Persistent left superior vena cava is a rare venous variant that is often combined with cardiovascular malformations. In thoracic surgery, especially mediastinal tumor resection, neglect of this variant may make the surgery difficult and risky, and careful preoperative imaging interpretation and adequate preoperative evaluation play an important role in the perioperative safety of the patient. In this paper, we reported a case of a 17-year-old female patient with a persistent left superior vena cava combined with mediastinal tumors. She was successfully discharged 5 days after thoracoscopic surgery, and after 3 years of postoperative follow-up, no tumor recurrence was observed.

In light of the professional characteristics of oral medicine,oral medical students may be challenged with higher medical risks during the clinical internship stage.This article analyzes the potential risk factors in the process of oral medicine internships and proposes corresponding preventive strategies,aiming to ensure medical safety and promote the healthy development of medical students.

Objective To develop a Self-Management Demand Scale for infertile patients with obese polycystic ovary syndrome(PCOS)suitable for domestic socio-cultural background,and to test its validity and reliability.Methods Based on the self-management model,the item pool of the scale was constructed through literature review,semi-structured interviews,and Delphi expert consultation.Using convenience sampling method,560 obese PCOS combined with infertility patients from a tertiary-level hospital in Wuhan City were selected for questionnaire survey from June to November 2023,and they were divided into 2 parts according to the time of survey for exploratory factor analysis and validation factor analysis.Results Finally,554 valid questionnaires were collected.The Self-Management Demand Scale for infertile patients with obese PCOS contains 3 dimensions and 37 entries.Exploratory factor analysis extracted 3 factors with the cumulative variance contribution rate of 78.785％.The results of the validation factor analysis showed a good model fit.The content validity indices at the scale entry level ranged from 0.830 to 1.000,and the content validity indices at the scale level were 0.920.The Cronbach's αcoefficients for the scale as a whole were 0.967,and those for the dimensions ranged from 0.890 to 0.971;the split-half reliabilities of the overall scale as a whole were 0.856 and the split-half reliabilities of the dimensions were 0.802～0.895.Conclusion The scale has ideal validity and reliability,which provided a scientific tool to measure accurately the self-management demands of the infertile patients with obese PCOS.

Objective To develop a Self-Management Demand Scale for infertile patients with obese polycystic ovary syndrome(PCOS)suitable for domestic socio-cultural background,and to test its validity and reliability.Methods Based on the self-management model,the item pool of the scale was constructed through literature review,semi-structured interviews,and Delphi expert consultation.Using convenience sampling method,560 obese PCOS combined with infertility patients from a tertiary-level hospital in Wuhan City were selected for questionnaire survey from June to November 2023,and they were divided into 2 parts according to the time of survey for exploratory factor analysis and validation factor analysis.Results Finally,554 valid questionnaires were collected.The Self-Management Demand Scale for infertile patients with obese PCOS contains 3 dimensions and 37 entries.Exploratory factor analysis extracted 3 factors with the cumulative variance contribution rate of 78.785％.The results of the validation factor analysis showed a good model fit.The content validity indices at the scale entry level ranged from 0.830 to 1.000,and the content validity indices at the scale level were 0.920.The Cronbach's αcoefficients for the scale as a whole were 0.967,and those for the dimensions ranged from 0.890 to 0.971;the split-half reliabilities of the overall scale as a whole were 0.856 and the split-half reliabilities of the dimensions were 0.802～0.895.Conclusion The scale has ideal validity and reliability,which provided a scientific tool to measure accurately the self-management demands of the infertile patients with obese PCOS.

Objective:To analyze the clinical characteristics and genetic basis of a male patient with primary infertility caused by Acephalic spermatozoa syndrome.Methods:A patient who had presented at the Henan Provincial People′s Hospital on October 1, 2022 was selected as the study subject. Clinical data and results of laboratory exams and sperm electron microscopy were collected. The patient was subjected to whole exome sequencing (WES), and candidate variants were verified by Sanger sequencing and pathogenicity analysis.Results:WES revealed that the patient has harbored compound heterozygous variants of the PMFBP1 gene, namely c. 853del (p.Ala285Leufs*24) and c. 1276A>T (p.Lys426X), which were both unreported previously. Sanger sequencing suggested that the c. 853del (p.Ala285Leufs*24) variant has derived from his deceased mother, whilst the c. 1276A>T (p.Lys426X) variant has derived from his father. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), both variants were classified as pathogenic (PVS1+ PM2_Supporting+ PP4). Conclusion:The compound heterozygous variants of the PMFBP1 gene probably underlay the Acephalic spermatozoa syndrome in this patient. The discovery of the novel variants has also enriched the mutational spectrum of Acephalic spermatozoa syndrome.

Nuclear receptor corepressor (NCoR1) interacts with various nuclear receptors and regulates the anabolism and catabolism of lipids. An imbalance in lipid/energy homeostasis is also an important factor in obesity and metabolic syndrome development. In this study, we found that the deletion of NCoR1 in intestinal epithelial cells (IECs) mainly activated the nuclear receptor PPARα and attenuated metabolic syndrome by stimulating thermogenesis. The increase in brown adipose tissue thermogenesis was mediated by gut-derived tricarboxylic acid cycle intermediate succinate, whose production was significantly enhanced by PPARα activation in the fed state. Additionally, NCoR1 deletion derepressed intestinal LXR, increased cholesterol excretion, and impaired duodenal lipid absorption by decreasing bile acid hydrophobicity, thereby reversing the possible negative effects of intestinal PPARα activation. Therefore, the simultaneous regulatory effect of intestinal NCoR1 on both lipid intake and energy expenditure strongly suggests that it is a promising target for developing metabolic syndrome treatment.

Objective:To investigate the clinical outcomes of infertility patients with multiple morphological abnormalities of the sperm flagella (MMAF) caused by DNAH1 gene mutation after intracytoplasmic sperm injection (ICSI). Methods:A retrospective cohort study analyzed the clinical data and genetic test results of 39 MMAF infertility patients who were treated in the Center for Reproductive Medicine of Henan Provincial People's Hospital from February 2018 to January 2020. Twelve MMAF patients caused by DNAH1 mutations were acted as DNAH1 positive group and 27 MMAF patients with no DNAH1 mutations were acted as DNAH1 negative group. Totally 100 cases of infertility patients with normal sperm morphology and their spouses who were age-matched by both men and women for ICSI during the same period were selected as control group. The outcomes of assisted pregnancy treatment in the three groups were analyzed. Results:All 39 MMAF patients underwent whole-exome sequencing. Among them, 12 patients had DNAH1 gene mutations, 10 cases of compound heterozygous mutations and 2 cases of homozygous mutations, and the other 27 cases were not detected the currently known DNAH1 mutations. The patients of three groups were treated with ICSI, and the differences in the number of oocytes obtained and the number of M II oocytes in the DNAH1 gene positive group, DNAH1 gene negative group and control group were statistically significant (17.08±5.32, 9.59±3.98, 10.44±6.33, P=0.001; 14.58±5.18, 6.78±3.38, 8.32±5.31, P<0.001). There were no statistically significant differences in the embryo implantation rate, the clinical pregnancy rate, the embryo miscarriage rate and the live birth rate (all P>0.05). Among them, 12 couples of male infertility caused by DNAH1 mutation received a total of 12 cycles of oocyte extraction, forming 79 day 3 embryos, 12 times of the first fresh or frozen embryo transplantation, and 10 biological offspring were obtained. Conclusion:For patients with MMAF caused by DNAH1 gene mutation, ICSI can help them to give birth to their own offspring, and has a higher clinical pregnancy rate and live birth rate.

Objective:To investigate the clinical outcomes of infertility patients with multiple morphological abnormalities of the sperm flagella (MMAF) caused by DNAH1 gene mutation after intracytoplasmic sperm injection (ICSI). Methods:A retrospective cohort study analyzed the clinical data and genetic test results of 39 MMAF infertility patients who were treated in the Center for Reproductive Medicine of Henan Provincial People's Hospital from February 2018 to January 2020. Twelve MMAF patients caused by DNAH1 mutations were acted as DNAH1 positive group and 27 MMAF patients with no DNAH1 mutations were acted as DNAH1 negative group. Totally 100 cases of infertility patients with normal sperm morphology and their spouses who were age-matched by both men and women for ICSI during the same period were selected as control group. The outcomes of assisted pregnancy treatment in the three groups were analyzed. Results:All 39 MMAF patients underwent whole-exome sequencing. Among them, 12 patients had DNAH1 gene mutations, 10 cases of compound heterozygous mutations and 2 cases of homozygous mutations, and the other 27 cases were not detected the currently known DNAH1 mutations. The patients of three groups were treated with ICSI, and the differences in the number of oocytes obtained and the number of M II oocytes in the DNAH1 gene positive group, DNAH1 gene negative group and control group were statistically significant (17.08±5.32, 9.59±3.98, 10.44±6.33, P=0.001; 14.58±5.18, 6.78±3.38, 8.32±5.31, P<0.001). There were no statistically significant differences in the embryo implantation rate, the clinical pregnancy rate, the embryo miscarriage rate and the live birth rate (all P>0.05). Among them, 12 couples of male infertility caused by DNAH1 mutation received a total of 12 cycles of oocyte extraction, forming 79 day 3 embryos, 12 times of the first fresh or frozen embryo transplantation, and 10 biological offspring were obtained. Conclusion:For patients with MMAF caused by DNAH1 gene mutation, ICSI can help them to give birth to their own offspring, and has a higher clinical pregnancy rate and live birth rate.

This paper reviews the concepts, evaluation tools, current level, main contents, influencing factors and intervention modes of self-management of young and middle-aged maintenance hemodialysis patients. This paper looks forward to the development of self-management of young and middle-aged maintenance hemodialysis patients, so as to provide a reference for the self-management practice and effect evaluation of young and middle-aged maintenance hemodialysis patients.

Objective:To explore the effect of dibutyl phthalate (DBP) on the rat testis Leydig cell apoptosis by AMP activated protein kinase/mammalian rapamycin target protein (AMPK/mTOR) signaling pathway.Methods:Rats with reproductive function impairment were divided into model (DBP) group of 17 rats, model+AMPK inhibitor [DBP+compound C (CC)] group of 17 rats, model+AMPK agonist [DBP+metformin (MF)] group of 17 rats, DBP+AMPK inhibitor+agonist (DBP+CC+MF) group of 17 rats by body mass ranking grouping method. Another 11 rats were taken as the blank group. The blank group and DBP group were intraperitoneally injected with the same amount of normal saline, while DBP+CC group and DBP+MF group were intraperitoneally injected with 20 mg/kg CC and 200 mg/kg MF respectively, and DBP+CC+MF group was intraperitoneally injected with CC and MF once a day for 4 weeks. Luteinizing hormone (LH), follicle-stimulating hormone (FSH) and testosterone (T) were measured by radioimmunoassay. Sperm quality was analyzed by automatic sperm quality analysis system. Leydig cell apoptosis was detected by terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) and flow cytometry. The expressions of AMPK, mTOR, Caspase 3 mRNA and protein, p-AMPK and p-mTOR protein were detected by RT-PCR and Western blotting. Results:The serum level of FSH in DBP+MF group [(9.88±0.67) U/L] increased, while that in DBP+CC group [(6.82±0.60) U/L] decreased compared with DBP group [(9.07±0.52) U/L] (all P<0.001). The serum LH, T levels and sperm concentration, percentage of (a+b) grade sperm in DBP+MF group [(3.97±0.70) U/L, (2.96±0.11) mg/L, (13.15±2.63)×10 6/mL, (22.20±4.13)%], DBP+CC group [(6.52±0.71) U/L, (4.48±0.15) mg/L, (25.47±2.18)×10 6/mL, (45.60±4.78)%] increased compared with DBP group [(4.51±0.75) U/L, (3.25±0.11) mg/L, (16.46±3.40)×10 6/mL, (25.43±4.36)%] (DBP group vs. DBP+MF group PLH=0.038, the other all P<0.001). HE staining showed that the structure of testis in blank group was normal. In DBP group and DBP+CC+MF group, the epithelial cells of seminiferous tubules atrophied and twisted in irregular shape, and the disease became serious in DBP+MF group, and there were a lot of vacuoles around the nucleus. The number of apoptosis, p-AMPK/AMPK protein relative expression and Caspase 3 mRNA and protein relative expression of Leydig cells in DBP+MF group (286.60±30.17, 0.95±0.08, 2.17±0.18, 1.23±0.10) increased, and DBP+CC group (88.00±21.34, 0.42±0.04, 1.35±0.15, 0.54±0.06) decreased compared with those in DBP group (142.40±26.78, 0.70±0.07, 1.85±0.14, 0.80±0.09, all P<0.001). Compared with DBP group (0.45±0.06), the p-mTOR/mTOR of DBP+MF group (0.23±0.04) decreased, and the p-mTOR/mTOR of DBP+CC group (0.84±0.07) increased (all P<0.001). Conclusion:DBP can damage the reproductive system of rats and increase the apoptosis rate of Leydig cells, which may be related to AMPK activation and mTOR inhibition.