Objective To evaluate the effect of delivery without perineum protection on maternal and neonatal outcomes .Methods The current study was conducted between July 1st, 2012 and February 1st, 2013. A total of 701 maternal women were included in the study , and 208 maternal women went on unprotected perineum delivery method and 493 went into routine episiotomy .Maternal and neonatal outcomes at the first day , the first week and the third month after delivery were compared and analyzed between the two groups .Results The aspects of intrapartum hemorrhage , suture material within delivery and the average hospitalization days in unprotected perineum group were significantly lower than those in the routine episiotomy group ( t= -14.58,-97.07,-21.88, respectively;P<0.01).The rate of episiotomy was 24.04%(50/208) in the unprotected perineum group and 61.26% (302/493) in the routine episiotomy group, and the difference was statistically significant (χ2 =81.06,P<0.01).In the unprotected perineum group ,65, 44, 93 and 6 patients had perineal integrity, incision, laceration and incision with laceration , which in the routine episiotomy group were 78,269, 113 and 33, respectively, and the difference was significant (χ2 =81.09,P<0.01).The perineal pain at the first day,the first week and the third month after delivery were significantly different between two groups (χ2 =82.95,32.51,5.58, respectively;P<0.01).The incidence of postpartum urinary retention (χ2 =10.07,P<0.01), healing complications (χ2 =18.79,P<0.01) at first week and painful sex (χ2 =18.83,P<0.01) in the unprotected perineum group were significantly lower than those in the routine episiotomy group .There were no significant differences between the two groups with the aspects of time of the first ( t=-1.72,P>0.05) and the second stage of birth (t=1.55,P>0.05), neonatal birth weight (t =0.91,P >0.05), Apgar scores (χ2 =0.10,P>0.05) and NICU admission (χ2 =0.60,P>0.05).Conclusions The unprotected perineum delivery could decrease short-term and long-term complications , and it can be a new idea of restrictive episiotomy.

Lung cancer is the top cause of cancer deaths globally.Advances in immune checkpoint inhibitors(ICIs)have transformed cancer treatment,but their use in lung cancer has led to more side effects.This study examined if past pulmonary tuberculosis(TB)affects ICIs'effectiveness and safety in lung cancer treatment.We reviewed lung cancer patients treated with ICIs at Beijing Chest Hospital from January 2019 to August 2022.We compared outcomes and side effects between patients with and without prior TB.Of 116 patients(40 with TB history,76 without),prior TB didn't reduce treatment effectiveness but did increase severe side effects.Notably,older patients(≥65 years)faced a higher risk of severe side effects.Detailed cases of two patients with severe side effects underscored TB as a risk factor in lung cancer patients receiving ICIs,stressing the need for careful monitoring and personalized care.

Primary biliary cholangitis (PBC) is a chronic progressive cholestatic liver disease often observed in the middle-aged and elderly women and it can eventually lead to liver cirrhosis or liver failure. Osteoporosis is one of the common complications in PBC patients and is characterized by decreased bone mass and increased susceptibility to fractures. Osteoporosis and fractures caused by osteoporosis seriously affect the quality of life of PBC patients, and with the improvement of PBC treatment strategies and the increase in life expectancy, early diagnosis, prevention, and treatment of PBC with osteoporosis is of particular importance. This article briefly summarizes the epidemiology, pathogenesis, and diagnosis and treatment of patients with PBC and osteoporosis and proposes current challenges and future research directions.

Objective: To investigate the methods for qualitative pathological assessment of dynamic changes in liver fibrosis/cirrhosis after antiviral therapy in patients with chronic hepatitis B (CHB), since antiviral therapy can partially reverse liver fibrosis and cirrhosis caused by hepatitis B and semi-quantitative, rather than qualitative, pathological assessment is often used for the research on liver fibrosis regression. Methods: Previously untreated CHB patients with liver fibrosis and cirrhosis were enrolled, and liver biopsy was performed before treatment and at 78 weeks after the antiviral therapy based on entecavir. The follow-up assessment was performed once every half a year. Based on the proportion of different types of fibrous septum, we put forward the new qualitative criteria called P-I-R classification (predominantly progressive, predominantly regressive, and indeterminate) for evaluating dynamic changes in liver fibrosis. This classification or Ishak fibrosis stage was used to evaluate the change in liver fibrosis after treatment and Ishak liver inflammation score was used to evaluate the change in liver inflammation after treatment. Results: A total of 112 CHB patients who underwent liver biopsy before and after treatment were enrolled, and among these patients, 71 with an Ishak stage of ≥3 and qualified results of live biopsy were included in the final analysis. Based on the P-I-R classification, 58% (41/71) were classified as predominantly progressive, 29% (21/71) were classified as indeterminate, and 13% (9/71) were classified as predominantly regressive; there were no significant differences between the three groups in alanine aminotransferase, aspartate aminotransferase, albumin, HBeAg positive rate, HBV DNA, and liver stiffness (P < 0.05). After treatment, the proportion of predominantly progressive, indeterminate, or predominantly regressive patients changed to 11% (8/71), 11% (8/71), and 78% (55/71), respectively. Among the 35 patients who had no change in Ishak stage after treatment, 72% (25/35) were classified as predominantly regressive and had certain reductions in the Laennec score, percentage of collagen area, and liver stiffness. Conclusion This new P-I-R classification can be used to assess the dynamic changes in liver fibrosis after antiviral therapy in CHB patients.