- Breast Surgery
- Cancer Center
- Ears, Nose, and Throat
- Emergency Room
- Family Medicine
- Fertility Clinic
- General Surgery
- Internal Medicine
- Medical Imaging
- Nuclear Medicine
- Orthopedics and Sports Medicine/Rehabilitation
- Respiratory Medicine
Smoking Cessation EducationLEARN MORE
Tobacco use is one of the biggest public health threats the world has ever faced, killing more than 8 million people a year around the world. More than 7 million of those deaths are the result of direct tobacco use while around 1.2 million are the result of non-smokers being exposed to second-hand smoke. Smoking cessation reduces risk for many adverse health effects, including poor reproductive health outcomes, cardiovascular diseases, chronic obstructive pulmonary disease (COPD), and cancer. When coming into the hospital setting, one of the most important actions you can take to improve your health is to quit smoking, no matter how old you are or how long you’ve been smoking. Jiahui International Hospital is committed in building a hospital environment that is smoking-free.
1. How does smoking affect people having surgery?
• In recent years, research has shown that compared to nonsmokers, smokers have a higher chance of surgery-related complications like heart attack, stroke, shock and death. Smoking decreases blood flow making surgical wounds less likely to close, less likely to heal well and more likely to become infected. Smoking also weakens the immune system, which increases the chance of infection after surgery.
• Smokers are more likely than nonsmokers to experience specific complications from all types of surgeries. For example:
◦ Orthopedic (bone or joint) surgery: bones can take longer to heal.
◦ Plastic surgery: higher chance of scarring.
◦ Breast reconstruction surgery: more likely to lose implants.
◦ Spinal fusion surgery: higher chance of infection and bone fracture.
◦ Even secondhand smoke is a problem when it comes to surgery. For example, children have more complications after surgery if their parents smoke around them.
2. How does quitting smoking help with surgical outcomes?
• Quitting cigarettes before surgery makes a huge difference. Patients can expect fewer complications if they stop smoking three to four weeks before other types of surgeries too, but even quitting a day or two before any surgery can make a tremendous difference.
• Just within a day or two after stopping, the body can bring more oxygen to cells and blood flow improves, making it easier for healing. Three to six weeks after stopping, the body’s defenses against bacterial infection improve.
3. When to quit smoking before surgery
• The sooner you can quit smoking prior to surgery, the better.
• With each passing smoke-free day, your overall risk of complications decreases. Quitting even 12 hours prior to surgery can make a difference, but quitting eight weeks before surgery can have a dramatic impact on your surgery and recovery.
• When you quit matters:
◦ 12 hours before surgery: improved oxygenation, blood pressure, and heart rate
◦ 2 weeks before surgery: less breathing problems during surgery
◦ 3 weeks before surgery: wound healing improves
◦ 8 weeks before surgery: decreased risk of clot-related problems (heart attack and stroke) and risk of infection; improved immunity and response to anesthetic medications
4. What is the policy of Jiahui International Hospital for smoking cessation?
• At our hospital, you will be advised not to smoke in doors.
• If you are a surgical patient, we recommend you start quitting smoking at least one week prior to your surgery to prepare you for the procedure and your recovery. This will be the best time for you to start quitting smoking while you’re taking care of by doctors and nurses.
• Any challenge through your quitting smoking journey, please call your health care providers (Call Center: 4008683000) to discuss any alternative method to do more to help you quit smoking.
5. What you should do if you want to quit smoke?
• It's a good idea to start by talking with your doctor or nurse. It is possible to quit on your own, without help. But getting help greatly increases your chances of quitting successfully.
• Here are some tips for you if you feel like you are ready to quit:
◦ Start by making a plan first:
Set a quit date;
Tell your family and friends that you plan to quit;
Plan ahead for the challenges you will face, such as cigarette cravings.
Global Burden of Disease [database].Washington, DC: Institute of Health Metrics;
2019. IHME,accessed 17 July 2021
Smoking and Tobacco Use | CDC
Same Day Surgery in Jiahui International Hospital(For adult)LEARN MORE
Welcome to Jiahui International Hospital (JIH) located in 689 Guiping Road, Xuhui District, Shanghai. Our mission is to provide excellence in healthcare for our patients. We are dedicated to providing you with an experience that is efficient, high quality and as comfortable as possible. We have provided this set of instructions to help you learn what to expect and how to prepare for your upcoming procedure. Advanced preparation helps you relax, and may speed your recovery. Please read this brochure and feel free to ask questions to learn more.
1. What to bring
• Please bring any test results not done at Jiahui Health when you check in on the day of surgery.
• Please bring all medication labeled containers or boxes if you currently take them regularly.
• Eyeglasses, contact lenses & case, Hearing aid(s) & case, denture case (if applicable).
• ID or passport, Chinese social security card, commercial insurance documents.
2. Preparing for surgery at home
• We recommend increasing the carbohydrates in your diet for 1 to 2 days before your surgery. This will help your body have the energy you need for surgery and recovery. Foods that are good sources of carbohydrates include: pasta, rice, cereals, bread, beans and lentils, milk and fruit.
• If you are diabetic, please discuss with your doctor about how to manage your diet.
• Fasting requirement (NPO):
1. No food starting 8 hours prior to surgery.
2. You may drink water or other clear liquids between 2-8 hours prior to surgery.
3. Absolutely no fluid or food starting 2 hours prior to surgery.
4. Clear liquids would include coffee or tea without milk or cream, carbonated water and water fortified with salt such as sports drinks. It must be completely transparent without any sediments.
If you do not follow this NPO requirement, your surgery may be cancelled.
Preparing Your Skin for Surgery
• Skin Preparation: According to the surgical site and types of the surgery, you are usually asked to have a bath / shower and hair shampoo the night before and the morning of the surgery.
• Surgeries may require you to use 2% chlorhexidine to start cleaning the surgical site one to three days prior to the day of the surgery.
• Put on clean and breathable clothes after showering.Smoking and alcohol
• If you smoke and you are scheduled for surgery, we recommend that you take immediate steps to stop smoking at once. Do not smoke at least one week before your surgery. Smoking will not only increase your airway secretion, but also decrease blood flow making surgical wounds less likely to close, less likely to heal well and more likely to become infected.
• Please do not drink alcohol for 48 hours before your operation. Alcohol may change how your body reacts to medications during the operation.Current medication taking
• Most medications should be taken on your usual schedule the day before your surgery. If you take medications listed below, please discuss with your doctor:
• Anticoagulant/blood thinning medication
Please discuss with your surgeon if and/or when you should stop the anticoagulation prior to your surgery.
• Blood Glucose Medication
Please follow your doctor’s instruction about holding or cutting down your morning diabetic medication dose.
• Antihypertensive medication
You may take your anti-hypertensive medication with a sip of water on the day of your surgery. If you are undergoing thoracic surgery, please stop taking anti-hypertensive medication that contains reserpine composition one week before the surgery.
• Hormonal Medication
You can continue to take your hormonal medication before surgery to avoid fluctuation of medication concentration (e.g. thyroxine sodium, female hormones). If you are currently taking steroids, please follow your doctor’s instruction. Your doctor may elect to substitute your oral steroids with an intravenous dose.
• Any medication you have been told to take before surgery, take it with small sips of water.
3. Arriving for surgery in the hospital
Arrive on time
Please arrive 2 hours before your scheduled surgery time. Every effort is made to ensure your surgery begins at the scheduled time. Your surgery might be delayed due to unexpected reasons, such as emergency or prolonged operation time for the first patient. We will inform you at the right time if this is the case.
A nurse will take you to the pre-operative area and complete a final checklist with you. You will be asked to change into a hospital gown. You will meet your anesthesiologist (the doctor who will provide your anesthesia) and other members of your surgical team who will answer any questions and ask you to sign or confirm the consent forms.
Information for families
• It is helpful to designate a family spokesperson, so the health care staff can update your condition to them during or after your surgery.
• We cannot share any medical information about you by phone to outside callers. Family or friends may wait for you in the surgical waiting area located on the 2nd floor of ambulatory building.
• COVID-19 negative test results are required within the required validated period (follow pre-surgery patient instruction by your nurse) for both you and any of your significant others accompanying you in the hospital.
• You will be receiving care from the anesthesia team who will keep you comfortable and pain-free. Inside the operating room, you will be introduced to your care team, you will be asked to participate in our safety checks, and then your anesthesia will be administered.
• Your anesthesiologist will use multimodal pain control regimens to help reduce your pain and discomfort. The multimodal pain control regimens will be adjusted according to its efficacy and if any adverse event occurs.
• Immediately after waking up, you may feel dizzy or sometimes nauseous. Your anesthesiologist will be by your side to provide further medication and treatment. This discomfort will gradually go away while you recover.
2. In the Operating Room
Staffing: Your Surgical Team usually includes the followingmembers:
• Surgeon, who is responsible for your overall care, leads your surgical team.
• A surgical assistant will be present when more than 1 doctor is necessary to perform your surgery.
• An anesthesiologist provides anesthesia or medication, and monitors vital signs.
• A scrub nurse sets up instruments and assists the surgeon.
• A circulating nurse prepares the OR, makes sure sterile methods are followed, and helps other team members.
• An IV (intravenous line) will be used to provide fluids to your body. When needed, medications and blood are also given through the IV. An IV feels like a pinprick when it is inserted.
• Monitors show your vital signs (blood pressure, heart rate, heart rhythm, etc.).
Electrocardiography records your heart functions. It is connected by wires to round, sticky patches that are placed on your upper body.
A pulse oximeter, placed on your finger, monitors your blood’s oxygen level.
Blood pressure cuff is placed on your arm to monitor your blood pressure.
There will be surgical lights overhead and other equipment around you in the room to help in your operation, and to make sure you are safe and comfortable.
1. In the PACU (Post-Anesthesia Care Unit)
After your surgery, you will wake up in the Post-Anesthesia Care Unit (PACU). Your nurse will check your blood pressure, pulse and incision frequently. The nurse will ask you about your pain and make sure you are comfortable. You will stay here for several hours until you are fully wake.
You may have:
• An oxygen mask over your face
• An intravenous line giving you fluids and medicine
• When you are ready, you will be discharged from the PACU to either go home or be admitted to a hospital room, depending on your level of recovery and the type of procedure that was performed.
• If you are discharged to go home, be sure to have an adult friend or family member drive you home after surgery.
• If you are admitted to the hospital for further observation, your family can visit you once you are in the ward.
2. Recovery in the Hospital
Most patients will experience some pain or discomfort after surgery, but it should never be unbearable. At Jiahui Health, your anesthesiologist manages pain relief during your surgery and afterwards. Our goal is for every patient to be comfortable enough to take deep breaths and move as needed because this helps your recovery process.
Your PACU nurse will ask you to describe your pain using a scale numbered between 0 to 10. 0 means no pain and 10 is the worst pain you can imagine. The goal is to keep your pain level below 3.
You may receive medicine through your IV or by mouth to help control your discomfort. Please let us know if you have uncontrolled pain.
Food may be hard to digest after surgery. So, you may have an IV for fluid and nutrition when you are in the hospital. You will start by drinking some water in PACU after you fully wake up. Usually your digestive function will return to normal 4-6 hours after surgery. Your doctor will give you specific orders about eating and drinking at home.
Discharge: You will be ready to go home when you have reached the following goals:
• Your pain is well-controlled.
• You are able to walk without assistance.
• You are able to drink water without too much nausea.
• You are able to use the bathroom on your own. If you have trouble to urinate please let your doctor or nurse know and they will help you.
3. Recovering at Home
Most patients improve each day following surgery. You will gradually feel stronger and become more active. It is important to keep your follow-up appointments with your doctor, even if you are
It is common to have discomfort after surgery. You may have discomfort from the incision and muscle aches. Getting up and moving around can ease some of the discomfort. Take your pain medications as ordered. Some medicine may upset an empty stomach. To prevent nausea, we recommend you take the medicine with food. If you are taking narcotic pain medication or sleeping medication, please do not drink any alcohol. You should not drive any vehicles while taking narcotics.
• Eat foods which are easy to digest such as clear liquids, soup or broth, and crackers.
• Slowly change to normal solid food and avoid fatty foods until your digestion returns to normal.
• Increase fiber and fluids if you get constipated.
Early activity such as walking, deep breathing, coughing, and turning can speed up your recovery and increase circulation to decrease complications such as blood clots, pneumonia and poor wound healing, etc. To avoid falling, ensure there is someone with you when you first start to exercise. You might experience dizziness if you move or change positions too quickly.
Gradually increase your activities as follows:
• Avoid heavy lifting, not more than a 4 liter bottle of water.
• Avoid strenuous exercise or sports for 6 weeks after major surgery.
• You should not drive for 24 hours after receiving general anesthesia. After that, do not drive until you can do so without discomfort and without using prescription pain medicine. This can take from 3 to 7 days.
• You may shower and wash your hair one day after surgery.
Caring for Your Incision
• It is important to keep your incision clean and dry to prevent infection. Wear comfortable clothing.
• Leave any covering over the incision in place for a week unless otherwise instructed.
• If you want to take a shower, it is better to wait until a day following surgery using a waterproof wrapper to cover your incision. When you have a shower, please care for the incision as follows:
◦ Always wash your hands before and after touching your incision.
◦ If the dressing is wet after the shower, please change the wet dressing. Pat the incision dry with a clean towel, rather than rubbing. You may use a hair dryer on low heat to dry your incisions.
◦ Do not soak the incisions in a tub till the wound is completely healed.
◦ Do not use lotions, cream or ointments on the wound unless they have been ordered by your doctor.
• Call immediately if a large amount of fluid starts to drain or redness develops.
It is common to not have a bowel movement for several days after surgery. Some pain medications can also cause constipation. To help your bowels stay regular:
• Drink more liquids
• Eat more whole grains, fruits and vegetables
• Get regular exercise (a 15-minute walk is a good start)
• Take stool softeners
• You will receive a phone call from the hospital within 24 hours after your surgery to make sure you are doing well. The nurse who calls you is available to answer any of your questions.
• Please come back for your follow-up visit on time as instructed by your surgeon.
When to Call Your Doctor
Please contact your doctor if you notice any of the following:
• Temperature over 38℃ (100.2°F), chills or sweats
• Drainage or fluid from the incision that continues or is foul-smelling
• Increased tenderness or soreness at the wound
• Wound edges that are no longer together
• Redness or swelling at the wound site
• Difficulty urinating or urinary frequency, urgency, or burning
• Worsening pain
• Chest pain, shortness of breath, dizziness
• Unable to drink fluids or keep fluids down
• If you do not feel well, or just aren’t sure whether your symptoms are normal
If you have any questions, you can call our 24/7 hotline number:4008683000
Lymphedema and Breast CancerLEARN MORE
Lymphedema and Breast Cancer
People who have been treated for breast cancer are at risk for developing lymphedema (limf-ah-deema). This pamphlet will give you information about lymphedema and its treatment.
When does BCRL usually occur?
Breast cancer-related lymphedema may appear weeks, months, or even years after breast cancer surgery or regional lymph node radiotherapy, but most of them occur within 3 years after surgery. If you are experiencing or have experienced treatment, you should seek professional advice for prevention and treatment of lymphedema.
What is the lymphatic system, and what is its function in the body?
Lymph fluid, lymphocytes (white blood cells), lymph vessels, and lymph nodes are part of the body’s lymphatic system. The lymphatic system removes cell waste and protects the body from infections and disease. It does this by collecting extra fluid, proteins, and other substances from the body’s tissues. It is moved through the body in tiny vessels that are much smaller than veins. Bean-shaped lymph nodes filter the fluid to remove waste and bacteria. Other lymph vessels carry the lymph back to the bloodstream.
What is lymphedema?
Lymphedema is a breakdown of lymphatic refluxes leading to the accumulation of protein-rich fluids in the stroma. When the lymphatic vessel load exceeds the transport capacity of the lymphatic system, it will cause the accumulation of filtrate, which will lead to lymphedema. Surgical removal of lymph nodes (lymph node resection) and radiotherapy are the main causes of lymphedema in breast cancer patients, but Breast Cancer-Related Lymphedema (BCRL) can also be caused by lymphatic or lymph node obstruction or by tumor cell infiltration (cancerous lymphangitis)
Some early symptoms of BCRL：
•Puffiness or edema in the hands or arms
•Clothes, underwear or jewelry feel tighter than before
•Grooves or marks are left on the skin when taking off jewelry or clothing
•A feeling of swelling in the breast, chest or arm
•Arms feels heavy
What are the risk factors for lymphedema?
Breast cancer and related treatments are the most common causes of upper limb lymphedema. The main risk factors for BCRL include the diagnosis of invasive cancer, axillary lymph node dissection/destruction, radiotherapy, local infection, and obesity, but other factors may also play a role.
We recommend the following precautions to protect affected limbs:
•Monitor limb condition, including measuring and recording upper limb size. Measurements should be taken at the palms of the hands (if edema is present), the wrists, and 10 cm below and above the elbow joint
•Carefully maintain skin hygiene and nail care to prevent infections that may cause cellulitis
•Protect exposed skin, including using sunscreen and wearing gloves when participating in activities that may cause skin damage
•Wear suitable graded pressure sleeves
•Avoid medical procedures that require puncturing the skin of affected limbs (e.g., vaccination, acupuncture, venous bleeding, venous catheterization, venography)
•Manage your weight
BCRL prevention advice for daily life:
Adhering to proper exercise habits can not only help blood circulation and maintain your ideal weight, but also control edema. It is recommended that exercise be carried out under the guidance of a medical professional.
For most people, some repetitive movements will not be a big problem, such as mopping the floor, using a vacuum cleaner, painting, or training on a rowing machine. However, some patients can develop lymphedema due to these repetitive actions. When you perform repetitive activities, please pay attention to how your arms and hands react. If you feel swelling or pain during or after the activity, you should immediately stop the activity, reduce its intensity, or shorten its length.
•Take a hot shower/bath or use a sauna
For some people, lymphedema could be caused by taking a hot shower or bath, or using a sauna. If you want to do any of these activities, start by doing it for a few minutes, paying close attention to possible edema reactions in your body.
Traveling by airplane
Before boarding the plane, during the flight, and after landing, you should drink plenty of water. Stretch your arms from time to time while you are waiting for the plane and during the flight. If you do not have lymphedema, it is not necessary to wear a pressure sleeve, but you must wear pressure sleeves when flying if you already have lymphedema. The selection and wearing of pressure sleeves needs to be carried out under the guidance of a physiotherapist.
Our Rehabilitation services for BCRL：
•Breast cancer postoperative posture correction training
•Breast cancer postoperative rehabilitation exercises
•Prevention of complications after breast surgery
•BCRL Risk Factors Screening
•Assessment of upper limb range of motion and muscle strength
•Multilayer compression bandage wrapping
•Intermittent Pneumatic Compression
•Customized home exercise plan for lymphedema prevention
Diet and Breast HealthLEARN MORE
The American Society for Cancer Research recommends that a majority of ahealthy diet should be composed of plant-based foods，with two-thirds ofeach meal being vegetables, fruits, whole grains or beans.The high levels offiber,vitamins,minerals and antioxidants in these foods helps fo improveimmunity and enhance physical health. Different colors 'of fruits andvegetables contain different kinds of unique phytochemicals (antioxidants),such as 3- carotene in orange and red fruits and vegetables, and resveratrolin blue and purple fruits and vegetables, which reduces cell oxygenation,helps with gene repair, reduces inflammation in the body, and thus reducesthe probability of cancer.It can also help slow the growth of cancer cells andcontrol the production of tumor hormones.
The high fiber content and very low density of plant food also supports breasthealth by preventing excessive weight gain. Celulose from plants can slowdown the time needed for food to pass through the digestive system,increase your sense of fulness, and make people less likely to be hungry.
Protein is also an important part of a healthy diet，and is essential tomaintaining the normal operation of human body and supporting theimmune system.High quality protein comes from meat, poultry, eggs, fish andseafood,'milk, beans， lentils,etc. You've probably heard that red meatincreases the risk of having colorectal cancer, pancreatic cancer, prostatecancer and breast cancer. The possible carcinogenic mechanism is thatcarcinogenic chemicals are produced during meat preservation processes(such as pickling and smoking). Meat also contains ferroheme,whichpromotes 'the production of carcinogens and increase the risk ofcarcinogenesis. Cooking meat under high temperature (such as frying,baking and barbecuing) also produce carcinogenic chemicals.The studyfound that the risk of developing hormone-related breast cancer is doubledamong women who consumed large amounts of red meat. Therecommended intake is no more than 500g cooked red meat per week. Theremaining protein needs can be obtained from a variety of other high-qualityproteins,such as chicken,duck,fish,，seafood，eggs，soybeans and soyproducts. ln addition,it is necessary to avoid processed meats,such assausage,bacon,preserved meat, ham, etc. , as they are high in salt andunhealthy saturated fatty acids.
Nowadays, the internet is full of different advice for dieting, especially dietsfor breast health and breast cancer.These often contain misleadinginformation and food myths that can confuse people, keeping them frommaking the right food choices and having a healthy diet.
Some common food myths:
Q1.can breast cancer patients eat dairy products?
Dairy products, including milk, cream, yogurt, cheese, etc., are good sourcesof protein , calcium and some vitamins.According to a report from the WorldCancer Research Foundation and the American Society for CancerResearch,there is no evidence that indicates dairy consumption increasesthe risk of breast cancer. Maintaining a healthy weight after treatmentreduces the risk of breast cancer recurrence, and some dairy products arehigh in fat and sugar, which contribute to weight gain. Dairy products withlow fat and less sugar are recommended.
Q2.Cancer cels feed on sugar, so you shouldn't eat any sugary foods
Sugar is one of the main energy sources for our body.People usually think ofwhite sugar, brown sugar , candies, chocolate, etc. as sugars. sugar also existsin more complicated forms in our diet.Carbohydrates are the colectivename for all different kinds of sugars.Cereals, potatoes, fruits, vegetables anddairy products are the main sources of carbohydrates. They are broken downinto simple sugars and used as energy by cells in our body.If all carbohydrateintake is restricted, the body breaks down muscle and fat tissue instead tomeet metabolic needs,resulting in malnutrition. At present，there is noevidence that indicates sugar infake is directly related to cancer.However,intake of added sugar can lead to weight gain, which increases the risk ofbreast cancer recurrence. So limiting foods and beverages with largequantities of added sugar is necessary, such as white sugar,brown sugar,candies,chocolate,cake, biscuits, soda, juice,etc.
3.Patients with breast or ovarian cancer shouldn't eat any soy products,because plant hormones stimulate the proliferation of breast cancer cells
Soybean contains a phytochemical caled isoflavone, which has anti-cancerand anti-oxidation effects. It is also called phytoestrogen because itschemical structure is similar to that of estrogen. The concentration ofisoflavones in natural soybean and soy food is not high. And weakestrogen-ike effects of isoflavone are not enough to change the estrogenlevels in your body. The current evidence shows that it is safe to havemoderate amounts of soy-based food in our diet, but concentrated soybeansupplements should be avoided.Choose non-genetically modified soybeansand soy products, as pesticides are commonly used on genetically modifiedproducts，which increases the risk of cancer. lsoflavone supplements areusually used to relieve menopause symptoms.These are not recommendedfor breast cancer patients, because there is insufficient scientific evidence toverify its safety.
How to maintain breast health and reduce the risk of breast cancer?
1.Plant food based diet, more fruits, vegetables and high quality protein
2.Maintain a healthy weight
3.Exercise at least 150 minutes every week
4.Quit smoking and limit alcohol intake
Breast Health ScreamingLEARN MORE
What Is Breast Screening
Regular breast screening is the first line of defense when it comes to early detection of breast lesions and breast cancer. Early detection of breast cancer can lead to improved cure rate, and regular breast self-examination, clinical examination by a breast specialist and breast imaging examination (breast ultrasound or mammography) form the foundation of early detection.
Who Needs Breast Screening
Women over the age of 20 should consider beginning breast screening to detect breast infections, benign and malignant tumors, and nipple abnormalities. Regular breast screening is even more important if you have any the following risk factors ¹ .
• Increasing age
• High weight and high body fat (BMI ≥30 kg/m2)
• Tall stature
• High estrogen levels
• Benign breast disease
• Dense breast tissue
• Earlier menarche or later menopause
• Nulliparity and multiparity
• Increasing age at first pregnancy
• Personal history of breast cancer
• Family history of breast cancer
• Inherited genetic mutations
• Night-shift work
• Exposure to therapeutic ionizing radiation
Breast Screening Protocol For Average Risk Women
For people under 40 years of age, automatic breast ultrasound scan (ABUS) is a suitable breast imaging examination. ABUS is used for breast screening in young populations or as a supplement to mammography for breast screening in populations with high breast density.
* Under some specific circumstances, the doctor may choose to do a hand-held ultrasound examination.
Mammography is the clinically recommended screening method for people over the age of 40.
After Embryo Transfer, Bed Rest Is Not NecessaryLEARN MORE
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The Reason of Embryo Stop GrowingLEARN MORE