With the development of preimplantation genetic testing (PGT) technology, the application of third-generation sequencing technology in PGT has been increasing. This article reports the pregnancy outcome of a patient with autosomal dominant polycystic kidney disease who underwent PGT using the third-generation sequencing technology. It summarizes the technical characteristics of third-generation sequencing technology, as well as its significant advantages and limitations in PGT for families with de novo mutations.

Objective:To investigate the effect of pre-pregnancy body mass index (BMI) on the cumulative live birth rate (CLBR) and perinatal outcomes in women with polycystic ovary syndrome (PCOS) undergoing first in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI).Methods:The clinical data of 1 013 patients with PCOS who received first IVF/ICSI treatment in Reproductive Medicine Center, Henan Provincial People′s Hospital from January 2017 to June 2020 were retrospectively analyzed. According to BMI China standard, they were divided into: normal weight group (18.5≤BMI<24.0 kg/m 2, 388 cases), overweight group (24.0≤BMI<28.0 kg/m 2, 367 cases), obese group (BMI≥28.0 kg/m 2, 258 cases). The effect of BMI on CLBR was analyzed by univariate analysis, multivariate logistic regression analysis and smooth curve fitting. The role of homeostasis model assessment of insulin resistance index (HOMA-IR) in the process of BMI on CLBR was analyzed by mediation analysis. Results:Among three groups, female age, basal level of follicle stimulating hormone, type of infertility and ovulation induction regimens were similar (all P>0.05). The infertility duration, basal testosterone level, HOMA-IR, the ovulation induction time and the total gonadotropin dosage increased with BMI (all P<0.01), anti-Müllerian hormone, basal luteinizing hormone level, the number of retrieved oocytes and available embryos decreased with BMI (all P<0.05). CLBR decreased with BMI increasing [84.08% (301/358) vs 74.26% (251/338) vs 71.88% (161/224); P<0.001]. The incidence of hypertensive disorder in pregnancy was highest in obese group, while premature rupture of membranes rate, premature delivery rate, low birth weight rate and macrosomia birth rate were the lowest in normal weight group. After adjusting for confounding factors, both smooth curve fitting and multiple logistic regression analysis revealed a significant trend: CLBR declined with increasing BMI ( OR=0.93, 95% CI: 0.89-0.97; P=0.002), with a reduction of 41% ( OR=0.59, 95% CI: 0.39-0.91; P=0.020) in overweight group, and a reduction of 48% ( OR=0.52, 95% CI: 0.32-0.83; P=0.010) in obese group. HOMA-IR mediated the effect of BMI on CLBR by 27.5% ( P<0.05). Conclusions:High BMI before IVF/ICSI in PCOS patients negatively impacts CLBR and raises maternal and infant risks during pregnancy and the perinatal period. 27.5% of the effect of BMI on CLBR is mediated by HOMA-IR. Thus, PCOS patients should manage their BMI and enhance insulin sensitivity prior to pregnancy.

With the development of preimplantation genetic testing (PGT) technology, the application of third-generation sequencing technology in PGT has been increasing. This article reports the pregnancy outcome of a patient with autosomal dominant polycystic kidney disease who underwent PGT using the third-generation sequencing technology. It summarizes the technical characteristics of third-generation sequencing technology, as well as its significant advantages and limitations in PGT for families with de novo mutations.

Objective:To investigate the effect of pre-pregnancy body mass index (BMI) on the cumulative live birth rate (CLBR) and perinatal outcomes in women with polycystic ovary syndrome (PCOS) undergoing first in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI).Methods:The clinical data of 1 013 patients with PCOS who received first IVF/ICSI treatment in Reproductive Medicine Center, Henan Provincial People′s Hospital from January 2017 to June 2020 were retrospectively analyzed. According to BMI China standard, they were divided into: normal weight group (18.5≤BMI<24.0 kg/m 2, 388 cases), overweight group (24.0≤BMI<28.0 kg/m 2, 367 cases), obese group (BMI≥28.0 kg/m 2, 258 cases). The effect of BMI on CLBR was analyzed by univariate analysis, multivariate logistic regression analysis and smooth curve fitting. The role of homeostasis model assessment of insulin resistance index (HOMA-IR) in the process of BMI on CLBR was analyzed by mediation analysis. Results:Among three groups, female age, basal level of follicle stimulating hormone, type of infertility and ovulation induction regimens were similar (all P>0.05). The infertility duration, basal testosterone level, HOMA-IR, the ovulation induction time and the total gonadotropin dosage increased with BMI (all P<0.01), anti-Müllerian hormone, basal luteinizing hormone level, the number of retrieved oocytes and available embryos decreased with BMI (all P<0.05). CLBR decreased with BMI increasing [84.08% (301/358) vs 74.26% (251/338) vs 71.88% (161/224); P<0.001]. The incidence of hypertensive disorder in pregnancy was highest in obese group, while premature rupture of membranes rate, premature delivery rate, low birth weight rate and macrosomia birth rate were the lowest in normal weight group. After adjusting for confounding factors, both smooth curve fitting and multiple logistic regression analysis revealed a significant trend: CLBR declined with increasing BMI ( OR=0.93, 95% CI: 0.89-0.97; P=0.002), with a reduction of 41% ( OR=0.59, 95% CI: 0.39-0.91; P=0.020) in overweight group, and a reduction of 48% ( OR=0.52, 95% CI: 0.32-0.83; P=0.010) in obese group. HOMA-IR mediated the effect of BMI on CLBR by 27.5% ( P<0.05). Conclusions:High BMI before IVF/ICSI in PCOS patients negatively impacts CLBR and raises maternal and infant risks during pregnancy and the perinatal period. 27.5% of the effect of BMI on CLBR is mediated by HOMA-IR. Thus, PCOS patients should manage their BMI and enhance insulin sensitivity prior to pregnancy.

Objective:To investigate the effect of "four-staff co-management" follow-up mode on risk factor control and medium-term prognosis improvement in patients with coronary heart disease after percutaneous coronary intervention (PCI).Methods:This was a intervention study. Patients with coronary heart disease who were admitted to the Xiamen Cardiovascular Hospital of Xiamen University from June 2021 to January 2022 and successfully discharged after PCI were included. According to the different types of follow-up after discharge, patients were divided into the traditional follow-up group and the "four-staff co-management" follow-up group. The "four-staff co-management" follow-up mode means that specialists, specialist managers in third-level A hospitals and general practitioners and health managers in basic hospitals were jointly responsible for post-discharge follow-up of PCI patients. Baseline clinical data were collected. The primary endpoints were the rate of compliance of coronary heart disease risk factor control at 12 months after surgery, the rate of secondary surgery, and the incidence of mid-term major adverse cardiovascular and cerebrovascular events (MACCE). Unplanned secondary PCI included symptom-driven secondary PCI and asymptomatic secondary PCI. MACCE includes myocardial infarction, hospitalization for heart failure, stroke, major bleeding, all-cause death, and composite endpoints including these events.Results:A total of 2 181 patients were enrolled, including 1 097 patients in the traditional follow-up group and 1 084 patients in the "four-staff co-management" follow-up group. At baseline, there were no statistically significant differences in gender, age, discharge diagnosis, co-existing diseases, echocardiographic indexes, and coronary artery lesions between the two groups (all P>0.05). There were no significant differences between the two groups in total PCI stent length, maximum internal diameter of stent, proportion of patients using drug balloon, proportion of patients with a planned second surgery during hospitalization, and discharge with drugs (all P>0.05). Twelve months after PCI, the reduction in HbA1c and low-density lipoprotein cholesterol was greater in the "four-staff co-management " follow-up group than that in the traditional follow-up group (all P<0.05), and the rate of reaching the standard for low-density lipoprotein cholesterol was higher than that in the traditional follow-up group ( P=0.001), but there was no statistical significance between the two groups for blood pressure and blood glucose (all P>0.05). During the follow-up period, the proportion of symptom-driven second operation patients was lower in the "four-staff co-management" follow-up group than that in the traditional follow-up group ( P<0.001), and there was no significant difference in the proportion of asymptomatic second operation patients between the two groups ( P=0.191). The proportion of hospitalized patients with heart failure in the "four-staff co-management" follow-up group was lower than that in the traditional follow-up group ( P=0.029), and there was no significant difference in the proportion of myocardial infarction, cerebral infarction, cerebral hemorrhage, massive hemorrhage, death and complex endpoint events between the two groups (all P>0.05). Conclusion:The "four-staff co-management" follow-up mode can effectively improve the control of risk factors and medium-term prognosis in patients with coronary heart disease after PCI.

Objective:To investigate the effect of "four-staff co-management" follow-up mode on risk factor control and medium-term prognosis improvement in patients with coronary heart disease after percutaneous coronary intervention (PCI).Methods:This was a intervention study. Patients with coronary heart disease who were admitted to the Xiamen Cardiovascular Hospital of Xiamen University from June 2021 to January 2022 and successfully discharged after PCI were included. According to the different types of follow-up after discharge, patients were divided into the traditional follow-up group and the "four-staff co-management" follow-up group. The "four-staff co-management" follow-up mode means that specialists, specialist managers in third-level A hospitals and general practitioners and health managers in basic hospitals were jointly responsible for post-discharge follow-up of PCI patients. Baseline clinical data were collected. The primary endpoints were the rate of compliance of coronary heart disease risk factor control at 12 months after surgery, the rate of secondary surgery, and the incidence of mid-term major adverse cardiovascular and cerebrovascular events (MACCE). Unplanned secondary PCI included symptom-driven secondary PCI and asymptomatic secondary PCI. MACCE includes myocardial infarction, hospitalization for heart failure, stroke, major bleeding, all-cause death, and composite endpoints including these events.Results:A total of 2 181 patients were enrolled, including 1 097 patients in the traditional follow-up group and 1 084 patients in the "four-staff co-management" follow-up group. At baseline, there were no statistically significant differences in gender, age, discharge diagnosis, co-existing diseases, echocardiographic indexes, and coronary artery lesions between the two groups (all P>0.05). There were no significant differences between the two groups in total PCI stent length, maximum internal diameter of stent, proportion of patients using drug balloon, proportion of patients with a planned second surgery during hospitalization, and discharge with drugs (all P>0.05). Twelve months after PCI, the reduction in HbA1c and low-density lipoprotein cholesterol was greater in the "four-staff co-management " follow-up group than that in the traditional follow-up group (all P<0.05), and the rate of reaching the standard for low-density lipoprotein cholesterol was higher than that in the traditional follow-up group ( P=0.001), but there was no statistical significance between the two groups for blood pressure and blood glucose (all P>0.05). During the follow-up period, the proportion of symptom-driven second operation patients was lower in the "four-staff co-management" follow-up group than that in the traditional follow-up group ( P<0.001), and there was no significant difference in the proportion of asymptomatic second operation patients between the two groups ( P=0.191). The proportion of hospitalized patients with heart failure in the "four-staff co-management" follow-up group was lower than that in the traditional follow-up group ( P=0.029), and there was no significant difference in the proportion of myocardial infarction, cerebral infarction, cerebral hemorrhage, massive hemorrhage, death and complex endpoint events between the two groups (all P>0.05). Conclusion:The "four-staff co-management" follow-up mode can effectively improve the control of risk factors and medium-term prognosis in patients with coronary heart disease after PCI.

Embryo implantation, as an important speed limiting step in pregnancy, is a dynamic developmental process that involves a series of intercellular communication and interactions between the embryo and endometrial cells. Exosomes are a subtype of extracellular vesicles that are widely present in cells and bodily fluids and can serve as new intercellular communication mediators in the body. Research has shown that exosomes can participate in regulating embryonic development, endometrial receptivity, embryo adhesion, immune tolerance, and angiogenesis, playing an important role in regulating complex embryo implantation processes. This article will review the role of exosomes in embryo implantation, in order to provide new insights into the failure of embryo implantation in human reproduction.

Objective:To investigate the effect of rebiopsy blastocyst on clinical pregnancy and neonatal outcomes in patients with preimplantation genetic testing (PGT) before embryo implantation.Methods:A retrospective cohort study analyzed the clinical pregnancy and neonatal outcomes of one biopsy and rebiopsy patients (453 and 60 patients, respectively) with PGT in the Reproductive Medicine Center of Henan Provincial People's Hospital from January 2019 to December 2022. The 2∶1 propensity score matching (PSM) method was used to match the age, body mass index (BMI) and infertility duration of women in the two groups, and the laboratory indexes and related indexes of transplant fertility and neonatal outcomes of PGT patients were compared between the two groups. The rebiopsy patients with PGT were divided into PGT for aneuploidy (PGT-A) subgroup, PGT for structural rearrangements (PGT-SR) subgroup and PGT for monogenic (PGT-M) subgroup according to PGT types, and the rebiopsy rate, the success rate of amplification and the rate of transferrable embryo were compared between each two subgroups.Results:After PSM, there were no significant differences in women's age, female body mass index, infertility type, ovulation induction program, PGT type and laboratory-related indexes between the two groups (all P>0.05). At the same time, the implantation rate, the clinical pregnancy rate and the live birth rate of rebiopsy embryos decreased, and the miscarriage rate increased, but the differences were not statistically significant (all P>0.05). The rate of day 3 available embryo in the rebiopsy PGT group [87.50% (434/496)] was significantly increased, and the number of blastocyst [4.00 (2.25,6.75)] was significantly decreased compared with one biopsy PGT group [82.19% (812/980), P=0.020; 5.50 (3.00,8.00), P=0.028]. Then the chromosomal euploidy rate of the rebiopsy embryo [35.9% (28/78)] decreased and the abnormality rate [9.0% (7/78)] increased in the rebiopsy PGT group compared with one biopsy PGT group [49.3% (226/458), P=0.028; 0.9% (4/458), P<0.001], and the differences were statistically significant. The aneuploidy rate and multi-chromosome mosaic rate in the rebiopsy PGT group were higher than those in the one biopsy PGT group, but the difference was not statistically significant (all P>0.05). There were no significant differences in birth weight, gestational age, sex ratio, low birth weight infants, macrosomia, small-for-gestational-age infants, large-for-gestational-age infants, and incidence of birth defects between the two groups (all P>0.05). There was no significant difference in the rebiopsy rate, the success rate of amplification and the rate of transferrable embryo between the subgroups of the PGT group (all P>0.05). Conclusion:For patients who fail the first biopsy, the clinical pregnancy rate, the live birth rate, the neonatal birth weight, and the birth defect incidence rate after the second biopsy of PGT are comparable to those of the patients with the first biopsy of PGT.

Breast cancer is currently the most common malignant tumor. During the treatment of tumors, radiotherapy, chemotherapy and endocrine therapy will produce different reproductive toxicity and cause damage to the patient's fertility. Assisted reproductive technology allows breast cancer patients to preserve their fertility, and fertility preservation process relies on ovulation stimulating treatment. The treatment process needs to consider issues such as timeliness and safety. The timeliness and safety of pregnancy after tumor therapy are also considered. This article reviews the effects of breast cancer treatment on female fertility, female fertility preservation regimens, ovulation induction regimens, pregnancy timing selection, and pregnancy safety, to provide reference for clinical application.

Embryo implantation, as an important speed limiting step in pregnancy, is a dynamic developmental process that involves a series of intercellular communication and interactions between the embryo and endometrial cells. Exosomes are a subtype of extracellular vesicles that are widely present in cells and bodily fluids and can serve as new intercellular communication mediators in the body. Research has shown that exosomes can participate in regulating embryonic development, endometrial receptivity, embryo adhesion, immune tolerance, and angiogenesis, playing an important role in regulating complex embryo implantation processes. This article will review the role of exosomes in embryo implantation, in order to provide new insights into the failure of embryo implantation in human reproduction.