Search

Objective:To compare the embryo condition and clinical outcomes between patients with low and normal serum luteinizing hormone (LH) levels on the day after a single trigger of gonadotropin-releasing hormone agonist (GnRH-a). In patients with low LH levels we further analyzed the efficacy of human chorionic gonadotropin (HCG) to trigger ovulation.Methods:We retrospectively analyzed 957 infertile patients (tubal factor, ovulation disorders, male sperm factor, or unexplained infertility) who were treated with in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI)-assisted pregnancy at the Chengdu Xinan Gynecology Hospital from July 2017 to December 2020. Patients with sufficient GnRH-a single trigger and normal serum LH levels on the next day were used as the control group (n=906), and patients with low LH levels were set as the experimental group (n=51), of whom 10 received HCG retriggering. We analyzed the effects of low and normal LH levels, and the efficacy HCG retriggering in patients with low LH level on the embryo status and embryonic transplantation after cryopreservation outcome of patients.Results:There were no significant differences in egg yield, 2PN fertilization rate, excellent embryo rate, or live birth rate of frozen-thawed embryos between patients with low and normal LH levels after GnRH-a trigger. There was also no difference in patients with low LH levels who received HCG retriggering or not.Conclusion:The outcomes of patients with low LH levels on the day after GnRH-a administration were similar to those of patients with normal LH levels. The embryo status and live birth rate of frozen-thawed embryos in patients with low LH levels in the HCG retriggering and non-HCG retriggering groups are similar. When blood LH< 10 miu/ml was measured on the day after GnRH-a trigger, no special treatment was required, and there was no significant effect on embryonic and clinical outcomes. No blood LH test is required on the day following the trigger, which does not affect the outcome of in vitro fertilization.

Background The current clinical practice regarding intraoperative ventilation management in non-cardiothoracic surgical setting among anesthesia providers in China is unclear. Methods We developed a 25-question anonymous survey which was distributed to anesthesia departments from 81 tertiary/university hospitals in China between August 2021 and September 2021. Information including participant characteristics, ventilatory settings, and opinions on lung-protective ventilation were obtained by electronic survey. Results were reported descriptively. Results The survey was completed by 1089 anesthesiologists from 57 institutions (70% institution response rate). The vast majority of respondents (1010/1089; 92.7%)used low tidal volume (6–8 ml kg − 1) ventilation. About three quarters (840/1089; 77.1%) utilized positive end-expiratory pressure, and most anesthesiologists set positive end-expiratory pressure of 1–5 cmH2O in either laparoscopic (639/840; 76.1%) or non-laparoscopic surgery (736/840; 87.6%). The majority of respondents (921/1089; 84.6%) performed alveolar recruitment maneuver intraoperatively. Approximate 20% of respondents routinely implemented lung-protective ventilation with bundles of low tidal volume, positive end-expiratory pressure, and alveolar recruitment maneuver. Conclusions We found that heterogeneity exists between individual practices regarding intraoperative ventilation management in the setting of non-cardiothoracic surgery, indicating the potential knowledge-practice gap among Chinese anesthesiologists. Trial registration number: ChiCTR2100047653; Registration date: June 21, 2021 Registry URL: Chictr.org.cn.

Background: Postoperative pulmonary complications (PPCs) is the most common perioperative complication following surgical site infection (SSI), which prolongs the hospital stay and increases health care cost. Lung-protective ventilation strategy is considered better practice in abdominal surgery to prevent PPCs. However, the role of inspiratory oxygen fraction (FiO₂) in the strategy remains disputable. Previous trials have focused on reducing SSI by increasing inhaled oxygen concentration but higher FiO₂ (80%) was found to be associated with a greater incidence of atelectasis and mortality in recent researches. The trial aims at evaluating the effect of different FiO₂ added to lung-protective ventilation strategy on the incidence of PPCs during general anesthesia for abdominal surgery. Methods: PROtective Ventilation with a low versus high Inspiratory Oxygen fraction trial（PROVIO）is a single-center, prospective, randomized, controlled trial planning to recruit 252 patients undergoing abdominal surgery lasting for at least 2 hours. The patients will be randomly assigned to (1) a low FiO₂ (30% FiO₂) group and (2) a high FiO₂ (80% FiO₂) group in lung-protective ventilation strategy. The primary outcome of the study is the occurrence of PPCs within the postoperative 7 days. Secondary outcomes include the severity grade of PPCs, the occurrence of postoperative extrapulmonary complications and all-cause mortality within the postoperative 7 and 30 days. Discussion: PROVIO trial assesses the effect of low versus high FiO₂ added to lung-protective ventilation strategy on PPCs for abdominal surgery patients and the results will provide practical approaches to intraoperative oxygen management. Trial registration number: Registered at www.ChiCTR.org.cn on 13 February 2018 with identifier no. ChiCTR18 00014901. Keywords: Postoperative pulmonary complications, Lung-protective ventilation, Fraction of inspired oxygen, Abdominal surgery.