Objective:To evaluate the efficacy and safety of domestic recombinant human follicle-stimulating hormone (rhFSH) in assisted reproductive technology (ART) of controlled ovarian hyperstimulation (COH).Methods:In a multicenter, randomized, double-blind, positive, parallel controlled non-inferiority clinical trial, the infertile women with normal ovarian reserve who received ART-COH in six reproductive medical centers from July 2017 to June 2019 were randomly divided into two groups: experimental group (domestic rhFSH, n=134) and control group (imported rhFSH, n=133). Eight subjects were excluded due to various reasons during the experimental process, 7 in experimental group and 1 in control group. At last, 127 subjects in experimental group and 132 subjects in control group complete the experiment following the research protocol. The total number of oocytes, usage of FSH, fertilization rate of oocytes, the number of high-quality embryos, clinical pregnancy rate, live birth rate, neonatal characteristics and the incidence of adverse reactions were compared between the two groups during the cycle of COH. Results:During the initiation cycle of ovulation induction therapy, the total number of oocytes obtained in experimental group and control group were 13.0±5.8 and 12.9±5.7, respectively, with no statistically significant difference ( P>0.05). Among the 82 intracytoplasmic sperm injection (ICSI) patients, the number of M II oocytes obtained in experimental group (39 cases) was markedly higher than that in control group (43 cases) (9.9±3.9 vs. 7.5±3.0, P=0.003). The fertilization rate of oocytes in experimental group was obviously higher than that in control group [63.82% (1048/1642) vs. 56.19% (958/1705), P<0.001]. There were no significant differences of stimulated duration and dosage of rhFSH, number of high-quality embryos, clinical pregnancy rate, preterm rate, live birth rate, incidence of neonatal abnormalities, neonatal weight or Apgar score between the two groups (all P>0.05). The incidence of ovarian hyperstimulation syndrome and other adverse reactions in treatment period were not significantly different between the two groups (all P>0.05), which were known adverse reaction occurred in the imported rhFSH. Conclusion:The efficacy and safety of domestic rhFSH were the same as that of imported rhFSH in infertile patients with normal ovarian reserve under the same ovarian stimulation regimen.

Objective:To evaluate the efficacy and safety of domestic recombinant human follicle-stimulating hormone (rhFSH) in assisted reproductive technology (ART) of controlled ovarian hyperstimulation (COH).Methods:In a multicenter, randomized, double-blind, positive, parallel controlled non-inferiority clinical trial, the infertile women with normal ovarian reserve who received ART-COH in six reproductive medical centers from July 2017 to June 2019 were randomly divided into two groups: experimental group (domestic rhFSH, n=134) and control group (imported rhFSH, n=133). Eight subjects were excluded due to various reasons during the experimental process, 7 in experimental group and 1 in control group. At last, 127 subjects in experimental group and 132 subjects in control group complete the experiment following the research protocol. The total number of oocytes, usage of FSH, fertilization rate of oocytes, the number of high-quality embryos, clinical pregnancy rate, live birth rate, neonatal characteristics and the incidence of adverse reactions were compared between the two groups during the cycle of COH. Results:During the initiation cycle of ovulation induction therapy, the total number of oocytes obtained in experimental group and control group were 13.0±5.8 and 12.9±5.7, respectively, with no statistically significant difference ( P>0.05). Among the 82 intracytoplasmic sperm injection (ICSI) patients, the number of M II oocytes obtained in experimental group (39 cases) was markedly higher than that in control group (43 cases) (9.9±3.9 vs. 7.5±3.0, P=0.003). The fertilization rate of oocytes in experimental group was obviously higher than that in control group [63.82% (1048/1642) vs. 56.19% (958/1705), P<0.001]. There were no significant differences of stimulated duration and dosage of rhFSH, number of high-quality embryos, clinical pregnancy rate, preterm rate, live birth rate, incidence of neonatal abnormalities, neonatal weight or Apgar score between the two groups (all P>0.05). The incidence of ovarian hyperstimulation syndrome and other adverse reactions in treatment period were not significantly different between the two groups (all P>0.05), which were known adverse reaction occurred in the imported rhFSH. Conclusion:The efficacy and safety of domestic rhFSH were the same as that of imported rhFSH in infertile patients with normal ovarian reserve under the same ovarian stimulation regimen.

The rapid development of oocyte cryopreservation in recent years has provided a new means for the preservation of women's fertility. Some assisted reproductive institutions in China have gradually carried out the clinical application of oocyte cryopreservation. However, oocyte cryopreservation is far behind embryo and sperm freezing in terms of technology, and cryopreservation of human oocytes can only be used as one of the options for female fertility preservation. Morever, allowing the egg bank completely has much management difficulties in our country, which can easily lead to ethical problems. However, there is a real need for oocyte cryopreservation in women with premature ovarian failure who are about to undergo radiotherapy and chemotherapy. This article summarizes the social, ethical and technical issues and controversies that may arise from egg freezing, and introduces the laws and regulations in various countries. We expect the healthy development of egg freezing technology and can satisfy the needs and wishes of women's reproduction effectively within a reasonable range.

The rapid development of oocyte cryopreservation in recent years has provided a new means for the preservation of women's fertility. Some assisted reproductive institutions in China have gradually carried out the clinical application of oocyte cryopreservation. However, oocyte cryopreservation is far behind embryo and sperm freezing in terms of technology, and cryopreservation of human oocytes can only be used as one of the options for female fertility preservation. Morever, allowing the egg bank completely has much management difficulties in our country, which can easily lead to ethical problems. However, there is a real need for oocyte cryopreservation in women with premature ovarian failure who are about to undergo radiotherapy and chemotherapy. This article summarizes the social, ethical and technical issues and controversies that may arise from egg freezing, and introduces the laws and regulations in various countries. We expect the healthy development of egg freezing technology and can satisfy the needs and wishes of women's reproduction effectively within a reasonable range.

OBJECTIVE: To screen new serum metabolic biomarkers for different drug resistance profiles of pulmonary tuberculosis (TB) and explore their mechanisms and functions. METHODS: We collected serum samples from TB patients with drug sensitivity (DS), monoresistance to isoniazid (MR-INH), monoresistance to rifampin (MR-RFP), multidrug resistance (MDR), and polyresistance (PR). The metabolites in the serum samples were extracted by oscillatory and deproteinization for LC-MS/MS analysis, and the results were normalized by Pareto-scaling method and analyzed using Metaboanalyst 4.0 software to identify the differential metabolites. The differential metabolites were characterized by function enrichment and co-expression analysis to explore their function and possible pathological mechanisms. RESULTS: Compared with the DS group, 286 abnormally expressed metabolites were identified in MR-INH group, 362 in MR-RPF group, 277 in MDR group and 1208 in PR group by LC-MS/MS analysis. Acetylagmatine ( < 0.05), aminopentol ( < 0.05), and tetracosanyl oleate ( < 0.05) in MR-INH group; Ala His Pro Thr ( < 0.001) and glycinoprenol-9 ( < 0.05) in MR-RFP group; trimethylamine ( < 0.05), penaresidin A ( < 0.05), and verazine ( < 0.05) in MDR group; and PIP (18:1(11Z)/ 18:3(6Z, 9Z, 12Z)) ( < 0.001), Pro Arg Trp Tyr ( < 0.001), N-methyldioctylamine ( < 0.001), and phytolaccoside E ( < 0.05) in PR group all showed significant differential expressions. Significant differential expressions of phthalic acid mono-2-ethylhexyl ester ( < 0.05) and eicosanoyl-EA ( < 0.05) were found in all the drug resistant groups as compared with DS group. CONCLUSIONS Acetylagmatine, aminopentol, tetracosanyl oleate, Ala His Pro Thr, glycinoprenol-9, trimethylamine, penaresidin A, verazine, PIP(18:1(11Z)/18:3(6Z, 9Z, 12Z)), Pro Arg Trp Tyr, N-methyldioctylamine, phytolaccoside E, phthalic acid mono-2-ethylhexyl ester, and eicosanoyl-EA are potentially new biomarkers that indicate monoresistance, multi-drug resistance and polyresistance of Mycobacterium tuberculosis. The combined use of these biomarkers potentially allows for assessment of drug resistance in TB and enhances the diagnostic sensitivity and specificity.
Biomarkers ; Chromatography, Liquid ; Humans ; Tandem Mass Spectrometry ; Tuberculosis, Multidrug-Resistant ; Tuberculosis, Pulmonary

Objective To detect plasma interleukins-35 (IL-35 )level in the patients with active tuberculosis complicated with bronchiectasis and to analyze its clinical significance.Methods Peripheral blood of patients with active tuberculosis from depart-ment of Dongguan 6th People′s hospital were collected,assigned to the active tuberculosis complicated with bronchiectasis group and active tuberculosis group.The healthy volunteers served as the control group.The plasma IL-35 level was measured by ELISA, and peripheral blood neutrophils and lymphocytes were detected by hematology analyzer.Results The levels of plasma IL-35 signif-icantly increased in both patients with active tuberculosis complicated with bronchiectasis and patients with active tuberculosis.The level of plasma IL-35 of patients with active tuberculosis complicated with bronchiectasis was significantly higher than that of the patients with active tuberculosis.The absolute value and percentage of peripheral blood neutrophils of patients with active tubercu-losis complicated with bronchiectasis were significantly higher than those of healthy volunteers.However,the percentage of periph-eral blood lymphocytes of patients with active tuberculosis complicated with bronchiectasis was significantly lower than that of healthy volunteers.Pearson correlation analysis showed that the absolute value of peripheral blood neutrophils of patients with ac-tive tuberculosis was positively correlated to the level of plasma IL-35.Conclusion IL-35 may play an important role in the progres-sion of active tuberculosis complicated with bronchiectasis.The determination of IL-35 may be helpful to the diagnosis of patients with active tuberculosis complicated with bronchiectasis.

Objective To study serum IL-22 levels in patients with pulmonary tuberculosis and diabetes mellitus (PPTDM) and to analysis their clinical significance.Methods ELISA was used to detect serum IL-22 levels in 30 cases PPTDM pa-tients,30 cases pulmonary tuberculosis (PTB)patients,30 cases diabetes mellitus (DM)patients and 30 cases healthy vol-unteers (HV).Results Serum IL-22 levels of PPTDM patients (54.4±4.81 pg/ml)were significantly lower than those in diabetes mellitus (DM)patients (72.36±5.12 pg/ml)and healthy volunteers (HV)(68.32±3.08 pg/ml)(t=2.557,P =0.013;t=2.437,P =0.018),respectively.There was no significantly different of serum IL-22 levels between PPTDM and PTB patients (t=1.190,P =0.239).Serum IL-22 levels of diabetes mellitus coincident with pulmonary tuberculosis (DM-PTB)patients (64.62±8.59 pg/ml)were significantly higher than those in pulmonary tuberculosis coincident with diabetes mellitus (PTB-DM)patients (44.21±2.68 pg/ml)(t=2.267,P =0.031).Conclusion IL-22 may play an important role in PPTDM development.

Objective To evaluate the effect of the difficult embryo transfer on the clinical pregnancy outcome of in vitro fertili-zation-embryo transfer(IVF-ET) .Methods There were 209 fresh cycles of difficultly transferring and 2 489 fresh cycles of easily embryo transferring between January 2011 and December 2012 .The clinical outcome was compared .Results There were statistical-ly significant differences in the catheter blood staining rates (51 .20% vs 27 .68% ,P< 0 .05) ,implantation rate(31 .14% vs 35 . 54% ,P<0 .05) ,and clinical pregnancy rate (46 .41% vs 55 .56% ,P<0 .05)between the two groups .There was no significant difference in the rates of ectopic pregnancy and miscarriage between the two groups (P>0 .05) .Conclusion Difficulty ET will in-fluence the clinical pregnancy .Therefore ,all efforts should be made to avoid the difficult transfer in order to increase the pregnant rate .

Objective This study was designed to investigate the correlationship between plasma metastin and pathogenesis of adolescent women with polycystic ovary syndrome(PCOS).MethodsFrom Jan 2006 to Jun.2006.42 PCOS patients including 19 adolescent women and 23 adults with syndrome were treated in Second Affiliated Hospital of Sun Yat-Sen University.According to the range of age,those patients were divided into 19 cases in adolascent group(≤19 years)and 23 cases in aduh group(＞19 years).Meanwhile,20 adolescent women were matched as controls.Blood samples were collected between day 1 and day 5 of a spontaneous bleeding episode in the PCOS groups and a menstrual cycle of the controls.The Jevels of luteinizing hormone(LH)，follicle-stimulating hormone(FSH)，testosterone(T)，free T(FT)，dehydroepiandrosterone sulfate(DHEAS)，sex hormone-binding globulin(SHBG)，insulin，glucose，and metastin were detected from day 1 to day 5 of spontaneous bleeding or withdrawal bleeding by progesterone.On the next day,oral glucose tolerance test(75 g)and insulin release test were performed on those above patients and controls.The area under carve(AUC),the ratio of fasting blood glucose to insulin(GIR)and homeostasis model assessment insulin resistance jndex ( HOMA-IR)were calculated.Results(1)The level of hormone:the level of LH was in(12±7)U/L in adult group and(12±8)U/L in adolescent PCOS group，which were significantly higher than(6±4)U/L in controls(P＜0.05).The level of FT was(2.3±1.2)pmol/L in adult group，which was significantly higher than(1.3±0.8)pmol/L in adolescent group and(1.1±0.5)pmol/L in control roup(P＜0.05).It was observed that the level of(3.1±2.7)μmol/L in adolescent group was significantly lower than(6.3±2.7)μmol/L in control group(P＜0.05).Meanwhile,the level of FAI of 5.6±4.1 in adult group was significantly higher than 3.0±1.3 in control group(P＜0.05).No significant difference in FSH，T and SHBG levels among three groups were observed (P＞0.05).(2)Metastin and metabolism:Both the levels of fasting blood insulin,2-hour insulin and AUC of insulin were(13±7)mU/L，(88±59)mU/L and(133±80)mU·L-1·min-1 in adolescent group，which were significantly higher than(7±3)mU/L，(57±29)mU/L and(82±34)mU·L-1·min-1 in control group.The fasting blood insulin of(13±7)mU/L in adolescent group was significantly higher than (9±5)mU/L in adult group.The level of fasting blood glucose and 2-hour glucose were(5.01±0.44)mmol/L and(6.48±1.16)mmol/L in adult group，which were significantly higher than(4.68±0.29)mmol/L and(5.44±0.83)mmol/L in control group and(4.67±0.30)mmol/L and(5.93±1.44)mmol/L in adolescent group.The glucose AUC of(9.99±1.85)mmol·L-1·min-1 in adult group was significantly higher than(8.42±1.53)mmol·L-1·min-1 in control group(P＜0.05).HOMA-IR of 2.6±2.0 in adolescent group was significantly higher than 1.4±0.7 in control group.GIR of 10±8 in adolescent group was significantly lower than 16±10 in control group(P＜0.05).The metastin level of (0.25±0.19)pmol/L in adolescent group and(0.29±0.29)pmol/L in adult group were all significantly higher than(0.18±0.23)pmol/L in control group(PPh glucose were observed(r=0.256，0.286 and 0.267.P=0.044.0.025 and 0.043).Conclusions The expression of metastin in adolescent PCOS women was significantly higher that of normal adolescent women The increased level of metastin might be associated with pathogenesis of adolescent women with PCOS.

Objective To investigate the effect of anti-Mlllerian hormone (AMH) on hormone secretion and P450 aromatase mRNA expression from cultured human luteinized granulosa cells. Methods Human luteinized granulose cells were derived from 10 patients treated by in vitro fertilization-embryo transplantation (IVF-ET) in the Second Affiliated Hospital of Sun Yat-sen University from June to December 2006. Granulose cells were divided into group A, B, C, D, E depending on different concentration of AMH,testosterone group and blank group. 1×10-7moL/L testosterone and 1,5,10,20,50 μg/L AMH were added into the culture medium of group A,B,C,D and E. 1×10-7mol/L testosterone was added into the culture medium of testosterone group while no other ingredient was added into the medium of blank group. Estrogen levels in supernates were measured at 24,48,72 hours after cell incubation. RT-PCR was performed to detect the P450 aromatase mRNA expression in group B, C, D, E and testosterone group at 72 hours after cell incubation. Results (1) Estrogen levels in supernates of granulose cell culture at 24,48,72 hours were (8.529±0.381)×104, (10.977±0.436)×104, (13.309±0.506)×104 pmol/L in group A, (7.027±0.276)×104, (9.167±0.300)×104, (10.794±0.555)×104 pmol/L in group B, (6.039±0.226)×104,(7.585±0.548)×104, (8.797±0.518)×104 pmol/L in group C, (5.118±0.460)×104, (5.716±0.496)×104, (6.205±0.667)×104 pmol/L in group D, (4.932±0.148)×104, (5.323±0.184)×104,(5.629±0.212)×104 pmol/L in group E. When compared with blank group [(0.001±0.001)×104,(0.006±0.003)×104, (0.029±0.011)×104 pmol/L], the statistical differences were observed in group A,B,C,D,E(P<0.01) ; when compared with testosterone group [ (8.418±0.569)×104, (10.841±0.689)×104, (13.301±0.637)×104 pmol/L], the statistical differences were observed in group B,C,D and E(P<0.01) ; statistical differences were also observed in group C, D and E when compared with group B, and also group D and E when compared with group C(P<0.01). No significant difference was observed between group D and E (P>0.05). In group A, B, C, D, E and testosterone group, the estrogen levels at 24 hours after cell culture were significantly lower than those at 48 and 72 hours (P<0.01) ; statistical difference was observed between estrogen levels at 48 and 72 hours(P<0.01). No significant difference was observed among 24,48 and 72 hours in blank group (P>0.05). (2) Relative ratios of intensity of P450 aromatase/β-actin at72 hours of cell culture in group B,C,D and E were 0.6148±0.0046, 0.5156±0.0012, 0.4698±0.0027 and 0.4282±0.0017, respectively, which were statistically lower than that in testosterone group (0.8224±0.0021, P<0.01) ;statistical differences were also observed in group C, D and E when compared with group B, and also group D and E when compared with group C(P<0.01). No significant difference was observed between group D and E (P>0.05). Conclusion It is suggested that AMH might affect estrogen synthesis by inhibiting P450 aromatose activity so that lead to hyperandrogenism microenvironment in local ovary.