Table of Content

  

10 October 2019
Volume 57 Issue 10

Progress in assisted reproductive technology

SHI Juanzi, CHEN Lijuan

Journal of Shandong University (Health Sciences). 2019, 57(10):  1-6.  doi:10.6040/j.issn.1671-7554.0.2019.726

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Human assisted reproductive technology(ART)has made much progress and acted as the most effective 山 东 大 学 学 报 (医 学 版)57卷10期 -师娟子,等.辅助生殖技术进展 \=-treatment for infertility. It has also been applied to block genetic diseases and preserve fertility. In the advances of ART, studies exploring genetics of gametes and embryos, embryo transfer strategy and fertility preservation have emerged in large numbers in recent years and a series of results have been published. In the future, ART is likely to be used in gene therapy of gametes and embryos, stem cells, and so on. These new technologies will bring serious challenges to safety, ethics and society, which need to be tackled with interdisciplinary efforts.

Hazards of common complications in assisted reproductive technology

HAO Guimin, LUO Zhuoye, CUI Na

Journal of Shandong University (Health Sciences). 2019, 57(10):  7-12.  doi:10.6040/j.issn.1671-7554.0.2019.724

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With the rapid development of assisted reproductive technology(ART), the risks and challenges accompanied cannot be ignored. Ovarian hyperstimulation syndrome, adnexal torsion, hemorrhage after oocyte retrieval, infection, organ damage, multiple pregnancy, and ectopic pregnancy are the common complications of ART. These complications may adversely affect pregnancy outcomes, having an impact on health-related quality of life or even being life-threatened. Serious concern is warranted in terms of risk factors and safety management of ART. Establishing standardized quality management system to identify risk factors in advance, taking effective prevention measures, identifying anomalies in time and providing individualized treatment will make ART more satisfactory.

Prevention and treatment of ovarian hyperstimulation syndrome in assisted reproductive therapy

SHI Yuhua, JIANG Qi

Journal of Shandong University (Health Sciences). 2019, 57(10):  13-19.  doi:10.6040/j.issn.1671-7554.0.2019.639

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Ovarian hyperstimulation syndrome(OHSS)is one of the common, complex iatrogenic complications after human assisted technology(ART). Nowadays, the pathological mechanism of OHSS is unclear. One generally accepted hypothesis is that an increase in the permeability of capillaries causes fluid leakage into the third lacuna, thus causing systematic hemodynamic change. The main risk factors of OHSS include young age, low weight, high level of estradiol(E₂), polycystic ovary syndrome(PCOS), previous episodes of OHSS, and so on. The prevention of OHSS relies on the monitoring of high-risk groups and the rational use of exogenous gonadotropins. The treatment of moderate and severe OHSS is mainly symptomatic treatment to reduce the occurrence of serious complications.

Prevention and treatment of multiple pregnancy in assisted reproductive therapy

ZHAO Junli, YUAN Yingying

Journal of Shandong University (Health Sciences). 2019, 57(10):  20-26.  doi:10.6040/j.issn.1671-7554.0.2019.745

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With the development of assisted reproductive technology(ART), the rate of multiple pregnancy is significantly increased. Multiple pregnancy has become a common iatrogenic complication of ART treatment and posed substantial risks to both mothers and perinatals by various pregnancy complications, premature birth, low birth weight infants. Ovulation induction and multiple embryos transfer in fresh and frozen embryo transfers cycle are the main factors 山 东 大 学 学 报 (医 学 版)57卷10期 -赵君利,等.辅助生殖治疗中多胎妊娠的防治 \=-causing multiple pregnancy. Strengthening the education of medical staff and the public on the harm of multiple pregnancy, amending the detailed regulations on the use of ovulation induction drugs and number of embryos transfer are the most effective guarantee to prevent multiple pregnancy. Strict and rational use of ovulation induction drugs, promotion of single embryo transfers and multiple pregnancy reduction can effectively reduce multiple births and related adverse consequences of ART.

Prevention and treatment of ectopic pregnancy after assisted reproductive technology

HUANG Wei, ZHU Huili

Journal of Shandong University (Health Sciences). 2019, 57(10):  27-32.  doi:10.6040/j.issn.1671-7554.0.2019.760

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Assisted reproductive technology(ART)has become one of the main factors causing ectopic pregnancy(EP), but the exact mechanism remains unclear. Current studies suggest that fallopian tube factors, influence of hyperphysiological hormone environment on endometrial receptivity, embryonic growth potential and ART operations may be 山 东 大 学 学 报 (医 学 版)57卷10期 -黄薇,等.辅助生殖技术后异位妊娠的防治 \=-high risk factors leading to ectopic pregnancy after ART. This article reviewed the prevention and treatment of ectopic pregnancy following ART from the aspects of fallopian factors, embryo factors, ART-related operations, and specific types of EP.

Possible causes and treatment of postoperative bleeding after transvaginal oocyte retrieval in assisted reproductive therapy

WU Qiongfang

Journal of Shandong University (Health Sciences). 2019, 57(10):  33-37.  doi:10.6040/j.issn.1671-7554.0.2019.758

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Since the birth of transvaginal oocyte retrieval(TVOR), the method of oocyte retrieval by laparoscopy has withdrawn from the historical stage. Although TVOR is currently the easiest and safest way to obtain ova, some related complications cannot be completely avoided. Severe intra-abdominal hemorrhage caused by TVOR may even endanger the patients life. Therefore, this article will detail the possible causes and treatment of postoperative bleeding after transvaginal oocyte retrieval in assisted reproductive therapy.

Application and key points of hysteroscopic surgery in assisted reproductive technology

LI Xiaojuan, DUAN Haixia

Journal of Shandong University (Health Sciences). 2019, 57(10):  38-44.  doi:10.6040/j.issn.1671-7554.0.2019.807

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Intrauterine lesion is one of the common causes of infertility and may lead to failure of assisted reproductive 山 东 大 学 学 报 (医 学 版)57卷10期 -李小娟,等.辅助生殖治疗中宫腔镜手术应用及注意问题 \=-technology(ART). Hysteroscopic technique is the “gold standard” and main approach for the diagnosis and treatment of intrauterine lesions, which can improve the pregnancy rate of ART. However, with the wide application of hysteroscopic techniques, the complications caused by energy devices are increasingly common and serious. Endoscopic doctors are urged to pay more attention to the safety and efficiency of hysteroscopic techniques. To this end, “cold knife” technique emerges. This technique not only protects the endometrium, but also reduces hospitalization rate and improves medical efficiency. At present, various different “cold knife” techniques are constantly being explored and expected to be a new trend of hysteroscopic surgery.

Application and problems of laparoscopic in assisted reproductive therapy

HAN Ting, CHEN Honglei

Journal of Shandong University (Health Sciences). 2019, 57(10):  45-51.  doi:10.6040/j.issn.1671-7554.0.2019.754

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With the continuous development of assisted reproductive technology and the significant increase of pregnancy rate, there are still many difficult problems, such as hydrosalpinx, endometriosis, and uterine myoma. These diseases affect the success rate of assisted reproductive therapy and produce many troublesome complications, such as ectopic 山 东 大 学 学 报 (医 学 版)57卷10期 -韩婷,等.辅助生殖治疗中腹腔镜手术应用及注意问题 \=-pregnancy and ovarian torsion, which often require laparoscopic surgery. This article reviews the application and attention problems of laparoscopic in assisted reproductive therapy in order to provide reference for the clinical treatment of infertile patients.

Safety of human assisted reproductive technology offspring

ZHANG Yingchun

Journal of Shandong University (Health Sciences). 2019, 57(10):  52-59.  doi:10.6040/j.issn.1671-7554.0.2019.873

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With the maturation of assisted reproductive technology(ART), it has become a reliable means for infertile patients to overcome disease and obtain offspring. The effects of a variety of clinical and laboratory interventions in ART process, including in vitro fertilization(IVF), intracytoplasmic sperm injection(ICSI), preimplantation genetic diagnosis(PGD), embryo cryopreservation and freeze-thaw embryo resuscitation, on the safety of ART offspring have become the focus of reproductive medicine research. Present studies have shown that the health status of ART conceived offspring is similar to that of children conceived naturally, and ART is relatively safe. However, influenced by the age of ART offspring and the sample size, those studies only reported the data on the early follow-up of ART offspring after birth. There is no authoritative study to reveal the long-term health outcomes of ART offspring after adulthood, and whether these findings are associated with ART indications, causes of infertility, maternal age, genetic factors, IVF, and adverse perinatal outcomes related to IVF. This article reviews the safety of offspring following ART, and discusses topics on ART and birth defects, ART and preterm birth, ART and low birth weight infants, ART offspring growth and development assessment, and mental health of ART offspring, to provide a basis for the safe and effective application of human ART.

Common ethical issues on assisted reproductive technology and their management

TAN Jichun, DONG Meng, LI Pingping

Journal of Shandong University (Health Sciences). 2019, 57(10):  60-66.  doi:10.6040/j.issn.1671-7554.0.2019.771

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The widespread use of assisted reproductive technology(ART)has resulted in an increasing number of ethical issues. As ART involves eggs, sperm and embryos, more attention should be paid to life ethics and legal behaviors. This article discusses common ethical issues in ART, including sperm donation, egg donation, disposal of frozen embryos in the case of divorce or death of a married couple, advanced age, gestational surrogacy, ethical conflict of multiple pregnancy and fetal reduction. From perspectives of legal guarantee, standardized management, ethical supervision and industry self-discipline, we seek to deal with these issues, in order to promote the healthy and orderly development of ART in China, and make ART research and application benefit patients livelihood.

Research progress on fertility of the Klinefelter syndrome

MA Gang, XU Chao

Journal of Shandong University (Health Sciences). 2019, 57(10):  67-73.  doi:10.6040/j.issn.1671-7554.0.2019.765

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The Klinefelter syndrome is the most frequent chromosomal aberration in infertile males. Due to testicular 山 东 大 学 学 报 (医 学 版)57卷10期 -马刚,等.克氏综合征的生育相关研究进展 \=-dysplasia, patients are often diagnosed with azoospermatism and cannot have offspring. Many couples choose to adopt or use donor sperms to have babies. In recent years, with the development of assisted reproductive technology, there have been more strategies for the treatment of patients with Klinefelter syndrome. Endocrine therapy and intracytoplasmic sperm injection with sperm acquired from the testicle make it possible for patients to have offspring. In this paper, we will review the research on fertility related to Klinefelter syndrome, and discuss the age of sperm extraction, surgical methods, endocrine therapy and genetic risks in patients with Klinefelter syndrome.

siRNA-mediated silencing of RRM2 in the treatment of epithelial ovarian cancer xenograft in nude mice

XUE Ting, WANG Liming, JIAO Jinwen, LI Yong, GUO Ailian, ZHAO Han

Journal of Shandong University (Health Sciences). 2019, 57(10):  74-79.  doi:10.6040/j.issn.1671-7554.0.2019.270

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Objective To explore the feasibility of siRNA silencing of ribonucleotide reductase M2(RRM2)gene combined with cisplatin on the treatment of human ovarian cancer subcutaneous xenograft in nude mice. Methods After conventional cultivation of human ovarian cancer cell line SKOV3 in vitro, subcutaneous injections of ovarian cancer were administered to nude mice to create a xenograft model. Twenty-four tumor-burdened mice were randomly divided into the control group(n=6), cisplatin group (n=6), siRNA group (n=6), and siRNA+cisplatin group (n=6). Tumor volume was measured and tumor growth inhibition rate was calculated. RRM2 gene expressions at mRNA level and protein level were detected by RT-PCR and immunohistochemistry. Results After single drug treatment, the tumor volumes of control group, siRNA group, cisplatin group and siRNA+cisplatin group were(358.28±46.40),(261.38±52.49),(261.65±31.97)and(189.37±41.67)mm³, respectively, with a significant statistical difference (F_siRNA-RRM2= 山 东 大 学 学 报 (医 学 版)57卷10期 -薛婷,等.siRNA介导RRM2基因沉默治疗人卵巢癌裸鼠移植瘤 \=-22.399,P_siRNA-RRM2<0.001; F_cisplatin=22.254, P_cisplatin<0.001). There was no interaction effect between the two drugs (F=0.474,P=0.499). The tumor growth inhibition rates of the four groups were 0, 36.39%, 41.10% and 64.33%, respectively. The single drug(siRNA-RRM2 or cisplatin)treatment reduced the expression levles of RRM2 mRNA(F_siRNA-RRM2=9.37, P_siRNA-RRM2=0.006; F_cisplatin=11.90, P_cisplatin=0.003)and protein (F_siRNA-RRM2=8.71, P_siRNA-RRM2=0.008; F_cisplatin=13.01, P_cisplatin=0.002), with a significant statistical difference. There was no interaction effect between the two drugs (F_{RRM2 mRNA}=3.93, P_{RRM2 mRNA}=0.061; F_{RRM2 protein}=1.72, P_{RRM2 protein}=0.204). Conclusion siRNA alone or combined with cisplatin can effectively inhibit the growth of human ovarian cancer subcutaneous xenograft, which may be related to the silencing of RRM2 gene expression. RRM2 gene silencing may be a potential treatment regimen for ovarian cancer in future.

Establishment of survival related multigene prognostic model of epithelial ovarian cancer

ZHU Aiguo, MA Zhenchi, WANG Jian

Journal of Shandong University (Health Sciences). 2019, 57(10):  80-85.  doi:10.6040/j.issn.1671-7554.0.2019.104

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Objective To establish a multigene prognostic model associated with the prognosis of the epithelial ovarian cancer(EOC)patients and validate the prognostic power through Gene Expression Omnibus(GEO)database and The Cancer Genome Atlas(TCGA)database. Methods The Affymetrix expression profiles(GSE14407)were downloaded 山 东 大 学 学 报 (医 学 版)57卷10期 -朱爱国,等.利用上皮源性卵巢癌预后的多基因信息建立预测预后模型 \=-and analyzed from GEO dataset. Different expression genes(DEGs)between EOC tissue and normal epithelial tissue were selected to identify a multigene prognostic model. DEGs were selected by univariate and multivariate Cox regression model to establish a multigene prognostic model and prognostic index(PI)formula. mRNA expression data and clinical data of patients were obtained from TCGA dataset. According to PI, the patients were divided into high risk group and low risk group. Clinical and pathological feature(age, neoplasm subdivision, histologic grade, residual tumor, clinical stage)and PI were evaluated as influence factors affecting overall survival(OS)of EOC patients. The prognostic value of multigene model by Kaplan-Meier survival analysis was verified in overall and subgroup EOC patients according to age, neoplasm subdivision, residual tumor, and clinical stage. Results A total of 47 DEGs between EOC and normal tissues were screened, in which 37 DEGs were down-regulated and 17 DEGs were up-regulated. By univariate and multivariate Cox model, 4DEGs, i.e., PACSIN3,KCNT1,LAMP3 and KIR3DX1, were finally selected to establish a four-gene prognostic model. PI formula was as follows:(-0.169 × the expression of PACSIN3 + 0.078 × the expression of KCNT1 -0.246 × the expression of LAMP3 -0.147 × the expression of KIR3DX1). Age, residual tumor and multigene gene prognostic model were independent prognostic factors of EOC patients(P<0.01). OS of low risk group was longer than high risk group by K-M plots(P<0.05). In different subgroups(age,clinical stage, neoplasm subdivision, residual tumor)of EOC patients, low risk group had longer OS than high risk group(P<0.05). Conclusion Four-gene prognostic model is the independent prognostic factor in EOC patients, and is demonstrated remarkable prognostic value in overall EOC patients and each subgroup according to different clinical and pathological factors.

Effects of mifepristone and misoprostol on the expression of TRIM22 in trophoblast cells

ZHAO Limei, YAN Lei, SHEN Xiaochang, SUN Yiqing, HE Pengjuan, ZHAO Xingbo

Journal of Shandong University (Health Sciences). 2019, 57(10):  86-92.  doi:10.6040/j.issn.1671-7554.0.2019.344

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Objective To investigate the effects of mifepristone and misoprostol on the expression of TRIM22 in trophoblast cells. Methods Forty cases of early pregnancy were divided into embryo aborting group(group A, n=12), artificial abortion group(group B, n=14)and drug abortion group(group C, n=14). HTR-8 cells were cultured in vitro and randomly divided into blank control group(group D), misoprostol group(group E), mifepristone group(group F), and mifepristone plus misoprostol group(group G)according to 2×2 factorial design. CCK-8 assay was used to detect the proliferation of cells, and cell scratch test was used to detect the migration ability of cells. The expression site and intensity of TRIM22 protein were detected by immunohistochemistry. Real-time fluorescence quantitative PCR and Western blotting were used to detect the expression of TRIM22 mRNA and protein and semi-quantitative analysis was performed. Results In the clinical cases, TRIM22 was mainly expressed in the nucleus of trophoblasts; the expression intensity of TRIM22 protein and mRNA in groups A and C was lower than that in group B(P<0.05), but there was no 山 东 大 学 学 报 (医 学 版)57卷10期 -赵立美,等.米非司酮、米索前列醇对滋养细胞TRIM22表达的影响 \=- significant difference between groups A and C (P>0.05). For the in vitro model of trophoblasts, the proliferation and migration ability of trophoblasts, and the expressions of TRIM22 protein and mRNA in the groups using mifepristone(group F, group G)were decreased compared with the groups without mifepristone(group D, group E)(P<0.001). There was no significant difference between misoprostol groups(group E, group G)and non-misoprostol group(group D, group F)(P>0.05); there was no significant interaction between mifepristone and misoprostol (P>0.05). Conclusion Mifepristone may inhibit the proliferation and migration of trophoblasts by down-regulating the expression of TRIM22. Misoprostol has no significant effect on the proliferation and migration of trophoblasts.

Risk factor for cerebral infarction in 12 patients after revascularization of 175 patients with Moyamoya disease

ZHAO Yani, LUAN Xiaorong, LI Haiyan

Journal of Shandong University (Health Sciences). 2019, 57(10):  93-100.  doi:10.6040/j.issn.1671-7554.0.2019.850

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Objective To evaluate the risk factors for cerebral infarction after vascular reconstruction for Moyamoya disease(MMD), and to explore the preventive strategies. Methods The clinical data of 175 MMD patients were retrospectively analyzed and the patients were classified into positive group and negative group according to the occurrence of emerging infarction. Demographic data, comorbidities, and preoperative, intraoperative and postoperative blood pressure were compared. Univariate and multivariate regression analyses were performed to explore the risk factors for cerebral infarction. Results The incidence of cerebral infarction was 6.8%(12/175). Univariate analysis revealed that age, diabetes, hypertension, preoperative mean systolic blood pressure, preoperative mean diastolic blood pressure, and transit ischemic attack were significantly different between the positive and negative groups (P<0.05). Multivariate analysis demonstrated that comorbidity with diabetes and hypertension, and high systolic pressure are independent risk factors for new cerebral infarction after vascular reconstruction for MMD (P<0.05). Conclusion Comorbidity with diabetes and hypertension, and high systolic pressure are independent risk factors for cerebral infarction after vascular reconstruction. Medical intervention is recommended for patients with these risk factors to control the blood sugar and blood pressure and to maintain the preoperative systolic pressure within the normal range. Intensive observation is recom- 山 东 大 学 学 报 (医 学 版)57卷10期 -赵亚妮,等.175例烟雾病血管重建术后12例发生脑梗死的危险因素分析 \=-men ded to find the premonition of cerebral infarction, and preventive treatment should be taken to reduce the risk of cerebral infarction.

Diagnosis value of serum exosome miR-205-5p/miR-152-5p on early non-small cell lung cancer

ZHENG Qingyue, ZHAO Qiuhong, QU Xiangyun, DONG Zhaonan, MA Xueqing, JIA Yunli

Journal of Shandong University (Health Sciences). 2019, 57(10):  101-106.  doi:10.6040/j.issn.1671-7554.0.2019.455

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Objective To study the comprehensive expression and diagnosis value of serum exosomal miR-205-5p and miR-152-5p for early non-small cell lung cancer(NSCLC). Methods The objects were divided into the NSCLC group (n=83), which were further divided into the adenocarcinoma group (n=55) and squamous cell carcinoma group (n=28), and the control group (n=50). The TNM stage of NSCLC patients was 0-II. Serum samples were collected, the exosomal miRNA were extracted, then the comprehensive expressions of miR-205-5p and miR-152-5p were detected. The comprehensive expression between the NSCLC group and control group, and among adenocarcinoma group, squamous cell carcinoma group and control group were compared. Multiple linear regression was used to analyze the correlation between expression level and gender, age, smoking history, tumor size and lymph node metastasis. The diagnostic 山 东 大 学 学 报 (医 学 版)57卷10期 -郑清月,等.血清外泌体miR-205-5p/miR-152-5p对早期非小细胞肺癌的诊断价值 \=-value of the comprehensive expression of miR-205-5p and miR-152-5p was evaluated with receiver operating characteristic(ROC)curve. Results The comprehensive expressions of control group, NSCLC group, adenocarcinoma group and squamous carcinoma group were 17.76±4.27, 20.52±5.51, 21.79±5.12, and 18.02±5.48, respectively. The expression was significantly higher in the NSCLC group than that in the control group (t=3.027,P=0.003). There were statistically significant differences among adenocarcinoma group, squamous cell carcinoma group and control group (F=10.412,P<0.001). The comprehensive expression of miR-205-5p/miR-152-5p was significantly higher in the adenocarcinoma group than that in the squamous cell carcinoma group (P=0.001) and the control group (P<0.001). The expression in the squamous cell carcinoma group and control group had no difference (P=0.823). Multiple linear regression analysis showed correlation between lymph node metastasis and expression level (P=0.037). For evaluation of diagnostic value of NSCLC, the area under the ROC curve(AUC)was 0.671(95%CI: 0.579-0.764),the cutoff value was 18.493, and the sensitivity and specificity were respective 73.3% and 64.0%. For evaluation of diagnostic value of lung adenocarcinoma, the AUC was 0.738(95%CI:0.642-0.883), the cutoff value was 18.495, the sensitivity and specificity were respective 78.2% and 64.0%. There was no diagnostic value for lung squamous cell carcinoma, with the AUC being 0.541(95%CI:0.399-0.684). Conclusion The comprehensive relative expressions of serum exosomal miR-205-5p and miR-152-5p are increased in early NSCLC patients, mainly in early lung adenocarcinoma patients. It has auxiliary value for early diagnosis of NSCLC.

Effects of serum levels of sEGFR, CEA and Cyfra21-1 on the prognosis of non-small cell lung cancer patients

XU Shuyuan, JI Quanjiang, GUO Li

Journal of Shandong University (Health Sciences). 2019, 57(10):  107-111.  doi:10.6040/j.issn.1671-7554.0.2019.691

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Objective To investigate the correlation between the expression levels of serum soluble epidermal growth factor receptor(sEGFR), carcinoembryonic antigen(CEA), cytokeratin 19 fragment(Cyfra21-1), and overall survival of patients with non-small cell lung cancer(NSCLC). Methods Altogether 127 NSCLC cases were involved, including 42 cases of squamous carcinoma and 85 cases of adenocarcinoma. The TNM stage was II+III in 45 cases and IV in 82 cases. The sEGFR expression was detected with ELISA, and CEA and cyfra21-1 levels were detected with electrochemical luminescence. The relationship between the levels of sEGFR, CEA, Cyfra21-1 and the clinicopathological characteristics and prognosis of NSCLC patients were analyzed. Results The expressions of sEGFR and CEA in NSCLC patients were correlated with the clinical stage (P<0.05). Patients with adenocarcinoma showed significantly higher CEA than patients with squamous carcinoma (P<0.05), while serum Cyfra21-1 had no statistically significant characteristics (P>0.05). The median survival of patients with reduced serum sEGFR, increased CEA, and increased Cyfra21-1 was 9.0(4.0-21.25)months, 8.5(4.0, 16.0)months and 8.0(4.0, 13.25)months, respectively, which were statistically significant compared with patients with normal expressions (P<0.05). Conclusion The decrease of sEGFR, increase of CEA and Cyfra21-1 in patients with NSCLC is significantly correlated with the overall survival, and the prognosis can be assessed by detecting the serum levels of sEGFR, CEA and Cyfra21-1. 山 东 大 学 学 报 (医 学 版)57卷10期 -徐淑媛,等.血清sEGFR、CEA及Cyfra21-1水平对非小细胞肺癌患者预后的影响 \=-

An analysis of the duration and clinical efficacy of pre-transition infantile spasm

JIA Guijuan, LI Baomin, LEI Gefei, SUN Ruopeng, LIU Xinjie

Journal of Shandong University (Health Sciences). 2019, 57(10):  112-117.  doi:10.6040/j.issn.1671-7554.0.2019.490

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Objective To explore the correlation between duration of pre-transition infantile spasm and clinical efficacy. Methods The clinical and electroencephalogram data, follow-up results and prognosis of 63 infants with pre-transition spasm were retrospectively analyzed. Results There were 40 male(63.5%)and 23 female(36.5%)infants. The onset was ≤1 year in 50 patients(79.36%), and >1 year in 13 patients(20.64%). Duration of the transition was 14 days to 23 months, average 8.06 months, median 6 months. The interval of seizure transition was ≤3 months in 10 patients(15.87%), and >3 months in 53 patients(84.13%). Latent causes were found in 28 cases(44.44%)and no obvious causes were found in 35 cases(55.56%). VEEG confirmed that 29 cases(46.03%)had the first tonic episode as the transition point, and 34 cases(53.97%)had transition point mixed with other seizure types. Clinical spasm remission was related to gender and transition interval, and the differences were statistically significant(P<0.05), but not related to the age of onset and the presence of latent etiology(P>0.05). Conclusion The remission rate of spasm is worse in males than in females and those with shorter duration of spasm before transition have better prognosis.