Application of Raman spectroscopy in selecting potential cleavage embyos / 预防医学

Objective To develop a method with Raman spectroscopy for selecting embryos with high developing potential. Methods A total of 100 samples of D3 spent cultural medium for embryos assigned to blastocyst culture were collected, and the Raman spectroscopy produced with optimal integration time. The original spectrums retrieved were processed by filtration, baseline correction and normalization methods to form characteristic spectral for the spent medium of cleavage embryo, suitable for analysis. A further 173 samples were collected to analyze the clinical relevance of Raman spectroscopy in selecting the potential embryos. Results Original Raman spectra with good resolution can be obtained with an integral time over 240 seconds. The characteristic spectral shift of embryo culture medium was 942, 1346, 1456 and 1656 cm-1 after processing. The spectral shift between the positive curve and the negative model was 1100-1800 cm-1. There was no significant difference in the intensity of real Raman spectral with different shifts (P>0.05) . A total of 80 positive curves, 70 negative curves, 23 neutral curves were obtained from the 173 D3 samples, and the blastocyst formation rates were 85.00％, 22.86％ and 65.22％, respectively, with statistically significant difference (P<0.001) . The sensitivity, specificity and Kappa value for the Raman spectrum curve predicting the blastocyst formation were 83.8％, 73.0％ and 0.572, respectively. Conclusion A clear, real and comparable Raman spectrum model could be obtained by improving the spectral collection conditions and preprocessing the original Raman spectrum. The potential embryo screened by this method is moderately consistent with that of blastocyst.

Clinical use of magnetic resonance plaque imaging for intracranial arteries / 中国医学科学院学报

<p><b>OBJECTIVE</b>To summarize the value and limitations of magnetic resonance (MR) plaque imaging for intracranial arteries.</p><p><b>METHOD</b>The data of MR plaque imaging of intracranial arteries in 422 patients performed in Peking Union Medical College Hospital from December 2006 to September 2010 were analyzed retrospectively.</p><p><b>RESULTS</b>The success rate for MR plaque imaging of intracranial arteries was 97%. MR plaque imaging clearly displayed the wall structure of the arteries trunk (M1 segment of middle cerebral arteries, M2-3 segment of anterior cerebral arteries, and basilar arteries). Good inter-observer (k=0.91, 95% CI=0.80-1.03) and intra-observer reproducibility (k=0.96,95% CI=0.88-1.03) was observed in the evaluation of middle cerebral arteries' atherosclerosis. The wall features had significant difference between symptomatic and asymptomatic intracranial arteries'stenosis; compared with asymptomatic middle cerebral artery stenosis(35 cases), symptomatic middle cerebral artery stenosis(26 cases) had a significantly larger wall area (P=0.000), greater remodeling ratio (P=0.000), higher prevalence of expansive remodeling (outward expansion of the vessel wall) (P=0.003), and lower prevalence of constrictive remodeling (P=0.008). Arteritis of middle cerebral artery (3 cases) showed circular wall-thickening with apparent gadolinium-diethylene triamine pentaacetic acid-biotin enhancement.</p><p><b>CONCLUSION</b>The MR plaque imaging is helpful in the evaluation of intracranial arteries stenosis, although it still has the limitations such as short scan range and low resolution.</p>

Outcome of in vitro fertilization in endometriosis-associated infertility: a 5-year database cohort study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Endometriosis affects natural fertility through various approaches, and in vitro fertilization (IVF) is a good treatment. But the IVF result of endometriosis patients is still under debate. We investigated the effect of endometriosis on IVF by analyzing the data from a single reproductive center.</p><p><b>METHODS</b>A retrospective, database-searched cohort study was performed. Relevant information was collected from the electronic records of women who underwent IVF/intracytoplasmic sperm injection between January 2006 and December 2010 in the Assisted Reproductive Unit of Sir Run Run Shaw Hospital. Patients with endometriosis were enrolled the study group. The rest of the women formed the control group. The main outcome was the clinical pregnancy rate. Secondary outcomes were oocytes retrieved number, fertilization rate, high-quality embryo rate, number of high-quality embryo for embryo transplantation, and implantation embryo/high-quality embryo ratio (IE/HQE ratio). Comparisons were performed by the c(2)-test and independent t-test.</p><p><b>RESULTS</b>The endometriosis group (n = 177) had a markedly lower oocytes retrieved number, fertilization rate, implantation rate, and clinical pregnancy rate (7.6 ± 5.1, 63.6%, 27.7%, and 45.2%, respectively) compared with the non-endometriosis group (n = 4267; 11.8 ± 7.3, 68.4%, 36.2%, and 55.2%, respectively). Stratified analysis showed that this difference was found in the subgroup younger than 35-years old, while only fertilization rate and implantation rate were different in the elder subgroup. The ratio of high-quality embryos transferred is lower in endometriosis group (53.7% vs. 71.8%, P < 0.05), but there is no difference in IE/HQE ratio between two groups. There is no significant difference in fertilization rate, implantation rate, and clinical pregnancy rate between mild and severe endometriosis patients.</p><p><b>CONCLUSIONS</b>Endometriosis patients suffer a decreasing IVF pregnancy rates mainly caused by reducing oocytes number and fertilization rate, regardless of the severity of the disease. Appropriate intracytoplasmic sperm injection manipulation might improve the outcomes of IVF.</p>

Outcome of conservative treatment and subsequent assisted reproductive technology for patients with early-stage endometrial adenocarcinoma and poor fertility potential / 中华医学杂志(英文版)

Conservative treatment with high doses of progestin is an alternative to standard hysterectomy for young patients with early-stage endometrial adenocarcinoma who desire to preserve their fertility. Here we report a patient with well-differentiated early-stage endometrial adenocarcinoma and poor fertility potential who failed to become pregnant in two in vitro fertilization-embryo transfer cycles and suffered a relapse after conservative treatment. This case illustrates that assessment of fertility potential is critical at the time of initial evaluation and conservative treatment planning for patients with endometrial adenocarcinoma.

Three-dimensional cultures of human endometrial cells on Matrigel mimic in vivo morphology / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The regulation of endometrial physiology and morphogenesis by the paracrine effectors has been well established using in vivo studies. A more complete understanding of the endometrial function has been delayed due, in part, to a lack of appropriate culture models. In this study, we aimed to simulate the in vivo three-dimensional (3-D) growth pattern of endometrial cells using a 3-D in vitro culture system.</p><p><b>METHODS</b>Isolated endometrial epithelial cells, stromal cells and RL95-2 cells were seeded into culture chambers coated with the extracellular matrix Matrigel and observed using light microscopy. Fluorescence staining and immunohistochemistry were used to assess the morphology.</p><p><b>RESULTS</b>Depending on the culture conditions, epithelial cells and RL95-2 cells formed multicellular structures on Matrigel; stromal cells remained individually distinguishable or grew together to form 3-D lattice-like structures.</p><p><b>CONCLUSIONS</b>Matrigel provided a good microenvironment for culturing endometrial cells. The cells cultured in the Matrigel-coated chambers closely resembled those seen in vivo.</p>

Characteristics of cerebral artery lesions in patients with limb-shaking transient ischemic attacks and its treatment / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the characteristics of cerebral artery lesions in patients with limb-shaking transient ischemic attacks (LS-TIA) and its treatment.</p><p><b>METHODS</b>We retrospectively analyzed the clinical data of 20 patients with LS-TIA who received treatment in Peking Union Medical College Hospital from 2005 to 2008.</p><p><b>RESULTS</b>Critical stenosis or occlusion of contralateral arteries were found in the siphonic part of internal carotid artery (ICA) in 6 patients, terminal ICA or proximal middle cerebral artery (MCA) in 6 patients, and distal MCA in 1 patient. Seven patients had proximal ICA occlusion. The brain MRI showed typical watershed cerebral infarctions in 8 patients. EEG studies failed to show epileptiform activity associated with LS-TIA, but found focal frontotemporal lobe slow activity in 6 patients, which was consistent with hypoperfusion area in CT perfusion. Six patients received surgical revascularization and no one recurred.</p><p><b>CONCLUSION</b>Intracranial artery including the siphonic part of ICA, terminal ICA and proximal MCA stenosis is the main underlying cause of LS-TIA in Chinese, and surgical revascularization may be effective in abolishing the attacks.</p>

Sperm morphology does not influence fertilization rate in vitro / 中华男科学杂志

<p><b>OBJECTIVE</b>To determine the correlation of the rate of morphologically normal sperm, sperm head defect, teratozoosperm index (TZI) and sperm deformity index (SDI) with the fertilization outcome of IVF and intracytoplasmic sperm injection (ICSI).</p><p><b>METHODS</b>We detected normal sperm morphology, sperm head defect, TZI and SDI by Krüger's strict criteria and compared them with the rate of fertilization.</p><p><b>RESULTS</b>In either IVF or ICSI, the fertilization rate did not show any correlation with the normal sperm morphology rate, the head defect rate, TZI and SDI, nor any statistic differences were found in the rates of fertilization, clinical pregnancy and quality embryos either between the SDI > 1.6 and the SDI < 1.6 groups (P > 0.05) or between the normal sperm morphology rate > 15% and < 15% groups (P > 0.05).</p><p><b>CONCLUSION</b>Sperm morphology has no predictive value for the rate of fertilization in vitro.</p>

Effects of gonadotropin-releasing hormone antagonists on the expression of vascular endothelial growth factor and its receptors in a rat model of ovarian hyperstimulation syndrome / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Ovarian hyperstimulation syndrome (OHSS) is one of the most life-threatening complications of assisted reproduction treatments. Gonadotropin-releasing hormone antagonists (GnRHanta) are thought to be effective in preventing this complication, and some clinical trials have found lower incidences of OHSS in patients treated with GnRHanta. Our aim was to investigate the effects of GnRHanta on vascular permeability and the expression of vascular endothelial growth factor (VEGF) and its receptors in a rat model of OHSS.</p><p><b>METHODS</b>An immature early OHSS rat model was established. Three ovarian stimulation protocols were used: pregnant mare serum gonadotropin/human chorionic gonadotropin (hCG) alone, with a GnRHanta, or with a gonadotropin-releasing hormone agonists (GnRHa). Blood and tissue samples were collected at 48 hours after hCG administration. Vascular permeability was evaluated by measuring the Evans-Blue content of extravasated peritoneal fluids. The expression of VEGF and its receptors, including flt-1 and KDR, were detected by reverse transcriptase-polymerase chain reaction and Western blotting.</p><p><b>RESULTS</b>Treatment with both a GnRHanta and a GnRHa resulted in significant reductions in serum estradiol and peritoneal vascular permeability, as well as decreased ovarian expression of VEGF and its two receptors. However, GnRHanta treatment caused a greater reduction in serum estradiol concentrations, and in VEGF receptor mRNA expression than GnRHa. There were no significant reductions in the expression of VEGF or its receptors in extra-ovarian tissues, including the liver, lungs and peritoneum.</p><p><b>CONCLUSION</b>Our results reveal that GnRHanta are more potent than GnRHa in preventing early OHSS through down-regulation of the expression of VEGF and its receptors in hyperstimulated ovaries.</p>

Intra-arterial thrombolysis in patients with acute ischemic stroke of the cervical internal carotid artery occlusive disease / 中国医学科学院学报

<p><b>OBJECTIVE</b>To observe the safety and efficacy of local intra-arterial thrombolysis (LIT) in patients with acute ischemic stroke of cervical internal carotid artery occlusive disease.</p><p><b>METHODS</b>10 patients were treated by LIT. 2 of 10 patients were further treated by either angioplasty or endarterectomy. Primary neuroradiological assessment was performed with CT in all patients. Angiographic recanalization level was classified according to thrombolysis in myocardial infarction (TIMI) grades. Clinical outcome was classified as good for Modified Rankin Scale (MRS) scores of 0 to 3 and as poor for MRS scores of 4 to 6.</p><p><b>RESULTS</b>Complete/partial recanalization after infusion was accomplished in 8 patients, seven of whom had good clinical outcome. Cerebral hemorrhage occurred in 2 of 10 patients.</p><p><b>CONCLUSION</b>The results of this study suggest that LIT may be helpful to improve the outcome in patients with acute cervical internal carotid artery occlusive disease if it is performed within 6 hours of stroke onset.</p>

Cerebral magnetic resonance imaging characteristics of eclampsia:an analysis of 15 cases / 中华神经科杂志

Objective To investigate cerebral MRI characteristics of patients with eclampsia. Methods A retrospective study was conducted on 15 cases of eclampsia and items reviewed cover all data concerning clinical features,cerebral MRI findings and results of follow-up survey.Results All of these patients had clinical symptoms of.blurred vision,headache,seizure,hypertension,proteinuria and edema of lower extremity.As for the characteristics of imaging,13 cases had only abnormal symmetric signals in parieto-occipital lobes,frontal lobe and basal ganglia were involved in 2 cases,and temporal lobe was involved in 1 case.The signals of lesions in DWI were isointense or hypointense,however they were hyperintense in ADC map.Two cases had hyperintense signals in DWI.All the patients recovered well,and all brain lesions disappeared during follow up.Conclusion The most important imaging of eclampsia is vasogenic edema with a good prognosis.