多囊卵巢综合征患者在高孕激素超促排卵中LH与IVF/ICSI临床结局的相关性分析

目的:探讨在高孕激素超促排卵方案中基础血黄体生成素(LH)水平对多囊卵巢综合征(PCOS)患者行体外受精/卵胞质内单精子显微注射(IVF/ICSI)治疗的临床结局的影响。方法:回顾性分析183例PCOS患者采用从早卵泡期开始使用安宫黄体酮(MPA)联合促性腺激素(Gn)的高孕激素超促排卵方案行IVF/ICSI治疗;根据基础LH水平分为3组,A组:0~5 IU/L,B组:5~10 IU/L,C组:10 IU/L,分析3组患者在高孕激素超促排卵过程中不同血LH水平与控制性超促排卵特征及IVF临床结局的相关性。结果:3组在促排卵过程中LH水平均呈下降趋势,且在基础LH水平、中期LH水平、诱发排卵当日的LH水平及诱发排卵次日的LH水平3组间比较均有统计学差异(P0.05),在扳机日LH水平波动于0.08~12.33 IU/L之间,无一例发生自发性LH峰;在获卵数、成熟卵数及获卵率A组与C组间有统计学差异(P0.05),而成熟卵率、正常受精卵数、优质胚胎数及有效胚胎数3组间比较无统计学差异(P0.05);后续的冻融胚胎移植(frozen-thawed embryo transfer,FET)周期结果表明,临床妊娠率、早期流产率及继续妊娠率组间比较均无统计学差异(P0.05)。结论:高孕激素促排卵方案可有效预防PCOS患者行IVF/ICSI治疗的自发性LH峰发生,并且基础高LH水平未损害PCOS患者的卵子及胚胎质量,对其临床结局也无明显影响,因此高孕激素超促排卵方案是一种新的简单安全、高效的垂体非降调节超促排卵方案,但还需大样本多中心的随机对照试验进一步证实。     

克罗米芬联合高孕激素促排卵抑制早发LH峰的临床结局研究

目的:探讨在控制性超促排卵中克罗米芬(CC)联合高孕激素促排卵方案抑制早发LH峰的临床效果。方法:回顾性分析126名行体外受精/卵胞质内单精子显微注射(IVF/ICSI)取卵周期的患者,分为CC联合高孕激素促排卵组(试验组,n=63)和短方案治疗组(对照组,n=63)。观察过早LH峰发生率、促排卵中Gn用量和用药天数、获卵数、成熟卵数、内分泌及胚胎试验室结果。结果:试验组获卵数、成熟卵数、有效胚胎数、生化妊娠率、临床妊娠率、胚胎种植率与对照组比较均无统计学差异(P0.05)。所有对象在促排卵过程中未监测到早发LH峰,试验组月经第9~10日和诱发排卵日LH水平与基础值间无统计学差异(P0.05)。试验组Gn用量和用药天数均高于对照组(P0.05)。结论:CC联合高孕激素促排卵方案可以有效抑制早发LH峰,促排卵过程中LH水平平稳,且可以获得有发育潜能的胚胎。     

卵巢功能正常患者高孕激素状态下促排卵的内分泌特征及IVF/ICSI临床结局的研究

目的:探讨高孕激素状态下促排卵方案在临床应用中的价值。方法:将因输卵管因素或男方因素或不明原因行IVF/ICSI治疗的不孕症患者分成高孕激素状态下促排卵组(A组,n=57)和短方案组(B组,n=59),观察患者的获卵数、成熟卵数、正常受精数、卵裂数、有效胚胎数及促排卵过程中血清FSH、LH、E2、P、抑制素A和B的水平及后续冻融胚胎移植(FET)周期的妊娠结局。结果:高孕激素促排卵组患者的获卵数10.8±5.4个,与短方案组相比无统计学差异(P0.05),获卵数、成熟卵数、受精数、卵裂数,有效胚胎数与短方案组相似(P0.05),后续的FET周期中,临床妊娠率和胚胎种植率比短方案组稍高(47.9%,42.1%vs 40.9%,31.9%),但均无统计学差异(P0.05)。高孕激素促排卵过程中LH水平逐渐下降,诱发排卵日的LH水平在1.3±0.9 IU/L,无一例发生自发LH峰。结论:高孕激素状态下促排卵组可以获得具有发育潜能的胚胎,还可以有效控制早发LH峰。高孕激素状态下促排卵方案可作为一种新的促排卵方案应用于临床实践,但是其广泛推广应用还有待多中心的联合研究。     

孕激素抑制LH峰在控制性卵巢刺激过程中的疗效观察

目的:探讨在控制性卵巢刺激(COS)过程中应用孕激素抑制黄体生成素(LH)峰的临床效果。方法:回顾性分析83例行体外受精/卵胞质内单精子注射-冻融胚胎移植(IVF/ICSI-FET)患者的资料,所有患者均采用孕激素联合促性腺激素方案,83个取卵周期共完成了92个FET周期,统计分析促排卵过程中的激素变化、胚胎实验室情况及妊娠结局。结果:在促排卵过程中,LH持续低水平,基础、中期(月经第9~11日)、诱发排卵当日LH水平分别为3.85±2.03 IU/L、3.64±2.01 IU/L、2.62±1.77 IU/L,未监测到LH峰。h MG的用药剂量为1 964.76±468.73 IU,孕激素(商品名:安琪坦)的用药剂量为2.05±0.34 g。平均获卵数为10.9±6.1,每个取卵周期平均冷冻5.0±2.5个胚胎。FET后临床妊娠率为52.17%(48/92),胚胎种植率为39.34%(72/183),流产率为10.42%(5/48)。结论:孕激素能够有效抑制LH峰,孕激素联合Gn促排卵方案为基于FET的促排卵技术提供了新的备选方案。     

卵巢储备功能减退患者继续黄体期促排卵的临床观察

目的:探讨卵巢储备功能减退的不孕症患者在辅助生殖助孕中卵泡期促排卵后继续行黄体期促排卵的可行性。方法:回顾性分析行体外受精/卵胞质内单精子显微注射(IVF/ICSI)助孕在卵泡期促排取卵后,继续于黄体期给予促性腺激素(Gn)促排卵65名卵巢储备功能减退患者的临床资料,分析获卵数、受精率及优质胚胎数等,所得可用胚胎均行全部胚胎冷冻。结果:65个黄体期促排卵周期中,3个周期未获卵,总获卵数为158个,平均获卵数为2.5±1.1个,受精率为74.1%,共获得优质胚胎数为53个,行全部胚胎冷冻。比较34例患者卵泡期拮抗剂方案和黄体期促排卵效果,黄体期促排卵MII卵获得率高,Gn用量少,h CG注射日黄体生成素(LH)值低,孕酮(P)值高,差异有统计学意义(P0.05),h CG注射日雌二醇(E2)值、促排卵天数、受精率及优质胚胎率组间差异无统计学意义。结论:卵巢储备功能减退的患者在IVF常规卵泡期促排卵中常出现优势卵泡少、空卵泡及提前排卵等不良结局,在优势卵泡取出或排卵后继续行黄体期促排卵可获得理想的卵子和优质胚胎数,为后续冻融胚胎移植提供可用胚胎,是一种安全可行的补充方案。     

GnRHa联合低剂量hCG扳机在高反应多囊卵巢综合征患者体外受精中的应用

目的探讨多囊卵巢综合征(PCOS)高反应患者行体外受精/卵胞质内单精子显微注射(IVF/ICSI)治疗使用低剂量联合扳机的安全性和有效性。方法回顾性队列分析2014年1月1日—2015年12月31日期间在本院生殖医学中心采取促性腺激素释放激素拮抗剂(GnRH-A)方案进行控制性促排卵行IVF/ICSI助孕的PCOS患者(n=364)的临床资料,分为低剂量联合扳机组(GnRH-A+低剂量hCG,A组,n=127)和标准扳机组(hCG,B组,n=237)。分析比较因卵巢高反应采用不同扳机方案患者的临床资料。结果患者一般情况和促排卵治疗用药组间均无统计学差异(P0.05)。A组患者hCG扳机日血清E_2水平[(19193.9±7837.5)pmol/L]及获卵数(29±9)均显著高于B组患者[(15786.8±7104.1)pmol/L,P0.05;24±6,P0.05]。两组患者的ICSI授精率、M_Ⅱ卵比率及双原核(2PN)胚胎率均无统计学差异(P0.05)。A组患者冻存胚胎数(14±6)显著多于B组患者(12±5,P0.05)。中重度卵巢过度刺激综合征(OHSS)发生率无统计学差异(P0.05)。冻融移植周期A组患者胚胎复苏率(62.3%)显著低于B组(77.0%,P0.05)。两组患者的移植胚胎数、临床妊娠率、着床率、流产率及活产率均无统计学差异(P0.05)。结论对于高反应PCOS患者使用拮抗剂方案基础上,应用减量联合扳机并全部胚胎冻存,不增加重度OHSS发生率,冻融胚胎移植周期也得到了满意的治疗结局。     

高效孕激素下超促排卵和微刺激方案在卵巢功能减退患者中应用效果分析

目的探讨高效孕激素下超促排卵(PPOS)和微刺激两种方案在卵巢功能减退患者(DOR)中的促排卵效果和全胚冷冻后行冻融胚胎移植(FET)的临床妊娠结局的差异。方法对2015年12月至2016年7月在郑州大学第二附属医院行体外受精-胚胎移植(IVF-ET)辅助生殖技术的431例卵巢储备功能下降患者的资料进行回顾性分析,其中PPOS方案组209例,微刺激组222例,比较两组的促排卵实验室结局和全胚冷冻后FET的妊娠结局。采用多因素Logistic回归校正混杂因素后比较两种促排卵方案的临床妊娠率。结果 PPOS组扳机日促黄体生成素(LH)水平低于微刺激组[3.63(2.40,5.46)U/L vs.7.07(4.04,11.92)U/L,P0.05],PPOS组取消取卵率低于微刺激组(1.44%vs.7.21%,P0.05),PPOS组获卵数、可利用胚胎数和优质胚胎数均高于微刺激组(P0.05)。全胚冷冻后行复苏移植,PPOS组临床妊娠率(29.17%)和胚胎着床率(14.63%)略高于微刺激组(19.70%和12.59%,P0.05)。多因素Logistic回归分析结果显示:PPOS方案可以获得更高的临床妊娠率(OR=6.79,95%CI 1.15~40.06,P=0.035)。结论对于DOR患者,PPOS方案较微刺激方案可减少取消取卵率,并可获得更多的获卵数、可利用胚胎数和优质胚胎数,累积胚胎提供更多移植机会。PPOS方案可作为DOR患者行IVF-ET辅助生殖技术时促排卵方案的一种选择。     

3种不同超促排卵方案对冻融胚胎移植结局的影响

目的:探讨不同超促排卵方案全部胚胎冷冻后行冻融胚胎移植(FET)的临床妊娠结局。方法:回顾性分析360例患者全胚胎冷冻后复苏移植周期的临床结局。按促排卵方案分为3组,A组:GnRH-a长方案组(n=131),B组:GnRH-a短方案(n=110),C组:CC+hMG组(n=119),按年龄段(<35岁,≥35岁)分别比较3组的促排卵效果及妊娠结局,并且以基础FSH(bFSH)=10 IU/L为界,把C组患者分为bFSH<10 IU/L和bFSH≥10 IU/L 2个亚组,比较其促排卵效果及妊娠结局。结果:C组获卵数、Gn使用总量、Gn用药天数显著低于A和B组(P<0.05),受精率和优质胚胎率高于A和B组(P<0.05);不同年龄段中C组与A和B组的临床妊娠结局均无统计学差异。3组的临床妊娠率分别为42.5%、35.6%、38.9%,胚胎种植率分别为23.9%、21.9%、17.2%,组间无统计学差异(P>0.05)。C组中bFSH≥10 IU/L亚组与bFSH<10 IU/L亚组的促排卵效果及妊娠结局无显著差异(P>0.05)。结论:CC+hMG方案在全部胚胎冷冻后行FET的患者中能取得与GnRH-α长、短方案相似的临床效果,同时Gn的用量大大低于长、短方案组,降低了药物对卵巢过度刺激造成的并发症,减轻了患者的经济和心理负担。     

孕激素对促排卵过程中抑制素水平的影响

目的探讨卵巢储备功能正常的妇女在促排卵过程中孕激素对抑制素水平的影响,分析高孕激素状态下促排卵(PPOS)的内分泌特征及随后的冻融胚胎移植(FET)结局。方法 93例接受体外受精/卵胞质内单精子注射(IVF/ICSI)治疗的卵巢储备功能正常者随机分到研究组(PPOS组,n=60)和对照组(短方案组,n=33),测定促排卵过程中(月经周期第3日、第10~12日、诱发排卵日、诱发排卵次日)激素水平、抑制素A和抑制素B表达水平。所有患者采取全部胚胎冷冻的策略,分析后续FET周期的结果。结果在研究组,抑制素A和B的水平随着促排卵过程的继续均呈现增长的趋势,诱发日的抑制素水平[抑制素A为(1 416.4±924.7)pg/m L,抑制素B为(1 188.5±819.1)pg/m L]较基础水平[抑制素A为(29.7±23.4)pg/m L,抑制素B为(82.5±49.4)pg/m L]均有明显增加(P0.05),诱发排卵次日的抑制素A水平较诱发日明显增加,达到(2 046.7±1 280.5)pg/m L(P0.05),而诱发排卵次日的抑制素B水平较诱发日略有下降(P0.05)。获卵数组间无统计学差异,在随后的FET周期中,两组的临床妊娠率、种植率、活产率均无统计学差异(P0.05)。结论促排卵过程中的高孕激素水平没有影响卵泡周围颗粒细胞分泌抑制素。安宫黄体酮(MPA)联合人绝经期促性腺激素(h MG)进行PPOS可以获得具有发育潜力的胚胎,在随后的FET周期中,可以获得满意的妊娠结局。     

安宫黄体酮和来曲唑联合Gn超促排卵在卵巢储备减退患者IVF/ICSI-FET中应用效果的比较

目的:比较安宫黄体酮(MPA)联合促性腺激素(Gn)超促排卵与来曲唑微刺激促排卵在卵巢储备功能减退(DOR)患者体外受精及冻融胚胎移植(FET)中的应用效果。方法:回顾分析730周期拟行体外受精助孕的DOR的不孕症患者的临床资料,380周期行MPA联合Gn促排卵(MPA组),350周期行来曲唑联合Gn促排卵(来曲唑组)。观察两组的周期取消率、Gn天数、Gn剂量、性激素水平、获卵数、可利用胚胎数、优胚率和FET妊娠率、种植率、流产率和活产率。结果:MPA组患者的Gn使用时间、Gn使用总量、优胚率均显著高于来曲唑组(P0.05),而HCG日LH水平、HCG日P水平、可用胚胎数显著低于来曲唑组(P0.05)。两组的获卵数、成熟卵数、受精卵数、卵裂数比较,差异均无统计学意义(P0.05)。MPA组患者的FET种植率和临床妊娠率均显著高于来曲唑组(P0.05)。两组患者的流产率、异位妊娠率和活产率比较,差异均无统计学意义(P0.05)。结论:与来曲唑联合Gn促排卵比较,MPA联合Gn促排卵对于DOR患者可有效抑制早发LH峰,减少提前排卵发生,能获得可观的临床妊娠率,值得临床应用推广。     

Comparison of the Accuracy of Fetal Pulmonary Maturity Testing Using Transvaginally and Transabdominally Collected Amniotic Fluid

To evaluate the reliability of transvaginally collected amniotic fluid in the assessment of fetal pulmonary maturity.

A retrospective chart review was conducted on mother-infant pairs in which delivery occurred before 3 7 weeks gestation and a lecithin/sphingomyelin ratio and phosphatidylglycerol had been determined within 1 week of the delivery.

Of 299 pairs, 154 had amniotic fluid collected transvaginally and 145 transabdominally. A lecithin/ sphingomyelin ratio of ≥2.0 predicted the absence of hyaline membrane disease with 99% accuracy in the transabdominal group compared with 96% in the transvaginal group. The false-negative rate of the lecithin/sphingomyelin ratio was 65% in the transabdominal group and 78% in the transvaginal group. The sensitivity of phosphatidylglycerol to predict the absence of hyaline membrane disease was approximately half that of a mature lecithin/sphingomyelin ratio (≥2), i.e., 48% versus 80% in the transabdominal group, 26% versus 50% in the transvaginal group. Only 2% (3/153) of premature infants ≥33 weeks gestational age developed hyaline membrane disease; none was in the transvaginal group.

A lecithin/sphingomyelin ratio of ≥2.0 using a transvaginally collected sample reliably excludes hyaline membrane disease. The higher false-negative rate of phosphatidylglycerol and the high positive predictive value of the lecithin/sphingomyelin ratio in both transabdominally and transvaginally collected specimens make the lecithin/sphingomyelin ratio a more clinically useful test for difficult management decisions involving preterm pregnancy. With ruptured membranes at ≥33 weeks, fetal maturity tests are at best confirmatory and may suggest disease risk where none exists.     

血清及卵泡液中抑制素B动态变化及其与促排卵结局的相关性研究

目的:探讨不同控制性超促排卵(controlled ovarian hyperstimulation,COH)方案中血清及卵泡液(follicular fluid,FF)中抑制素B(inhibin B,INHB)的动态变化及其与COH结局的相关性。方法:收集因输卵管因素和/或男方因素首次接受体外受精/卵细胞质内单精子注射-胚胎移植(IVF/ICSI-ET)助孕患者COH过程各时间节点的血清及取卵(ovum pick up,OPU)日不同大小卵泡的FF,按筛选要求选取长方案组(A组,n=38)及非降调节方案组(B组,n=38)患者,对其血清及FF中INHB水平进行检测并行相关性分析。结果:①降调节过程中,血清INHB水平显著下降(P0.01),且Gn启动日A组血清INHB水平较B组明显下降(P=0.000)。②A组和B组Gn启动后血清INHB水平呈上升趋势,至h CG注射日达高峰后下降,OPU后2 d显著下降(P0.01);A组和B组基础及Gn启动后的血清INHB水平无统计学差异(P0.05)。③ Gn第5日血清INHB水平与COH结局相关性最强,且Gn启动日血清INHB水平与Gn用量呈高度负相关(P0.01)。④A组和B组FF中血清INHB水平随卵泡直径增大而升高,大卵泡的FF中INHB水平无统计学差异(P0.05),但A组中小卵泡的FF中INHB水平显著高于B组(P0.01);且大卵泡的FF中INHB水平与COH结局相关性最好。结论:①降调节后血清INHB水平预示降调节对卵泡同步化作用较好;②COH过程中血清及大中卵泡的FF中INHB水平能很好地预测卵巢反应性及COH结局。     

Intrapartum pain management at the Royal Hospital for Women

AIMS: To explore use of, and women's satisfaction with, intrapartum pain management at Royal Hospital for Women (RHW), Sydney, Australia. METHODS: From October 2002 to January 2003 women aged over 16 who had been in labour at RHW were given a questionnaire to complete in the first week post-partum regarding their intrapartum pain management. Supplementary information was obtained from patient records. RESULTS: A total of 496 women participated (69% response rate), including 95 birth centre clients. The mean age was 32 years and 73% percent had a normal vaginal delivery. At least one form of pain management ('natural', nitrous oxide, pethidine, epidural, local infiltration of the perineum) was used by 463 (93%) women, with 74% using two or more methods. Labour pain was 'worse' or 'much worse' than expected for 55%. Seventy-two percent were 'very' or 'quite' satisfied with overall pain management. Epidural analgesia had the highest utility scores (89%'very useful') and likelihood of use in subsequent labours (67%), and pethidine the lowest. Factors affecting analgesic use included cervical dilation on admission, labour length, English-speaking background, delivery suite versus birth centre care, parity, and syntocinon use. CONCLUSIONS: Women at RHW use a variety of pain management methods in labour and most use multiple methods. Labour was rated more painful than expected by a majority; however, most were satisfied with their pain management. Labour length and cervical dilation on admission were most predictive of pain management use.     

Effects of sildenafil and tadalafil on ischemia/reperfusion injury in fetal rat brain

Objective.?The aim of the present study was to evaluate the effects of phosphodiesterase type 5 (PDE5) inhibitory drugs, sildenafil and tadalafil, in ischemia/reperfusion (I/R)-induced oxidative injury in fetal rat brain.

Methods.?Timed pregnant adult Wistar rats were randomly assigned to the following groups (n?=?6 for each group): saline?+?none I/R (1), saline?+?I/R (2), sildenafil?+?none I/R (3); sildenafil?+?I/R (4), tadalafil?+?none I/R (5) and tadalafil?+?I/R (6). Fetal ischemia was induced by clamping the utero-ovarian artery bilaterally. Fetuses were delivered and 268 fetal rats were decapitated. Malondialdehyde (MDA) levels and, superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities were assessed in fetal brain tissue homogenates by spectrophotometric methods.

Results.?In saline?+?I/R group, MDA levels were increased and, SOD and GSH-Px activities were decreased significantly comparing with saline?+?none I/R group. Both tadalafil and sildenafil treatment decreased the MDA levels significantly in ischemia/reperfusion groups, whereas this effect was significantly more potent with tadalafil. SOD levels were significantly decreased in all groups after I/R. Tadalafil seems to be more effective than sildenafil by means of increasing GSH-Px activity significantly after I/R.

Conclusion.?Our results indicate some beneficial effects of PDE5 inhibitory drugs, especially tadalafil, on oxidative I/R injury in fetal rat brains.     

Regulation of the cell cycle and P13K/AKT/mTOR signaling pathway by phthalates in normal human breast cells

ObjectiveTo investigate the impact of phthalates, including Butyl benzyl phthalate (BBP), di(n-butyl) phthalate (DBP), and di(2-ethylhexyl) phthalate (DEHP), in breast carcinogenesis.Materials and methodsMCF-10A normal breast cells were treated with phthalates (100 nM) and 17β-estradiol (E2, 10 nM), which were co-cultured with fibroblasts from normal mammary tissue adjacent to estrogen receptor positive primary breast cancers. Cell viability was determined using a 3-(4,5-Dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay. Cell cycles were analyzed using flow cytometry. The proteins involving cell cycles and P13K/AKT/mTOR signaling pathway were then evaluated by Western blot analysis.ResultsMCF-10A co-cultured cells treated with E2, BBP, DBP, and DEHP exhibited a significant increase in cell viability using MTT assay. The expressions of P13K, p-AKT, and p-mTOR, as well as PDK1 expression, were significantly higher in MCF-10A cells treated with E2 and phthalates. E2, BBP, DBP, and DEHP significantly increased cell percentages in the S and G2/M phases. The significantly higher expression of cyclin D/CDK4, cyclin E/CDK2, cyclin A/CDK2, cyclin A/CDK1, and cyclin B/CDK1 in MCF-10A co-cultured cells were induced by E2 and these three phthalates.ConclusionThese results provide consistent data regarding the potential role of phthalates exposure in the stimulating proliferation of normal breast cells, enhancing cell viability, and driving P13K/AKT/mTOR signaling pathway and cell cycle progression. These findings strongly support the hypothesis that phthalates may play a crucial role in breast tumorigenesis.     

始基卵泡活化的分子机制研究进展

始基卵泡是哺乳动物整个生殖期限中各级卵泡及卵子发育的源头。始基卵泡的激活既需要卵母细胞内如PI3K-PTEN-AKT-FOXO3、mTORC1及p27Kip1-CDK体系等信号通路的正常激活,也需要一些卵母细胞特异性的分子如Nobox和Sohlh1等的参与,除此之外,始基卵泡周围的前颗粒细胞也发挥巨大作用,其首先在m TORC1等信号通路的调节下分化为立方形颗粒细胞,改变自身形态,启动始基卵泡活化,其次可通过分泌KITL与卵细胞表面KIT结合后激活调节卵细胞生长的关键通路——PI3K信号通路,最终导致卵母细胞生长及始基卵泡的正常激活。了解始基卵泡活化过程有助于阐明卵子发生的分子机制,为女性不孕提供新的治疗靶点。     

Effects of neutral red assisted viability assessment on the cryotolerance of isolated bovine preantral follicles

Purpose

Fertility preservation strategies warrant non-invasive viability assessment of preantral follicles (PAF) such as staining with Neutral Red (NR) that is incorporated by viable follicles. To optimize the procedure, we firstly determined the lowest concentration and shortest exposure time needed for optimal viability screening of isolated bovine PAF. Secondly, we combined this protocol to a vitrification procedure to assess cryotolerance of the stained follicles.

Methods

Isolated PAF (900, divided over 6 replicates) were cultured in DMEM/Ham’s F12 (Culture Medium - Cm) for 4 days (38.5 °C, 5 % CO₂). On D0, D2 and D4, follicles were stained, by adding NR medium (NRm = Cm with different concentrations NR) after which viability was assessed by counting stained/non-stained PAF every 30 min for a period of 2 h.

Results

Following a binary logistic regression analysis with staining as a result (yes/no) versus log-concentration, a probability model could be fitted, indicating that the proportion of stained follicles remained stable after 30 min when 15 μg/ml NR was used, without compromising follicular health and viability. Consequently, using this protocol, no significant effect of staining prior to vitrification, was found on PAF viability immediately after warming or following 4 days of culture.

Conclusions

In conclusion, we propose NR staining as a non-invasive, non-detrimental viability assessment tool for PAF, when applied at 15 μg/ml for 30 min, being perfectly compatible with PAF vitrification.     

微波子宫内膜消除术治疗月经过多30例分析

目的：观察微波子宫内膜消除术（MEA）治疗月经过多的效果。方法：采用英国Microsulis公司生产的微波子宫内膜消除仪，对30例月经过多的患者实施子宫内膜消除术，观察月经量等方面的变化。结果：30例中出现无月经者9例（30．0％），月经量明显减少者14例（46．7％），点滴量月经4例（13．3％），1例（3．3％）术后闭经4个月发生阴道少量出血3天后再次出现无月经，1例（3．3％）月经量减少3个月后闭经，1例（3．3％）无明显效果。结论：微波子宫内膜消除术是治疗月经过多最简单、快速、安全、有效的微创手术方法。     

A comparative study of two devices used for cervical cell sampling raises some doubts about liquid-based cytology

The objective of this study was to compare the quality of smears obtained by a newly designed cervical cell sampler (the implement) to those obtained with the cervex brush, using liquid-based cytology (LBC). A prospective randomized controlled trial with the approval of the local ethics committees after informing the Medical Devices Agency in the UK was used in this study. The study was carried out in colposcopy clinics in two district general NHS Trust Hospitals in London. A total of 200 women were recruited (100 from each hospital). The women were randomized into two groups, each of them having two smears at the same time. One hundred (50%) of the women had their first smear with the new implement, and the other 100 (50%) had their first smear with the cervex brush. The main outcome of this study is good-quality smears, assessed by evidence of effective sampling of the transformation zone, including immature metaplastic cells and also endocervical cells. Eighty-five percent of the smears taken by the new implement showed good-quality smears compared to 91% of those taken by the cervex brush, a statistically marginally nonsignificant result, with P value = 0.052 (McNemar exact test). A larger number of good-quality smears, judged by evidence of sampling of transformation zone, were obtained with the cervex brush, though the difference was statistically marginally nonsignificant, using the British society for clinical cytology criteria. Surprisingly, despite the use of LBC, there was a higher rate of inadequate smears obtained with both the devices (8% with each) compared to our previous study using the conventional slide test (1.3% with the new implement and 1.8% with the Jordan's spatula).