Objective:To analyze the clinical phenotype, sperm morphological characteristics and assisted reproductive therapy efficiency in patients with total globozoospermia.Methods:Four male patients with total globozoospermia were collected during November 2019 to May 2022 from Reproductive Medical and Genetic Center, the People's Hospital of Guangxi Zhuang Autonomous Region. Peripheral blood samples were collected for genetic detection and the whole exome sequencing to explore the pathogenic genes. Semen characteristics, sperm morphology and ultrastructure were analyzed. Four patients were treated with intracytoplasmic sperm injection (ICSI) combined with artificial oocyte activation (AOA). Conventional ICSI cycles ( n=9) were selected as control group, and the development dynamic parameters were monitored by Time-lapse. The fertilization and embryo development parameters, developmental dynamic parameters and clinical outcomes were analyzed between the two groups. Results:Four patients were complicated with low sperm motility and increased sperm DNA fragmentation. Sperm morphology analysis and acrosome fluorescence staining represented that all the spermatozoas were with a small round head lacked of acrosome. By the transmission electron microscope, it was observed that round-headed spermatozoas were lacked of acrosome completely, loose chromatin structure, vacuolation and other abnormal changes in the head, mitochondrial sheath in neck were reduced arranged in disorder, and the structure of "9+2" of the flagellar axial filament was incomplete. Of the 4 patients, 1 was homozygous deletion of DPY19L2 gene and 1 was homozygous frameshift mutation of DPY19L2 gene. There were no significance differences in fertilization rate, two pronuclei fertilization rate, day 3 high-quality embryo rate, day 6 blastocyst formation rate and day 6 high-quality blastocyst formation rate between total globozoospermia group and control group (all P>0.05). The developmental dynamic parameters as the time at which the second polar body is extruded, the time when both (or the last) PN disappear, two to six discrete cells in the total globozoospermia group were significantly earlier than those in control group, and the difference was statistically significant (all P<0.05). There was no significant difference in the embryo cleavage patterns between the two groups ( P>0.05). Among the 4 patients with total globozoospermia, 2 live births with signal healthy male baby were achieved by fresh embryo transfer, and 2 live births with one signal healthy male baby and one healthy female baby were achieved by frozen-thawed embryo transfer respectively. Conclusion:Abnormal morphology characteristics of spermatozoas from patients with total globozoospermia are obvious, patients with total globozoospermia could have favorable clinical outcomes following ICSI combined with AOA.

Objective:To analyze the clinical phenotype, sperm morphological characteristics and assisted reproductive therapy efficiency in patients with total globozoospermia.Methods:Four male patients with total globozoospermia were collected during November 2019 to May 2022 from Reproductive Medical and Genetic Center, the People's Hospital of Guangxi Zhuang Autonomous Region. Peripheral blood samples were collected for genetic detection and the whole exome sequencing to explore the pathogenic genes. Semen characteristics, sperm morphology and ultrastructure were analyzed. Four patients were treated with intracytoplasmic sperm injection (ICSI) combined with artificial oocyte activation (AOA). Conventional ICSI cycles ( n=9) were selected as control group, and the development dynamic parameters were monitored by Time-lapse. The fertilization and embryo development parameters, developmental dynamic parameters and clinical outcomes were analyzed between the two groups. Results:Four patients were complicated with low sperm motility and increased sperm DNA fragmentation. Sperm morphology analysis and acrosome fluorescence staining represented that all the spermatozoas were with a small round head lacked of acrosome. By the transmission electron microscope, it was observed that round-headed spermatozoas were lacked of acrosome completely, loose chromatin structure, vacuolation and other abnormal changes in the head, mitochondrial sheath in neck were reduced arranged in disorder, and the structure of "9+2" of the flagellar axial filament was incomplete. Of the 4 patients, 1 was homozygous deletion of DPY19L2 gene and 1 was homozygous frameshift mutation of DPY19L2 gene. There were no significance differences in fertilization rate, two pronuclei fertilization rate, day 3 high-quality embryo rate, day 6 blastocyst formation rate and day 6 high-quality blastocyst formation rate between total globozoospermia group and control group (all P>0.05). The developmental dynamic parameters as the time at which the second polar body is extruded, the time when both (or the last) PN disappear, two to six discrete cells in the total globozoospermia group were significantly earlier than those in control group, and the difference was statistically significant (all P<0.05). There was no significant difference in the embryo cleavage patterns between the two groups ( P>0.05). Among the 4 patients with total globozoospermia, 2 live births with signal healthy male baby were achieved by fresh embryo transfer, and 2 live births with one signal healthy male baby and one healthy female baby were achieved by frozen-thawed embryo transfer respectively. Conclusion:Abnormal morphology characteristics of spermatozoas from patients with total globozoospermia are obvious, patients with total globozoospermia could have favorable clinical outcomes following ICSI combined with AOA.

Objective:To explore the clinical characteristics of elderly patients with type 2 diabetes mellitus (T2DM) complicated with coronary atherosclerotic heart disease (CHD) and analyze the risk factors of CHD in patients with T2DM.Methods:Using the method of retrospective cohort study, 406 elderly male patients with T2DM (≥75 years old) admitted to Xinhua Hospital Affiliated to Shanghai Jiaotong University from January 2017 to January 2020 were selected and divided into T2DM without CHD group (165 cases) and T2DM with CHD group (241 cases). The clinical characteristics in elderly patients with T2DM complicated with CHD and risk factors for CHD were analyzed.Results:The age ((86.78±5.35 )years old), course of T2DM((12.32±0.46) years), fasting blood glucose(FPG)((7.64±2.81) mmol/L), hemoglobin a1c (HbA1c)((7.59±1.21)%), the proportion of hypertension(84.65%(204/241)), D-dimer((0.50±0.13) mg/L), the incidence of thromboembolic events(46.06%(111/241)), blood serum creatinine ((94.81±12.70) μmol/L), urea nitrogen((8.31±4.46) mmol/L), uric acid((376.44±116.01) μmol/L) in T2DM with CHD group were higher than those in T2DM without CHD((78.51±4.81)years old, (10.66±0.67)years, (6.84±2.19) mmol/L, (7.02±2.15)%, 63.03%(104/165), (0.21±0.04 ) mg/L, 13.33%(22/165), (83.01±14.40) μmol/L, (6.79±2.89) mmol/L, (333.56±95.15) μmol/L ), and the differences were statistically significant( t=15.908, t=2.042, t=3.055, t=3.088, χ 2=23.828, t=5.059, χ 2=42.098, t=2.401, t=4.188, t=4.075; all P<0.05). The total bilirubin(TBil)(8.80(6.60, 11.60) μmol/L), glomerular filtration rate(GFR)((76.49±29.80) mL/(min·1.75 m 2)) in T2DM with CHD group were lower than those in T2DM without CHD group (11.25(8.23, 15.28) μmol/L, (91.81±28.31) mL/(min·1.75 m 2)), the differences were statistically significant( Z=2.304, t=5.126; all P<0.001). The total cholesterol((3.84±0.85) mmol/L), low-density lipoprotein cholesterol(LDL-C)((2.12±0.68 ) mmol/L) in T2DM with CHD group were lower than those in T2DM without CHD group((4.10±1.00) mmol/L, (2.45±0.85) mmol/L), the differences were statistically significant( t=2.828, 4.156; all P<0.05). The rate of starting lipid-lowering and stable plaque treatment in T2DM with CHD group (82.57%(199/261))was higher than that in T2DM without CHD group(42.42%(70/165)), and the difference was statistically significant (χ 2=70.614, P<0.001). Influenced by lipid-lowering therapy, the total cholesterol and LDL-C in T2DM patients with CHD were significantly decreased.Logistic regression analysis showed that age elevated( OR 1.346, 95% CI 1.263-1.434, P<0.001), elevated hemoglobin a1c concentration( OR 1.427, 95% CI 1.140-1.785, P=0.002), complicated with hypertension( OR 3.534, 95% CI 1.684-7.418, P=0.001), elevated D-dimer concentration( OR 3.969, 95% CI 1.227-12.841, P=0.021)and elevated uric acid concentration( OR 1.005, 95% CI 1.001-1.008, P=0.006)were independent risk factors for CHD in elderly male patients with T2DM. Conclusion:Elderly patients with T2DM complicated with CHD are more likely to be in hypercoagulable state, more likely to have thromboembolic events, and more obvious renal function damage.Poor fasting blood glucose control and decreased total bilirubin concentration are the influencing factors of CHD in elderly male patients with T2DM.Age elevated, elevated hemoglobin a1c concentration, complicated with hypertension, elevated D-dimer concentration and elevated uric acid concentration are independent risk factors for CHD in elderly male patients with T2DM.

Objective:To establish a technical system for early judgment and rescue artificial oocyte activation of oocytes after fertilization failed, intracytoplasmic sperm injection (ICSI) and to explore the activation efficiency and application value.Methods:Firstly, a retrospective analysis was performed in 150 ICSI cycles cultured by Time-lapse system during January 2017 to March 2018 from Reproductive Medical and Genetic Center, the People's Hospital of Guangxi Zhuang Autonomous Region, the time distribution of the second polar body (Pb2) exclusion and its relationship with fertilization and embryo development outcomes, the feasibility of Pb2 exclusion as an early indicator of fertilization failure in ICSI was discussed. Secondly, 225 fertilization failed oocytes from 93 ICSI cycles during March 2018 to June 2019 were collected for randomized controlled trials according to different artificial activation modes. They were divided into three groups including non-activation group (NAOA group), rescue activation group (RAOA group) and late activation group (LAOA group). At the same time, the rest of injected oocytes from ICSI cycles include in this study were used as control group. Fertilization and embryo development parameters were used to explore the efficiency and application value of rescue artificial activation for after fertilization failure oocytes ICSI.Results:Time-lapse monitoring showed that the fertilization rate and 2PN fertilization rate were 99.91% and 97.76% in the Pb2-exclusion group, 0.03% and 0% in the without Pb2-exclusion group after ICSI, with significant differences between the two groups ( P<0.001); the exclusion time of Pb2 after ICSI was (3.04±1.45) h, and the distribution and proportion of Pb2 exclusion time were 0-3 h (58.00%), 3-5 h (36.29%), 5-8 h (3.92%) and >8 h (1.21%). The Pb2 exclusion rate, the fertilization rate and the 2PN fertilization rate in NAOA group were all 0%, and the 2PN fertilization rate (36.00%), day 3 (D3) high-quality embryo rate (8.00%), day 5 (D5) blastocyst formation rate (0%) and D5 high-quality blastocyst formation rate (0%) in LAOA group were significantly lower than those in RAOA group (60.00%, 44.19%, 51.16%, 25.58%) ( P=0.005, P=0.002, P<0.001, P=0.005), and also in control group (97.63%, 48.62%, 63.23%, 37.94%) ( P<0.001); the Pb2 exclusion rate (84.00%), the fertilization rate (81.33%), the 2PN fertilization rate (60.00%) and the 2PN cleavage rate (95.56%) in RAOA group were significantly lower than those in control group (100.00%, 99.68%, 97.63%, 99.51%) ( P<0.001, P<0.001, P<0.001, P=0.04). However, there was no significant difference in D3 high-quality embryo rate, D5 blastocyst formation rate and D5 high-quality blastocyst formation rate between the two groups ( P>0.05). Conclusion:Time-lapse monitoring of the Pb2 exclusion can be used as an early judgment indicator of fertilization failure in ICSI cycles. Rescue artificial activation of fertilization failed oocytes in 5 h after ICSI can achieve normal fertilization and acceptable embryo development outcomes.

Objective:To establish a technical system for early judgment and rescue artificial oocyte activation of oocytes after fertilization failed, intracytoplasmic sperm injection (ICSI) and to explore the activation efficiency and application value.Methods:Firstly, a retrospective analysis was performed in 150 ICSI cycles cultured by Time-lapse system during January 2017 to March 2018 from Reproductive Medical and Genetic Center, the People's Hospital of Guangxi Zhuang Autonomous Region, the time distribution of the second polar body (Pb2) exclusion and its relationship with fertilization and embryo development outcomes, the feasibility of Pb2 exclusion as an early indicator of fertilization failure in ICSI was discussed. Secondly, 225 fertilization failed oocytes from 93 ICSI cycles during March 2018 to June 2019 were collected for randomized controlled trials according to different artificial activation modes. They were divided into three groups including non-activation group (NAOA group), rescue activation group (RAOA group) and late activation group (LAOA group). At the same time, the rest of injected oocytes from ICSI cycles include in this study were used as control group. Fertilization and embryo development parameters were used to explore the efficiency and application value of rescue artificial activation for after fertilization failure oocytes ICSI.Results:Time-lapse monitoring showed that the fertilization rate and 2PN fertilization rate were 99.91% and 97.76% in the Pb2-exclusion group, 0.03% and 0% in the without Pb2-exclusion group after ICSI, with significant differences between the two groups ( P<0.001); the exclusion time of Pb2 after ICSI was (3.04±1.45) h, and the distribution and proportion of Pb2 exclusion time were 0-3 h (58.00%), 3-5 h (36.29%), 5-8 h (3.92%) and >8 h (1.21%). The Pb2 exclusion rate, the fertilization rate and the 2PN fertilization rate in NAOA group were all 0%, and the 2PN fertilization rate (36.00%), day 3 (D3) high-quality embryo rate (8.00%), day 5 (D5) blastocyst formation rate (0%) and D5 high-quality blastocyst formation rate (0%) in LAOA group were significantly lower than those in RAOA group (60.00%, 44.19%, 51.16%, 25.58%) ( P=0.005, P=0.002, P<0.001, P=0.005), and also in control group (97.63%, 48.62%, 63.23%, 37.94%) ( P<0.001); the Pb2 exclusion rate (84.00%), the fertilization rate (81.33%), the 2PN fertilization rate (60.00%) and the 2PN cleavage rate (95.56%) in RAOA group were significantly lower than those in control group (100.00%, 99.68%, 97.63%, 99.51%) ( P<0.001, P<0.001, P<0.001, P=0.04). However, there was no significant difference in D3 high-quality embryo rate, D5 blastocyst formation rate and D5 high-quality blastocyst formation rate between the two groups ( P>0.05). Conclusion:Time-lapse monitoring of the Pb2 exclusion can be used as an early judgment indicator of fertilization failure in ICSI cycles. Rescue artificial activation of fertilization failed oocytes in 5 h after ICSI can achieve normal fertilization and acceptable embryo development outcomes.