Despite that sleep disturbance and poor neurocognitive performance are common complaints among coronavirus disease 2019 (COVID-19) survivors, few studies have focused on the effect of post-COVID-19 sleep disturbance (PCSD) on cognitive function. This study aimed to identify the impact of PCSD on neurocognitive function and explore the associated risk factors for the worsening of this condition. This cross-sectional study was conducted via the web-based assessment in Chinese mainland. Neurocognitive function was evaluated by the modified online Integrated Cognitive Assessment (ICA) and the Number Ordering Test (NOT). Propensity score matching (PSM) was utilized to match the confounding factors between individuals with and without PCSD. Univariate analyses were performed to evaluate the effect of PCSD on neurocognitive function. The risk factors associated with worsened neurocognitive performance in PCSD individuals were explored using binary logistic regression. A total of 8692 individuals with COVID-19 diagnosis were selected for this study. Nearly half (48.80%) of the COVID-19 survivors reported sleep disturbance. After matching by PSM, a total of 3977 pairs (7954 individuals in total) were obtained. Univariate analyses revealed that PCSD was related to worse ICA and NOT performance (P<0.05). Underlying disease, upper respiratory infection, loss of smell or taste, severe pneumonia, and self-reported cognitive complaints were associated with worsened neurocognitive performance among PCSD individuals (P<0.05). Furthermore, aging, ethnicity (minority), and lower education level were found to be independent risk factors for worsened neurocognitive performance in PCSD individuals (P<0.05). PCSD was related to impaired neurocognitive performance. Therefore, appropriate prevention and intervention measures should be taken to minimize or prevent PCSD and eliminate its potential adverse effect on neurocognitive function.
Humans ; COVID-19/epidemiology* ; Male ; Female ; Sleep Wake Disorders/epidemiology* ; Propensity Score ; Middle Aged ; Cross-Sectional Studies ; Adult ; SARS-CoV-2 ; Aged ; Risk Factors ; China/epidemiology* ; Cognition ; Cognitive Dysfunction/etiology* ; Neuropsychological Tests

Objective To explore the mechanism of Cistanche phenylethanoid glycosides(CPhGs)in treating osteoporosis by regu-lating osteogenic differentiation via SIRT2-C/EBPβ-AREG axis.Methods An osteoporosis mouse model was established using ova-riectomy.Trabecular number/thickness,bone formation rate,and tissue morphology were evaluated using micro-computed tomography,calcein double labeling,and hematoxylin and eosin staining,respectively.SIRT2,C/EBPβ,AREG,proteins related to the SIRT2-C/EBPβ-AREG axis,were analyzed by Western blotting and co-immunoprecipitation.The mRNA expression of osteogenic differentiation marker genes OCN,OPN,RUNX2,C/EBPβ,and AREG were detected by real-time quantitative PCR.Results CPhGs intervention significantly improved the trabecular microarchitecture and promoted bone formation in mice undergoing ovariectomy,and the mechanism involved the activation of SIRT2-mediated deacetylation of C/EBPβ,which in turn upregulated AREG expression.Cell experiments confirmed that CPhGs significantly increased the activity of alkaline phosphatase and the expression of osteogenic genes such as OCN,OPN,and RUNX2 in MC3T3-E1 cells by enhancing the interaction between SIRT2 and C/EBPβ.Notably,this effect could be reversed by SIRT2 knockdown.Conclusion CPhGs regulate the osteogenic differentiation process through the SIRT2-C/EBPβ-AREG axis,providing a new molecular target and theoretical basis for the treatment of osteoporosis with the active ingredients of traditional Chinese medicine.

Objective To explore the mechanism of Cistanche phenylethanoid glycosides(CPhGs)in treating osteoporosis by regu-lating osteogenic differentiation via SIRT2-C/EBPβ-AREG axis.Methods An osteoporosis mouse model was established using ova-riectomy.Trabecular number/thickness,bone formation rate,and tissue morphology were evaluated using micro-computed tomography,calcein double labeling,and hematoxylin and eosin staining,respectively.SIRT2,C/EBPβ,AREG,proteins related to the SIRT2-C/EBPβ-AREG axis,were analyzed by Western blotting and co-immunoprecipitation.The mRNA expression of osteogenic differentiation marker genes OCN,OPN,RUNX2,C/EBPβ,and AREG were detected by real-time quantitative PCR.Results CPhGs intervention significantly improved the trabecular microarchitecture and promoted bone formation in mice undergoing ovariectomy,and the mechanism involved the activation of SIRT2-mediated deacetylation of C/EBPβ,which in turn upregulated AREG expression.Cell experiments confirmed that CPhGs significantly increased the activity of alkaline phosphatase and the expression of osteogenic genes such as OCN,OPN,and RUNX2 in MC3T3-E1 cells by enhancing the interaction between SIRT2 and C/EBPβ.Notably,this effect could be reversed by SIRT2 knockdown.Conclusion CPhGs regulate the osteogenic differentiation process through the SIRT2-C/EBPβ-AREG axis,providing a new molecular target and theoretical basis for the treatment of osteoporosis with the active ingredients of traditional Chinese medicine.

Objective:To explore the clinical effects of a series of posture intervention strategies on correcting abnormal fetal position, so as to provide a basis for Clinical position management and promotion of natural delivery.Methods:This study was a randomized controlled trial. The convenience sampling method was used to select 196 full-term primiparas women with abnormal fetal orientation confirmed by ultrasound as single fetal head position in the Women′s Hospital, School of Medicine, Zhejiang University from March to October 2022 as the research objects. They were divided into control group 106 cases and research group 90 cases by random number table method. The control group received normal nursing and chose comfortable position by themselves during labor. The research group received a series of ultrasound-guided postural intervention strategies for postural management in the first and second stages of labor on the basis of normal nursing. The angle of progression and the midline angle, the fetal orientation, fetal orientation during complete uterine orifice and delivery outcome were compared between the two groups.Results:Finally, 190 cases were included, 105 cases in the control group and 85 cases in the research group. There were 76 vaginal deliveries in the research group and 95 in the control group. The rate of anterior occipital position and the angle of fetal head rotation in the research group were 73.68% (56/76) and 64.55 (37.90, 85.55)°, which were higher than 45.26% (43/95) and 33.00 (14.00, 60.00)° in the control group;the midline angle of the research group was 57.10(38.50, 75.80)°, which was lower than 80.00 (52.50, 90.30)° of the control group. There was significant difference between the two groups ( χ2 = 14.14, Z = 4.17, - 3.74, all P<0.01). The first stage of labor was 522.50 (413.00, 695.00) minutes and the total stage of labor was 611.00 (488.00, 812.00) minutes in the research group, which was lower than 620.00 (450.00, 795.00) and 700.00 (539.00, 904.00) minutes in the control group ( Z = - 2.34, - 2.03, both P<0.05). Conclusions:The application of the serial position intervention strategy under the ultrasound guidance during the labor process can improve the abnormal fetal position, shorten the first stage of labor time effectively and safely, while it does not have any significant effect on the improvement of the delivery outcome.

Objective:To explore the effect of insulin resistance (IR) on clinical outcomes after first embryo transfer during in vitro fertilization (IVF) treatment in polycystic ovarian syndrome (PCOS) patients. Methods:In this retrospective study, a total of 1 105 PCOS patients and 2 136 non-PCOS (control) patients with first embryo transfer from January 2018 to December 2020 in Reproductive Medical Center, Henan Provincial People's Hospital were recruited. All the patients were divided into four groups according to whether they had IR or not: PCOS with IR group (group A1); PCOS without IR (group A2); control with IR (group B1); control without IR (group B2). Baseline data and clinical outcomes were compared among the four groups.Results:1) There were significant differences in number of oocytes punctured (16.8±8.1, 17.8±7.9, 12.6±6.2, 13.4±6.2; P<0.001), number of oocytes retrieved (14.2±7.9, 15.3±7.7, 11.5±6.0, 12.3±6.3; P<0.001), the rate of oocytes retrieved [84.6% (8 518/10 070), 86.1% (7 738/8 986), 91.8% (8 346/9 096), 91.9% (17 367/18 898); P<0.001], the number of mature oocytes (12.1±7.0, 13.0±7.0, 9.7±5.3, 10.4±5.5; P<0.001), the number of two pronuclei (2PN) cleavage embryos (8.2±5.3, 9.0±5.4, 6.7±4.1, 7.4±4.3; P<0.001), the number of available embryos (7.1±4.8, 7.6±4.9, 5.7±3.7, 6.4±3.9; P<0.001), the rate of available embryos [82.3% (4 207/5 110), 82.2% (3 851/4 684), 82.3% (4 124/5 008), 83.9% (8 972/10 690); P=0.008], the number of high-quality embryos (3.7±3.4, 4.0±3.5, 3.2±2.7, 3.5±2.9; P<0.001), and the rate of high-quality embryos [42.8% (2 185/5 110), 43.5% (2 037/4 684), 45.7% (2 290/5 008), 46.9% (5 009/10 690); P<0.001], among group A1, group A2, group B1 and group B2 while the M Ⅱ rate, 2PN cleavage rate and available blastocyst formation rate were similar among the four groups (all P>0.05). 2) The rate of early miscarriage rate was significantly different among the four groups [16.3% (63/387), 9.7% (34/351), 12.1% (56/464), 8.7% (82/939); P=0.001], while the clinical pregnancy rate, the implantation rate and the ectopic rate were comparable (all P>0.05). Further subgroup analysis showed that the early miscarriage rate of group A1 [16.3% (63/387)] was significantly higher than that of group A2 [9.7% (34/351), P=0.008] and group B2 [8.7% (82/939), P<0.001]. 3) Multivariate logistic regression analysis suggested that IR was the independent factor of early miscarriage ( OR=1.464, 95% CI: 1.361-2.065, P=0.019). Conclusion:IR may play an important role in the early miscarriage results in PCOS patients during IVF treatment.

Objective:To explore the effect of insulin resistance (IR) on clinical outcomes after first embryo transfer during in vitro fertilization (IVF) treatment in polycystic ovarian syndrome (PCOS) patients. Methods:In this retrospective study, a total of 1 105 PCOS patients and 2 136 non-PCOS (control) patients with first embryo transfer from January 2018 to December 2020 in Reproductive Medical Center, Henan Provincial People's Hospital were recruited. All the patients were divided into four groups according to whether they had IR or not: PCOS with IR group (group A1); PCOS without IR (group A2); control with IR (group B1); control without IR (group B2). Baseline data and clinical outcomes were compared among the four groups.Results:1) There were significant differences in number of oocytes punctured (16.8±8.1, 17.8±7.9, 12.6±6.2, 13.4±6.2; P<0.001), number of oocytes retrieved (14.2±7.9, 15.3±7.7, 11.5±6.0, 12.3±6.3; P<0.001), the rate of oocytes retrieved [84.6% (8 518/10 070), 86.1% (7 738/8 986), 91.8% (8 346/9 096), 91.9% (17 367/18 898); P<0.001], the number of mature oocytes (12.1±7.0, 13.0±7.0, 9.7±5.3, 10.4±5.5; P<0.001), the number of two pronuclei (2PN) cleavage embryos (8.2±5.3, 9.0±5.4, 6.7±4.1, 7.4±4.3; P<0.001), the number of available embryos (7.1±4.8, 7.6±4.9, 5.7±3.7, 6.4±3.9; P<0.001), the rate of available embryos [82.3% (4 207/5 110), 82.2% (3 851/4 684), 82.3% (4 124/5 008), 83.9% (8 972/10 690); P=0.008], the number of high-quality embryos (3.7±3.4, 4.0±3.5, 3.2±2.7, 3.5±2.9; P<0.001), and the rate of high-quality embryos [42.8% (2 185/5 110), 43.5% (2 037/4 684), 45.7% (2 290/5 008), 46.9% (5 009/10 690); P<0.001], among group A1, group A2, group B1 and group B2 while the M Ⅱ rate, 2PN cleavage rate and available blastocyst formation rate were similar among the four groups (all P>0.05). 2) The rate of early miscarriage rate was significantly different among the four groups [16.3% (63/387), 9.7% (34/351), 12.1% (56/464), 8.7% (82/939); P=0.001], while the clinical pregnancy rate, the implantation rate and the ectopic rate were comparable (all P>0.05). Further subgroup analysis showed that the early miscarriage rate of group A1 [16.3% (63/387)] was significantly higher than that of group A2 [9.7% (34/351), P=0.008] and group B2 [8.7% (82/939), P<0.001]. 3) Multivariate logistic regression analysis suggested that IR was the independent factor of early miscarriage ( OR=1.464, 95% CI: 1.361-2.065, P=0.019). Conclusion:IR may play an important role in the early miscarriage results in PCOS patients during IVF treatment.

Objective:To explore the effect of anti-Müllerian hormone (AMH) on early pregnancy loss after first embryo transfer during in vitro fertilization (IVF) treatment. Methods:A total of 3973 women with positive human chorionic gonadotropin (hCG) after first embryo transfer from July 2016 to June 2019 in Reproductive Medical Center, Henan Provincial People's Hospital were studied retrospectively. All patients were categorized into four groups according to AMH levels: group A (AMH≤1.97 μg/L), group B (1.97 μg/L5.41 μg/L). Univariate analysis, multivariate logistic regression analysis and curve fitting analysis were used to investigate the effect of AMH level on early pregnancy loss rate.Results:1) The total early pregnancy loss rate of the first transfer cycle was 15.71% (624/3973).There were significant differences in AMH level [(1.21±0.50) μg/L, (2.63±0.38) μg/L, (4.26±0.60) μg/L, (8.26±2.78) μg/L, P<0.001], age [(32.35±5.00) years, (30.77±4.24) years, (29.90±3.96) years, (29.35±3.85) years, P<0.001], antral follicular count of both ovaries (8.01±4.04, 11.46±4.40, 13.55±4.73, 16.08±5.08, P<0.001), number of transfer embryos (1.74±0.44, 1.73±0.45, 1.69±0.46, 1.66±0.47, P<0.001), developmental days of transfer embryos (cleavage embryos/blastocysts) (85.49%/14.51%, 76.42%/23.58%, 69.55%/30.45%, 65.79%/34.21%, P<0.001), type of transfer cycles (fresh transfer/frozen transfer) (75.08%/24.92%, 71.15%/28.85%, 57.79%/42.21%, 39.46%/60.54%, P<0.001) and early pregnancy loss rate (22.12%, 12.25%, 12.76%, 15.64%, P<0.001) among the four groups, while the body mass index, type of infertility and type of fertilization were comparable (all P>0.05). 2) After adjusting for confounding factors, group A was set as control group in multivariate logistic regression analysis, the early pregnancy loss rate was significantly lower in group B (adjusted OR=0.60, 95% CI=0.46-0.79, P<0.001) and group C (adjusted OR=0.70, 95% CI=0.51-0.97, P=0.033) for the total women. Further multivariate logistic regression analysis according to age sub-groups showed that the early pregnancy loss rates of group B (adjusted OR=0.46, 95% CI=0.30-0.71, P<0.001), group C (adjusted OR=0.62, 95% CI=0.39-0.98, P=0.041) and group D (adjusted OR=0.56, 95% CI=0.33-0.93, P=0.026) were significantly lower than those in group A for women no more than 35 years old, while the early pregnancy rates were comparable among the four groups for women aged 35 years or above (all P>0.05). The curve fitting analysis found that the relationship between AMH and early pregnancy loss was a curve line. The early pregnancy loss rate was decreased with the increasing of AMH level and gradually plateaued. Conclusion:For the first embryo transfer cycles, AMH level has some effects on the early pregnancy loss for women no more than 35 years old.

Objective:To explore the effect of anti-Müllerian hormone (AMH) on early pregnancy loss after first embryo transfer during in vitro fertilization (IVF) treatment. Methods:A total of 3973 women with positive human chorionic gonadotropin (hCG) after first embryo transfer from July 2016 to June 2019 in Reproductive Medical Center, Henan Provincial People's Hospital were studied retrospectively. All patients were categorized into four groups according to AMH levels: group A (AMH≤1.97 μg/L), group B (1.97 μg/L5.41 μg/L). Univariate analysis, multivariate logistic regression analysis and curve fitting analysis were used to investigate the effect of AMH level on early pregnancy loss rate.Results:1) The total early pregnancy loss rate of the first transfer cycle was 15.71% (624/3973).There were significant differences in AMH level [(1.21±0.50) μg/L, (2.63±0.38) μg/L, (4.26±0.60) μg/L, (8.26±2.78) μg/L, P<0.001], age [(32.35±5.00) years, (30.77±4.24) years, (29.90±3.96) years, (29.35±3.85) years, P<0.001], antral follicular count of both ovaries (8.01±4.04, 11.46±4.40, 13.55±4.73, 16.08±5.08, P<0.001), number of transfer embryos (1.74±0.44, 1.73±0.45, 1.69±0.46, 1.66±0.47, P<0.001), developmental days of transfer embryos (cleavage embryos/blastocysts) (85.49%/14.51%, 76.42%/23.58%, 69.55%/30.45%, 65.79%/34.21%, P<0.001), type of transfer cycles (fresh transfer/frozen transfer) (75.08%/24.92%, 71.15%/28.85%, 57.79%/42.21%, 39.46%/60.54%, P<0.001) and early pregnancy loss rate (22.12%, 12.25%, 12.76%, 15.64%, P<0.001) among the four groups, while the body mass index, type of infertility and type of fertilization were comparable (all P>0.05). 2) After adjusting for confounding factors, group A was set as control group in multivariate logistic regression analysis, the early pregnancy loss rate was significantly lower in group B (adjusted OR=0.60, 95% CI=0.46-0.79, P<0.001) and group C (adjusted OR=0.70, 95% CI=0.51-0.97, P=0.033) for the total women. Further multivariate logistic regression analysis according to age sub-groups showed that the early pregnancy loss rates of group B (adjusted OR=0.46, 95% CI=0.30-0.71, P<0.001), group C (adjusted OR=0.62, 95% CI=0.39-0.98, P=0.041) and group D (adjusted OR=0.56, 95% CI=0.33-0.93, P=0.026) were significantly lower than those in group A for women no more than 35 years old, while the early pregnancy rates were comparable among the four groups for women aged 35 years or above (all P>0.05). The curve fitting analysis found that the relationship between AMH and early pregnancy loss was a curve line. The early pregnancy loss rate was decreased with the increasing of AMH level and gradually plateaued. Conclusion:For the first embryo transfer cycles, AMH level has some effects on the early pregnancy loss for women no more than 35 years old.

Objective:To explore the cumulative delivery rate and related factors of infertile women with anti-Müllerian hormone (AMH) no more than 1 μg/L during in vitro fertilization and embryo transfer (IVF-ET) treatment. Methods:In this retrospective cohort study, we analyzed 793 infertile women with AMH no more than 1 μg/L and underwent their first IVF-ET treatment in Henan Provincial People's Hospital between July 2016 and February 2018. All the patients were categorized into two groups according to cumulative delivery with at least one live baby or not. Baseline data and outcomes were compared between the two groups. The regression analysis was conducted to identify the independent factors of cumulative delivery rate and clinical outcomes of different age groups were compared.Results:1) The total cumulative delivery rate per start cycle was 23.83% (189/793). There were significant differences in age [33(30,37) years vs. 39(34,43) years], AMH [0.67(0.46,0.87) μg/L vs. 0.51(0.22,0.74) μg/L], antral follicle count (AFC) [6(4,8) vs. 4(2,6)], basal follicle-stimulating hormone (bFSH) [9.11(6.98,11.03) IU/L vs. 11.06(7.75,13.13) IU/L], starting dosage of gonadotropin (Gn) used [225.0(187.5,225.0) IU vs. 225.0(225.0,300.0) IU], total dosage of Gn used [2 475.0(1 800.0,3 137.5) IU vs. 2 100.0(1 575.0,2 850.0) IU], duration of Gn stimulation [10(8,12) d vs. 9(6,11) d], number of oocytes retrieved [5.0(3.0,7.5) vs. 2.5(1.0,4.0)], number of M II oocytes [4(3,6) vs. 2(1,3)] and number of available cleavage embryos [3.0(2.0,4.5) vs.1.0(0,2.0)] between the two groups (all P<0.001). 2) Multivariate logistic regression analysis suggested that age ( OR=0.878, 95% CI=0.846-0.911, P<0.001) was the vital factor of cumulative delivery rate. The cumulative pregnancy rate and the cumulative delivery rate were significantly decreased with age increasing (all P<0.001). And the cancelation rate of group with age more than 40 years was much higher ( P<0.001). Conclusion:Age was the independent influencing factor of cumulative delivery rate. The cumulative delivery rate decreased significantly with age increasing.

Objective:To explore the cumulative delivery rate and related factors of infertile women with anti-Müllerian hormone (AMH) no more than 1 μg/L during in vitro fertilization and embryo transfer (IVF-ET) treatment. Methods:In this retrospective cohort study, we analyzed 793 infertile women with AMH no more than 1 μg/L and underwent their first IVF-ET treatment in Henan Provincial People's Hospital between July 2016 and February 2018. All the patients were categorized into two groups according to cumulative delivery with at least one live baby or not. Baseline data and outcomes were compared between the two groups. The regression analysis was conducted to identify the independent factors of cumulative delivery rate and clinical outcomes of different age groups were compared.Results:1) The total cumulative delivery rate per start cycle was 23.83% (189/793). There were significant differences in age [33(30,37) years vs. 39(34,43) years], AMH [0.67(0.46,0.87) μg/L vs. 0.51(0.22,0.74) μg/L], antral follicle count (AFC) [6(4,8) vs. 4(2,6)], basal follicle-stimulating hormone (bFSH) [9.11(6.98,11.03) IU/L vs. 11.06(7.75,13.13) IU/L], starting dosage of gonadotropin (Gn) used [225.0(187.5,225.0) IU vs. 225.0(225.0,300.0) IU], total dosage of Gn used [2 475.0(1 800.0,3 137.5) IU vs. 2 100.0(1 575.0,2 850.0) IU], duration of Gn stimulation [10(8,12) d vs. 9(6,11) d], number of oocytes retrieved [5.0(3.0,7.5) vs. 2.5(1.0,4.0)], number of M II oocytes [4(3,6) vs. 2(1,3)] and number of available cleavage embryos [3.0(2.0,4.5) vs.1.0(0,2.0)] between the two groups (all P<0.001). 2) Multivariate logistic regression analysis suggested that age ( OR=0.878, 95% CI=0.846-0.911, P<0.001) was the vital factor of cumulative delivery rate. The cumulative pregnancy rate and the cumulative delivery rate were significantly decreased with age increasing (all P<0.001). And the cancelation rate of group with age more than 40 years was much higher ( P<0.001). Conclusion:Age was the independent influencing factor of cumulative delivery rate. The cumulative delivery rate decreased significantly with age increasing.