Objective To investigate the factors that influence the potential for cryoembryo implantation and multiple pregnancy. Methods In this retrospective study, a total of 93 7 thawing cycles （859 couples） in which 3286 d...Objective To investigate the factors that influence the potential for cryoembryo implantation and multiple pregnancy. Methods In this retrospective study, a total of 93 7 thawing cycles （859 couples） in which 3286 d 3-embryos were thawed. Rates of implantation, clinical pregnancy and multiple conception following FET were observed. Results There were significant differences in female age （P〈0.05） and number of good quality embryos （P〈0. 05） between cycles that resulted in pregnancy and those did not. There was a trend toward decreasing rates of implantation, clinical pregnancy and multiple pregnancy with increasing female age. Compared with transferring 1 good quality embryo, clinical pregnancy rate of transferring 2 and 3 good quality embryos was increased significantly （P〈0. 001）, there was no significant difference in clinical pregnancy rate between transferring 2 and 3 good quality embryos. Multiple pregnancy rate was increased significantly in the group of transferring 3 good quality embryos （P〈0.05）,but there was no significant differences in multiple pregnancy rate between transferring 1 and 2 good quality embryos. Younger women （≤ 30 years） also had a significantly higher multiple pregnancy rates （28.13%） than the older ones（〉35 years） （13.64%）. With an increase in age from ≤ 30 years to〉40 years, clinical pregnancy rate declined from 47 61% to 25.00%.Conclusion Female age and the number of gooa quality embryos transferred are important factors influencing the clinical and multiple pregnancy rate, reducing the number of good quality embryos transferred may decrease the rate of multiple pregnancy but do not affect the clinical pregnancy rate.展开更多
Objective: Observe and correlate the cervical length by ultrasound and likelihood of cervical incompetence and premature delivery in multiple gestations. Materials and Methods: Retrospective study in multiple pregnanc...Objective: Observe and correlate the cervical length by ultrasound and likelihood of cervical incompetence and premature delivery in multiple gestations. Materials and Methods: Retrospective study in multiple pregnancy (twin, triplet, quadruplet) delivered between 2002-2003, in King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. A total of 68 multiple pregnancies underwent routine ultrasound for fetal assessment between 16 - 32 weeks when the cervix was observed. The sonographic measurements included cervix > 2.5 cm and <2.5 cm. The time of ultrasound was divided in five groups by gestational age from 18 - 20 weeks, 21 - 24 weeks, 25 - 26 weeks, 29 - 32 weeks and >32 weeks. The gestational age at delivery was our outcome parameter. The data was analyzed statistically using Fisher’s exact test and P-value below 0.05 was considered significant. Results: Endovaginal ultrasongoraphic cervical measurement in multiple pregnancies predicted increased preterm delivery risk regardless of maternal age, previous history of preterm deliveries or presence of vaginal infection. It was found that spontaneous preterm labor < 32 weeks is a relatively rate outcome with cervix > 25 mm;this majority reached > 32 weeks while the patient who had cervix < 25 mm, 1 in 25 of the women who underwent a cervical ultrasound assessment will have preterm labor. The finding in ultrasound justifies the results of higher aggressive management inpatient with cervix Conclusion: Cervical assessment during routine ultrasound in multiple gestations seems to be useful for prediction of preterm delivery and counseling the patient without risk factors regarding cervical cerclage. Because of restricted number of patients, we suggest further study with bigger sample and prospective trial for valued conclusions.展开更多
Rationale:If one of the partners is having balanced autosomal translocation,it is usually observed that the offspring inherit either normal chromosomes,balanced translocation identical to one of the parent or unbalanc...Rationale:If one of the partners is having balanced autosomal translocation,it is usually observed that the offspring inherit either normal chromosomes,balanced translocation identical to one of the parent or unbalanced chromosomal rearrangements of the same parental chromosome having translocation.Concern:A unique case presented with history of 8 miscarriages for genetic counseling.The last abortus material evaluation showed monosomy of chromosome X(Turner syndrome)in all the analyzed cells.There was a history of infertility and also repeated second trimester abortions on the paternal side.On the maternal side,there was a history of intellectual disability.Diagnose:History of repeated abnormal pregnancy outcomes.Wife’s karyotype is normal;however,husband shows translocation between chromosome 4 and 22.Intervention:Peripheral blood sample around 3 mL was collected for karyotype.Embryo biopsy was done and DNA was extracted and processed for whole exome sequencing.Outcomes:Wife’s karyotype is normal and husband has translocation between chromosome 4 and 22.Surprisingly,the entire pregnancy outcome including embryo screening has different,complete or partial aneuploidies of chromosomes other than chromosome 4 and 22.Main lesson:Though the translocation in one of the parent is balanced,we have to think beyond traditional ways for evaluating a couple with repeated pregnancy loss as we cannot predict the errors at cell division.Option of in vitro fertilization and preimplantation genetic diagnosis in couples having balanced translocations should be discussed so that early intervention can prevent the agony of pregnancy loss.展开更多
Active inflammation in“inactive”progressive multiple sclerosis:Traditionally,the distinction between relapsing-remitting multiple sclerosis and progressive multiple sclerosis(PMS)has been framed as an inflammatory v...Active inflammation in“inactive”progressive multiple sclerosis:Traditionally,the distinction between relapsing-remitting multiple sclerosis and progressive multiple sclerosis(PMS)has been framed as an inflammatory versus degenerative dichotomy.This was based on a broad misconception regarding essentially all neurodegenerative conditions,depicting the degenerative process as passive and immune-independent occurring as a late byproduct of active inflammation in the central nervous system(CNS),which is(solely)systemically driven.展开更多
Objective:To investigate the potential link between chromosomal polymorphisms in couples who had a medical history of idiopathic recurrent pregnancy loss.Methods:Cytogenetic investigation was conducted with mitogen(Ph...Objective:To investigate the potential link between chromosomal polymorphisms in couples who had a medical history of idiopathic recurrent pregnancy loss.Methods:Cytogenetic investigation was conducted with mitogen(Phytohemagglutinin-M,Gibco)stimulated blood T lymphocytes by Giemsa trypsin Giemsa banding and Ag-NOR banding on 580 couples with a history of idiopathic recurrent pregnancy loss and 240 couples from the general population.Thirty good chromosomal spreads were captured,karyotyped,and analyzed.The karyotypes were designated using the International System for Human Cytogenomic Nomenclature 2024.Pearson Chi-square test was used to compare the frequency of chromosomal polymorphism variations in the idiopathic recurrent pregnancy loss group with the general population group.Results:A conventional cytogenetic investigation revealed that 45.43%of couples experiencing idiopathic recurrent pregnancy loss presented with various types of chromosomal polymorphic variants,compared to 11.88%in the general population.The overall frequency of these chromosomal polymorphic variants was significantly higher in the idiopathic recurrent pregnancy loss group compared to the general population group(OR 9.97,95%CI 6.99-14.21;P<0.05).Additionally,the prevalence of polymorphic variants was higher among males(49.14%)than females(41.72%)(P=0.01).Conclusions:Chromosomal polymorphic analysis may play a crucial role in the assessment and careful clinical management of cases with idiopathic recurrent pregnancy loss,especially when no other conclusive reasons are identified during the initial evaluation.Therefore,heteromorphism should not be overlooked while investigating the causes of idiopathic recurrent pregnancy loss.展开更多
This paper is dedicated to fixed-time passivity and synchronization for multi-weighted spatiotemporal directed networks.First,to achieve fixed-time passivity,a type of decentralized power-law controller is developed,i...This paper is dedicated to fixed-time passivity and synchronization for multi-weighted spatiotemporal directed networks.First,to achieve fixed-time passivity,a type of decentralized power-law controller is developed,in which only one parameter needs to be adjusted in the power-law terms;this greatly decreases the inconvenience of parameter adjustment.Second,several fixed-time passivity criteria with LMI forms are derived by using a Gauss divergence theorem to deal with the spatial diffusion of nodes and by applying the Hölder’s inequality to dispose rigorously the power-law term greater than one in the designed control scheme;this improves the previous theoretical analysis.Additionally,the fixed-time synchronization of spatiotemporal directed networks with multi-weights is addressed as a direct result of fixed-time strict passivity.Finally,a numerical example is presented in order to show the validity of the theoretical analysis.展开更多
BACKGROUND The accurate prediction of lymph node metastasis(LNM)is crucial for managing locally advanced(T3/T4)colorectal cancer(CRC).However,both traditional histopathology and standard slide-level deep learning ofte...BACKGROUND The accurate prediction of lymph node metastasis(LNM)is crucial for managing locally advanced(T3/T4)colorectal cancer(CRC).However,both traditional histopathology and standard slide-level deep learning often fail to capture the sparse and diagnostically critical features of metastatic potential.AIM To develop and validate a case-level multiple-instance learning(MIL)framework mimicking a pathologist's comprehensive review and improve T3/T4 CRC LNM prediction.METHODS The whole-slide images of 130 patients with T3/T4 CRC were retrospectively collected.A case-level MIL framework utilising the CONCH v1.5 and UNI2-h deep learning models was trained on features from all haematoxylin and eosinstained primary tumour slides for each patient.These pathological features were subsequently integrated with clinical data,and model performance was evaluated using the area under the curve(AUC).RESULTS The case-level framework demonstrated superior LNM prediction over slide-level training,with the CONCH v1.5 model achieving a mean AUC(±SD)of 0.899±0.033 vs 0.814±0.083,respectively.Integrating pathology features with clinical data further enhanced performance,yielding a top model with a mean AUC of 0.904±0.047,in sharp contrast to a clinical-only model(mean AUC 0.584±0.084).Crucially,a pathologist’s review confirmed that the model-identified high-attention regions correspond to known high-risk histopathological features.CONCLUSION A case-level MIL framework provides a superior approach for predicting LNM in advanced CRC.This method shows promise for risk stratification and therapy decisions,requiring further validation.展开更多
Objective:To characterize placental morphologic features in Moroccan women with adverse outcomes,across different clinical contexts,based on the Amsterdam consensus classification.Methods:A prospective analysis was co...Objective:To characterize placental morphologic features in Moroccan women with adverse outcomes,across different clinical contexts,based on the Amsterdam consensus classification.Methods:A prospective analysis was conducted on placentas with umbilical cords collected fresh between March 1,2024 and July 15,2024 from women with adverse pregnancy outcomes.Clinical data(age,parity,gravidity,complications)were retrieved.Macroscopic parameters(weight,dimensions,cord insertion,membranes,lesions)were assessed,followed by systematic sampling.Tissue was processed by standard histology(formalin fixation,paraffin embedding,hematoxylin and eosin staining),and lesions were classified per Amsterdam criteria.Results:16 placentas from patients with adverse pregnancy outcomes were included.The median maternal age was 30 years.Adverse conditions included placental abruption(50%),intrauterine growth restriction(IUGR,38%),intrauterine fetal death(IUFD,31%),pre-eclampsia/eclampsia(19%),premature rupture of membranes(13%),and oligohydramnios(13%).Several placentas were associated with more than one adverse condition.Histopathology revealed maternal vascular malperfusion lesions in 94%,particularly in pre-eclampsia,IUGR,and IUFD.Fetal vascular malperfusion was found in 88%,mainly in IUGR and IUFD.Inflammatory lesions,dominated by acute maternal and fetal responses stage 3(necrotizing chorioamnionitis and funisitis),were primarily linked to IUFD.Conclusions:Placental examination enhances understanding of the pathophysiology underlying adverse pregnancy outcomes,supports diagnostic confirmation,and guides preventive strategies for recurrence.This study highlights the prevalence of maternal vascular malperfusion in Moroccan women and emphasizes the importance of systematic placental histopathology in obstetric care.展开更多
Dear Editor,Early pregnancy loss is a condition whose relevance is determined not only by high incidence but also by the frequency of this pathology progressing into habitual miscarriage.According to the American Preg...Dear Editor,Early pregnancy loss is a condition whose relevance is determined not only by high incidence but also by the frequency of this pathology progressing into habitual miscarriage.According to the American Pregnancy Association,non-developing pregnancy(NDP),one of the forms of pregnancy loss,accounts for half of all miscarriages in the early stages[1].展开更多
AIM:To investigate the changes of retinal vascular parameters and retinal layer thickness in patients with multiple sclerosis(MS).METHODS:This single-centered case-control study was performed on a MS group of 42 patie...AIM:To investigate the changes of retinal vascular parameters and retinal layer thickness in patients with multiple sclerosis(MS).METHODS:This single-centered case-control study was performed on a MS group of 42 patients diagnosed with MS and a control group of 43 healthy hospital staff matched in terms of age and sex at Iran University,department of neurology and ophthalmology from March 2020 to March 2021.The ophthalmic parameters of each patient were recorded,and optical coherence tomography was used to evaluate the retinal thickness in the layers.RESULTS:This study enrolled a total of 85 participants,with a mean age of 40.44±11.52 years,including 61 females(72%).The control group consisted of 43 individuals with a mean age of 39.49±11.07 years,while the MS group comprised 42 participants with a mean age of 41.40±12.01 years.The mean disease duration in the MS group was 8.45±6.04 a.The thickness of the ganglion cell layer in the right eye was significantly lower in the MS group compared to the control group(P=0.034).In addition,except for the left nasal sector(P=0.106),the mean peripapillary neurofibrillation in all examined sectors were significantly lower in the MS group than in the control group(P<0.05).The average vessel density in both the deep and superficial capillary plexuses across all regions of both eyes was lower in the MS group than in the control group,with all comparisons for the superficial capillary plexus showing statistical significance(P<0.05 for all except the left nasal sector).CONCLUSION:The thickness of the retina of patients with MS is significantly reduced.Therefore,optical coherence tomography results can be used as a reliable tool to evaluate disease progression and prognosis in MS patients.展开更多
Multiple evanescent white dot syndrome(MEWDS)is an inflammatory fundus disease primarily affecting the outer retina.It is characterized by transient yellow-white dots on the outer retina.Although the exact pathogenesi...Multiple evanescent white dot syndrome(MEWDS)is an inflammatory fundus disease primarily affecting the outer retina.It is characterized by transient yellow-white dots on the outer retina.Although the exact pathogenesis remains unclear,the progress in multimodal imaging(MMI)has enhanced our understanding of MEWDS.Most cases of MEWDS are idiopathic,lacking a definite cause,and can spontaneously recover;these are what we term classic MEWDS.Consequently,MEWDS is often referred to as the“common cold of the retina”.Simultaneously,patients with other disorders may present with varying degrees of manifestations similar to MEWDS.The resemblance in clinical or imaging findings can lead to misdiagnosis and inappropriate treatment.These MEWDS-like presentations are actually caused by other systemic or ocular disorders with diverse mechanisms.Thus,they differ from classic MEWDS in certain aspects.Using the keywords“MEWDSlike”and“Secondary MEWDS”,we searched for all relevant studies published in the PubMed database from January 2021 to January 2024.Subsequently,we retrospectively summarized the clinical and imaging characteristics of MEWDS,along with the manifestations in other diseases that resembled those of MEWDS,and compared classic MEWDS with these similar presentations.Based on our review,we classified such similar presentations under other conditions into two categories and summarized their features for differential diagnosis.We recommend paying close attention to patients suspected of having MEWDS,as there may be more serious systemic or ocular disorders that require prompt treatment.展开更多
BACKGROUND Complement-mediated thrombotic microangiopathy(TMA)is a rare endothelial injury syndrome caused by dysregulated activation of the alternative complement pathway,often linked to genetic abnormalities in comp...BACKGROUND Complement-mediated thrombotic microangiopathy(TMA)is a rare endothelial injury syndrome caused by dysregulated activation of the alternative complement pathway,often linked to genetic abnormalities in complement factor H(CFH),complement factor I,or complement factor H-related(CFHR)proteins.Both renal transplantation and pregnancy are independent triggers for recurrence.This case highlights a genetically high-risk patient who achieved a successful term pregnancy after renal transplantation without complement inhibition,emphasizing individualized risk stratification,close surveillance,and multidisciplinary management for favourable maternal and graft outcomes.CASE SUMMARY A 32-year-old woman with end-stage renal disease secondary to genetically confirmed complement-mediated TMA—homozygous CFH exon 17 deletion and CFHR3-CFHR1 duplication—was maintained on dialysis for 2.5 years before undergoing a successful live-donor kidney transplant from her mother.Post-transplant immunosuppression included tacrolimus,mycophenolate mofetil,and prednisolone,later modified to azathioprine during pregnancy planning.One-year post-transplant,she conceived spontaneously.Pregnancy was complicated by transient gestational hypertension,controlled with nifedipine,labetalol,and amlodipine.Proteinuria remained<150 mg/day;white blood cell counts 5.8-7.2×109/L without cytopenia.Serum creatinine ranged 0.9-1.1 mg/dL,and tacrolimus trough levels 5-7 ng/mL.At 36 weeks,she delivered a healthy 3 kg infant by elective caesarean section.Postpartum follow-up at three months confirmed stable maternal and graft function.CONCLUSION High-risk complement-mediated TMA patients can achieve successful pregnancy post-transplant through individualized care without mandatory complement blockade.展开更多
Multiple sclerosis is a severe autoimmune disorder that is mainly mediated by pathogenic cluster of CD4^(+)T cell subsets.Despite advancements in the management of multiple sclerosis,there is a critical need for more ...Multiple sclerosis is a severe autoimmune disorder that is mainly mediated by pathogenic cluster of CD4^(+)T cell subsets.Despite advancements in the management of multiple sclerosis,there is a critical need for more effective and safer treatments.In the present study,we administered Lycium barbarum glycopeptide to a mouse model of experimental autoimmune encephalomyelitis-an animal model of multiple sclerosis-and evaluated its effects on pathogenic CD4^(+)T cell activation both in vivo and in vitro.Lycium barbarum glycopeptide significantly mitigated the clinical severity of experimental autoimmune encephalomyelitis,as demonstrated by reduced demyelination and neuroinflammation.Moreover,Lycium barbarum glycopeptide treatment decreased the infiltration of peripheral leukocytes into the central nervous system and suppressed pro-inflammatory cytokine expression.Lycium barbarum glycopeptide also modulated pathogenic CD4^(+)T cell activation by inhibiting T helper 1/T helper 17 cell differentiation while promoting regulatory T cell expansion.Notably,no side effects were observed,suggesting the long-term safety and tolerability of Lycium barbarum glycopeptide.Furthermore,RNA sequencing data indicated that Lycium barbarum glycopeptide inhibits activator protein-1,an essential regulator of T cell activation and differentiation.This finding was supported by the reversal of T helper/T helper 17 cell response suppression upon AP-1 blockade.Collectively,these results highlight the potential of Lycium barbarum glycopeptide as an innovative therapeutic agent for CD4^(+)T cell-associated autoimmune or inflammatory diseases,such as multiple sclerosis.展开更多
In this article,we have commented on the article by Augustin et al.The authors presented a systematic review of the diagnosis,treatment,and outcomes of primary hyperparathyroidism-induced acute pancreatitis in pregnan...In this article,we have commented on the article by Augustin et al.The authors presented a systematic review of the diagnosis,treatment,and outcomes of primary hyperparathyroidism-induced acute pancreatitis in pregnant women.Since acute pancreatitis during pregnancy could cause maternal as well as fetal adverse outcomes,understanding this pathology is essential.Although there are various etiologies of acute pancreatitis during pregnancy,primary hyperparathyroidism is one of the causes that complicate hypercalcemia.Along with conventional treatment for acute pancreatitis,parathyroidectomy can effectively normalize calcium levels and improve acute pancreatitis.Augustin et al have provided vital information that can enable physicians to understand and treat hyperparathyroidism-induced acute pancreatitis in pregnant women,which could contribute to better maternal and fetal outcomes.In addition,since primary hyperparathyroidism is associated with multiple endocrine neoplasia,further consideration regarding screening for multiple endocrine neoplasia might lead to better prognoses.展开更多
Multiple myeloma(MM),one of the most common hemato logical neoplasms worldwide,originates from malignant plasma cells in the bone marrow.MM remains an incurable disease,although continued treatment advancements have m...Multiple myeloma(MM),one of the most common hemato logical neoplasms worldwide,originates from malignant plasma cells in the bone marrow.MM remains an incurable disease,although continued treatment advancements have markedly increased overall survival.Many patients with MM eventually experience relapse or become treatment-refractory1.Patients with relapsed or refractory multiple myeloma(RRMM)become progressively more challenging to manage and have poor prognosis2.展开更多
Malfunction of the thyroid gland is the second most common endocrine disorder encountered during pregnancy. It is well known that overt disease of the thyroid gland, either hyper or hypo can adversely affect pregnancy...Malfunction of the thyroid gland is the second most common endocrine disorder encountered during pregnancy. It is well known that overt disease of the thyroid gland, either hyper or hypo can adversely affect pregnancy outcome. There is also an ongoing debate surrounding the issue of subclinical hypothyroidism and its effect on the cognitive development of the unborn child. The goal of this paper is to present a systematic review of the literature and the current recommendations for diagnosis and treatment of thyroid disease in pregnancy and postpartum.展开更多
Multiple quantum well(MQW) Ⅲ-nitride diodes that can simultaneously emit and detect light feature an overlapping region between their electroluminescence and responsivity spectra, which allows them to be simultaneous...Multiple quantum well(MQW) Ⅲ-nitride diodes that can simultaneously emit and detect light feature an overlapping region between their electroluminescence and responsivity spectra, which allows them to be simultaneously used as both a transmitter and a receiver in a wireless light communication system. Here, we demonstrate a mobile light communication system using a time-division multiplexing(TDM) scheme to achieve bidirectional data transmission via the same optical channel.Two identical blue MQW diodes are defined by software as a transmitter or a receiver. To address the light alignment issue, an image identification module integrated with a gimbal stabilizer is used to automatically detect the locations of moving targets;thus, underwater audio communication is realized via a mobile blue-light TDM communication mode. This approach not only uses a single link but also integrates mobile nodes in a practical network.展开更多
Pregnant women with high-risk pregnancy face a higher risk of complications due to factors such as chronic diseases,multiple pregnancies,and a history of adverse pregnancy and childbirth,requiring more systematic and ...Pregnant women with high-risk pregnancy face a higher risk of complications due to factors such as chronic diseases,multiple pregnancies,and a history of adverse pregnancy and childbirth,requiring more systematic and dynamic health management support.In view of this,“Internet+continuous nursing”can break the limitations of time and space by integrating mobile communication,remote monitoring,data sharing,and intelligent analysis technologies,realizing closed-loop care with collaboration among hospitals,communities,and families.Research shows that continuous nursing based on the“Internet+”significantly improves the professional response ability of caregivers.Medical staff can grasp the patient’s status in real time,optimize diagnosis and treatment decisions,providing a feasible path for building an efficient,precise,and humanized high-risk pregnancy management system,which has broad clinical promotion value and public health significance.展开更多
Acute fatty liver of pregnancy(AFLP)is a rare but potentially life-threatening liver disease associated with mitochondrial dysfunction.It is characterized by microvesicular hepatic steatosis and typically occurs in th...Acute fatty liver of pregnancy(AFLP)is a rare but potentially life-threatening liver disease associated with mitochondrial dysfunction.It is characterized by microvesicular hepatic steatosis and typically occurs in the third trimester,though it may rarely present postpartum.AFLP is considered a non-thrombotic microangiopathy(TMA)but may present with overlapping TMA features.Its incidence ranges from 1 in 7000 to 1 in 20000 pregnancies,although milder cases may go unrecognized.AFLP can rapidly progress to acute liver failure and 20%to 40%of affected women exhibit clinical features of preeclampsia.Acute kidney injury(AKI)is a frequent complication,observed in 55%to 75%of AFLP cases,which is significantly higher than the 7%to 20%occurrence seen in preeclampsia or hemolysis,elevated liver enzymes,and low platelets syndrome.The exact mechanism behind AKI in AFLP remains unclear,but renal histology has shown tubular deposits of free fatty acids,which correlate with current theories regarding liver pathology.While AFLP-associated AKI is often reversible after delivery,some patients may develop persistent AKI that requires dialysis.Therapeutic plasma exchange(TPE)has been explored in these cases,but available evidence is limited.This review summarizes the current understanding of the epidemiology,pathophysiology,clinical features,and management of AKI in the context of AFLP,and discusses the potential role of adjunctive therapies such as TPE.展开更多
Teenage pregnancy has been acknowledged as a global public health concern,especially in low-and middle-income nations[1].This is predominantly because teenagers are more likely to experience pregnancy complications(vi...Teenage pregnancy has been acknowledged as a global public health concern,especially in low-and middle-income nations[1].This is predominantly because teenagers are more likely to experience pregnancy complications(viz.anemia,obstructed labour,etc.),higher rates of maternal mortality,and neonatal complications,including mortality[1,2].It is not unusual that many teen mothers have to experience exclusion from their families and communities,which limits access to quality healthcare services and is a major reason for emotional stress and mental health problems[2].展开更多
文摘Objective To investigate the factors that influence the potential for cryoembryo implantation and multiple pregnancy. Methods In this retrospective study, a total of 93 7 thawing cycles （859 couples） in which 3286 d 3-embryos were thawed. Rates of implantation, clinical pregnancy and multiple conception following FET were observed. Results There were significant differences in female age （P〈0.05） and number of good quality embryos （P〈0. 05） between cycles that resulted in pregnancy and those did not. There was a trend toward decreasing rates of implantation, clinical pregnancy and multiple pregnancy with increasing female age. Compared with transferring 1 good quality embryo, clinical pregnancy rate of transferring 2 and 3 good quality embryos was increased significantly （P〈0. 001）, there was no significant difference in clinical pregnancy rate between transferring 2 and 3 good quality embryos. Multiple pregnancy rate was increased significantly in the group of transferring 3 good quality embryos （P〈0.05）,but there was no significant differences in multiple pregnancy rate between transferring 1 and 2 good quality embryos. Younger women （≤ 30 years） also had a significantly higher multiple pregnancy rates （28.13%） than the older ones（〉35 years） （13.64%）. With an increase in age from ≤ 30 years to〉40 years, clinical pregnancy rate declined from 47 61% to 25.00%.Conclusion Female age and the number of gooa quality embryos transferred are important factors influencing the clinical and multiple pregnancy rate, reducing the number of good quality embryos transferred may decrease the rate of multiple pregnancy but do not affect the clinical pregnancy rate.
文摘Objective: Observe and correlate the cervical length by ultrasound and likelihood of cervical incompetence and premature delivery in multiple gestations. Materials and Methods: Retrospective study in multiple pregnancy (twin, triplet, quadruplet) delivered between 2002-2003, in King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. A total of 68 multiple pregnancies underwent routine ultrasound for fetal assessment between 16 - 32 weeks when the cervix was observed. The sonographic measurements included cervix > 2.5 cm and <2.5 cm. The time of ultrasound was divided in five groups by gestational age from 18 - 20 weeks, 21 - 24 weeks, 25 - 26 weeks, 29 - 32 weeks and >32 weeks. The gestational age at delivery was our outcome parameter. The data was analyzed statistically using Fisher’s exact test and P-value below 0.05 was considered significant. Results: Endovaginal ultrasongoraphic cervical measurement in multiple pregnancies predicted increased preterm delivery risk regardless of maternal age, previous history of preterm deliveries or presence of vaginal infection. It was found that spontaneous preterm labor < 32 weeks is a relatively rate outcome with cervix > 25 mm;this majority reached > 32 weeks while the patient who had cervix < 25 mm, 1 in 25 of the women who underwent a cervical ultrasound assessment will have preterm labor. The finding in ultrasound justifies the results of higher aggressive management inpatient with cervix Conclusion: Cervical assessment during routine ultrasound in multiple gestations seems to be useful for prediction of preterm delivery and counseling the patient without risk factors regarding cervical cerclage. Because of restricted number of patients, we suggest further study with bigger sample and prospective trial for valued conclusions.
基金support from ICMR-National Institute for Research in Reproductive Health(ICMR-NIRRH).
文摘Rationale:If one of the partners is having balanced autosomal translocation,it is usually observed that the offspring inherit either normal chromosomes,balanced translocation identical to one of the parent or unbalanced chromosomal rearrangements of the same parental chromosome having translocation.Concern:A unique case presented with history of 8 miscarriages for genetic counseling.The last abortus material evaluation showed monosomy of chromosome X(Turner syndrome)in all the analyzed cells.There was a history of infertility and also repeated second trimester abortions on the paternal side.On the maternal side,there was a history of intellectual disability.Diagnose:History of repeated abnormal pregnancy outcomes.Wife’s karyotype is normal;however,husband shows translocation between chromosome 4 and 22.Intervention:Peripheral blood sample around 3 mL was collected for karyotype.Embryo biopsy was done and DNA was extracted and processed for whole exome sequencing.Outcomes:Wife’s karyotype is normal and husband has translocation between chromosome 4 and 22.Surprisingly,the entire pregnancy outcome including embryo screening has different,complete or partial aneuploidies of chromosomes other than chromosome 4 and 22.Main lesson:Though the translocation in one of the parent is balanced,we have to think beyond traditional ways for evaluating a couple with repeated pregnancy loss as we cannot predict the errors at cell division.Option of in vitro fertilization and preimplantation genetic diagnosis in couples having balanced translocations should be discussed so that early intervention can prevent the agony of pregnancy loss.
文摘Active inflammation in“inactive”progressive multiple sclerosis:Traditionally,the distinction between relapsing-remitting multiple sclerosis and progressive multiple sclerosis(PMS)has been framed as an inflammatory versus degenerative dichotomy.This was based on a broad misconception regarding essentially all neurodegenerative conditions,depicting the degenerative process as passive and immune-independent occurring as a late byproduct of active inflammation in the central nervous system(CNS),which is(solely)systemically driven.
基金funded by the Technology Development Board(TDB)of India's Ministry of Science and Technology(TDB/M-25/2018-19).
文摘Objective:To investigate the potential link between chromosomal polymorphisms in couples who had a medical history of idiopathic recurrent pregnancy loss.Methods:Cytogenetic investigation was conducted with mitogen(Phytohemagglutinin-M,Gibco)stimulated blood T lymphocytes by Giemsa trypsin Giemsa banding and Ag-NOR banding on 580 couples with a history of idiopathic recurrent pregnancy loss and 240 couples from the general population.Thirty good chromosomal spreads were captured,karyotyped,and analyzed.The karyotypes were designated using the International System for Human Cytogenomic Nomenclature 2024.Pearson Chi-square test was used to compare the frequency of chromosomal polymorphism variations in the idiopathic recurrent pregnancy loss group with the general population group.Results:A conventional cytogenetic investigation revealed that 45.43%of couples experiencing idiopathic recurrent pregnancy loss presented with various types of chromosomal polymorphic variants,compared to 11.88%in the general population.The overall frequency of these chromosomal polymorphic variants was significantly higher in the idiopathic recurrent pregnancy loss group compared to the general population group(OR 9.97,95%CI 6.99-14.21;P<0.05).Additionally,the prevalence of polymorphic variants was higher among males(49.14%)than females(41.72%)(P=0.01).Conclusions:Chromosomal polymorphic analysis may play a crucial role in the assessment and careful clinical management of cases with idiopathic recurrent pregnancy loss,especially when no other conclusive reasons are identified during the initial evaluation.Therefore,heteromorphism should not be overlooked while investigating the causes of idiopathic recurrent pregnancy loss.
基金supported by the National Natural Science Foundation of China(62373317)the Tianshan Talent Training Program(2022TSYCCX0013)+3 种基金the Key Project of Natural Science Foundation of Xinjiang(2021D01D10)the Basic Research Foundation for Universities of Xinjiang(XJEDU2023P023)the Xinjiang Key Laboratory of Applied Mathematics(XJDX1401)the Intelligent Control and Optimization Research Platform in Xinjiang University.
文摘This paper is dedicated to fixed-time passivity and synchronization for multi-weighted spatiotemporal directed networks.First,to achieve fixed-time passivity,a type of decentralized power-law controller is developed,in which only one parameter needs to be adjusted in the power-law terms;this greatly decreases the inconvenience of parameter adjustment.Second,several fixed-time passivity criteria with LMI forms are derived by using a Gauss divergence theorem to deal with the spatial diffusion of nodes and by applying the Hölder’s inequality to dispose rigorously the power-law term greater than one in the designed control scheme;this improves the previous theoretical analysis.Additionally,the fixed-time synchronization of spatiotemporal directed networks with multi-weights is addressed as a direct result of fixed-time strict passivity.Finally,a numerical example is presented in order to show the validity of the theoretical analysis.
基金Supported by Chongqing Medical Scientific Research Project(Joint Project of Chongqing Health Commission and Science and Technology Bureau),No.2023MSXM060.
文摘BACKGROUND The accurate prediction of lymph node metastasis(LNM)is crucial for managing locally advanced(T3/T4)colorectal cancer(CRC).However,both traditional histopathology and standard slide-level deep learning often fail to capture the sparse and diagnostically critical features of metastatic potential.AIM To develop and validate a case-level multiple-instance learning(MIL)framework mimicking a pathologist's comprehensive review and improve T3/T4 CRC LNM prediction.METHODS The whole-slide images of 130 patients with T3/T4 CRC were retrospectively collected.A case-level MIL framework utilising the CONCH v1.5 and UNI2-h deep learning models was trained on features from all haematoxylin and eosinstained primary tumour slides for each patient.These pathological features were subsequently integrated with clinical data,and model performance was evaluated using the area under the curve(AUC).RESULTS The case-level framework demonstrated superior LNM prediction over slide-level training,with the CONCH v1.5 model achieving a mean AUC(±SD)of 0.899±0.033 vs 0.814±0.083,respectively.Integrating pathology features with clinical data further enhanced performance,yielding a top model with a mean AUC of 0.904±0.047,in sharp contrast to a clinical-only model(mean AUC 0.584±0.084).Crucially,a pathologist’s review confirmed that the model-identified high-attention regions correspond to known high-risk histopathological features.CONCLUSION A case-level MIL framework provides a superior approach for predicting LNM in advanced CRC.This method shows promise for risk stratification and therapy decisions,requiring further validation.
文摘Objective:To characterize placental morphologic features in Moroccan women with adverse outcomes,across different clinical contexts,based on the Amsterdam consensus classification.Methods:A prospective analysis was conducted on placentas with umbilical cords collected fresh between March 1,2024 and July 15,2024 from women with adverse pregnancy outcomes.Clinical data(age,parity,gravidity,complications)were retrieved.Macroscopic parameters(weight,dimensions,cord insertion,membranes,lesions)were assessed,followed by systematic sampling.Tissue was processed by standard histology(formalin fixation,paraffin embedding,hematoxylin and eosin staining),and lesions were classified per Amsterdam criteria.Results:16 placentas from patients with adverse pregnancy outcomes were included.The median maternal age was 30 years.Adverse conditions included placental abruption(50%),intrauterine growth restriction(IUGR,38%),intrauterine fetal death(IUFD,31%),pre-eclampsia/eclampsia(19%),premature rupture of membranes(13%),and oligohydramnios(13%).Several placentas were associated with more than one adverse condition.Histopathology revealed maternal vascular malperfusion lesions in 94%,particularly in pre-eclampsia,IUGR,and IUFD.Fetal vascular malperfusion was found in 88%,mainly in IUGR and IUFD.Inflammatory lesions,dominated by acute maternal and fetal responses stage 3(necrotizing chorioamnionitis and funisitis),were primarily linked to IUFD.Conclusions:Placental examination enhances understanding of the pathophysiology underlying adverse pregnancy outcomes,supports diagnostic confirmation,and guides preventive strategies for recurrence.This study highlights the prevalence of maternal vascular malperfusion in Moroccan women and emphasizes the importance of systematic placental histopathology in obstetric care.
基金financial support of the Russian Science Foundation(Grant No.23-13-00201)。
文摘Dear Editor,Early pregnancy loss is a condition whose relevance is determined not only by high incidence but also by the frequency of this pathology progressing into habitual miscarriage.According to the American Pregnancy Association,non-developing pregnancy(NDP),one of the forms of pregnancy loss,accounts for half of all miscarriages in the early stages[1].
文摘AIM:To investigate the changes of retinal vascular parameters and retinal layer thickness in patients with multiple sclerosis(MS).METHODS:This single-centered case-control study was performed on a MS group of 42 patients diagnosed with MS and a control group of 43 healthy hospital staff matched in terms of age and sex at Iran University,department of neurology and ophthalmology from March 2020 to March 2021.The ophthalmic parameters of each patient were recorded,and optical coherence tomography was used to evaluate the retinal thickness in the layers.RESULTS:This study enrolled a total of 85 participants,with a mean age of 40.44±11.52 years,including 61 females(72%).The control group consisted of 43 individuals with a mean age of 39.49±11.07 years,while the MS group comprised 42 participants with a mean age of 41.40±12.01 years.The mean disease duration in the MS group was 8.45±6.04 a.The thickness of the ganglion cell layer in the right eye was significantly lower in the MS group compared to the control group(P=0.034).In addition,except for the left nasal sector(P=0.106),the mean peripapillary neurofibrillation in all examined sectors were significantly lower in the MS group than in the control group(P<0.05).The average vessel density in both the deep and superficial capillary plexuses across all regions of both eyes was lower in the MS group than in the control group,with all comparisons for the superficial capillary plexus showing statistical significance(P<0.05 for all except the left nasal sector).CONCLUSION:The thickness of the retina of patients with MS is significantly reduced.Therefore,optical coherence tomography results can be used as a reliable tool to evaluate disease progression and prognosis in MS patients.
文摘Multiple evanescent white dot syndrome(MEWDS)is an inflammatory fundus disease primarily affecting the outer retina.It is characterized by transient yellow-white dots on the outer retina.Although the exact pathogenesis remains unclear,the progress in multimodal imaging(MMI)has enhanced our understanding of MEWDS.Most cases of MEWDS are idiopathic,lacking a definite cause,and can spontaneously recover;these are what we term classic MEWDS.Consequently,MEWDS is often referred to as the“common cold of the retina”.Simultaneously,patients with other disorders may present with varying degrees of manifestations similar to MEWDS.The resemblance in clinical or imaging findings can lead to misdiagnosis and inappropriate treatment.These MEWDS-like presentations are actually caused by other systemic or ocular disorders with diverse mechanisms.Thus,they differ from classic MEWDS in certain aspects.Using the keywords“MEWDSlike”and“Secondary MEWDS”,we searched for all relevant studies published in the PubMed database from January 2021 to January 2024.Subsequently,we retrospectively summarized the clinical and imaging characteristics of MEWDS,along with the manifestations in other diseases that resembled those of MEWDS,and compared classic MEWDS with these similar presentations.Based on our review,we classified such similar presentations under other conditions into two categories and summarized their features for differential diagnosis.We recommend paying close attention to patients suspected of having MEWDS,as there may be more serious systemic or ocular disorders that require prompt treatment.
文摘BACKGROUND Complement-mediated thrombotic microangiopathy(TMA)is a rare endothelial injury syndrome caused by dysregulated activation of the alternative complement pathway,often linked to genetic abnormalities in complement factor H(CFH),complement factor I,or complement factor H-related(CFHR)proteins.Both renal transplantation and pregnancy are independent triggers for recurrence.This case highlights a genetically high-risk patient who achieved a successful term pregnancy after renal transplantation without complement inhibition,emphasizing individualized risk stratification,close surveillance,and multidisciplinary management for favourable maternal and graft outcomes.CASE SUMMARY A 32-year-old woman with end-stage renal disease secondary to genetically confirmed complement-mediated TMA—homozygous CFH exon 17 deletion and CFHR3-CFHR1 duplication—was maintained on dialysis for 2.5 years before undergoing a successful live-donor kidney transplant from her mother.Post-transplant immunosuppression included tacrolimus,mycophenolate mofetil,and prednisolone,later modified to azathioprine during pregnancy planning.One-year post-transplant,she conceived spontaneously.Pregnancy was complicated by transient gestational hypertension,controlled with nifedipine,labetalol,and amlodipine.Proteinuria remained<150 mg/day;white blood cell counts 5.8-7.2×109/L without cytopenia.Serum creatinine ranged 0.9-1.1 mg/dL,and tacrolimus trough levels 5-7 ng/mL.At 36 weeks,she delivered a healthy 3 kg infant by elective caesarean section.Postpartum follow-up at three months confirmed stable maternal and graft function.CONCLUSION High-risk complement-mediated TMA patients can achieve successful pregnancy post-transplant through individualized care without mandatory complement blockade.
基金supported by the National Natural Science Foundational of China,Nos.U24A20692(to CJZ),82371355(to CJZ),and 82101414(to MH)National NaturalScience Foundational of China for Excellent Young Scholars,No.82022019(to CJZ)+5 种基金Sichuan Special Fund for Distinguished Young Scholars,No.24NSFJQ0052(to CJZ)The Innovationand Entrepreneurial Team of Sichuan Tianfu Emei Program,No.CZ2024018(to CJZ)Funding for Distinguished Young Scholars of Sichuan Provincial People’sHospital,No.30420230005Funding for Distinguished Young Scholars of University of Electronic Science and Technology of China,No.A1098531023601381(toCJZ)Sichuan Science and Technology Support Project,No.2023YFS0212(to BH)Project of Sichuan Provincial Health Commission,No.19PJ265(to LD).
文摘Multiple sclerosis is a severe autoimmune disorder that is mainly mediated by pathogenic cluster of CD4^(+)T cell subsets.Despite advancements in the management of multiple sclerosis,there is a critical need for more effective and safer treatments.In the present study,we administered Lycium barbarum glycopeptide to a mouse model of experimental autoimmune encephalomyelitis-an animal model of multiple sclerosis-and evaluated its effects on pathogenic CD4^(+)T cell activation both in vivo and in vitro.Lycium barbarum glycopeptide significantly mitigated the clinical severity of experimental autoimmune encephalomyelitis,as demonstrated by reduced demyelination and neuroinflammation.Moreover,Lycium barbarum glycopeptide treatment decreased the infiltration of peripheral leukocytes into the central nervous system and suppressed pro-inflammatory cytokine expression.Lycium barbarum glycopeptide also modulated pathogenic CD4^(+)T cell activation by inhibiting T helper 1/T helper 17 cell differentiation while promoting regulatory T cell expansion.Notably,no side effects were observed,suggesting the long-term safety and tolerability of Lycium barbarum glycopeptide.Furthermore,RNA sequencing data indicated that Lycium barbarum glycopeptide inhibits activator protein-1,an essential regulator of T cell activation and differentiation.This finding was supported by the reversal of T helper/T helper 17 cell response suppression upon AP-1 blockade.Collectively,these results highlight the potential of Lycium barbarum glycopeptide as an innovative therapeutic agent for CD4^(+)T cell-associated autoimmune or inflammatory diseases,such as multiple sclerosis.
文摘In this article,we have commented on the article by Augustin et al.The authors presented a systematic review of the diagnosis,treatment,and outcomes of primary hyperparathyroidism-induced acute pancreatitis in pregnant women.Since acute pancreatitis during pregnancy could cause maternal as well as fetal adverse outcomes,understanding this pathology is essential.Although there are various etiologies of acute pancreatitis during pregnancy,primary hyperparathyroidism is one of the causes that complicate hypercalcemia.Along with conventional treatment for acute pancreatitis,parathyroidectomy can effectively normalize calcium levels and improve acute pancreatitis.Augustin et al have provided vital information that can enable physicians to understand and treat hyperparathyroidism-induced acute pancreatitis in pregnant women,which could contribute to better maternal and fetal outcomes.In addition,since primary hyperparathyroidism is associated with multiple endocrine neoplasia,further consideration regarding screening for multiple endocrine neoplasia might lead to better prognoses.
基金supported by grant from the National Natural Science Foundation of China(Grant No.82300231).
文摘Multiple myeloma(MM),one of the most common hemato logical neoplasms worldwide,originates from malignant plasma cells in the bone marrow.MM remains an incurable disease,although continued treatment advancements have markedly increased overall survival.Many patients with MM eventually experience relapse or become treatment-refractory1.Patients with relapsed or refractory multiple myeloma(RRMM)become progressively more challenging to manage and have poor prognosis2.
文摘Malfunction of the thyroid gland is the second most common endocrine disorder encountered during pregnancy. It is well known that overt disease of the thyroid gland, either hyper or hypo can adversely affect pregnancy outcome. There is also an ongoing debate surrounding the issue of subclinical hypothyroidism and its effect on the cognitive development of the unborn child. The goal of this paper is to present a systematic review of the literature and the current recommendations for diagnosis and treatment of thyroid disease in pregnancy and postpartum.
基金jointly supported by the National Natural Science Foundation of China (U21A20495)Natural Science Foundation of Jiangsu Province (BG2024023)+1 种基金National Key Research and Development Program of China (2022YFE0112000)111 Project (D17018)。
文摘Multiple quantum well(MQW) Ⅲ-nitride diodes that can simultaneously emit and detect light feature an overlapping region between their electroluminescence and responsivity spectra, which allows them to be simultaneously used as both a transmitter and a receiver in a wireless light communication system. Here, we demonstrate a mobile light communication system using a time-division multiplexing(TDM) scheme to achieve bidirectional data transmission via the same optical channel.Two identical blue MQW diodes are defined by software as a transmitter or a receiver. To address the light alignment issue, an image identification module integrated with a gimbal stabilizer is used to automatically detect the locations of moving targets;thus, underwater audio communication is realized via a mobile blue-light TDM communication mode. This approach not only uses a single link but also integrates mobile nodes in a practical network.
文摘Pregnant women with high-risk pregnancy face a higher risk of complications due to factors such as chronic diseases,multiple pregnancies,and a history of adverse pregnancy and childbirth,requiring more systematic and dynamic health management support.In view of this,“Internet+continuous nursing”can break the limitations of time and space by integrating mobile communication,remote monitoring,data sharing,and intelligent analysis technologies,realizing closed-loop care with collaboration among hospitals,communities,and families.Research shows that continuous nursing based on the“Internet+”significantly improves the professional response ability of caregivers.Medical staff can grasp the patient’s status in real time,optimize diagnosis and treatment decisions,providing a feasible path for building an efficient,precise,and humanized high-risk pregnancy management system,which has broad clinical promotion value and public health significance.
文摘Acute fatty liver of pregnancy(AFLP)is a rare but potentially life-threatening liver disease associated with mitochondrial dysfunction.It is characterized by microvesicular hepatic steatosis and typically occurs in the third trimester,though it may rarely present postpartum.AFLP is considered a non-thrombotic microangiopathy(TMA)but may present with overlapping TMA features.Its incidence ranges from 1 in 7000 to 1 in 20000 pregnancies,although milder cases may go unrecognized.AFLP can rapidly progress to acute liver failure and 20%to 40%of affected women exhibit clinical features of preeclampsia.Acute kidney injury(AKI)is a frequent complication,observed in 55%to 75%of AFLP cases,which is significantly higher than the 7%to 20%occurrence seen in preeclampsia or hemolysis,elevated liver enzymes,and low platelets syndrome.The exact mechanism behind AKI in AFLP remains unclear,but renal histology has shown tubular deposits of free fatty acids,which correlate with current theories regarding liver pathology.While AFLP-associated AKI is often reversible after delivery,some patients may develop persistent AKI that requires dialysis.Therapeutic plasma exchange(TPE)has been explored in these cases,but available evidence is limited.This review summarizes the current understanding of the epidemiology,pathophysiology,clinical features,and management of AKI in the context of AFLP,and discusses the potential role of adjunctive therapies such as TPE.
文摘Teenage pregnancy has been acknowledged as a global public health concern,especially in low-and middle-income nations[1].This is predominantly because teenagers are more likely to experience pregnancy complications(viz.anemia,obstructed labour,etc.),higher rates of maternal mortality,and neonatal complications,including mortality[1,2].It is not unusual that many teen mothers have to experience exclusion from their families and communities,which limits access to quality healthcare services and is a major reason for emotional stress and mental health problems[2].
