Objective:To investigate the impact of early cleavage on the pregnancy and obstetric outcomes of fresh cycle single cleavage embryo and single blastocyst transfer.Methods:A retrospective study was conducted to analyze 794 patients who underwent single cleavage embryo transfer and 1466 patients who underwent single blastocyst transfer in the reproductive medicine center of our hospital from August 2018 to December 2022 during the fresh cycle treatment of in vitro fertilization/intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET).The patients were divided into two groups according to whether the transferred embryos underwent normal early cleavage.In the single cleavage embryo transfer,there were 383 cases in the normal early cleavage group(early cleavage group)and 411 cases in the non normal early cleavage group(non-early cleavage group);in the single blastocyst transfer,there were 815 cases in the early cleavage group and 651 cases in the non-early cleavage group.The pregnancy and obstetric outcomes of the early cleavage group and non-early cleavage group were compared in single cleavage embryo transfer and single blastocyst transfer.Results:In the single cleavage embryo transfer,the human chorionic gonadotropin(hCG)positive rate,clinical pregnancy rate,and live birth rate in the early cleavage group were significantly higher than those in the non-early cleavage group(64.0％vs.55.7％,P=0.018;54.6％vs.47.0％,P=0.032;46.7％vs.38.7％,P=0.022).There were no significant differ-ences in biochemical abortion rate,multiple pregnancy rate,abortion rate,early abortion rate,premature delivery rate,low birth weight rate,macrosomia rate,and birth defect rate compared with the non-early cleavage group(P＞0.05);in the single blastocyst transfer,there were no significant differences in pregnancy outcomes and obstetric indicators between the early cleavage group and the non-early cleavage group(P＞0.05).Multivariate Logistic regression analysis showed that after adjusting for confounding factors on pregnancy outcomes,in the single cleavage embryo transfer,the hCG positive rate(aOR 1.54,95％CI 1.12-2.11,P=0.008),clinical preg-nancy rate(aOR 1.49,95％CI 1.09-2.04,P=0.012),and live birth rate(aOR 1.53,95％CI 1.12-2.09,P=0.008)in the early cleavage group were significantly higher than those in the non-early cleavage group;in the sin-gle blastocyst transfer,there were no significant differences for these indicators between the early cleavage group and the non-early cleavage group(P＞0.05).Conclusions:Transplantation of single cleavage embryo with nor-mal early cleavage can significantly improve the clinical pregnancy rate and live birth rate.Early cleavage during single blastocyst transplantation had no significant effect on clinical pregnancy outcome.Early cleavage had no significant effect on the obstetric outcomes of single cleavage embryo and single blastocyst transfer.

Objective To investigate the correlations of serum levels of soluble vascular cell ad-hesion molecule-1(sVCAM-1),homocysteine(Hcy)and D-dimer(D-D)with inner ear microcircu-lation disorders in patients with sudden sensorineural hearing loss.Methods Eighty-four patients with sudden deafness were selected as subjects.Patients were divided into mild(17 cases),moderate(31 cases)and severe(36 cases)groups based on the degree of hearing loss.According to the types of audiogram maps,they were divided into low-frequency group(22 cases),high-frequency group(33 cases)and full-frequency group(29 cases).Forty-two healthy individuals undergoing physical examination during the same period served as healthy group.The levels of sVCAM-1,Hcy as well as D-D and inner ear microcirculation arterial diameters were compared among different audiogram types and degrees of hearing loss.Pearson correlation analysis and linear regression analysis were em-ployed to verify the correlations between the aforementioned serum indicators and arterial diameters in inner ear microcirculation of affected patients.Results Compared with the healthy group,the diameters of the internal auditory artery,basilar artery,and anterior inferior cerebellar artery in the inner ear microcirculation were significantly reduced in the low-frequency type,high-frequency type and full-frequency type groups,with the high-frequency and full-frequency types being significantly smaller than the low-frequency type,and the full-frequency type being significantly smaller than the high-frequency type(P＜0.05).Serum levels of sVCAM-1,Hcy and D-D were significantly higher in the low-frequency type,high-frequency type and full-frequency type groups compared with the healthy group,with the full-frequency type being significantly higher than the low-frequency and high-frequency types(P＜0.05).Serum levels of sVCAM-1,Hcy and D-D were significantly high-er in the mild,moderate and severe groups compared with the healthy group,with the severe group being significantly higher than the mild and moderate groups(P＜0.05).The diameters of the in-ternal auditory artery,basilar artery and anterior inferior cerebellar artery in the inner ear microcir-culation were significantly smaller in the mild,moderate and severe groups compared with the healthy group(P＜0.05).Compared with the mild group,the diameters of the internal auditory ar-tery,basilar artery and anterior inferior cerebellar artery were significantly reduced in the moderate and severe groups,with the severe group being significantly smaller than the moderate group(P＜0.05).Serum levels of sVCAM-1,Hcy and D-D showed negative correlation with the diameters of the internal auditory artery,basilar artery and anterior inferior cerebellar artery(P＜0.05).Arterial di-ameters of the internal auditory artery,basilar artery and anterior inferior cerebellar artery were inde-pendently correlated with serum levels of sVCAM-1,Hcy and D-D(P＜0.05).Conclusion Serum levels of sVCAM-1,Hcy and D-D are closely related to inner ear microcirculation disorders in pa-tients with sudden deafness.As serum levels of sVCAM-1,Hcy and D-D increase,the severity of hearing loss and inner ear microcirculation disorder intensifies.

Objective To compare the clinical efficacy of narrow band imaging(NBI)-guided microscopic CO2 laser surgery and conventional microscopic CO2 laser surgery in treatment of patients with vocal cord atypical hyperplasia.Methods A total of 90 patients with vocal cord atypical hyper-plasia were enrolled as study subjects.Based on different surgical approaches,they were divided into conventional group(43 cases,undergoing conventional microscopic CO2 laser surgery)and NBI-guided group(47 cases,undergoing NBI-guided microscopic CO2 laser surgery).The negative mar-gin rate,complication rate,recurrence rate,and the levels of voice-related parameters(jitter,shim-mer,noise-to-harmonic ratio)and inflammatory factors[C-reactive protein(CRP),interleukin-6(IL-6)]before and after surgery were compared between the two groups.Results The negative mar-gin rate of the first-time biopsy after laser surgery in the NBI-guided group was 97.87％,which was higher than 86.05％in the conventional group,with a statistically significant difference(P＜0.05).After surgery,the jitter,shimmer and noise-to-harmonic ratio in both groups were lower than those before surgery,with statistically significant differences(P＜0.05),but there was no statistically sig-nificant difference between the two groups(P＞0.05).After surgery,the levels of CRP and IL-6 in both groups were lower than those before surgery,with statistically significant differences(P＜0.05),but there was no statistically significant difference between the two groups(P＞0.05).The compli-cation rate was 4.26％in the NBI-guided group,and 9.30％in the conventional group,with no statistically significant between-group difference(P＞0.05).During a follow-up of 6 months to 2 years,the recurrence rate in the NBI-guided group was 2.13％and 6.98％in the conventional group,with no statistically significant between-group difference(P＞0.05).Conclusion Com-pared with conventional microscopic CO2 laser surgery,NBI-guided microscopic CO2 laser surgery can more precisely determine the range of the lesion and the surrounding mucosal margins and re-duce the number of intraoperative biopsies in the treatment of vocal cord atypical hyperplasia.How-ever,the two surgical methods have similar impacts on postoperative voice-related parameters,in-flammatory factors,complications and recurrence rates.

ObjectiveTo investigate the effect of video-based educational intervention combined with maternal presence on perioperative adverse outcomes in preschool children undergoing general anesthesia， including cooperation in anesthesia induction， perioperative anxiety， pain and agitation during recovery. MethodsA total of 300 preschool children scheduled for general anesthesia in our hospital from June to December 2023 were randomly assigned to control group （n=150） and intervention group （n=150）. The control group received routine recovery care. For the intervention group， in addition to routine recovery care， a preoperative visit was scheduled one day before surgery. During this visit， mothers were guided to watch anesthesia videos with their children. During the waiting period in the operating room and 30 minutes after awakening， the mothers were guided to accompany the children for more than 30 minutes. Recovery conditions were recorded using the surgical anesthesia information system， and the children’s anesthetic induction compliance， perioperative anxiety， pain， and agitation were evaluated and recorded using the modified Yale Preoperative Anxiety Scale （m-YPAS）， the Induction Compliance Scale （ICC）， the Children’s Pain Behavior Scale （FLACC）， and the Pediatric Agitation and Emergence Delirium Scale （PAED）. ResultsOn the preoperative visit day， there were no statistically significant differences in baseline data between the two groups （P > 0.05）. For perioperative anxiety， the m-YPAS scores of the intervention group were significantly lower than those of the control group， both when entering the operating room waiting area （35.27±6.48 vs. 41.79±6.68， P < 0.05） and 30 minutes after postoperative recovery （20.13±7.05 vs. 35.75±9.51， P < 0.05）. In terms of anesthesia induction cooperation， the ICC scores of the intervention group were significantly lower than those of the control group （1.84±0.95 vs. 3.17±0.62， P < 0.05）， and the proportion of good induction cooperation was significantly higher than that of the control group （24.00% vs. 12.67%， P < 0.05）. There was no significant difference in awakening duration between the two groups， but the intervention group had a significantly shorter length of stay in the post-anesthesia care unit than the control group （0.90±0.29 hours vs. 1.29±0.42 hours， P < 0.001）. For perioperative agitation， the PAED scores of the intervention group were significantly lower than those of the control group （entering in the operating room waiting area： 8.5 vs. 9.2， P < 0.05； 30 minutes after postoperative recovery： 4.2 vs. 7.8， P < 0.05）. In terms of pain scores， the FLACC scores of the intervention group were also significantly lower than those of the control group， both when entering the operating room waiting area （ 5.3 vs. 6.7， P < 0.05； 30 minutes after postoperative recovery： 2.1 vs. 4.9， P < 0.05）. ConclusionsVideo-based educational intervention combined with maternal presence reduces the perioperative anxiety， pain and agitation of preschool children undergoing general anesthesia， and improved the compliance of anesthesia induction. It is recommended to promote this intervention measure in clinical practice.

Objective:To investigate the epidemiological characteristics and trends of birth defects related to assisted reproductive technology (ART) in Jiangxi Province from 2014 to 2023, and to explore the correlation factors of birth defect occurrence.Methods:A retrospective collection of ART treatment data and follow-up results from January 2014 to December 2023 across 18 reproductive centers in Jiangxi Province was conducted. The trend of birth defects and the rank order of defect types were analyzed. Exact probability methods were used to estimate the 95% confidence intervals ( CI) of the incidence rates, and Poisson regression was applied to identify independent correlation factors. Results:A total of 65 003 ART offspring were included in this study, comprising 2 025 offspring from intrauterine insemination (IUI) and 62 978 from in vitro fertilization and embryo transfer (IVF-ET). The overall incidence of birth defects was 13.46‰ (95% CI: 12.59‰-14.38‰), with 9.38‰ (95% CI: 5.66‰-14.61‰) for IUI and 13.59‰ (95% CI:12.70‰-14.53‰) for IVF-ET. The incidence of birth defects showed a decreasing trend from 2014 to 2023 (17.11‰ to 11.47‰, Ptrend=0.003). The top three birth defect types were circulatory system defects (3.71‰, 95% CI: 3.25‰-4.21‰), musculoskeletal system defects (2.37‰, 95% CI: 2.01‰-2.77‰), and congenital malformations of the face, ears, eyes, and neck (1.23‰, 95% CI: 0.98‰-1.53‰). Univariate analysis indicated that male offspring from IVF-ET had a higher incidence of birth defects than that in female offspring (14.72‰ vs. 12.31‰, P=0.009). Additionally, gestational age, birth weight, fetal number, cause of infertility, and year of delivery were significantly associated with birth defect incidence in IVF-ET offspring ( P<0.001, P<0.001, P<0.001, P=0.025, P=0.037). Multivariate analysis showed that in singleton pregnancies, male offspring, gestational age 32-36 weeks birth weight <1 500 g, and infertility with bilateral factors were independent risk factors for birth defects ( OR=1.21, 95% CI: 1.00-1.47, P=0.046; OR=1.90,95% CI: 1.41-2.56, P<0.001; OR=3.37, 95% CI: 1.33-8.51, P=0.010; OR=1.38, 95% CI: 1.12-1.69, P=0.003), while in multiple pregnancies, male offspring, gestational age <32 weeks, gestational age 32-36 weeks, birth weight <1 500 g, birth weight 1 500-2 499 g, maternal age 25-29 years and maternal age 30-34 years were independent risk factors ( OR=1.25, 95% CI: 1.03-1.52, P=0.023; OR=2.06, 95% CI: 1.35-3.15, P=0.001; OR=1.32,95% CI: 1.05-1.66, P=0.016; OR=1.98,95% CI: 1.19-3.28, P=0.009; OR=2.06,95% CI: 1.64-2.60, P<0.001; OR=2.00, 95% CI: 1.31-3.06, P=0.001; OR=1.90,95% CI: 1.24-2.92, P=0.003). Conclusion:Over the past 10 years, the incidence of birth defects in ART offspring in Jiangxi Province has shown a decreasing trend annually, with circulatory system malformations being the most common. The occurrence of birth defects in IVF offspring is primarily associated with maternal and infant characteristics, such as gender, gestational age, birth weight, number of fetuses, and cause of infertility, independent of ART treatment factors.

Objective:To screen serum biomarkers of polycystic ovary syndrome (PCOS) patients by high throughput data independent acquisition (DIA) proteomics technology.Methods:This was a case-control study. A total of 39 peripheral blood samples were collected at Reproductive Medical Center of Jiangxi Maternal and Child Health Hospital from March to November 2021. Among which, 20 cases were from PCOS patients, and 19 cases were from women who underwent assisted reproduction due to male factors causing infertility. DIA proteomics technology combined with bioinformatics analysis were performed to screen for differential protein expression profiles in the serum of PCOS patients. Typical differentially expressed proteins were selected for expression analysis and receiver operating characteristic (ROC) curve analysis, followed by enzyme-linked immunosorbent assay (ELISA) validation.Results:The results of DIA proteomics combined with bioinformatics analysis showed that compared with control group, 194 significantly differentially expressed proteins were screened in the peripheral blood of PCOS patients, including 64 upregulated proteins and 130 downregulated proteins. The ROC curve analysis results showed that the area under curve values of PSMD8, RPS15A, NDUFB1, GM2A, and TOP2A were all above 0.9, indicating that these proteins have good diagnostic value. The ELISA validation results showed that the content of TOP2A in peripheral blood of PCOS patients was significantly upregulated ( P=0.046), while the content of GM2A was significantly downregulated ( P=0.021), when compared with control group, which consistent with the DIA results. Conclusion:DIA proteomics can be used to screen the differential expression of peripheral blood proteins in PCOS patients, among which, PSMD8, RPS15A, NDUFB1, GM2A and TOP2A can be used as serum biomarkers for PCOS diagnosis and treatment.

In recent years, as societal perceptions have evolved and women's social standing has improved, the average age of childbearing for women in China has generally increased. This shift has contributed to a notable decline in fertility rates among Chinese women. The introduction of the "three-child" policy and the inclusion of assisted reproductive technology (ART) in medical insurance coverage across many regions have further fueled the rapid rise in demand for ART among older women. However, numerous high-level evidence-based medical studies have confirmed that age remains a critical factor influencing the success rates of ART treatments. Many older women seeking pregnancy assistance, particularly than aged 43 years and above, continue to experience unsatisfactory outcomes despite multiple attempts at ART. Therefore, considering the principles of beneficence, protection of offspring, and social welfare, and in light of relevant domestic and international guidelines, consensus, policies, regulations, and research data, should there be an age limit for high-aged patients undergoing ART treatments? This issue warrants a thorough ethical examination.

Objective:To investigate the epidemiological characteristics and trends of birth defects related to assisted reproductive technology (ART) in Jiangxi Province from 2014 to 2023, and to explore the correlation factors of birth defect occurrence.Methods:A retrospective collection of ART treatment data and follow-up results from January 2014 to December 2023 across 18 reproductive centers in Jiangxi Province was conducted. The trend of birth defects and the rank order of defect types were analyzed. Exact probability methods were used to estimate the 95% confidence intervals ( CI) of the incidence rates, and Poisson regression was applied to identify independent correlation factors. Results:A total of 65 003 ART offspring were included in this study, comprising 2 025 offspring from intrauterine insemination (IUI) and 62 978 from in vitro fertilization and embryo transfer (IVF-ET). The overall incidence of birth defects was 13.46‰ (95% CI: 12.59‰-14.38‰), with 9.38‰ (95% CI: 5.66‰-14.61‰) for IUI and 13.59‰ (95% CI:12.70‰-14.53‰) for IVF-ET. The incidence of birth defects showed a decreasing trend from 2014 to 2023 (17.11‰ to 11.47‰, Ptrend=0.003). The top three birth defect types were circulatory system defects (3.71‰, 95% CI: 3.25‰-4.21‰), musculoskeletal system defects (2.37‰, 95% CI: 2.01‰-2.77‰), and congenital malformations of the face, ears, eyes, and neck (1.23‰, 95% CI: 0.98‰-1.53‰). Univariate analysis indicated that male offspring from IVF-ET had a higher incidence of birth defects than that in female offspring (14.72‰ vs. 12.31‰, P=0.009). Additionally, gestational age, birth weight, fetal number, cause of infertility, and year of delivery were significantly associated with birth defect incidence in IVF-ET offspring ( P<0.001, P<0.001, P<0.001, P=0.025, P=0.037). Multivariate analysis showed that in singleton pregnancies, male offspring, gestational age 32-36 weeks birth weight <1 500 g, and infertility with bilateral factors were independent risk factors for birth defects ( OR=1.21, 95% CI: 1.00-1.47, P=0.046; OR=1.90,95% CI: 1.41-2.56, P<0.001; OR=3.37, 95% CI: 1.33-8.51, P=0.010; OR=1.38, 95% CI: 1.12-1.69, P=0.003), while in multiple pregnancies, male offspring, gestational age <32 weeks, gestational age 32-36 weeks, birth weight <1 500 g, birth weight 1 500-2 499 g, maternal age 25-29 years and maternal age 30-34 years were independent risk factors ( OR=1.25, 95% CI: 1.03-1.52, P=0.023; OR=2.06, 95% CI: 1.35-3.15, P=0.001; OR=1.32,95% CI: 1.05-1.66, P=0.016; OR=1.98,95% CI: 1.19-3.28, P=0.009; OR=2.06,95% CI: 1.64-2.60, P<0.001; OR=2.00, 95% CI: 1.31-3.06, P=0.001; OR=1.90,95% CI: 1.24-2.92, P=0.003). Conclusion:Over the past 10 years, the incidence of birth defects in ART offspring in Jiangxi Province has shown a decreasing trend annually, with circulatory system malformations being the most common. The occurrence of birth defects in IVF offspring is primarily associated with maternal and infant characteristics, such as gender, gestational age, birth weight, number of fetuses, and cause of infertility, independent of ART treatment factors.

Objective:To screen serum biomarkers of polycystic ovary syndrome (PCOS) patients by high throughput data independent acquisition (DIA) proteomics technology.Methods:This was a case-control study. A total of 39 peripheral blood samples were collected at Reproductive Medical Center of Jiangxi Maternal and Child Health Hospital from March to November 2021. Among which, 20 cases were from PCOS patients, and 19 cases were from women who underwent assisted reproduction due to male factors causing infertility. DIA proteomics technology combined with bioinformatics analysis were performed to screen for differential protein expression profiles in the serum of PCOS patients. Typical differentially expressed proteins were selected for expression analysis and receiver operating characteristic (ROC) curve analysis, followed by enzyme-linked immunosorbent assay (ELISA) validation.Results:The results of DIA proteomics combined with bioinformatics analysis showed that compared with control group, 194 significantly differentially expressed proteins were screened in the peripheral blood of PCOS patients, including 64 upregulated proteins and 130 downregulated proteins. The ROC curve analysis results showed that the area under curve values of PSMD8, RPS15A, NDUFB1, GM2A, and TOP2A were all above 0.9, indicating that these proteins have good diagnostic value. The ELISA validation results showed that the content of TOP2A in peripheral blood of PCOS patients was significantly upregulated ( P=0.046), while the content of GM2A was significantly downregulated ( P=0.021), when compared with control group, which consistent with the DIA results. Conclusion:DIA proteomics can be used to screen the differential expression of peripheral blood proteins in PCOS patients, among which, PSMD8, RPS15A, NDUFB1, GM2A and TOP2A can be used as serum biomarkers for PCOS diagnosis and treatment.