressure is greater than or equal to 200 psi（1 psi=6 894.76 Pa）, as the liquid flow rate increased, the spray angle gradually increased. At a flow rate of 0.7 mL/s and working pressure of 300 psi, the median droplet diameter of aerosol D ₅₀ was 16 μm with a spray angle up to 89.2°. CONCLUSION As a novel intraperitoneal drug delivery technology, PIPAC requires further research focusing on reducing droplet size, expanding drug distribution, improving tissue permeability, and increasing drug concentration.
Nebulizers and Vaporizers ; Aerosols ; Particle Size ; Pressure ; Drug Delivery Systems

Objective To analyze the relationship between post-traumatic growth(PTG)and health-related quality of life(HRQOL)among long-term cancer survivors(time since diagnosis≥5 years)and to explore the trends and reasons for changes over time.Methods A total sampling method was used to conduct baseline and follow-up surveys on long-term cancer survivors from 6 cancer registries in Germany during 2008-2011 and 2018-2019.General information questionnaires,Post-Traumatic Growth Inventory,and European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire were applied.The collected data were analyzed using a linear mixed-effects regression model for longitudinal relationships.Results A total of 2704 long-term cancer survivors completed the baseline and follow-up surveys and the effective sample size is 2 686.The high PTG group had a significantly higher overall health status/QOL score than the low PTG group,with a statistically significant difference(P＜0.05).However,the difference in scores between the 2 groups at follow-up was not statistically significant(P＞0.05).The interaction between PTG groups and time was statistically significant for overall health status and insomnia(all P＜0.05).There was a stable positive relationship between PTG and economic difficulty scores with a statistically significant difference(P＜0.001).Conclusion There is a positive correlation between PTG and HRQOL among long-term cancer survivors that weakens over time,and the perceived economic burden related to health is a continuous source of stress.

Purpose To investigate the clinicopathological features,differential diagnosis,and prognosis of breast carcinoma within fibroadenoma(FA).Methods A retrospective analysis was performed on the clinical and imaging data of 21 cases of FA-associated carcinoma.HE staining,immunohistochemistry using the EnVision method,and next-generation sequencing were employed to assess the clinicopathological characteristics and genetic alterations,with a review of the relevant literature.Results All patients were female,aged 21-67 years,with a median age of 48 years.Clinically,all lesions presented with well-circumscribed mass lesions.On imaging,12 cases demonstrated punctate or coarse calcifications,while 3 cases exhibited locally indistinct margins.Pathological examination revealed that the tumors had an average maximum diameter of 2.25 cm,with a gray-white nodular cut surface resembling FA.Microscopically,there was proliferation of either epithelial or spindle cells.The pathological diagnosis was FA-associat-ed in situ carcinoma in 16 cases(15 cases of low-grade ductal carcinoma in situ and 1 case of lobular carcinoma in si-tu),and invasive carcinoma in 5 cases(comprising 2 cases of invasive carcinoma-no special type,1 case of invasive lobular carcinoma,1 case of low-grade adenosquamous carcinoma and 1 case of fibromatosis-like metaplastic carcino-ma).In 18 cases,the carcinoma was confined within the FA,whereas in 3 cases the tumor locally extended beyond the FA,and 1 case exhibited ipsilateral axillary lymph node metastasis.Immunophenotypically,tumor cells in in situ carcinomas were negative for CK5/6,while the myoepithelial cells were p63-positive,and both estrogen receptor(ER)and progesterone receptor(PR)were diffusely and consistently positive.In invasive carcinoma,both ductal and lobular subtypes were ER and PR positive and HER2 negative.Conversely,in the low-grade adenosquamous carcinoma and fi-bromatosis-like metaplastic carcinoma,ER,PR,and HER2 were all negative,with p63 and CK5/6 positivity.Two ca-ses were negative for mismatch repair protein PMS2.Six cases had a family or personal history of malignant tumors;a-mong the 5 cases that underwent next-generation sequencing,2 cases harbored germline BRCA2 mutations,2 cases had germline PMS2 mutations,and 1 case exhibited no definitive genetic alteration.Conclusion Carcinoma arising within FA exhibits atypical clinical and imaging features.In patients with high-risk factors for breast cancer or family history of malignancy,or when calcifications are observed on imaging,prompt excision and biopsy are recommended.Recogniz-ing the abnormal morphology within FA and the use of immunohistochemistry are essential for accurate diagnosis,with careful differentiation from spindle cell metaplastic carcinoma and low-grade adenosquamous carcinoma.Overall,the prognosis is relatively favorable,and treatment should be tailored according to tumor type,molecular subtype,and stage.

Purpose To investigate the clinicopathological features,differential diagnosis,and prognosis of breast carcinoma within fibroadenoma(FA).Methods A retrospective analysis was performed on the clinical and imaging data of 21 cases of FA-associated carcinoma.HE staining,immunohistochemistry using the EnVision method,and next-generation sequencing were employed to assess the clinicopathological characteristics and genetic alterations,with a review of the relevant literature.Results All patients were female,aged 21-67 years,with a median age of 48 years.Clinically,all lesions presented with well-circumscribed mass lesions.On imaging,12 cases demonstrated punctate or coarse calcifications,while 3 cases exhibited locally indistinct margins.Pathological examination revealed that the tumors had an average maximum diameter of 2.25 cm,with a gray-white nodular cut surface resembling FA.Microscopically,there was proliferation of either epithelial or spindle cells.The pathological diagnosis was FA-associat-ed in situ carcinoma in 16 cases(15 cases of low-grade ductal carcinoma in situ and 1 case of lobular carcinoma in si-tu),and invasive carcinoma in 5 cases(comprising 2 cases of invasive carcinoma-no special type,1 case of invasive lobular carcinoma,1 case of low-grade adenosquamous carcinoma and 1 case of fibromatosis-like metaplastic carcino-ma).In 18 cases,the carcinoma was confined within the FA,whereas in 3 cases the tumor locally extended beyond the FA,and 1 case exhibited ipsilateral axillary lymph node metastasis.Immunophenotypically,tumor cells in in situ carcinomas were negative for CK5/6,while the myoepithelial cells were p63-positive,and both estrogen receptor(ER)and progesterone receptor(PR)were diffusely and consistently positive.In invasive carcinoma,both ductal and lobular subtypes were ER and PR positive and HER2 negative.Conversely,in the low-grade adenosquamous carcinoma and fi-bromatosis-like metaplastic carcinoma,ER,PR,and HER2 were all negative,with p63 and CK5/6 positivity.Two ca-ses were negative for mismatch repair protein PMS2.Six cases had a family or personal history of malignant tumors;a-mong the 5 cases that underwent next-generation sequencing,2 cases harbored germline BRCA2 mutations,2 cases had germline PMS2 mutations,and 1 case exhibited no definitive genetic alteration.Conclusion Carcinoma arising within FA exhibits atypical clinical and imaging features.In patients with high-risk factors for breast cancer or family history of malignancy,or when calcifications are observed on imaging,prompt excision and biopsy are recommended.Recogniz-ing the abnormal morphology within FA and the use of immunohistochemistry are essential for accurate diagnosis,with careful differentiation from spindle cell metaplastic carcinoma and low-grade adenosquamous carcinoma.Overall,the prognosis is relatively favorable,and treatment should be tailored according to tumor type,molecular subtype,and stage.

Objective To analyze the relationship between post-traumatic growth(PTG)and health-related quality of life(HRQOL)among long-term cancer survivors(time since diagnosis≥5 years)and to explore the trends and reasons for changes over time.Methods A total sampling method was used to conduct baseline and follow-up surveys on long-term cancer survivors from 6 cancer registries in Germany during 2008-2011 and 2018-2019.General information questionnaires,Post-Traumatic Growth Inventory,and European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire were applied.The collected data were analyzed using a linear mixed-effects regression model for longitudinal relationships.Results A total of 2704 long-term cancer survivors completed the baseline and follow-up surveys and the effective sample size is 2 686.The high PTG group had a significantly higher overall health status/QOL score than the low PTG group,with a statistically significant difference(P＜0.05).However,the difference in scores between the 2 groups at follow-up was not statistically significant(P＞0.05).The interaction between PTG groups and time was statistically significant for overall health status and insomnia(all P＜0.05).There was a stable positive relationship between PTG and economic difficulty scores with a statistically significant difference(P＜0.001).Conclusion There is a positive correlation between PTG and HRQOL among long-term cancer survivors that weakens over time,and the perceived economic burden related to health is a continuous source of stress.

Objective To construct an evaluation index system of core competence of assisted reproductive technology specialist nurses,and to conduct preliminary validation,so as to provide reference standards for the training and evaluation of assisted reproductive technology specialist nurses.Methods Based on the core competence of specialist nurses of the International Council of Nurses and the Hamric Advanced Practice Nurse competence framework as the theoretical framework,through literature research and research group discussion,the core competence index of specialist nurses in assisted reproductive technology was preliminarily established.A total of 23 experts were consulted with 2 rounds of Delphi method to complete index and determine weight coefficients in April 2024.In August 2024,50 assisted reproductive technology specialist nurses from 18 provinces and cities across the country were selected to conduct a satisfaction survey on the evaluation index system,in order to preliminarily verify the application effect of indicators.Results The questionnaire recovery rates for 2 rounds of expert consultations were both 100％,and the expert authority coefficients were both 0.943.The coefficient of variation was 0～0.287 and 0～0.236,and the Kendall harmony coefficient was 0.241～0.337 and 0.250～0.431,respectively.The final evaluation index of core competence of assisted reproductive technology specialist nurses included 6 first-level indicators,20 second-level indicators and 57 third-level indicators.Assisted reproductive technology specialist nurses were satisfied with the evaluation index system of core competence,with a score of(18.26±2.52).Conclusion The evaluation index system of core competence of assisted reproductive technology specialist nurses is practical,with comprehensive content and outstanding professional characteristics.

Objective To construct an evaluation index system of core competence of assisted reproductive technology specialist nurses,and to conduct preliminary validation,so as to provide reference standards for the training and evaluation of assisted reproductive technology specialist nurses.Methods Based on the core competence of specialist nurses of the International Council of Nurses and the Hamric Advanced Practice Nurse competence framework as the theoretical framework,through literature research and research group discussion,the core competence index of specialist nurses in assisted reproductive technology was preliminarily established.A total of 23 experts were consulted with 2 rounds of Delphi method to complete index and determine weight coefficients in April 2024.In August 2024,50 assisted reproductive technology specialist nurses from 18 provinces and cities across the country were selected to conduct a satisfaction survey on the evaluation index system,in order to preliminarily verify the application effect of indicators.Results The questionnaire recovery rates for 2 rounds of expert consultations were both 100％,and the expert authority coefficients were both 0.943.The coefficient of variation was 0～0.287 and 0～0.236,and the Kendall harmony coefficient was 0.241～0.337 and 0.250～0.431,respectively.The final evaluation index of core competence of assisted reproductive technology specialist nurses included 6 first-level indicators,20 second-level indicators and 57 third-level indicators.Assisted reproductive technology specialist nurses were satisfied with the evaluation index system of core competence,with a score of(18.26±2.52).Conclusion The evaluation index system of core competence of assisted reproductive technology specialist nurses is practical,with comprehensive content and outstanding professional characteristics.

Objective:To explore the effect of pregnancy outcome of the first in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) and embryo transfer cycle on the next frozen-thawed embryo transfer cycle. Methods:A retrospective cohort study was designed by collecting data from 6658 infertile patients in Department of Reproductive Endocrinology, Women's Hospital of Zhejiang University from January 2010 to December 2019. Two groups were included, the fresh embryo-frozen embryo group ( n=4310) and the frozen embryo-frozen embryo group ( n=2348), and each group was divided into four subgroups according to the pregnancy outcome of the first transfer cycle: non-pregnancy subgroup, biochemical pregnancy subgroup, pregnancy loss subgroup, and live birth subgroup. In each group, the live birth rate (LBR) of the second transfer cycle was compared among the four subgroups. Results:In the second transfer cycle of the fresh embryo-frozen embryo group, LBR in each subgroup was 31.3% (972/3109), 33.7% (92/273), 33.3% (169/507), and 39.2% (165/421), respectively. Compared with non-pregnancy subgroup, the difference of LBR in the live birth subgroup was statistically significant [after adjustment, a P<0.001, a OR(95% CI)=1.555(1.245-1.942)]. In the second transfer cycle of the frozen embryo-frozen embryo group, LBR in each subgroup was 37.3% (655/1754), 47.0% (79/168), 45.4% (122/269), and 44.6% (70/157), respectively. Compared with non-pregnancy subgroup, the differences of LBR in biochemical pregnancy subgroup, pregnancy loss subgroup and live birth subgroup were statistically significant [after adjustment, a P=0.018, a OR(95% CI)=1.471(1.069-2.026); a P=0.014, a OR(95% CI)=1.388 (1.069-1.802); a P=0.035, a OR(95% CI)=1.452(1.026-2.054)]. Conclusion:In the fresh embryo-frozen embryo group, live birth in the first transfer cycle is associated with increased LBR in the subsequent cycles, while in the frozen embryo-frozen embryo group, biochemical pregnancy, pregnancy loss, or live birth in the first transfer cycle are associated with increased LBR in the following cycles.

Objective:To explore the effect of pregnancy outcome of the first in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) and embryo transfer cycle on the next frozen-thawed embryo transfer cycle. Methods:A retrospective cohort study was designed by collecting data from 6658 infertile patients in Department of Reproductive Endocrinology, Women's Hospital of Zhejiang University from January 2010 to December 2019. Two groups were included, the fresh embryo-frozen embryo group ( n=4310) and the frozen embryo-frozen embryo group ( n=2348), and each group was divided into four subgroups according to the pregnancy outcome of the first transfer cycle: non-pregnancy subgroup, biochemical pregnancy subgroup, pregnancy loss subgroup, and live birth subgroup. In each group, the live birth rate (LBR) of the second transfer cycle was compared among the four subgroups. Results:In the second transfer cycle of the fresh embryo-frozen embryo group, LBR in each subgroup was 31.3% (972/3109), 33.7% (92/273), 33.3% (169/507), and 39.2% (165/421), respectively. Compared with non-pregnancy subgroup, the difference of LBR in the live birth subgroup was statistically significant [after adjustment, a P<0.001, a OR(95% CI)=1.555(1.245-1.942)]. In the second transfer cycle of the frozen embryo-frozen embryo group, LBR in each subgroup was 37.3% (655/1754), 47.0% (79/168), 45.4% (122/269), and 44.6% (70/157), respectively. Compared with non-pregnancy subgroup, the differences of LBR in biochemical pregnancy subgroup, pregnancy loss subgroup and live birth subgroup were statistically significant [after adjustment, a P=0.018, a OR(95% CI)=1.471(1.069-2.026); a P=0.014, a OR(95% CI)=1.388 (1.069-1.802); a P=0.035, a OR(95% CI)=1.452(1.026-2.054)]. Conclusion:In the fresh embryo-frozen embryo group, live birth in the first transfer cycle is associated with increased LBR in the subsequent cycles, while in the frozen embryo-frozen embryo group, biochemical pregnancy, pregnancy loss, or live birth in the first transfer cycle are associated with increased LBR in the following cycles.