To explore early predictive value of scores of modified amplitude integrated electroencephalogram (aEEG) combined with serum level of neuron specific enolase (NSE) in newborns with neonatal bilirubin brain injury.

From March 2017 to February 2018, a total of 80 cases of newborns with hyperbilirubinemia who were hospitalized in neonatal ward of Northern Jiangsu People′s Hospital were selected as research subjects. According to results of head MRI examination of being present high signal changes in globus pallidus or not, they were divided into brain injury group (n=37) and non brain injury group (n=43). Meanwhile, there were 40 cases of healthy and full term newborns who born in the same hospital were selected as control group. For newborns in above 3 groups, their aEEG was monitored, and scores of aEEG were performed; serum concentration of total bilirubin (TBiL) and level of NSE, and brainstem auditory evoked potential (BAEP) were detected. The general clinical data, score of modified aEEG, serum concentration of TBiL and level of NSE of newborns in 3 groups were overall compared and further compared between each two groups by one-way ANOVA and least significant difference (LSD)-t test. Spearman rank correlation analysis was used to analyze correlation between score of modified aEEG, serum level of NSE, aEEG degree respectively, and BAEP degree. Receiver operating characteristic curve (ROC) was drawn to compare predictive value of score of modified aEEG, serum level of NSE and combination of these two indicators of bilirubin brain injury in neonates with hyperbilirubinemia. This study followed the ethical standards formulated by the Ethics Committee of our hospital, and was approved (Approval No. 2016KY-064). All guardians of included subjects were informed concents.

①There were no significant differences among 3 groups in gender composition, admission age and gestational age, weight, height, head and chest circumference at birth of newborns, and pregnancy and parity of their mothers (P>0.05). ② Scores of modified aEEG of newborns in brain injury group was (7.7±1.6) scores, which was lower than those of (10.4±1.5) scores and (10.9±1.3) scores in non brain injury group and control group, respectively; while serum concentration of TBiL and level of NSE were (349.7±74.0) μmol/L and (47.6±13.2) μg/L, respectively, which were significantly higher than those of (295.7±31.4) μmol/L and (32.3±7.7) μg/L in brain injury group, and those of (185.1±35.9) μmol/L and (28.6±7.3) μg/L in control group, and all the differences were statistically significant (all P<0.001). ③ For all subjects in this study, score of modified aEEG was negatively correlated with BAEP degree (r_s=-0.718, P<0.001), serum level of NSE and aEEG degree were both positively correlated with BAEP degree (r_s=0.685, P<0.001; r_s=0.647, P<0.001). ④ Area under curve of ROC (ROC-AUC) of score of modified aEEG, serum level of NSE and combination of these two indicators for prediction of bilirubin brain injury of neonates with hyperbilirubinemia were 0.875 (95%CI: 0.795-0.954, P<0.001), 0.853 (95%CI: 0.769-0.937, P<0.001) and 0.938 (95%CI: 0.861-0.980, P<0.001), respectively, the sensitivity of these three methods for prediction of brain injury of newborns were 86.5%, 62.2%, 83.8%, and the specificity were 74.4%, 93.0%, 90.7%, respectively.

The early predictive value of score of modified aEEG combined with serum level of NSE was higher than that of score of modified aEEG or serum level of NSE only.

To explore risk factors and early diagnosis method of persistent ectopic pregnancy (PEP) in fallopian tubal pregnancy (FTP) patients based on propensity score matching (PSM) analysis.

From January 2011 to December 2018, a total of 17 patients with FTP who underwent laparoscopic conservative operations therapy (COT) in the West China Second University Hospital of Sichuan University and developed to PEP after operation were selected as research subjects and included into PEP group. At the same time, 148 patients who received laparoscopic COT in our hospital during the same period and recovered well after operation were randomly selected as control group. Clinical data of patients in two groups were collected by retrospective analysis. Mann-Whitney U test was used to compare the duration of serum β-human chorionic gonadotropin (hCG) decreased to <20 mIU/mL and <10 mIU/mL after operation, and the decrease ratio of serum β-hCG within 24-48 h after operation compared with that before operation in two matched groups. The incidence rates of pelvic adhesion, tubal interstitial and ampulla pregnancy were compared by chi-square test. The receiver operator characteristic (ROC) curve of decrease ratio of serum β-hCG within 24-48 h after operation compared with that before operation for diagnosis of PEP in FTP patients after COT was drawn and the area under ROC curve (ROC-AUC) was calculated. According to the maximum principle of Youden index, the optimal cut-off value of decrease ratio of serum β-hCG within 24-48 h after operation compared with that before operation for diagnosis of PEP in FTP patients after COT was determined. This study met the requirements of World Medical Association Declaration of Helsinki revised in 2013.

①After PSM, 65 patients in control group were matched successfully. There were no significant differences between two groups matched by PSM in terms of age, gravidity, body mass index (BMI) and menopause duration (P>0.05). ②After PSM, the incidence rates of pelvic adhesion and tubal interstitial pregnancy in PEP group were 88.2% (15/17) and 29.4% (5/17), respectively, which were significantly higher than those 61.5% (40/65) and 3.1% (2/65) in control group, and both the differences were statistically significant (χ²=4.349, P=0.037; χ²=8.834, P=0.003). ③After PSM, the duration of serum β-hCG decreased to <20 mIU/mL and <10 mIU/mL after operation in PEP group was 45.0 d (32.7-61.2 d) and 59.5 d (41.0-68.7 d), respectively, which were significantly longer than those 15.0 d (10.0-19.0 d) and 17.5 d (10.7-27.2 d) in control group, and both the differences were statistically significant (Z=4.703, 4.418; P<0.001). ④After PSM, the decrease ratio of serum β-hCG within 24-48 h after operation compared with that before operation in PEP group was 47.0% (-8.0%-70.1%), which was significantly lower than that 69.0% (61.2%-79.2%) in control group, and the difference was statistically significant (Z=3.506, P<0.001). The ROC-AUC of decrease ratio of serum β-hCG within 24-48 h after operation compared with that before operation for diagnosis of PEP in FTP patients after COT was 0.777 (95%CI: 0.626-0.929, P<0.001). According to the maximum principle of Youden index, the optimal cut-off value of decrease ratio of serum β-hCG within 24-48 h after operation compared with that before operation for diagnosis of PEP in FTP patients after COT was 52.9%, and the sensitivity, specificity, positive predictive value, negative predictive value, accuracy, missed diagnosis rate and misdiagnosis rate were 64.7%, 95.4%, 78.6%, 91.2%, 89.0%, 35.3% and 4.6%, respectively.

Tubal interstitial pregnancy and pelvic adhesion may be high risk factors of PEP in FTP patients after COT. The decrease ratio of serum β-hCG within 24-48 h after operation compared with that before operation may be one of the indicators for early diagnosis of PEP in FTP patients after COT.

To evaluate physical health status of left-behind children in some rural areas of China, and to provide evidence-based medical evidence for left-behind children′s health care services.

Cross-sectional studies about physical health status of left-behind children in China were searched from China National Knowledge Infrastructure (CNKI), China Biology Medicine (CBM), VIP, and Wanfang Database. Retrieval time was set from the inception of each database to August 2019. Two researchers independently screened the studies according to the inclusion criteria and exclusion criteria of this study, and evaluated the quality of each literature and extracted data from each literature. After cross-checking by these two researchers, Meta-analysis of physical health status of left-behind children in some rural areas of China was conducted by RevMan 5.3 software. The Agency for Healthcare Research and Quality (AHRQ) recommendation for cross-sectional study analysis criteria was used to evaluate the methodological quality of included literature. I² test was used for the heterogeneity analysis among the studies. Fixed effect model Meta-analysis was used when P≥0.10 and/or I²≤50%, and random effect model Meta-analysis was used when P<0.10 and/or I²>50%. The evaluation indexes of health situation of left-behind children included detection rate of nutritional diseases (nutritional anemia, malnutrition and zinc deficiency) and detection rate of growth retardation, and rate of underweight.

①A total of 9 articles involving 14 588 cases of children were included. They were from Anhui, Guangdong, Henan, Hubei, Hunan, Shandong, and Shaanxi Province, respectively. According to the definition of left-behind children in this study, they were divided into left-behind children group (n=8 010) and non-left-behind children group (n=6 578). ②The methodological quality evaluation results of included studies showed that there were 1 low-quality study, 5 medium-quality studies and 3 high-quality studies. ③Meta-analysis showed that there was no statistical difference between two groups in detection rate of malnutrition, and detection rate of growth retardation (P>0.05). The detection rate of nutritional anemia, detection rate of zinc deficiency, and rate of underweight in left-behind children group all were significantly higher than those in non-left-behind children group, and all the differences were statistically different (OR=1.93, 1.64, 1.22; 95%CI: 1.20-3.11, 1.19-2.27, 1.03-1.44; P=0.006, 0.003, 0.200).

Current evidence shows that left-behind children still have more health problems than non-left-behind children in parts of China. The detection rates of nutritional anemia and zinc deficiency, and rate of underweight are higher than those of non-left-behind children. However, due to the limitation of quantity and quality of studies included in this research, and the heterogeneity among the studies, large-sample, multi-center and high-quality studies are still needed to conduct to fully grasp the health problems of left-behind children in China, and then providing better health care services for them.

To establish a preliminary scoring model for postpartum hemorrhage (PPH) in pregnant women with placenta previa status (PPS) after artificial termination of pregnancy (ATP).

A total of 142 pregnant women with PPS who underwent ATP in Chengdu Women′s and Children′s Central Hospital from January 2010 to December 2018 were selected as research subjects by retrospective method. Chi-square test was used for univariate analysis of influencing factors of PPH in pregnant women with PPS after ATP. Then, with the consideration of existing research results, clinical experience and the factors with statistically significant differences in the results of univariate analysis, 5 possible influencing factors of PPH in pregnant women with PPS were analyzed by multivariate unconditional logistic regression analysis. According to the OR value of influencing factors in the results of logistic regression analysis, scores were assigned to the influencing factors of PPH. According to this scoring standard, the total PPH risk scores of all pregnant women were calculated. The receiver operator characteristic (ROC) curve of total PPH risk score for predicting the occurence of PPH in pregnant women with PPS was drawn, and the area under the ROC curve (ROC-AUC) was calculated. According to the maximum principle of Youden index, the optical critical value of total PPH risk score for predicting the occurrence of PPH in pregnant women was determined. The procedures followed in this study were in line with the requirements of the World Medical Association Declaration of Helsinki revised in 2013.

①Univariate analysis of the influencing factors of PPH in pregnant women with PPS showed that factors with statistically significant difference included the history of ATP (≥3 times or <3 times), body mass index (BMI)≥25 kg/m² or <25 kg/m^2, cesarean section history, types of PPS (marginal, partial or complete PPS), and status of placenta accreta (without placenta adhesion, placenta adhesion or placenta accreta). ②Multivariate unconditional logistic regression analysis was performed on the above 5 possible influencing factors of PPH, and the results showed that cesarean section history (OR=18.865, 95%CI: 4.013-88.671, P<0.001), complete PPS (OR=20.148, 95%CI: 3.387-119.846, P<0.001), placenta adhesion (OR=44.045, 95%CI: 9.772-198.523, P<0.001) and placenta accreta (OR=87.494, 95%CI: 11.685-655.111, P<0.001) all were independent risk factors for PPH in pregnant women with PPS, and they were signed to 1 score, 1 score, 2 scores ad 4 scores, respectively according to the OR value of these independent risk factors of PPH. The ROC-AUC of total PPH risk score for predicting the occurrence of PPH in pregnant women with PPS was 0.926 (95%CI: 0.876-0.975, P<0.001). According to the maximum principle of Youden index, the optimal critical value for total PPH risk score for predicting PPH in pregnant women with PPS was 3 scores. At the same time, the sensitivity of total PPH risk score for predicting PPH in pregnant women with PPS was 83.3%, the specificity was 92.5%, and the accuracy was 88.0%.

The predictive scoring model of PPH in pregnant women with PPS established in this study can effectively predict the risk of PPH after ATP, which is beneficial to individual choice of ATP. Because this study just is a single-center and retrospective research, multi-center, large-sample and prospective studies are needed to further confirm the clinical value of this scoring model.

To investigate the high-risk factors that may affect the cardiac contractility reserve (CCR) of high-risk pregnant women in the third trimester, and to evaluate the value of the phonocardiogram test (PCGT) in assessment of CCR of pregnant women in the third trimester.

From May 1, 2013 to July 31, 2013, a total of 65 cases of high-risk pregnant women with CCR abnormalities in the third trimester (28-41^{+ 6} weeks of gestation) in Chengdu Women′s and Children′s Central Hospital were selected as research subjects and included in study group. Simultaneously, others 489 cases of normal CCR pregnant women in the third trimester (28-41^{+ 6} gestational weeks) during the same period and in the same hospital were selected as control and included in control group. PCGT were used to measure CCR-related indicators, including heart rate, ratio of the amplitude of the first heart sound to the second heart sound (S1/S2), ratio of diastolic to systolic duration (D/S), and ratio of S1 amplitude at tricuspid valve auscultation area to that at mitral auscultation area (T1/M1). Through questionnaires and medical history taking, 14 factors that might affect CCR-related indicators between two groups of pregnant women were collected, and multivariate unconditional logistic regression analysis was performed to analyze the high-risk factors that might affect the CCR of pregnant women in the third trimester. The consistency of CCR indexes S1/S2, D/S and echocardiographic detection of cardiac ejection fraction (EF) and electrocardiogram results in diagnosis of cardiac function in pregnant women in the third trimester were analyzed. This study was in line with the requirements of World Medical Association Declaration of Helsinki revised in 2013. All participants confirmed and signed consent forms for clinical trials.

①Combined with high-risk pregnancies, combined with family history of cardiovascular and cerebrovascular diseases, ≥29-35 years old, ≥35 years old, systolic blood pressure ≥140-160 mmHg (1 mmHg=0.133 kPa) and systolic blood pressure ≥160 mmHg were independent risk factors for abnormal heart rate (OR=3.158, 1.816, 1.760, 1.901, 6.066, 17.055, 95%CI: 1.555-6.415, 1.156-2.853, 1.046-2.960, 1.132-3.194, 1.131-32.548, 2.353-123.599, P=0.001, 0.010, 0.033, 0.015, 0.035, 0.005). Junior college and above education levels of pregnant women was an independent protective factor for heart rate (OR=0.529, 95%CI: 0.321-0.870, P=0.012). ②With 32-34^{+ 6} gestational weeks, combined with high-risk pregnancy, and systolic blood pressure ≥140-160 mmHg, systolic blood pressure≥160 mmHg were independent risk factors for abnormal S1/S2 (OR=2.400, 5.842, 4.293, 12.875, 95%CI: 1.265-4.553, 2.966-11.506, 1.460-26.467, 2.496-113.852, P=0.007, 0.028, 0.035, 0.005). ③Combined with high-risk pregnancy, diastolic blood pressure ≥90-110 mmHg and diastolic blood pressure ≥110 mmHg were independent risk factors for abnormal D/S (OR=4.706, 1.993, 6.458, 95%CI: 2.556-8.665, 1.532-17.708, 2.391-28.166, P=0.020, 0.010, 0.047). ④Gravidity≥4 times was an independent risk factor for abnormal T1/M1 (OR=9.555, 95%CI: 1.147-77.955, P=0.037). ⑤Among 65 cases of abnormal CCR pregnant women in the third trimester(study group), the coincidence rates of S1/S2 with cardiac EF and routine electrocardiogram results in diagnosis of cardiac function in pregnant women in the third trimester were 93.8% (61/65) and 89.2% (58/65), respectively. And the coincidence rates of D/S with these two examination results were the same as S1/S2.

Multiple pregnancies, 32-34^{+ 6} gestational weeks, combined with high-risk pregnancies, combined with family history of cardiovascular and cerebrovascular diseases, ≥29 years old, systolic blood pressure ≥140 mmHg, and diastolic blood pressure ≥90 mmHg are risk factors for abnormal CCR in pregnant women in the third trimester. We should strengthen the prenatal care for these pregnant women. The consistency rates of CCR indexes with echocardiography(EF) and routine electrocardiogram results are high, and PCGT has the advantages of easy to operation and low cost in assessment of CCR in pregnant women in the third trimester, and can be used to screen the CCR of these pregnant women.

To explore the clinical application value of one-stop clinic for assessment of risk (OSCAR) for Down syndrome (DS) during frist trimester.

From March 2016 to December 2017, a total of 4 219 pregnant women who underwent OSCAR screening during frist trimester were selected into thisi study. The pre-delivery age was 17.3-51.8 years old and the gestational age was 11-13^{+ 6} weeks. All pregnant women were measured for nuchal translucency (NT) at gestational age of 11-13^{+ 6} weeks. Time-resolved immunofluorescence analysis was used to detect the serum pregnancy-related protein (PAPP-A) and free β-human chorionic gonadotropin (fβ-hCG) levels of pregnant women. The measured serum PAPP-A and fβ-hCG values were input into the prenatal screening data management software LifeCycle 4.0. The software automatically calculated the multiples of median of serum fβ-hCG and PAPP-A levels (MoM). The risks of DS and 18- trisomy syndrome were calculated in combination with the clinical data of pregnant women′s pre-delivery age, body weight on the day of blood drawing, gestational age indicated by ultrasound examination, number of fetuses, etc. For those with high risk of screening results, further amniocentesis is recommended for karyotype analysis of amniotic fluid cells. The screening result is that low-risk pregnant women will undergo prenatal screening again during second trimester. All high-risk pregnant women were followed up to 42 days after the birth of the fetus. The procedure followed in this study conforms to the ethical standards formulated by the Medical Ethics Committee of Nanning Second People′s Hospital. All pregnant women have signed an informed consent form before undergoing OSCAR screening or interventional prenatal diagnosis during the first trimester of pregnancy with the approval of the Committee (Approval No. 20190924).

① Among the 4 219 pregnant women screened by OSCAR during first trimester, the high risk rate of DS was 2.5% (103/4 219) and the high risk rate of 18-trisomy syndrome was 0.3% (11/4 219). The difference of DS and 18-trisomy syndrome in different pre-delivery age groups was statistically significant, respectively (P<0.05). Further comparison of DS high-risk rate shows that the DS high risk rate of pregnant women ≥35 years old was higher than that of other four different age ranges, and the differences were also statistically significant (P<0.05). ② NT value increased gradually with the increase of gestational age, and MoM of NT value also increased with the increase of gestational age. ③ The median serum PAPP-A level of pregnant women increased with the increase of pregnancy age, while the median serum fβ-hCG level decreased with the increase of pregnancy age. ④ Among the 4 219 pregnant women who underwent OSCAR in early pregnancy, 113 (2.7%) were at high risk and 4 106 (97.3%) were at low risk. Among 113 high-risk pregnant women, 42 (37.2%, 42/113) agreed to undergo amniocentesis or chorionic villus biopsy, and 3 were diagnosed as abnormal by karyotype analysis of amniotic fluid cells, of which 2 cases (34 and 33 years old, respectively) were DS and 1 case (22 years old) was 13-trisomy syndrome. ⑤ In 113 cases of screening high-risk pregnant women, 1 case of pregnant women had stopped growth and development before prenatal diagnosis, and then induced labor. Further follow-up screening of low-risk pregnant women found that 2 pregnant women had stillbirth and induced labor. The PAPP-A MoM values of the 2 pregnant women were abnormal during prenatal screening, which were 0.35 and 0.28, respectively (normal reference range was 0.5-2.5). ⑥ Follow-up results of 113 pregnant women screened for high-risk showed that 106 cases (93.8%) were successfully followed up and 7 cases (6.2%) were missed.

OSCAR for DS during first trimester is simple, economical and cost-effective. In addition, the abnormal PAPP-A MoM value can be used as a reference index for adverse pregnancy outcomes.

To evaluate the efficacy and safety of cervical pessaries in the prevention of preterm birth in twin pregnancy with short cervical length (CL).

Based on the principles and methods of Cochrane systematic reviews, we searched the Embase, PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Ovid-Medline, American College of Physicians (ACP), China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), VIP, and Wanfang databases for randomized controlled trial (RCT) to evaluate efficacy and safety of cervical pessaries in the prevention of preterm birth in twin pregnancy with short CL from the date of database inception to January 2018. Related conference papers and dissertations were also searched manually. The methodological quality and data extraction of the included studies were assessed independently by two reviewers followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and Meta-analysis was conducted using RevMan 5.0 software. The heterogeneity of the treatment was evaluated with the I² statistic. RR value and its 95%CI were computed for dichotomous data and were combined with a fixed-effects model (I²<50%) using the Mantel-Haenszel method. A random-effects model was used to analyze the results (with values of I²>50%).

Five RCTs, involving 2 465 twin pregnancies and 827 of them combined with short CL that pertained to pessary use, met the inclusion criteria. Treatment with a pessary was associated with a significant reduction in the rate of admission to the neonatal intensive care unit (NICU) (RR=0.73, 95%CI: 0.53-1.00, P=0.05). There were higher incidences of vaginal discharge (RR=3.07, 95%CI: 1.29-7.30, P=0.01) and retinopathy of prematurity(ROP) (RR=3.85, 95%CI: 1.19-12.45, P=0.02) in cervical pessary group. No significant differences were found between pessary group and control group among other major maternal and neonatal outcomes. A subgroup analysis of twin pregnancies associated with short CL by different CL values (CL≤ 25 mm or <38 mm) was conducted. Treatment with a pessary was associated with a significant reduction in the rate of preterm birth< 37 gestational weeks (RR=0.81, 95%CI: 0.69-0.94, P=0.007), neonatal sepsis (RR=0.50, 95%CI: 0.30-0.86, P=0.01) and neonatal necrotising enterocolitis (RR=0.43, 95%CI: 0.20-0.95, P=0.04) in twin pregnancy with CL<38 mm. In twin pregnancy with CL ≤25 mm, no significant difference was found between pessary group and control group among major maternal and neonatal outcomes.

These results suggest that cervical pessary in the twin pregnancy is not likely to facilitate the prevention of PTB, but can significantly reduce the rate of NICU. It seems that cervical pessary has much more protective efficacy in twin pregnancy with a cervical length <38 mm.

To investigate the efficacy and safety of caspofungin in treatment of children with hematological diseases complicated with invasive fungal disease (IFD).

From June 2013 to June 2016, a total of 57 children with hematological diseases who were diagnosed as complicated with IFD, and treated by caspofungin in the department of Pediatric Hematology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, were chosen as research objects. Their clinical case data were analyzed retrospectively. Chi-square test and t test were applied to compare treatment effective rates of caspofungin between hematological disease children with different diagnostic grades of IFD, treatment effective rates of caspofungin between the first-line and the second-line treatment in each diagnostic grades of IFD, the survival rates of hematological disease children with different diagnostic grades of IFD after 12 weeks of caspofungin treatment, also the courses of caspofungin treatment between hematological disease children with effective and ineffective treatment, as well as treatment effective rates of caspofungin between hematological disease children with different duration of neutropenia. And the safety of caspofungin in treatment of children with hematological diseases complicated with IFD was also evaluated. This study was in line with the requirements of World Medical Association Declaration of Helsinki revised in 2013, and all guardians of these children signed the informed consent forms for treatment by caspofungin.

①Among hematological disease children of this study, 91.2%(52/57) were single site infected with fungi, and pulmonary infection by fungi was the most common (78.9%, 45/57). Among them, 5 cases (8.8%) were proven IFD, 38 cases (66.7%) were probable IFD, and 14 cases (24.5%) were possible IFD. ②The total treatment effective rate of caspofungin in 57 hematological disease children was 86.0%(49/57). Treatment effective rate of caspofungin in probable and possible IFD children were 90.4%(47/52), which were higher than that of 40.0%(2/5) in proven IFD children, and the difference was statistically significant (χ²=9.597, P=0.001). ③Treatment effective rate of caspofungin as the first-line treatment in hematological disease children with proven and probable IFD was 96.7%(29/30), which was higher than that of 76.9%(10/13) in caspofungin as the second-line treatment, and the difference was statistically significant (χ²=4.190, P=0.041). The effective rate of caspofungin as the first-line treatment in hematological disease children with possible IFD was 90.0%(9/10), which was higher than that of 25.0%(1/4) in caspofungin as the second-line treatment, and the difference was statistically significant (χ²=5.915, P=0.015). ④There was no significant difference among proven, probable and possible IFD in the survival rates after 12 weeks of treatment by caspofungin (P>0.05). ⑤The course of treatment in hematological disease children with effective treatment of caspofungin was (16±7) d, which was longer than that in hematological disease children with ineffective treatment (8±6) d, and the difference was statistically significant (t=3.730, P=0.032). ⑥The effective rate of caspofungin between hematological disease children with duration of neutropenia≥14 d was 66.6%, which was significantly lower than that of hematological disease children with duration of neutropenia <14 d (92.9%), and the difference was statistically significant (χ²=6.284, P=0.012). ⑦None of hematological disease children occurred adverse reactions related to the treatment by caspofungin.

Caspofungin has significant curative effect in treatment of hematological diseases complicated with IFD in children, and neutropenia might affect its effect. Caspofungin has no obvious adverse reactions and it can be recommended for the first-line antifungal therapy in hematological disease children complicated with IFD, and its course of treatment would be more than 14 d.

Respiratory diseases have become one of the leading causes of death in premature infants in China. Due to the application of prenatal glucocorticoid for the treatment of fetal lung maturation, pulmonary surfactant (PS), various types of respiratory support technologies, clinical diagnosis and treatment strategies for respiratory diseases are more effective, and the diagnosis and treatment of most of the common respiratory diseases of premature infants have their own guidelines and clinical pathways. At present, most of the clinical research hotspots of respiratory diseases focus on genes research, early intervention methods and precise diagnosis and treatment of immature lung and pulmonary diseases in premature infants. This article intends to elaborate on the pathological basis, imaging findings and outcomes of common pulmonary diseases in premature infants and immature lung, to explore the clinical value of imaging examination in pulmonary diseases of premature infants and immature lung, and to assist in the clinical implementation of accurate diagnosis and treatment of pulmonary diseases in premature infants.

To explore the psychological function of children with precocious puberty and their mothers.

From March 2016 to January 2018, 70 grils who visited the Department of Pediatrics of Maternal & Child Care Center of Qinghuangdao were selected into this study. They were divided into 3 groups according to whether they were complicated with precocious puberty, central precocious puberty (CPP) group (n=24), premature adrenarche (PA) group (n=22) and early normal puberty (ENP) group (n=24). All the 70 girls and their mothers were assessed with scales within 2 weeks after their first visits. Children older than 6.0 years were assessed by self-report of Children′s Depression Inventory (CDI) and Harter Pictorial Scale of Perceived Competence (Harter scale), and children aged 1.5-5.0 years old were assessed by parent report of Child Behavior Checklist (CBCL). Mothers′ psychological functions were assessed by using 5-Point Likert Scale, Depression, Anxiety and Stress Scale (DASS), and Positive and Negative Affect Schedule (PANAS). The procedure of this study was consistent with ethical standard established by the committee of investigation in human beings of Maternal & Child Care Center of Qinghuangdao [Approval No. 2016(61)]. All the guardians of the girls signed clinical research informed consents.

①There were no significant differences among 3 groups in age at delivery of mothers and modes of delivery (P>0.05). However, there was a statistically significant difference among 3 groups in the aspect of age (P<0.05). ②There were no significant differences among 3 groups in the aspects of total scores of CDI, 4 sub-items of Harter scale and 2 sub-items of CBCL (P>0.05). ③The psychological function evaluation results of mothers of 3 groups were as follows. The depression sub-item scores in DASS of CPP group, PA group and ENP group were (3.9±0.5) scores, (4.7±0.8) scores and (1.2±0.3) scores, respectively, and the tension sub-item scores were (8.7±2.6) scores, (10.9±3.0) scores and (4.9±0.5) scores, respectively. The differences among 3 groups were statistically significant (F=6.184, P=0.035; F=7.228, P=0.014). Further comparison showed that the scores of PA group were higher than those of ENP group, and the differences were statistically significant (t=6.322, P=0.021; t=7.356, P=0.013). While there were no significant differences among 3 groups in the aspects of the scores of stress sub-items in DASS, scores of 5 items of Likert scale and 2 items of PANAS of mothers (P>0.05).

The mother of female PA children has higher depression and tension. Psychological pressure is not an indication for the treatment of precocious puberty.

To investigate the values of transport risk index of physiologic stability (TRIPS) at admission to evaluate illness severity and prognosis of preterm infants.

From July 2014 to December 2016, a total of 130 preterm infants with gestational age < 32 weeks who were hospitalized in the neonatal intensive care unit (NICU) of Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University were selected as research subjects. All preterm infants included in the study were given TRIPS score and neonatal critical illness score (NCIS) at the same time. Pearson correlation analysis was used to analyze the correlation between TRIPS score and NCIS, then the results of NCIS were taken as standard, the receiver operating characteristic (ROC) curve which assessed the severity of preterm infants with TRIPS score was drawn, to get the best cutoff value of TRIPS score in judging the severity of preterm infants. According to this best cutoff value, preterm infants of this study were divided into two groups: the non-critical group (TRIPS score < the best cutoff value) and the critical group (TRIPS score > the best cutoff value). The independent-samples t test, Wilcoxon rank sum test and chi-square test were used to compare the measurement and numeration data of premature birth related complications and clinical outcomes between two groups of preterm infants. This study was in line with World Medical Association Declaration of Helsinki revised in 2013.

①Pearson correlation analytic results showed that there was a linear negative correlation between TRIPS score and NCIS (r=-0.421, P<0.001). ②The ROC curve of evaluation of the severity of preterm infants by TRIPS score showed that the best cutoff value for judging the severity of preterm infants by TRIPS score was 13.5 scores, the area under curve (AUC) was 0.721(95%CI: 0.634-0.807), the sensitivity was 86.5%, and the specificity was 52.6%. ③Grouping results according to the best cutoff value of TRIPS score were 76 preterm infants in non-critical group and 54 cases in critical group. ④The incidence rate of bronchopulmonary dysplasia (BPD) and intracranial hemorrhage of preterm infants in critical group (37.0%, 40.7%) were all higher than those in non-critical group (15.8%, 15.8%), also the body weight at discharge from NICU and hospital discharge rate based on improved patients′ condition in critical group [(2 025±533) g, 72.2%] were all lower than those in non-critical group [(2 192±267) g, 96.1%], and all the differences were statistically significant (χ²=7.681, P=0.006; χ²=10.176, P=0.001; t=-2.351, P=0.020; χ²=15.441, P<0.001). There were no significant differences between two groups of preterm infants in incidence rate of necrotizing enterocolitis, hospital onset of infection, retinopathy of prematurity (ROP) and duration of hospitalization (P>0.05).

TRIPS score at admission could be used to evaluate illness severity and prognosis of preterm infants.

Selection of embryos with higher potentiality of development has been one of the major challenges in assisted reproductive technology (ART). Morphological scoring method is a general method to evaluate embryonic quality, but it′s not an accurate method due to the personal error. In the past decade, with the development of metabolomics and proteomics, metabolities in embryo culture media such as pyruvate, amino acids, human leukocyte antigen (HLA)-G can be precisely analyzed by newly developed technologies such as Fourier transformation infrared (FTIR) spectroscopy, near infrared spectroscopy (NIR), ¹H-proton nuclear magnetic resonance (¹H-NMR) spectroscopy, and Raman spectroscopy. Studies have shown that the metabolic profiles vary between pregnancy and non-pregnancy embryos. Thus, noninvasive metabolomics and proteomics might be applied to guide clinical protocol adjustments of in vitro fertilization (IVF) and select transplanted embryo with the best quality. However, chromosome abnormalities in embryo can not be detected by morphological scoring method, metabolomics, proteomics, and genomics can make up for this deficiency. Genomic screening could be conducted to detect non-euploidy embryo before transplantation and thus improve the success rate of ART. This paper reviews the latest research progress of the embryo quality assessment methods.

To investigate the effects of diffusion-weighted MRI (DW-MRI) on the evaluation of renal function in children with chronic kidney disease (CKD) by the apparent diffusion coefficient (ADC).

A total of 77 children with CKD who were admitted to West China Second Hospital, Sichuan University from January 2014 to June 2017 were recruited as research subjects in case group. According to the CKD staging of children, subjects in case group were further divided into CKD 1-2 stage subgroup (n=60) and CKD 3-5 stage subgroup (n=17). A total of 16 healthy children volunteers recruited in the same hospital during the same period were selected in control group. DW-MRI was used to detect the ADC values of bilaterally renal cortex and medulla of all subjects. Meanwhile, serum creatinine concentrations and estimated glomerular filtration rate (eGFR) were measured within 1 month before DW-MRI examination in all subjects. Independent-samples t test was used compare the ADC values of bilaterally renal cortex and medulla between case group and control group, and paired-samples t test was used to compare within the group. One-way ANOVA analysis was used to compare the ADC values of bilaterally renal cortex and medulla in CKD 1-2 stage subgroup, CKD 3-5 stage subgroup and control group, and the Bonferroni method was used for further comparison between each two groups. Pearson correlation analysis was conducted to analyze the correlation between ADC values of bilaterally renal cortex, medulla and eGFR, serum creatinine concentration in children with CKD. This study was approved by the Ethics Committee of Human Beings in West China Second University Hospital, Sichuan University (approval No. 2014081). The guardians of every subject obtained informed consent and signed informed consent form before MRI examination. There were no statistical differences between two groups in the aspects of gender ratio and age (P=0.785, 0.980).

①There were no significant differences in the ADC values of left and right renal cortex, and the ADC values of left and right renal medulla of case group (P>0.05). There were no significant differences in the ADC values of left and right renal cortex, and the ADC values of left and right renal medulla of control group (P>0.05). ②The ADC values of bilaterally renal cortex and medulla in the CKD 1-2 stage subgroup were (2.22±0.09) × 10^-3 m²/s and (1.97±0.11) × 10^-3 m²/s, respectively, and (2.02±0.16) × 10^-3 m²/s, (1.72±0.14) × 10^-3 m²/s, respectively in CKD 3-5 stage subgroup, and (2.35±0.06) × 10^-3 m²/s, (2.09±0.09) ×10^-3 m²/s, respectively in control group. There were significant differences in the ADC values of bilaterally renal cortex and medulla among above three groups (F=42.942, 48.956; P<0.001). Further comparison results showed that there were statistical differences between any two groups out of the above three groups in the cortex and medulla ADC values (P<0.001). ③In case group, there were linear positive correlations between ADC values of bilaterally renal cortex, medulla and eGFR (r=0.621, 0.657; P<0.001), and there were linear negative correlations between ADC values of bilaterally renal cortex, medulla and serum creatinine concentrations (r=-0.708, -0.681; P<0.001).

In our study, DW-MRI is considered to be an effective method to evaluate renal functions of children with CKD. The ADC value can reflect the children′s renal functions. In addition, the ADC value can provide a reference for clinical judgment of healthy children, children with mild CKD and children with moderate to severe CKD. However, whether there is prospect for application of CKD renal functions assessment in children by DW-MRI, large-sample, multi-center randomized controlled trials are needed for further study and confirmation.

To investigate affects on the pelvic floor functions of primiparae in early postpartum period with different delivery modes by pelvic floor function of pelvic organ prolapse quantification (POP-Q) scoring system.

From January 1 to December 31, 2016, a total of 200 primiparae who were with single birth, full-term pregnancy and cephalic presentations in Chengdu Women and Children′s Central Hospital were chosen as study subjects by retrospective analysis method and random digits table method. According to different delivery modes, they were divided into observation group (n=100, with elective cesarean section delivery mode) and control group (n=100, with transvaginal delivery mode). All the primiparae received epidural anesthesia during labor and were managed in accordance with the Standard of New Production Process and Expert Consensus (2014). Primiparae with genital malformation, stress urinary incontinence (SUI), pelvic floor dysfunction (PFD) before pregnancy, and with internal and external severe complications were excluded from this study. At about 42 d after delivery, the incidences of SUI, 9 indicators in POP-Q scoring system, grades of vaginae anterior prolapse, vaginae posterior prolapse and uterine prolapse, muscle strength classification in Ⅰ and Ⅱ types of pelvic floor muscle fiber in two groups were detected. Independent sample t test was used to compare the results of 9 indicatons in POP-Q scoring system of two groups. Chi-square test was used to compare the incidences of SUI in early postpartum period and grade Ⅰ-Ⅲ vaginae anterior prolapse, vaginae posterior prolapse and uterine prolapse of two groups. Wilcoxon rank sum test was used to compare constituent ratios of muscle strength classification in Ⅰ and Ⅱ types of pelvic floor muscle fibers in two groups. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Chengdu Women and Children′s Central Hospital.

①There were no significant differences between two groups among the incidences of obstetrical complications, such as premature rupture of membranes, gestational diabetes mellitus and subclinical hypothyroidism, as well as age, body mass index (BMI) before pregnancy, weight gain during pregnancy, and birth weight of newborns, respectively (P>0.05). ②The results of POP-Q scoring system of primiparae in two groups showed as follows. The lengths of gh (genital hiatus) in observation group and control group were (2.8±0.4) cm and (3.0±0.6) cm, respectively; lengths of pb (perineal body) were (3.6±0.3) cm and (3.5±0.3) cm, respectively; tvl (total vaginal length) were (8.4±0.6) cm and (7.4±3.9) cm, respectively; point Aa (point in the anterior vaginal wall, 3 cm from hymen) were located at (-2.0±0.8) cm and (-1.3±0.8) cm, respectively; point Ba (point in the anterior vaginal prolapse, farthest from hymen) were located at (-2.1±0.8) cm and (-1.4±0.7) cm, respectively; point Bp (point in the posterior vaginal prolapse, farthest from hymen) were located at (-2.9±0.4) cm and (-2.7±0.5) cm, respectively; and all the differences between two groups in the measurement results were statistically significant (t=-2.774, P=0.006; t=2.537, P=0.019; t=-2.534, P=0.012; t=-6.187, P<0.001; t=-6.585, P<0.001; t=-3.123, P=0.002). There were no significant differences between two groups in the measurement results of point Ap (point in the posterior vaginal wall, 3 cm from hymen), point C (point in the anterior fornix of vagina or vaginal stump), and point D (point in the vaginal posterior fornix) (P>0.05). ③The incidence of grade Ⅰ-Ⅲ vaginae anterior prolapse in observation group was 21.0% (21/100), which was significantly lower than that in control group 98.0% (98/100); and the incidence of grade Ⅰ-Ⅲ vaginae posterior prolapse was 13.0% (13/100), which was significantly lower than that in control group 26.0% (26/100), and both the differences were statistically significant (χ²=119.846, P<0.001; χ²=5.383, P=0.016). But there was no significant difference between two groups in the incidence of grade Ⅰ-Ⅲ uterus prolapse (P>0.05). ④ There were no significant differences between two groups in the incidence of SUI in early postpartum period and constituent ratio of muscle strength classification inⅠ and Ⅱ types of pelvic floor muscle fibers (P>0.05).

As to primiparae in early postpartum period with elective cesarean section and transvaginal delivery, there are no differences in the incidences of SUI, muscle strength classification in pelvic floor muscle fibers and uterus prolapse. But the evaluation results of POP-Q scoring system show that transvaginal delivery may be the high risk factor of PFD.

To compare the accuracy of visual observation method and hemoglobin assay method in estimation of volume of postpartum hemorrhage (PPH).

A total of 332 cases of pregnant women delivered in Department of Obstetrics, Chengdu Women and Children′s Hospital, from January 2012 to January 2013 were included in the study. They were divided into two groups according to the modes of delivery: cesarean section group (n=186) and vaginal delivery group (n=146). ①General clinical data between 2 groups were analyzed by stastical methods. ②Volumes of PPH within 24 h after delivery between 2 groups were evaluated by visual observation method and hemoglobin assay method, respectively. ③Incidence rates of PPH between 2 groups were evaluated by visual observation method and hemoglobin assay method, respectively. ④The volume of PPH were calculated when per 10 g/L of hemoglobin (Hb) level decreased. The study protocol was approved by the Ethical Review Board of Investigation in Human Beings of Chengdu Women and Children′s Central Hospital. Informed consent was obtained from each participating patient.

①There were no significant differences between 2 groups of pregnant women in the aspects of maternal age, gravidity and parity, gestational age, weight before birth, and birth weight and length of the neonates (P>0.05). ②The volumes of PPH within 24 h after delivery in cesarean section group and vaginal delivery group evaluated by visual observation method were 380.0 mL (348.8-406.3 mL) and 274.5 mL(220.0-331.1 mL), respectively. The median volume of PPH within 24 h after delivery of cesarean section group evaluated by visual observation method was significantly higher than that of vaginal delivery group, and the difference was statistically significant (H=84.4, P<0.001). The volumes of PPH within 24 h after delivery of 142 and 121 cases with Hb level decreased in cesarean section group and vaginal delivery group evaluated by the hemoglobin assay method were 340.2 mL (170.1-539.5 mL) and 377.1 mL (103.1-652.8 mL), respectively. The volumes of PPH within 24 h after delivery in vaginal delivery group evaluated by hemoglobin assay method was significantly higher than that of cesarean section group, and the difference was statistically significant (H=6.6, P<0.001). ③The incidence rates of PPH estimated by visual observation method in cesarean section group and vaginal delivery group, and in the 263 cases of pregnant women with Hb levels decrease, were significantly lower than those of hemoglobin assay method, and the differences were statistically significant (χ²=21.4, 45.6, 64.0; P<0.001). ④When per 10 g/L of Hb level decrease, the median volume of PPH within 24 h after delivery was 374.9 mL (330.0-419.6 mL).

The hemoglobin assay method provides more accurate estimates of volume of PPH within 24 h after delivery than that of the visual observation method, but it has limitations to estimate the volume of PPH by hemoglobin assay method alone.

To investigate the significance of neonatal critical illness score (NCIS)(Draft) for treating critically ill neonates.

A total of 581 cases of critically ill neonates who were treated in Department of Neonatology, Bazhong Central Hospital of Sichuan Province from May 2012 to May 2015 were selected as research subjects. All the 581 cases met the neonatal critical cases diagnostic criteria in NCIS (Draft) and their clinical data were collected by retrospective method. The single index that matched the index of critically ill neonates of NCIS (Draft) and the score points of inspection items of NCIS for critically ill neonates whose NCIS score ≤90 points were statistically analyzed. According to the prognosis of the 581 cases, they were enrolled into good prognosis group (n=445), and poor prognosis group (n=136). The clinical data between two groups were statistically analyzed. Combined with the results of existing researches and clinical practice, some factors were introduced into multivariate unconditional logistic regression analysis to analyzed the prognostic factors of critically ill neonates.

①Among the 581 cases of critically ill neonates, the number of male neonates was higher than female neonates (370∶211). Most neonates were born in 1 d (420 cases, 72.3%), and there were more neonates via cesarean section than those via vaginal delivery (337∶244). And 54.7% (318/581) neonates had at least one high risk factor. The first three diseases of critically ill neonates were neonatal respiratory distress syndrome (NRDS) (32.4%, 188/581), neonatal pneumonia (22.7%, 132/581), and neonatal asphyxia (15.8%, 92/581). ②Among the 581 cases of critically ill neonates, 455 cases (78.3%) were diagnosed as neonatal critical cases by single index of NCIS (Draft), which were mostly presented as requiring tracheal intubation or repeating apnea without response to stimulation (59.3%, 270/455), severe hyper bilirubinemia (16.7%, 76/455), and hypoglycemia (10.1%, 46/455). Among the 581 cases of critically ill neonates, 585 cases (96.0%) were diagnosed as neonatal critical cases by NCIS score ≤ 90 points. And the first three inspection items with most easily deducted were pH value ≤7.25 or ≥7.50 (31.5%, 176/558), respiratory rate ≤ 25 time/min or ≥ 60 time/min (18.1%, 101/558), and partial pressure of oxygen in artery (PaO₂) ≤ 60 mmHg (1 mmHg=0.133 kPa) (16.8%, 94/558). ③There were no statistical differences between good prognosis group and poor prognosis group in the gender ratio, onset age, and gestational age (P>0.05). Compared with poor prognosis group, the birth weight in good prognosis group was heavier, the hospitalization time was longer, cesarean delivery rate was higher, but the proportion of very critical newborns (NCIS score< 70 points) in good prognosis group was lower, and all the differences were statistically significant (P<0.05). ④The results of multivariate unconditional logistic regression analysis indicated that birth weight, hospitalization time and NCIS score were independent factors affecting the prognosis of critically ill newborns (OR=2.528, 95%CI: 1.178-5.426, P=0.017; OR=76.736, 95%CI: 27.279-215.858, P<0.001; OR=106.697, 95%CI: 43.952-259.019, P<0.001).

The single index and NCIS score in NCIS (Draft) can reflect the state of neonatal lesions accurately and effectively. So this method can guide the treatment and prognosis assessment of critically ill newborns and is beneficial for building referral mechanism in primary hospital and emergency access for critical neonates. Thus it can improve the rate of successful rescue and reduce the mortality rate of critically ill neonates.

To discuss correlation on the S100B protein, caspase-3 protein levels of neonatal umbilical cord blood and neonatal behavior neurological assessment (NBNA) score in gestational diabetes mellitus (GDM) women.

From January 2015 to March 2016, a total of 86 neonates delivered in the First People′s Hospital of Lianyungang were recruited into this study. They were divided into GDM group (n=33) and control group (n=53) on the basis of mother with or without GDM during pregnancy period. The content of S100B protein and caspase-3 protein of neonatal umbilical cord blood were detected by enzyme-linked immuosorbent assay (ELISA). The NBNA scores were determined at postnatal day 3.

①There were no significant differences between two groups in the aspects of constitution ratio of gender, gestational age, birth weight maternal age, etc. (P>0.05). ②The contents of S100B protein and caspase-3 protein in GDM group were higher than those of control group [(38.8±9.3) pg/mL vs (12.4±2.6) pg/mL, (5.3±1.7) μg/mL vs (2.8±0.6) μg/mL], and the differences were statistically significant (t=8.314, 15.977; P<0.001). The NBNA score in GDM group was lower than that of control group [(36.3±1.2) scores vs (38.3±1.2) scores], and the difference was statistically significant (t=8.129, P<0.001). ③In GDM group, the content of S100B protein and caspase-3 protein of neonatal umbilical cord blood were negative correlated with NBNA score in GDM group, respectively (r=-0.583, -0.814; P<0.001), and the content of S100B protein of neonatal umbilical cord blood was positive correlated with caspase-3 protein (r= 0.394, P=0.023 ). While in control group, S100B protein, caspase-3 protein of neonatal umbilical cord blood and NBNA score had no correlation with each other (P>0.05).

GDM is probably the one of the risk factors of neonatal brain damage. It is suggested that S100B protein and caspase-3 protein of neonatal umbilical cord blood can be used as an reference index predicting the degree of brain damage.

To assess the stress disorders status and its influencing factors of children with limb fractures, to provide clinical evidence for laying down the post-fractured nursing mode.

From April to August 2016, a total of 81 cases of children with limb fractures who were treated in Department of Pediatric Orthopedics, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were recruited as research objects by accidental sampling method. The self-designed Basic Information Survey of Children With Limb Fractures and Fracture Knowledge Questionnaire for Parents, and the Child Stress Disorders Checklist (CSDC) which was used to investigate children′s post-traumatic psychological status were conducted among children and their parents, to get the data about limb fractured children′s immediate response scores and post-traumatic response scores, and fracture knowledge that the parents grasped. Through statistical analysis, finding out the influencing factors of limb fractured children′s stress disorders status. Informed consent was obtained from the guardians of each children.

①A total of 81 sets of questionnaires were handed out and 81 sets of valid questionnaires were collected, the feedback rate of valid questionnaires was 100%. ②According to the survey results of CDSC, the median score of CDSC was 7 scores (0-28 scores), and the median scores of immediate and post-traumatic response were 4 scores (1-9 scores) and 2 scores (0-23 scores), respectively. ③According to the survey results of self-designed Fracture Knowledge Questionnaire for Parents, 50.6% (41/81) parents could answer 3-4 questions correctly among 7 questions. However, only 3.7% (3/81) parents could answer all the fracture knowledge correctly. ④ Among those 81 cases of children with limb fracture, the immediate response score of limb fractured children who were >7-14 years old was lower than that of children who were 2-7 years old, and the difference was statistically significant (Z=-2.668, P=0.008). The immediate response score of children with siblings was lower than that of only-child children, meanwhile the score of re-experiencing of post-traumatic response was higher than that of only-child children, and both the differences were statistically significant (Z=-2.049, P=0.040; Z=-2.295, P=0.022). There were no statistical differences in the scores of immediate response, post-traumatic response, CSDC and scores of re-experience, avoidance, numbness and separation, increased alertness and functional lesion of post-traumatic response between the children whose parents could at least answer 4 questions correctly and the children whose parents could only answer less than 4 questions correctly (P>0.05).

The children′s age and only-child could influence the stress disorders status of children with limb fractures. As the sample size in this study is relatively small, the influences of fracture knowledge that the parents have grasped on stress disorders status of children with limb fractures still need large sample, multi-center randomized controlled study to confirm.

To explore the effect on ovarian reserve function and the sensitive marker after laparoscopic operation on unilateral ovarian endometrioma.

From February 2013 to October 2015, a total of 115 women with ovarian cyst underwent laparoscopic cystectomy were included into this study. They were divided into two groups according to histopathological analysis, group A (n=65, histopathological analysis showed ovarian follicle) and group B (n=50, histopathological analysis showed without ovarian follicle). The serum follicle-stimulating hormone (FSH), estradiol and anti-Müllerian hormone (AMH) levels before operation and at seventh day, third month and sixth month after operation were detected, meanwhile, antral follicle count (AFC) and ovarian volume before operation and at seventh day, third month and sixth month after operation were measured by ultrasonic examination. Serum FSH and estradiol levels were detected by electrochemiluminescence immunoassay, and serum AMH levels were detected by enzyme-linked immunosorbent assay (ELISA). The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Northern Jiangsu People′s Hospital. Informed consent was obtained from the parents of each participating patients.

①There were no significant differences between two groups in the aspects of constitution ratio of older than 35 years old, constitution ratio of ovarian endometriotic cyst diameter≥5 cm, operation duration, bleeding volume, et al (P>0.05). ②The level of serum FSH increased at seventh day after the operation than that before the operation, and the levels of serum estradiol and AMH decreased at seventh day after the operation than that before the operation, which both had significant difference (P<0.05). The serum AMH level at third month after the operation still lower than that before operation (P<0.05), but there were no significant difference in serum FSH and estradiol (P>0.05). At the sixth month after the operation, the serum AMH of group A still significant lower than that before the operation (P<0.05), but there were no significant difference in serum FSH and estradiol compared before the operation (P>0.05). As for group B, there were no significant difference in serum FSH, estradiol and AMH levels compared before the operation(P>0.05). ③ There were no significant differences in serum FSH, estradiol and AMH levels between two groups at every different time points (P>0.05). ④ There were no significant differences between two groups in AFC before operation and at sixth month after the operation (P>0.05). The AFC in group A was less than that of group B at the third month after the operations (P<0.05). ④There were no significant difference between two groups of the sizes of ovarian volume of cyst side at the third and sixth month (P>0.05).

The ovarian reserve function is influenced after laparoscopic operation on unilateral ovarian endometrioma. The patients with ovarian follicle whose ovarian reserve function was still in the recovery phase at the sixth month after the operation. The serum AMH can be used as a more sensitive marker of ovarian reserve function assessment, it could be a follow-up marker of premature ovarian failure.