OBJECTIVES: To explore the effects of exogenous trigger (hCG/GnRHa) versus endogenous LH surge in natural cycle IVF/ICSI (NC-IVF/ICSI) for patients with diminished ovarian reserve (DOR). METHODS: A retrospective analysis was conducted on 1,118 NC-IVF/ICSI cycles from two reproductive centers between 2013 and 2024. Propensity score matching (PSM) and multivariate logistic regression were used to adjust for confounding factors. The trigger-day hormone threshold was determined using receiver operating characteristic (ROC) curve analysis. Outcome measures included oocyte retrieval rate, 2PN fertilization rate, clinical available embryo rate, high-quality embryo rate, fresh cycle clinical pregnancy rate (CPR), and live birth rate (LBR). RESULTS: After adjusting for confounders via PSM and logistic regression, the exogenous trigger group demonstrated significantly better outcomes across all the evaluated parameters (oocyte retrieval rate, 2PN fertilization rate, transferable embryo rate, high-quality embryo rate, fresh cycle CPR, and LBR) than the endogenous LH surge group (P<0.05). Age-stratified analysis revealed that for the entire cohort, exogenous triggering significantly increased the number of transferable embryos and high-quality embryos (P<0.001). In the 35-39 years old subgroup, exogenous triggering showed significant advantages in oocyte yield, high-quality embryo rate, CPR, and LBR (P<0.05) and resulted in the most pronounced improvement in LBR (OR=6.25, 95% CI: 1.34-29.23). ROC analysis established a decision-day LH threshold of 19.055 mIU/mL (AUC=0.945, specificity=93.3%) for precise stratification of the clinical pathways. CONCLUSIONS For DOR patients undergoing NC-IVF/ICSI, exogenous triggering comprehensively improves the treatment outcomes, particularly providing significant live birth benefits for women aged 35-40 years. An individualized protocol incorporating the LH threshold (19.055 mIU/mL) effectively enhances embryonic developmental potential and live birth rates.
Humans ; Female ; Ovarian Reserve ; Pregnancy ; Propensity Score ; Retrospective Studies ; Fertilization in Vitro ; Sperm Injections, Intracytoplasmic ; Chorionic Gonadotropin ; Pregnancy Rate ; Logistic Models ; Ovulation Induction/methods* ; Gonadotropin-Releasing Hormone ; Adult ; Oocyte Retrieval

Neuroblastoma is a common extracranial solid tumors in children，and patients with high-risk disease have poor prognosis. Since the pathogenesis of neuroblastoma has not been fully elucidated，early diagnosis and timely，effective clinical intervention are key strategies to improve survival in affected children. As a neuroendocrine tumor，neuroblastoma is characterized by abnormal secretion of catecholamine compounds，the synthesis and release of which are closely associated with both diagnosis and prognosis. This review summarizes the biosynthetic and metabolic pathways of catecholamines and their clinical applications in neuroblastoma，and further discusses the molecular mechanisms by which catecholamines contribute to neuroblastoma progression.

Objective:The clinicalpathological features of TAFRO syndrome were analyzed to clarify the similarities and differences between TAFRO syndrome and autoimmune diseases and to establish differential diagnosis.Methods:Six patients diagnosed with TAFRO syndrome in Shanxi Bethune Hospital from January 2014 to March 2022 were collected. The clinical, examination, pathology and treatment of TAFRO syndrome were analyzed and compared with autoimmune diseases, especially systemic lupus erythematosus and Sj?gren′s syndrome.Results:Among the 6 patients, 4 were males and 2 were females, with an average age of (57.5 ±9.8) years. All the 6 patients had fever, edema (including chest and abdominal effusion and systemic edema), thrombocytopenia (3 main criteria) and more than 2 secondary criteria.ESR and CRP were significantly elevated in 6 patients. There were 1 case of elevated IgA and IgG (IgA 4.10 g/L, IgG19.05 g/L), 1 case of elevated igg (IgG 19.33 g/L), 3 cases of normal and 1 case of undetected. Serum IgG4 was negative in 4 cases and undetected in 2 cases. Autoantibodies: 4 cases were ANA positive, including 1 case with anti-SSA/Ro52(+), anti-SSA/Ro60(+), anti-SSB (+), 1 case with anti-SSA /Ro60(+), and 2 untested. Bone marrow cytological examination was performed in 6 cases, all of which showed active hyperplasia, 2 cases showed elevated megakaryocytes, and 1 case was accompanied by interstitial fibrosis. Pathological examination of lymph nodes: 5 cases were consistent with Castleman′s disease, and 1 case was suggestive of reactive hyperplasia of lymph nodes. Conclusion:Although the diagnostic criteria of TAFRO syndrome should exclude autoimmune diseases, TAFRO syndrome and autoimmune diseases can coexist, and the connective tissue disease complicated with TAFRO syndrome has its specific clinical characteristics and treatment plan, which needs to be identified clinically.

Preimplantation genetic testing for aneuploidy (PGT-A) is a crucial technique currently used to improve embryo implantation rate, reduce miscarriage rate, and shorten the time to pregnancy for patients who are of advanced maternal age (≥35 years), have experienced repeated implantation failures, or have a history of recurrent miscarriages. Conventional PGT-A necessitates an invasive embryo biopsy, which may pose potential risks to subsequent embryo development and long-term health outcomes. Consequently, there is a growing interest among reproductive medicine professionals in developing non-invasive, safe, accurate, and effective methods for assessing embryo chromosomal status and quality. This paper provides an overview of recent advancements in the use of next-generation sequencing for detecting cell-free DNA (cfDNA) in non-invasive preimplantation genetic testing for aneuploidy (niPGT-A). The review highlights both the potential of this approach and its existing limitations. Additionally, the paper proposes a novel hypothesis regarding the application of single-molecule nanopore technology for cfDNA detection in niPGT-A, offering new insights and serving as a reference for future research in this field.

Objective:To determine the optimal threshold for trigger-day progesterone levels in gonadotropin-releasing hormone (GnRH) antagonist protocols.Methods:A cohort study was performed. The clinical data were retrospectively analyzed from patients who underwent in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) for assisted reproduction at the Reproductive Medicine Center of Tianjin Central Obstetrics and Gynecology Hospital between January 2014 and May 2023. The study included 5 760 fresh transfer cycles where the female partner had undergone ovarian stimulation using a GnRH antagonist protocol. This was a single-arm study. The primary outcome measures were clinical pregnancy rate and live birth rate. The association between progesterone level on the trigger day and clinical pregnancy outcome and the dose-response relationship were analyzed by restricted cubic spline. Results:The progesterone level on the day of human chorionic gonadotropin trigger was (1.33±0.38) μg/L. Among the included cycles, 2 900 cycles underwent conventional IVF fertilization, while 2 860 cycles underwent ICSI. The biochemical pregnancy rate was 44.79% (2 580/5 760), the clinical pregnancy rate was 40.35% (2 324/5 760), and the live birth rate was 31.46% (1 812/5 760). Progesterone levels on the trigger day in GnRH antagonist protocols showed a nonlinear association with both clinical pregnancy rate and live birth rate (both P<0.001). When progesterone levels were below 0.61 μg/L, the clinical pregnancy rate increased with rising progesterone levels, but decreased significantly once this threshold was exceeded. Similarly, the live birth rate increased with progesterone levels below 0.63 μg/L and declined beyond that point. Conclusion:Progesterone levels on the optimal trigger day for achieving the highest clinical pregnancy rate and live birth rate in GnRH antagonist protocols are peak values of 0.61 μg/L and 0.63 μg/L, respectively. Using these thresholds, the impact of progesterone levels on the trigger day shows a positive effect on both clinical pregnancy rate and live birth rate up to these points, after which the effects become negative.

Preimplantation genetic testing for aneuploidy (PGT-A) is a crucial technique currently used to improve embryo implantation rate, reduce miscarriage rate, and shorten the time to pregnancy for patients who are of advanced maternal age (≥35 years), have experienced repeated implantation failures, or have a history of recurrent miscarriages. Conventional PGT-A necessitates an invasive embryo biopsy, which may pose potential risks to subsequent embryo development and long-term health outcomes. Consequently, there is a growing interest among reproductive medicine professionals in developing non-invasive, safe, accurate, and effective methods for assessing embryo chromosomal status and quality. This paper provides an overview of recent advancements in the use of next-generation sequencing for detecting cell-free DNA (cfDNA) in non-invasive preimplantation genetic testing for aneuploidy (niPGT-A). The review highlights both the potential of this approach and its existing limitations. Additionally, the paper proposes a novel hypothesis regarding the application of single-molecule nanopore technology for cfDNA detection in niPGT-A, offering new insights and serving as a reference for future research in this field.

Objective:To determine the optimal threshold for trigger-day progesterone levels in gonadotropin-releasing hormone (GnRH) antagonist protocols.Methods:A cohort study was performed. The clinical data were retrospectively analyzed from patients who underwent in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) for assisted reproduction at the Reproductive Medicine Center of Tianjin Central Obstetrics and Gynecology Hospital between January 2014 and May 2023. The study included 5 760 fresh transfer cycles where the female partner had undergone ovarian stimulation using a GnRH antagonist protocol. This was a single-arm study. The primary outcome measures were clinical pregnancy rate and live birth rate. The association between progesterone level on the trigger day and clinical pregnancy outcome and the dose-response relationship were analyzed by restricted cubic spline. Results:The progesterone level on the day of human chorionic gonadotropin trigger was (1.33±0.38) μg/L. Among the included cycles, 2 900 cycles underwent conventional IVF fertilization, while 2 860 cycles underwent ICSI. The biochemical pregnancy rate was 44.79% (2 580/5 760), the clinical pregnancy rate was 40.35% (2 324/5 760), and the live birth rate was 31.46% (1 812/5 760). Progesterone levels on the trigger day in GnRH antagonist protocols showed a nonlinear association with both clinical pregnancy rate and live birth rate (both P<0.001). When progesterone levels were below 0.61 μg/L, the clinical pregnancy rate increased with rising progesterone levels, but decreased significantly once this threshold was exceeded. Similarly, the live birth rate increased with progesterone levels below 0.63 μg/L and declined beyond that point. Conclusion:Progesterone levels on the optimal trigger day for achieving the highest clinical pregnancy rate and live birth rate in GnRH antagonist protocols are peak values of 0.61 μg/L and 0.63 μg/L, respectively. Using these thresholds, the impact of progesterone levels on the trigger day shows a positive effect on both clinical pregnancy rate and live birth rate up to these points, after which the effects become negative.

Objective To establish a risk model of rivaroxaban-related bleeding events in elderly patients with non-valvular atrial fibrillation(NVAF)based on gene polymorphism.Methods A total of 268 elderly NVAF patients receiving rivaroxaban treatment in Department of General Practice of the First Affiliated Hospital of Shihezi University from January 2021 to July 2023 were enrolled in this study.According to whether bleeding events occurred in 12 months'follow-up,they were divided into a bleeding group(47 cases)and a non-bleeding group(221 cases).The clinical data and results of gene polymorphism were compared between the two groups.Multivari-ate logistic regression was adopted to construct a risk prediction model of bleeding events based on gene polymorphism,and the predictive performance was verified.Results Significantly ad-vanced age and lower creatinine level were observed in the bleeding group than the non-bleeding group(P＜0.01).The bleeding group had obviously lower GG genotype frequency at the rs1128503 locus and TT genotype frequency at the rs4148738 of ATP-binding cassette,sub-family B member 1(ABCB1),and lower AC genotype frequency at the rs1057910 locus of cytochrome P450 2C9(CYP2C9)than the non-bleeding group(P＜0.05).Multivariate logistic regression analy-sis showed that age(OR=1.136,95％CI:1.031-1.251),and AA genotype(OR=15.407,95％CI:4.259-55.741)and GA genotype(OR=6.990,95％CI:1.599-30.546)of ABCB1 rs1 128503 were risk factors for rivaroxaban-related bleeding events in elderly NVAF patients(P＜0.01).Creatinine(OR=0.943,95％CI:0.899-0.989),TT genotype at ABCB1 rs4148738(OR=0.048,95％CI:0.009-0.242)and AC genotype of CYP2C9 rs1057910(OR=0.092,95％CI:0.021-0.408)were protective factors for the risk(P＜0.05).ROC curve analysis indicated that the AUC value of the risk model based on gene polymorphism was 0.827(95％CI:0.776-0.870),the spe-cificity was 81.90％,and the sensitivity was 76.60％.Conclusion Our risk model of rivaroxaban-related bleeding events based on ABCB1 gene and CYP2C9 gene has high application value for elderly NVAF patients.

Objective To establish a risk model of rivaroxaban-related bleeding events in elderly patients with non-valvular atrial fibrillation(NVAF)based on gene polymorphism.Methods A total of 268 elderly NVAF patients receiving rivaroxaban treatment in Department of General Practice of the First Affiliated Hospital of Shihezi University from January 2021 to July 2023 were enrolled in this study.According to whether bleeding events occurred in 12 months'follow-up,they were divided into a bleeding group(47 cases)and a non-bleeding group(221 cases).The clinical data and results of gene polymorphism were compared between the two groups.Multivari-ate logistic regression was adopted to construct a risk prediction model of bleeding events based on gene polymorphism,and the predictive performance was verified.Results Significantly ad-vanced age and lower creatinine level were observed in the bleeding group than the non-bleeding group(P＜0.01).The bleeding group had obviously lower GG genotype frequency at the rs1128503 locus and TT genotype frequency at the rs4148738 of ATP-binding cassette,sub-family B member 1(ABCB1),and lower AC genotype frequency at the rs1057910 locus of cytochrome P450 2C9(CYP2C9)than the non-bleeding group(P＜0.05).Multivariate logistic regression analy-sis showed that age(OR=1.136,95％CI:1.031-1.251),and AA genotype(OR=15.407,95％CI:4.259-55.741)and GA genotype(OR=6.990,95％CI:1.599-30.546)of ABCB1 rs1 128503 were risk factors for rivaroxaban-related bleeding events in elderly NVAF patients(P＜0.01).Creatinine(OR=0.943,95％CI:0.899-0.989),TT genotype at ABCB1 rs4148738(OR=0.048,95％CI:0.009-0.242)and AC genotype of CYP2C9 rs1057910(OR=0.092,95％CI:0.021-0.408)were protective factors for the risk(P＜0.05).ROC curve analysis indicated that the AUC value of the risk model based on gene polymorphism was 0.827(95％CI:0.776-0.870),the spe-cificity was 81.90％,and the sensitivity was 76.60％.Conclusion Our risk model of rivaroxaban-related bleeding events based on ABCB1 gene and CYP2C9 gene has high application value for elderly NVAF patients.

Objective:The clinicalpathological features of TAFRO syndrome were analyzed to clarify the similarities and differences between TAFRO syndrome and autoimmune diseases and to establish differential diagnosis.Methods:Six patients diagnosed with TAFRO syndrome in Shanxi Bethune Hospital from January 2014 to March 2022 were collected. The clinical, examination, pathology and treatment of TAFRO syndrome were analyzed and compared with autoimmune diseases, especially systemic lupus erythematosus and Sj?gren′s syndrome.Results:Among the 6 patients, 4 were males and 2 were females, with an average age of (57.5 ±9.8) years. All the 6 patients had fever, edema (including chest and abdominal effusion and systemic edema), thrombocytopenia (3 main criteria) and more than 2 secondary criteria.ESR and CRP were significantly elevated in 6 patients. There were 1 case of elevated IgA and IgG (IgA 4.10 g/L, IgG19.05 g/L), 1 case of elevated igg (IgG 19.33 g/L), 3 cases of normal and 1 case of undetected. Serum IgG4 was negative in 4 cases and undetected in 2 cases. Autoantibodies: 4 cases were ANA positive, including 1 case with anti-SSA/Ro52(+), anti-SSA/Ro60(+), anti-SSB (+), 1 case with anti-SSA /Ro60(+), and 2 untested. Bone marrow cytological examination was performed in 6 cases, all of which showed active hyperplasia, 2 cases showed elevated megakaryocytes, and 1 case was accompanied by interstitial fibrosis. Pathological examination of lymph nodes: 5 cases were consistent with Castleman′s disease, and 1 case was suggestive of reactive hyperplasia of lymph nodes. Conclusion:Although the diagnostic criteria of TAFRO syndrome should exclude autoimmune diseases, TAFRO syndrome and autoimmune diseases can coexist, and the connective tissue disease complicated with TAFRO syndrome has its specific clinical characteristics and treatment plan, which needs to be identified clinically.