Objective To evaluate the relationship between endometriosis fertility index (EFI) and pregnancies after laparoscopic surgery in endometriosis-associated infertility.Methods From Jan.2005 to Jan.2010,medical documents of 350 infertile patients due to endometriosis undergoing laparoscopic surgery were studied retrospectively.Pregnancy outcomes were followed up by telephone.EFI was calculated by history factors,least function score and some aspects of the revised American Fertility Society (r-AFS) endometriosis stage.The cumulative pregnancy rate was calculated and compared by Kaplan-Meier survival analysis.Results Within 3 years after surgery,the cumulative pregnancy rates among patients with EFI score 8,9,10 were 62.5％,69.8％ and 81.1％,respectively.There was no significant difference in pregnancy rates among those three groups of patients ( P =0.24 ).The cumulative pregnancy rates among patients with EFI score 5,6,7 were 49.8％,43.9％ and 41.6％,respectively,which did not reach statistical difference ( P =0.83 ).The cumulative pregnancy rates of EFI score 8 - 10 was significantly higher than that of EFI score 5 -7 (71.8％ vs.44.4％,P =0.000).The patients with EFI score 0 -4 was quite small with only 33 cases,among which 15 cases were pregnant.Conclusions There is relationship between EFI and pregnancy in patients with endometriosis-associated infertility.EFI is meaningful to guide post surgical treatment.

Objective To investigate the genomic amplification of the human telomerase RNA component (hTERC) gene in cervical cytology and evaluate its role in screening of cervical lesions. Methods A total of 301 cases were recruited, with liquid-based cytology diaghoses as normal (n=203), atypical squamous cells (ASC, n=66), low-grade squamous intraepithelial lesions ( LSIL,n=18), and high-grade squamous intraepithelial lesions ( HSIL, n=14). Following cytological examination, the slides were analyzed using a two-color fluorescence in aitu hybridization ( FISH ) probe targeted to chromosome 3q26 containing hTERC. The hTERC findings were compared to the cytologic and histologie results, as well as high-risk human papilloma viruses (HPV) results. Results Genomie amplification of hTERC was found in 3.0% (6/203)of normal specimens, 21.2% (14/66) of ASC, 44.4% (8/18) of LSIL and 92.9% (13/14) of HSIL, with a significant difference in each pair wise (all P<0.05). Significantly more cells with 3q26 gain were found in cervical intraepithelial lesion (CIN) Ⅱ than in CIN Ⅰ(75.0% vs. 20.0% ), as well as in CIN Ⅲ (86.7% vs. 20.0% ) and squamous cervical cancer (SCC) than in CIN Ⅰ (100.0% vs. 20.0%) ( all P<0.01). The sensitivity of hTERC amplification was significantly higher than cytological screening (82.6% vs. 17.4%, P<0.01), and its specificity was higher than high-risk HPV test (67.8%-73.5% vs. 25.6%-27.7%, P<0.01) in the diagnosis of HSIL (CIN Ⅱ - Ⅲ). The abnormal hTERC signal type mostly was 2:3 in CIN Ⅰ (84.9% ) ; whereas in CIN Ⅱ-Ⅲ, 2: 3, 2:4 and 4:4 accounted for 44.6%, 24.8% and 17.8%, respectively. Conclusion Testing the gain of chromosome 3q26 in cytological specimens using specific probe for hTERC is powerful in screening of HSIL, and the amplification patterns of 2:4 and 4:4 may serve as potential prognosis markers.

In recent years, in the face of the risks and challenges of public health emergencies, the demand and supply of public health talents are relatively tight, and the reform and exploration of the standardized training of public health professionals has become one of the most urgent and important topics. This study analyzed the problems of curriculum system setting, implementation of practical links and composition of tutors in the training process, and learned that Wenzhou Medical University has carried out practical exploration in strengthening theoretical study, highlighting the combination of research and study, deepening professional practice, etc., which has achieved the orderly promotion of public health training supported by supporting reform measures; Take the post competence as the guidance, and vigorously improve the practicing ability; Based on the process and result assessment, promote the reform of training mode and other preliminary results. However, there are also shortcomings and deficiencies in accuracy, supply and effectiveness. Looking at the current situation, it is suggested to promote mechanism construction, increase skill training, develop training standards, improve supporting measures, establish expert committees and other reform ideas, and explore and implement a new model of degree education connection.

Objective To investigate the significance of genomic amplification of the telomerase RNA component (TERC) gene to serve as a genetic biomarker in the screening of cervicallesions.Methods A total of 715 cases were recruited,with liquid-based cytology diagnosis as normal (n=347),atypical squamous cells of undetermined significance (ASCUS,n=180),atypical squamous cells cannot exclude a high-grade lesion (ASC-H,n=13),low-grade squamous intraepithelial lesions (LSIL,n=115),high-grade squamous intraepithelial lesions(HSIL,n=59)and atypical glandular cells(AGC,n=1).The remaining cervical cells in the cytological preserving fluid were analyzed using a two-color fluorescence in situ hybridization (FISH) probe targeted to chromosome 3q26 containing TERC gene.The TERC gene findings were compared to the cytological and histological detected results,as well as high-risk human papillomavirus (HPV) detected results.Results Genomic amplification of TERC gene was found in 5.8% of normal specimens,22.2% of ASCUS.30.8% of ASC-H,27.8% of LSIL,86.4% of HSIL and 1/1 of AGC.The positive rate was significantly lower in normal,ASCUS,ASC-H and ISIL.compared with HSIL(all P<0.01).Significantly more cells with genomic amplification of TERC gene were found in cervical intraepithelial lesion(CIN) Ⅱ-Ⅲ than CIN Ⅰ (77.8% vs.9.3%),as well as invasive cervical cancer (96.7% vs.9.3%).both P < 0.01.The rate of TERC gene amplification was higher in HPV positive patients (33.5%) than in HPV negative patients(5.2%,P<0.01).The sensitivity of TERC gene amplification was significantly higher than that of cytological screening (81.88% vs.36.96%,P<0.01) in the differentiation of CIN Ⅱ or higher and CIN Ⅰ or lower diseases,its specificity Was hisher than high-risk HPV test (93.32% vs.33.93%,P<0.01) and positive prediction value (81.29%) was similar with cytological method (86.44%,P>0.05);but its negative prediction value (93.56%) was lower than HPV test (97.06%,P<0.05).Conclusions The positive rates of TERC gene amplification increased as cervical diseases worsened.TERC gene amplification is related to HPV infection.The gain of chromosome 3q26 in cytological specimens is an effective molecular genetic biomarker in screening of CIN Ⅱ or higher and invasive cervical cancer.

Objective To analyze the dilemma of medical insurance fund regulation under cross-location medical treatment in China,and put forward coping strategies to provide theoretical reference and reference for enhancing the efficiency of cross-location medical treatment regulation in China.Methods A systematic search was conducted to retrieve the literature related to the regulation of health insurance funds under off-site medical care from the time of database construction to December 2023 NVivo 12 Plus software was used to code and analyse the included litera-ture.Results 38 Articles were finally retained for qualitative research through searching and screening.Fifty-three ini-tial concepts,18 initial categories and 5 main categories were extracted,and the dilemma nodes of the supervision of cross-district medical fund in the dimensions of incomplete supervision mechanism,imperfect supervision law,single supervision means,insufficient capacity of supervision subject and moral risk of supervision object and moral risk of supervision object were obtained,insufficient capacity of the regulatory body and moral risk of the regulatory object.Conclusion The supervision of medical insurance fund under the cross-location medical care is constrained by many factors,and the soundness of the supervision mechanism is the core issue;the completeness and effectiveness of the supervision law is the important basis for supervision;the innovation of the supervision means and the promotion of the improvement of the effectiveness of the supervision are the important means of the supervision of the medical insurance fund under the cross-location medical care;and the restriction of the moral hazards of the institutions in the place of medical care and of the insured persons is the key link of the super-vision process.

The construction of "Curriculum Civics" in medical schools needs to go in the same direction as "Civics Curriculum" and "Liberal Studies Education" , and explore the realization path of shaping noble souls through positive ideological and political leadership and mutual collision of hearts and minds.The integration of Wuliande’s spirit into medical education is an all-round exploration from the perspectives of value connotation, contemporary meaning and path exploration, which has important contemporary significance and application value, and is also a practical requirement for inheriting and innovating Wuliande’s spirit and constructing a "Great Thought and Politics" work system under the pattern of "Great Health" in the new era. Based on the above background, this paper explored and interpreted how to fully follow the law of talent growth and the law of education to cultivate new-age medical and health talents who are red and professional, benevolent, health guardian and public health fighter from the perspective of collaborative education of medical ethics education and ideological and political education.

The construction of "Curriculum Civics" in medical schools needs to go in the same direction as "Civics Curriculum" and "Liberal Studies Education" , and explore the realization path of shaping noble souls through positive ideological and political leadership and mutual collision of hearts and minds.The integration of Wuliande’s spirit into medical education is an all-round exploration from the perspectives of value connotation, contemporary meaning and path exploration, which has important contemporary significance and application value, and is also a practical requirement for inheriting and innovating Wuliande’s spirit and constructing a "Great Thought and Politics" work system under the pattern of "Great Health" in the new era. Based on the above background, this paper explored and interpreted how to fully follow the law of talent growth and the law of education to cultivate new-age medical and health talents who are red and professional, benevolent, health guardian and public health fighter from the perspective of collaborative education of medical ethics education and ideological and political education.

Objective:To investigate the relationship between double-triggering and abnormal movement of air in the lungs (pendelluft phenomenon) under pressure support ventilation (PSV).Methods:A prospective observational study was conducted, postoperative patients admitted to department of critical care medicine of Beijing Tiantan Hospital, Capital Medical University from April 1, 2019 to August 31, 2020 and received invasive mechanical ventilation with PSV mode were enrolled. Electrical impedance tomography (EIT) monitoring was performed. Airway pressure-time, flow-time, global and regional impedance-time curves were synchronously collected and analyzed offline. The volume of abnormal movement of air in the lungs at the beginning of inspiration was measured and defined as pendelluft volume. Double-triggered breaths were identified by trained researchers. Pendelluft volume during double-triggering was measured including the first triggered breath, the double-triggered breath, and the breath immediately following the double-triggered breath. Pendelluft volume was also measured for normal breath during the study. According to the frequency of double-triggering, patients were divided into severe (≥1 time/min) and non-severe double-triggering group. Pendelluft volume, parameters of respiratory mechanics, and clinical outcomes between the two groups were compared.Results:In 40 enrolled patients, a total of 9 711 breaths [(243±63) breaths/patient] were collected and analyzed, among which 222 breaths (2.3%) were identified as double-triggering. The Kappa of interobserver reliability to detect double-triggering was 0.964 [95% confidence interval (95% CI) was 0.946-0.982]. In 222 double-triggered breaths, pendelluft volume could not be measured in 7 breaths (3.2%), but the pendelluft phenomenon did exist as shown by opposite regional impedance change at the beginning of double-triggered inspiration. Finally, pendelluft volume was measured in 215 double-triggered breaths. Meanwhile, 400 normal breaths (10 normal breaths randomly selected for each patient) were identified as control. Compared with normal breath, pendelluft volume significantly increased in the first breath, the double-triggered breath, and the following normal breath [mL: 3.0 (1.4, 6.4), 8.3 (3.6, 13.2), 4.3 (1.9, 9.1) vs. 1.4 (0.7, 2.8), all P < 0.05]. Patients in severe double-triggering, pendelluft volume of normal breath and double-triggered breath were significantly higher than those in non-severe double-triggering group [mL: 1.8 (0.9, 3.2) vs. 1.1 (0.5, 2.1), P < 0.001; 8.5 (3.9, 13.4) vs. 2.0 (0.6, 9.1), P = 0.008]. Patients in severe double-triggering group had significantly higher respiratory rate than that in the non-severe double-triggering group (breaths/min: 20.9±3.5 vs. 15.2±3.7, P < 0.001). There were no significant differences in other respiratory mechanics parameters and main clinical outcomes between the two groups. Conclusions:During PSV, the abnormal movement of air in the lungs (pendelluft phenomenon) was more likely to occur in double-triggering especially in double-triggered breath. The more frequent the double-triggering occurred, the more serious the pendelluft phenomenon was. A higher pendelluft volume of normal breath and a higher respiratory rate were related to severity of double-triggering.