1.PET/CT imaging of PD-1 receptor probe targeting S180 sarcoma in mice
Haifeng HUANG ; Jiangnan SUN ; Huan ZOU ; Tao BAO ; Hua ZHU ; Xianteng YANG ; Shanshan LI
Acta Universitatis Medicinalis Anhui 2026;61(4):682-688
ObjectiveTo explore the feasibility of constructing a programmed death receptor-1(PD-1) molecular probe for non-invasive micro-positron emission tomography/computed tomography (Micro-PET/CT) imaging of PD-1 protein in mouse S180 sarcoma. MethodsA transgenic PD-1 C57 S180 sarcoma mouse model was established using the S180 sarcoma cell injection. Furthermore, 124I-anti-PD-1 monoclonal antibody probe was synthesized. 18.5 MBq of the 124I-anti-PD-1 probe was injected into the tail vein of transgenic PD-1 C57 mice. Subsequently, S180 sarcoma was imaged using Micro-PET/CT. ResultsStudy successfully established a transgenic PD-1 C57 S180 sarcoma mouse model. Immunohistochemical (IHC) results showed PD-1 protein expression in S180 sarcoma. Micro-PET/CT imaging successfully visualized the PD-1 protein receptor in S180 sarcoma at different time points (20, 48, 72, and 120 h) after probe injection. ConclusionThe 124I-anti-PD-1 monoclonal antibody molecular probe successfully targets the PD-1 receptor in S180 sarcoma of transgenic PD-1 C57 mice, and presents clear Micro-PET/CT immunoassay results, thus it potentially enables the non-invasive screening of patients with PD-1 positive malignant tumors.
2.Evaluation of Effect of Tongnaoyin on Blood-brain Barrier Injury in Acute Ischemic Stroke Patients Based on Dynamic Contrast-enhanced Magnetic Resonance Imaging
Yangjingyi XIA ; Shanshan LI ; Li LI ; Xiaogang TANG ; Xintong WANG ; Qing ZHU ; Hui JIANG ; Cuiping YUAN ; Yongkang LIU ; Zhaoyao CHEN ; Wenlei LI ; Yuan ZHU ; Minghua WU
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(2):140-146
ObjectiveTo evaluate the effects of Tongnaoyin on the blood-brain barrier status and neurological impairment in acute ischemic stroke (AIS) patients with the syndrome of phlegm-stasis blocking collaterals by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). MethodsA total of 63 patients diagnosed with AIS in the Jiangsu Province Hospital of Chinese Medicine from October 2022 to December 2023 were enrolled in this study. According to random number table method,the patients were assigned into a control group (32 cases) and an observation group (31 cases). The control group received conventional Western medical treatment,and the observation group took 200 mL Tongnaoyin after meals,twice a day from day 2 of admission on the basis of the treatment in the control group. After 7 days of treatment,the patients were examined by DCE-MRI. The baseline data for two groups of patients before treatment were compared. The National Institute of Health Stroke Scale (NIHSS) score and modified Rankin Scale (mRS) score were recorded before treatment and after 90 days of treatment for both groups. The rKtrans,rKep,and rVe values were obtained from the region of interest (ROI) of the infarct zone/mirror area and compared between the two groups. ResultsThere was no significant difference in the NIHSS or mRS score between the two groups before treatment. After 90 days of treatment,the NIHSS and mRS scores declined in both groups,and the observation group had lower scores than the control group (P<0.05). After treatment,the rKtrans and rVe in the observation group were lower than those in the control group (P<0.01). ConclusionCompared with conventional Western medical treatment alone,conventional Western medical treatment combined with Tongnaoyin accelerates the repair of the blood-brain barrier in AIS patients,thereby ameliorating neurological impairment after AIS to improve the prognosis.
3.Research progress in tolerance of petroleum hydrocarbon pollutant-degrading strains.
Shanshan WANG ; Xiaoqian ZHU ; Zhibei CAO ; Lu WANG ; Mingzhu DING
Chinese Journal of Biotechnology 2025;41(1):199-215
Petroleum hydrocarbon pollution has become one of the global environmental problems, posing a serious threat to the environment and human health. Microbial remediation plays an important role in the remediation of petroleum hydrocarbon-contaminated environment. Nevertheless, the stress factors present in the environment polluted by petroleum hydrocarbons limit the effectiveness of microbial remediation. This paper reviews the common stress factors in petroleum hydrocarbon-polluted environment and the response mechanisms of microorganisms to these factors. Furthermore, we introduce the methods to improve microbial tolerance, such as irrational modification, rational modification based on systems biology tools or tolerance mechanisms, and the construction of microbial consortia. The application of these methods is expected to improve the viability and remediation efficiency of microorganisms in petroleum hydrocarbon-contaminated environment and provide new perspectives and technical support for environmental remediation.
Biodegradation, Environmental
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Petroleum/metabolism*
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Hydrocarbons/isolation & purification*
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Bacteria/genetics*
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Environmental Pollutants/isolation & purification*
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Petroleum Pollution
4.Effects of enhanced core stabilization training based on real-time ultrasound imaging in patients with chronic nonspecific low back pain
Shanshan LIN ; Bo ZHU ; Yan WANG
Chinese Journal of Rehabilitation Medicine 2025;40(7):1040-1046
Objective:To investigate the efficacy of enhanced core stabilization training based on real-time ultrasound im-aging in patients with chronic nonspecific low back pain(CNLBP).Method:From May,2020 to July,2022,30 patients with CNLBP were randomly divided into two groups with 15 patients in each group.The treatment course was 4 weeks,with real-time ultrasound imaging feed-back combined with core stabilization training or core stabilization training alone.The pain was assessed with visual analogue scale(VAS),the lumbar spine mobility was assessed with the finger-to-floor distance(FFD),and the HUMAC NORM multi-joint isokinetic testing and rehabilitation system was used to evaluate the spine flexion absolute error(AE).The musculoskeletal ultrasonography was used to evaluate the thickness and con-traction rate of transversus abdominis(TrA).Result:After training,the scores of VAS,FFD,and AE in the flexion position of 2 groups were improved compared with the scores before treatment,and the differences were statistically significant(P<0.05),and the improvement in the experimental group was more obvious than that in the control group(P<0.05).There was no statistical significance in the thickness of TrA between the two groups after training.However,the contrac-tion rate of TrA in the observation group was significantly higher than that in the control group,and the dif-ference was statistically significant(P<0.05).Conclusion:Enhanced core stabilization training based on real-time ultrasound imaging has a better short-term therapeutic effect on CNLBP,which is more helpful in reducing pain intensity,enhancing muscle contraction efficiency,and improving the dysfunction of CNLBP patients.
5.Effects of Split Formulas of Biyuan Heji on Paranasal Sinus Mucosal Inflammation in ARS Rats Based on the Pathogenesis of"Wind-Cold Transforming into Lung-Heat"
Huixia ZHOU ; Shanshan XUE ; Lu BAI ; Yang FANG ; Xinchen SUN ; Zhiyuan ZHU ; Yongjun WU
Journal of Nanjing University of Traditional Chinese Medicine 2025;41(5):689-695
OBJECTIVE To investigate the effects of the split formulas of Biyuan Heji(BYHJ)on paranasal sinus mucosal in-flammation in rats with acute rhinosinusitis(ARS)based on the pathogenesis of"wind-cold transforming into lung-heat".METHODS Unilateral nasal cavity occlusion combined with nasal dripping of Staphylococcus aureus were performed to establish a rat model of ARS.SD rats were randomly divided into blank,model,BYHJ(wind-cold removal+lung-heat removal),lung-heat removal,wind-cold removal,and positive drug groups,with 6 rats in each group.The rats were treated with the corresponding drugs for 7 d and then the samples were collected.HE staining was used to observe the pathological changes of rat paranasal sinus mucosa tissues,ELISA was employed to determine the levels of interleukin-1β(IL-1β),IL-6,IL-8,IL-9,IL-10,and IL-12 in serum,immunohistochemis-try(IHC)was adopted to measure the protein expression of tumor necrosis factor-α(TNF-α)and intercellular adhesion molecule(ICAM-1)in paranasal sinus mucosa tissues,and Western blot was used to detect the protein expression of phosphorylated p38 mito-gen-activated protein kinase(p38 MAPK),nuclear transcription factor-κB p50(NF-κB p50),and NF-κB p65 in paranasal sinus mucosa tissues.RESULTS The acute sinusitis rat inflammation model was successfully established.Compared with the model group,the water drinking,diet eating,and body weight of rats in the BYHJ group,wind-cold removal,lung-heat removal,and positive drug groups were significantly improved,the aggregation of inflammatory cells in the paranasal sinus mucosal tissue was reduced,and the levels of IL-1β,IL-6,IL-8,IL-9,and IL-12 in the serum were significantly reduced(P<0.01),IL-10 content significantly in-creased(P<0.01),the protein expression of TNF-α,ICAM-1,p38 MAPK,NF-κB p50,and NF-κB p65 in the paranasal sinus mucosa was significantly decreased(P<0.01).The comparison between various traditional Chinese medicine groups showed that the decrease of IL-1β,IL-6,IL-8,IL-9,IL-12,TNF-α,ICAM-1,p38 MAPK,NF-κB p50,and NF-κB p65 and the increase of IL-10 in the BYHJ group were better than those in the split formula groups(P<0.01),and the lung-heat removal group was better than the wind-cold removal group(P<0.01).CONCLUSION BYHJ and its split formulas can effectively inhibit the inflammatory response in rats with ARS.
6.Health economic evaluation of minimally invasive surgery in treatment of digestive tract cancers: a Meta-analysis
Xiaoyue YIN ; Ning ZHOU ; Xueli YANG ; Zhuoyu SUN ; Yinghui BAO ; Shengshu WANG ; Ke HAN ; Jing LONG ; Min ZHAO ; Haowei LI ; Rongrong LI ; Shimin CHEN ; Junhan YANG ; Huaihao LI ; Yueting SHI ; Guoning ZHU ; Jianhua WANG ; Shanshan YANG ; Boyan LI ; Wenchang WANG ; Shengyan DU ; Yao HE ; Enqiang LING-HU ; Huikai LI ; Miao LIU ; Juan XIE
Chinese Journal of Epidemiology 2025;46(1):154-165
Objective:To compare minimally invasive surgery with traditional open surgery, analyze the current application status of health economic evaluations in the treatment of digestive tract cancers, such as esophageal cancer, gastric cancer, and colorectal cancer by minimally invasive surgery and provide evidence for the rational selection of clinical treatment, alleviation of disease-related economic burdens, and rational allocation of healthcare resources.Methods:By using five databases, i.e. China National Knowledge Infrastructure, Wanfang data, Chinese Biomedical Literature Database, PubMed, and Embase, a database was established to retrieve all the papers about health economic studies of minimally invasive surgery for esophageal cancer, gastric cancer, and colorectal cancer published until December 31, 2023. Literature was analyzed by using software NoteExpress 3.8, and data were processed using Excel 2021. The quality of included papers was evaluated using the CHEERS 2022 checklist, and Meta-analysis was conducted by using software Stata 17.0.Results:A total of 10 919 relevant papers were retrieved, and 59 studies were included. Only 14 studies (23.7%) used standard health economic evaluation methods. Meta-analysis results revealed no significant differences in direct medical expenditure and total expenditure between minimally invasive surgery and open surgery. However, the expenditure for minimally invasive surgery exhibited a significant increase [mean difference ( MD)=5 973.12 yuan, P<0.001], while hospital stay and indirect expenditure significantly decreased ( MD: -4.85 days and -733.79 yuan, P<0.001). In China, for gastric cancer, the direct medical expenditure of endoscopic surgery was lower than that of open surgery ( MD=-33 000.00 yuan) with no significant difference ( P<0.001). In colorectal cancer cases, the direct medical and surgical expenditures for laparoscopic surgery were higher than those for open surgery ( MD: 4 277.94 yuan and 4 267.80 yuan, P<0.001), while the indirect and total medical expenditures decreased ( MD: -768.34 yuan and -159.10 yuan). Hospital stays in patients who had minimally invasive surgery for all three types of cancer were shorter than those who had open surgery ( P<0.001). Conclusions:In the treatment of gastrointestinal cancer, compared with open surgery, minimally invasive surgery shows higher expenditure, but has advantages, such as shorter hospital stay and lower indirect expenditure, and there were no significant differences in direct medical and total expenditures between the two approaches. When conducting health economic evaluation, factors such as postoperative complications, hospital stay, and patient's economic status should be considered for their impact on total medical expenditure. It is necessary to pay attention to the application of health economic evaluations in healthcare decision-making.
7.Analysis of optic disc morphology changes and related factors in children and adolescents with high myopia
Shanshan WANG ; Jun ZHU ; Yingying ZHOU ; Shuya JIA ; Jinmei WU ; Lei SUN ; Min XU ; Zhe LI ; Fang CHEN
Chinese Journal of Ocular Fundus Diseases 2025;41(7):534-541
Objective:To investigate the incidence and influencing factors of optic disc changes in children and adolescents with high myopia.Methods:A clinical cross-sectional study. A total of 162 children and adolescents with high myopia (162 eyes) who visited Department of Ophthalmology, Northern Jiangsu People's Hospital Affiliated to Yangzhou University from January to April 2025 were included in this study. Myopia refractive error ≥6.00 D and/or axial length (AL) ≥26 mm. All participants underwent best-corrected visual acuity, refraction, fundus color photography, swept-source optical coherence tomography (SS-OCT), and AL measurement. Subfoveal choroidal thickness (ChT) was measured within 1 mm using SS-OCT. Optic disc changes assessed included tilt, rotation, peripapillary atrophy (PPA), and peripapillary hyperreflective ovoid mass-like structures (PHOMS). The patients were divided into the children group (4-11 years old) and the adolescents group (12-18 years old) based on age, with 63 (38.9%, 63/162) and 99 (61.1%, 99/162) cases respectively. The incidence of ocular features and optic disc morphology changes in the two groups was compared and observed. According to the myopia diopter, the patients were divided into the high diopter long axial group (myopia diopter ≥6.00 D, AL≥26 mm) and the low diopter long axial group (myopia diopter <6.00 D, AL≥26 mm), with 85 (52.5%, 85/162) and 77 (47.5%, 77/162) eyes respectively. The incidence of optic disc morphological changes in the two groups was compared and observed. The comparison of quantitative data between groups was conducted using the Mann-Whitney U test. Multivariate logistic regression was used to analyze the correlations between PPA, optic disc tilt, PHOMS occurrence and gender, age, diopter, AL, and ChT. Results:Among the 162 patients, 103 were male and 59 were female. Age was 12 (10.5, 13.5) years old. Among the 162 eyes, the optic disc morphology changed in 152 eyes (93.8%, 152/162). Among them, the PPA, optic disc tilt, PHOMS, and optic disc rotation were 148 (91.4%, 148/162), 95 (58.6%, 95/162), 62 (38.3%, 62/162), and 35 (21.6%, 35/162) eyes respectively. Myopic macular degeneration in 137 eyes. There were 56 eyes with peripheral retinopathy. There was no statistically significant difference in myopia diopter, AL and ChT between the children group and the adolescent group ( Z=-1.201, -1.934, ?0.761; P=0.230, 0.053, 0.447). There was no statistically significant difference in the incidences of PPA, optic disc tilt and optic disc rotation ( χ2=0.293, 2.618, 0.398; P>0.05). There was no statistically significant difference in the incidence of optic disc morphological changes between the low diopter long axial group and the high diopter long axial group ( χ2=0.000, P>0.05). The results of multivariate logistic regression analysis showed that the thinner the ChT, the higher the risk of PPA [odds ratio (OR) =0.98, 95% confidence interval ( CI) 0.97-0.99, P<0.001]. Female ( OR=2.3, 95% CI 1.04-5.07, P=0.039), older age ( OR=1.17, 95% CI 1.01-1.37, P=0.043), thinner ChT ( OR=0.99, 95% CI 0.99-1.00, P=0.012), the higher the risk of optic disc tilt. The older the age, the higher the risk of developing PHOMS ( OR=1.22, 95% CI 1.06-1.40, P=0.006). Conclusions:Optic disc morphology changes may be the most common fundus alterations in children and adolescents with high myopia. The influencing factors of optic disc morphological changes (including PPA, optic disc tilt, and PHOMS) are female sex, advanced age, and ChT thinning.
8.Clinical effect of indocyanine green angiography-assisted design and harvest of expanded flaps for scar reconstruction
Yanan HU ; Tingjun XIE ; Yuanbo LIU ; Shan ZHU ; Zengjie YANG ; Jia TIAN ; Cheng GAN ; Hu JIAO ; Shanshan LI ; Zixiang CHEN ; Lu ZHOU ; Bing HAN ; Shengyang JIN ; Yan ZENG ; Miao WANG ; Mengqing ZANG
Chinese Journal of Burns 2025;41(4):341-347
Objective:To investigate the clinical effect of indocyanine green angiography (ICGA)-assisted design and harvest of expanded flaps for scar reconstruction.Methods:This study was a retrospective observational study. From April 2019 to August 2023, 19 patients with scars (8 males, 11 females; aged 3-38 years) treated at the Plastic Surgery Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences met the inclusion criteria. The scars were distributed on the head, face, trunk, and extremities. In stage Ⅰ surgery, skin soft tissue expanders were implanted in suitable areas around the scars for skin soft tissue expansion. In stage Ⅱ surgery, the scar tissue was excised, resulting in wound areas ranging from 100 to 210 cm 2, and expanded flaps were designed. ICGA was used to identify target perforators and their accompanying veins, and the flap design was adjusted to ensure the inclusion of complete arterial and venous axes. The expanded flap with an area of 120 to 240 cm2 was harvested using unilateral back-cut technique and transferred to the recipient site, and the donor site wound was sutured directly. The durations of the arterial and venous phases of ICGA during flap design were recorded. The length-to-width ratios of the back-cut flaps were calculated for different regions. After stage Ⅱ surgery, the blood perfusion and survival of the flap, the wound healing at the donor site, and the occurrence of complications were observed. During follow-up, the appearance, color, and texture of the patient's flap were observed. Results:The arterial phase of ICGA lasted 10-27 (18±5) s, and the venous phase lasted 78-116 (100±10) s. The length-to-width ratios of the back-cut flaps were 1.22±0.32, 1.63±0.12, and 1.15±0.21 for the head and neck, trunk, and limb regions, respectively. After stage Ⅱ surgery, one patient had a large area of insufficient blood perfusion in the flap. By comparing ICGA images before and after flap transfer, the sutures at the oral commissure were loosened, the blood flow of the flap was restored. The blood perfusion of the flaps in other patients was good. All flaps survived completely, with well-healed donor site wounds and no complications. During 0.5-14.0 months of follow-up, all flaps of patients demonstrated excellent appearance, with color and texture matching the surrounding skin.Conclusions:As a means of superficial blood flow visualization, ICGA can not only clearly show the microvascular distribution of the expanded flap before operation, assist in optimizing the design of the flap, but also evaluate the blood perfusion of the flap after operation, reduce the occurrence of complications, and provide a full-process navigation for the harvesting of expanded flaps, thereby improving the safety of flap transfer for scar reconstruction.
9.Clinical Study on the Classic Prescription Xinyi Powder in Treating Allergic Rhinitis with Lung Deficiency Related Cold
Shanshan XUE ; Bingruo ZHENG ; Xinchen SUN ; Rongjin LU ; Zhiyuan ZHU ; Yongjun WU
Journal of Nanjing University of Traditional Chinese Medicine 2025;41(2):257-262
OBJECTIVE To explore the clinical efficacy and possible mechanism of the classic prescription Xinyi Powder in the treatment of allergic rhinitis with lung deficiency related cold.METHODS A total of 189 patients who met the inclusion criteria of al-lergic rhinitis with lung deficiency related cold in the otolaryngology clinic of Jiangsu Province Hospital of Chinese Medicine from Janu-ary 2023 to July 2024 were selected and randomly divided into the experimental group(n=126)and the control group(n=63).The control group was treated with oral loratadine,and the experimental group took Xinyi Powder.Before and after treatment,the TNSS,TNNSS scores and TCM syndrome scores of the two groups of patients were compared to comprehensively evaluate the clinical efficacy.The changes in the patients'quality of life were evaluated in multiple dimensions using nasal VAS and RQLQ scores.The changes in serum IL-4,IL-5,IgE,SP and CGRP expression levels were detected by ELISA.RESULTS After 14 days of treatment,the TNSS,TNNSS,VAS,RQLQ scores and TCM syndrome scores of the two groups of patients were reduced(P<0.01);the experi-mental group was better than the control group in improving the concomitant symptoms such as nasal congestion,runny nose,postnasal drip,and itchy eyes(P<0.05,P<0.01),and it could also significantly improve the symptoms of fear of wind and cold,spontaneous sweating,shortness of breath,and cough with thin sputum(P<0.01),and the total RQLQ score was significantly better than the con-trol group(P<0.01).After treatment,the serum IL-4,IL-5,IgE,SP,and CGRP levels of the two groups of patients were signifi-cantly reduced(P<0.01),and there was no statistical difference between the two groups.CONCLUSION Xinyi Powder can signifi-cantly alleviate the nasal symptoms and systemic concomitant symptoms of patients with allergic rhinitis of lung deficiency and cold type,and significantly improve the quality of life of patients.It may play a therapeutic role by inhibiting the expression of inflammatory factors and neuropeptides and regulating neuroimmunity.
10.Application of assisted reproductive technology in fertility pre-servation and promotion for women with malignant tumors.
Chunmei MA ; Xiaoling HU ; Shanshan ZHANG ; Lanfeng XING ; Yingwei ZHANG ; Yimin ZHU
Journal of Zhejiang University. Medical sciences 2025;():1-10
OBJECTIVES:
To evaluate the strategies and outcomes of assisted reproductive technology (ART) for fertility preservation and promotion in women with malignant tumors, and to analyze ART outcomes across different tumor types.
METHODS:
We conducted a retrospective analysis of female patients who underwent ART for fertility preservation or treatment at the Reproductive Center of the Women's Hospital, Zhejiang University School of Medicine, between January 1, 2018, and December 31, 2023. A total of 163 ART-aided pregnancy patients with malignant tumors were included in the case group, among which 6 patients underwent embryo cryopreservation for fertility preservation before radiotherapy or chemotherapy. Additionally, 11 unmarried women underwent oocyte cryopreservation due to borderline ovarian tumors, ovarian cancer, breast cancer, or hematological malignancies. The control group was selected from women without a history of malignant tumors who received ART treatment during the same period, using propensity score matching at a ratio of 1∶2, resulting in 326 cases. Data were collected through the reproductive medical record system and telephone follow-up (as of October 31, 2024). Baseline characteristics, controlled ovarian hyperstimulation parameters, laboratory indicators, and pregnancy outcomes were compared between case and control groups and among patients with different tumor types, and the tumor recurrence of the patients was followed up.
RESULTS:
Patients in the case group had significantly lower ovarian reserve (AMH, AFC) and a higher proportion of diminished ovarian reserve compared to the control group (all P<0.01). Regarding the ovulation induction protocol, the proportion of patients using the minimal stimulation protocol in the case group was significantly higher than that in the control group (29.45% vs. 12.88%, P<0.01), and the total dosage of gonadotropins used was lower (P<0.01). In terms of assisted reproductive outcomes, there were no statistically significant differences between the two groups in the number of retrieved oocytes, number of high-quality embryos, fertilization rate, cumulative pregnancy rate, cumulative live birth rate, or miscarriage rate (all P>0.05). However, the number of oocyte retrieval cycles and embryo transfer cycles required to achieve a live birth outcome in the case group were significantly higher than those in the control group (both P<0.05). Subgroup analysis showed that there were no significant differences in cumulative pregnancy rate and live birth rate among patients with different tumor types (thyroid cancer, reproductive system tumors, breast cancer, lung cancer). Nevertheless, lung cancer patients had the lowest ovarian reserve and required the most oocyte retrieval cycles due to their older age; breast cancer patients had a relatively lower fertilization rate partially because some of them were complicated with male factors. A follow-up of 154 tumor patients (with a follow-up rate of 88.5%) revealed that 6 patients (4.20%) had tumor recurrence, and 1 breast cancer patient died due to tumor recurrence. None of the 11 unmarried patients who had undergone oocyte cryopreservation had used the cryopreserved oocytes for assisted pregnancy yet, and 1 patient who had undergone fertility preservation died due to tumor recurrence.
CONCLUSIONS
Women of reproductive age with malignant tumors are at risk of diminished fertility. ART can effectively preserve and promote fertility, enabling favorable pregnancy and live birth outcomes. It is recommended to initiate a multidisciplinary assessment promptly prior to radiotherapy/chemotherapy and formulate an individualized ART regimen for fertility preservation or promotion, so as to achieve reproductive goals or safeguard future fertility potential.

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