Objective To analyze the factors affecting the prognosis of patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) undergoing immunotherapy and construct an individualized prognostic nomogram prediction model. Methods A retrospective analysis was conducted on the clinical data of 385 patients with driver gene-negative, locally advanced or metastatic NSCLC who received first-line immune checkpoint inhibitors. Univariate and multivariate Cox regression analyses were used to identify prognostic risk factors, and a prognostic nomogram model was established. The predictive performance of the model was evaluated using the concordance index (C-index), time-dependent receiver operating characteristic (ROC) curves and area under the curve (AUC), and calibration curves. The cutoff value of the nomogram was calculated to stratify patients by risk. Survival curves were calculated by Kaplan-Meier analysis. Results Age (HR=1.775, 95%CI: 1.265-2.490), degree of differentiation (HR=0.365, 95%CI: 0.257-0.519), low PD-L1 expression (HR=0.661, 95%CI: 0.455-0.960), high PD-L1 expression (HR=0.423, 95%CI: 0.297-0.603), SCC-Ag (HR=1.549, 95%CI: 1.109-2.163), and CONUT score (HR=2.527, 95%CI: 1.797-3.554) were independent risk factors affecting overall survival (OS) of patients with NSCLC undergoing immunotherapy. The nomogram prediction model constructed on the basis of these factors had a C-index of 0.767. Time-dependent ROC curves for survival showed that the AUCs for 1-, 2-, and 3-year OS were 0.830, 0.853, and 0.886, respectively. Calibration curves indicated that the nomogram-predicted survival rates were in good agreement with the actual outcomes. The cutoff value for the study’s nomogram prediction model was 136.60 points, and survival curves showed statistically significant differences between different risk groups (P<0.05). Conclusion The nomogram model established in this study can effectively predict the prognosis of patients with driver gene-negative locally advanced or metastatic NSCLC treated with first-line immunosuppressive therapy. It provides a new tool for assessing prognosis and aids clinicians in formulating individualized treatment plans.

Objective:To investigate the awareness levels of doctors from various departments regarding fertility preservation to provide reference and suggestions for further improving awareness and promoting multidisciplinary development in fertility preservation.Methods:From November to December 2023, the China Alliance of Fertility Preservation initiated this survey covering 88 hospitals in 23 cities across 20 provinces in China. The survey focused on the degree of understanding of basic concepts, technological perceptions, treatment concepts, and related challenges regarding fertility preservation. Descriptive statistics and Fisher's exact test were used to analyze the difference in awareness levels across various departments.Results:There was a significant difference in the awareness of fertility preservation guidelines among physicians from different departments ( P<0.001). Reproductive center physicians had the highest level of understanding [68.3% (41/60)]. Doctors in the reproductive centers had a higher awareness rate of the five fertility preservation techniques (ovarian tissue cryopreservation, oocyte cryopreservation, sperm cryopreservation, testicular tissue cryopreservation, and embryo cryopreservation) than that in other departments (all P<0.05). Regarding treatment concepts, more reproductive center physicians believed that psychological counselling about fertility preservation before oncological treatment was necessary ( P=0.016). Hematologists had more worries and concerns about fertility preservation treatment. Additionally, 96.7% (58/60) of reproductive center physicians expressed the need to establish effective referral mechanisms within the same city, province, or across provinces. However, 55.6% (35/63) of oncologists, 64.6% (31/48) of hematologists, and 77.8% (7/9) of pediatricians considered treating primary tumors far more important than fertility preservation. Conclusion:Doctors from different departments have varying levels of understanding regarding fertility preservation. It is necessary to strengthen the dissemination and training of fertility preservation knowledge among physicians from various departments, as well as to promote a multidisciplinary treatment model to improve efficiency, to establish a comprehensive referral mechanism to improve patients' opportunities for fertility preservation.

Since the birth of the first "test-tube baby" in Chinese mainland in 1988, assisted reproductive technology (ART) in China has matured significantly. The number of ART cycles has surpassed one million, and the number of assisted reproductive institutions and practitioners has attained a significant scale, contributing to the establishment of a fertility-friendly society. However, due to the complexity of the ART process, the diversity of personnel backgrounds, and the profound impact of any error that may occur, there is an urgent need to establish an efficient and effective safety management model for error prevention. This paper aims to outline the key processes and steps involved in the implementation of ART, explore control measures for these critical processes, and delve into error prevention strategies for gamete and embryo laboratories through the creation and utilization of a "gamete safety checklist".

Objective:To investigate the impact of hysteroscopic surgery on fresh embryo transfer outcomes in patients with transvaginal ultrasound-diagnosed FIGO Type Ⅱ/Ⅲ uterine fibroids that may affect the uterine cavity morphology, providing a reference for clinical practice.Methods:A retrospective cohort study was performed to analyze the clinical data of 346 patients who visited the Reproductive Medicine Center, Department of Obstetrics and Gynecology, Peking University Third Hospital between January 2020 and December 2022, with transvaginal ultrasound findings indicating uterine fibroids adjacent to or protruding into the uterine cavity (FIGO Type Ⅱ, Ⅲ) and who underwent fresh embryo transfer. Patients were divided into two groups based on whether hysteroscopic surgery were performed: the hysteroscopic surgery group ( n=237, the group that underwent hysteroscopy before embryo transfer) and the non-surgery group ( n=109, the group that proceeded directly to embryo transfer without hysteroscopy). Basic patient characteristics and pregnancy outcomes were compared between the two groups. Multivariate logistic regression analysis was used to identify factors influencing clinical pregnancy rate and live birth rate. Results:The baseline characteristics showed no statistically significant differences between the two groups. The clinical pregnancy rate [44.3% (105/237)] and the live birth rate [32.5% (77/237)] following fresh embryo transfer in the hysteroscopic surgery group were significantly higher than those in the non-surgery group [31.2% (34/109), P=0.021; 18.3% (20/109), P=0.007], whereas the pregnancy loss rate showed no significant difference. Stratified analysis by age revealed that for patients aged <35 years, the clinical pregnancy rate [62.1% (54/87)] and the live birth rate [51.7% (45/87)] in fresh embryo transfer cycles were significantly higher in the hysteroscopic surgery group compared with the non-surgery group [30.8% (12/39), P=0.001; 25.6% (10/39), P=0.006]. Multivariate logistic regression analysis further confirmed that hysteroscopic surgery was an independent factor influencing live birth rate ( OR=2.128, 95% CI: 1.152-3.930, P=0.016). Among patients aged <35 years, hysteroscopic surgery was an influencing factor of both clinical pregnancy rate ( OR=4.222, 95% CI: 1.745-10.215, P=0.001) and live birth rate ( OR=3.449, 95% CI: 1.436-8.282, P=0.006). Conclusion:For infertile patients with ultrasound findings of uterine fibroids adjacent to or protruding into the uterine cavity, especially younger patients, hysteroscopy is recommended. It can improve pregnancy outcomes of fresh embryo transfer, increasing both the clinical pregnancy rate and the live birth rate.

Objective:To analyze the effects of electrophysiological combined therapy on pelvic floor function and electrophysiological indexes of pelvic floor in elderly patients with pelvic prolapse.Methods:A total of 46 elderly patients with pelvic prolapse admitted to Noncommissioned Officer School Hospital, Army Medical University from Jan. 2022 to Jul. 2023 were selected as subjects. All patients were divided into control group and study group by random number table method, with 23 cases in each group. The control group was treated with conventional operation, and the study group was treated with electrophysiological combination. The therapeutic effect, psychological state, pelvic floor electrophysiology and pelvic floor muscle function before and after treatment were compared between the two groups.Results:The treatment efficacy rate in the observation group was 95.65%, while that in the control group was 73.91%, with the observation group showing a significantly higher rate than the control group ( P<0.05). There were no statistically significant differences between the two groups in terms of psychological state scores, pelvic floor electrophysiological indicators, or pelvic floor muscle function before treatment ( P>0.05). After treatment, the SAS score, SDS score, fatigue degree of Type I muscle fibers, fatigue degree of Type II muscle fibers, and absolute values of gh scores in the observation group were lower than those in the control group ( P<0.05) ; The observation group had higher Type I muscle fiber strength, Type II muscle fiber strength, Ba point, Bp point, pb point, TVL point, pelvic floor contraction pressure, rapid contraction pressure, resting pressure, and number of contractions than the control group ( P<0.05) . Conclusion:Electrophysiological combined therapy is helpful to improve the therapeutic effect of elderly patients with pelvic prolapse, improve their psychological state, pelvic floor electrophysiological indexes and pelvic floor muscle function.

Objective:To investigate the role of serotonergic (5-HT) neurons activation in the dorsal raphe nucleus (DRN) in heat-induced seizures and its influence on breathing patterns in Scn1a + /- mice. Methods:24-day-old male Scn1a + /- mice were used for experiments, and sudden unexpected death in epilepsy(SUDEP) model was established through heat induction for 5 consecutive days. (1) Fluoxetine intervention experiment: 20 male mice were randomly divided into model group( n=10) and fluoxetine group ( n=10) according the weight-matched method. The fluoxetine group received intraperitoneal injection of fluoxetine (10 mg/kg) 45 min before heat induction each day for 5 consecutive days, while the model group received equal volume of 0.9% NaCl solution. (2) Chemogenetic activation experiment: 20 male mice were randomly divided into vector control group( n=10) and chemogenetic activation group ( n=10) according the weight-matched method. Empty vector or rAAV-TPH2-hM3d(Gq)-EGFP-WPREs was stereotaxically injected into DRN 14 d prior to seizure induction, and deschloroclozapine (5 mg/kg) was intraperitoneally injected 30 min before heat induction. Seizure characteristics and survival were assessed through video monitoring, and respiratory parameters were monitored. Immunofluorescence was used to detect colocalization of tryptophan hydroxylase 2(TPH2) and c-Fos in DRN. Statistical analysis was performed using SPSS 24.0 and GraphPad Prism 9.0. The independent sample t-test or Mann-Whitney test was used for inter-group comparison. Results:(1) In the fluoxetine intervention experiment: the survival rates between the model group and fluoxetine group showed no statistically significant difference ( χ2=2.23, P>0.05). As for the frequency of grade Ⅳ seizures, the model group (1.50(1.25, 2.35)min) demonstrated higher frequency than the fluoxetine group (0.43(0.20, 0.67)min) ( t=-3.40, P<0.05).With respect to respiratory parameters, the model group demonstrated shorter expiratory time ((0.10±0.02) s) and inspiratory time ((0.15±0.02) s) compared to the fluoxetine group ((0.16±0.05) s, (0.19±0.04) s) ( t=-3.47, -3.73, both P<0.01). The respiratory rate in the model group ((269.96±44.84) times/min) was significantly higher compared to the fluoxetine group ((195.04±52.37) times/min) ( t=3.44, P<0.01). The tidal volume in the model group ((0.10±0.02) mL) was significantly lower than the fluoxetine group ((0.13±0.04) mL) ( t=-2.19, P<0.05).The number of TPH2+ /c-Fos+ co-expressing cells in the model group (11.00±4.00) was lower than that in the fluoxetine group (33.00±8.39)( t=-4.16, P<0.05). (2) In the chemogenetic activation experiment: compared to the vehicle group, the chemogenetic activation group demonstrated significantly enhanced survival rates ( χ2=5.83, P<0.05). As for the frequency of grade Ⅴ seizures, the vehicle group (2.11(1.62, 3.44) times/min) showed higher frequency compared to the chemogenetic activation group (0.81(0.00, 1.62) times/min) ( t=18.00, P<0.05). In terms of respiratory parameters, the vehicle group showed shorter expiratory time ((0.10±0.01) s) and inspiratory time ((0.14±0.01) s) compared to the chemogenetic activation group ((0.12±0.01) s, (0.15±0.01) s) ( t=-2.78, -2.50, both P<0.05). The respiratory rate in the vehicle group ((208.37±9.73) times/min) was significantly higher than the chemogenetic activation group ((191.85±8.83) times/min) ( t=3.98, P<0.01). The tidal volume in the vehicle group ((0.09±0.01) mL) was significantly lower than the chemogenetic activation group ((0.12±0.02) mL) ( t=-4.77, P<0.001).The number of TPH2+ /c-Fos+ co-expressing cells in the vehicle group (9.00±3.46) was lower than that in the chemogenetic activation group (43.00±11.02)( t=-5.20, P<0.01). Conclusion:Specific activation of serotonergic neurons in the DRN can ameliorate heat-induced epileptic symptoms, improve respiratory function, and prolong survival time in Scn1a + /- mice.

Objective:To analyze the effects of electrophysiological combined therapy on pelvic floor function and electrophysiological indexes of pelvic floor in elderly patients with pelvic prolapse.Methods:A total of 46 elderly patients with pelvic prolapse admitted to Noncommissioned Officer School Hospital, Army Medical University from Jan. 2022 to Jul. 2023 were selected as subjects. All patients were divided into control group and study group by random number table method, with 23 cases in each group. The control group was treated with conventional operation, and the study group was treated with electrophysiological combination. The therapeutic effect, psychological state, pelvic floor electrophysiology and pelvic floor muscle function before and after treatment were compared between the two groups.Results:The treatment efficacy rate in the observation group was 95.65%, while that in the control group was 73.91%, with the observation group showing a significantly higher rate than the control group ( P<0.05). There were no statistically significant differences between the two groups in terms of psychological state scores, pelvic floor electrophysiological indicators, or pelvic floor muscle function before treatment ( P>0.05). After treatment, the SAS score, SDS score, fatigue degree of Type I muscle fibers, fatigue degree of Type II muscle fibers, and absolute values of gh scores in the observation group were lower than those in the control group ( P<0.05) ; The observation group had higher Type I muscle fiber strength, Type II muscle fiber strength, Ba point, Bp point, pb point, TVL point, pelvic floor contraction pressure, rapid contraction pressure, resting pressure, and number of contractions than the control group ( P<0.05) . Conclusion:Electrophysiological combined therapy is helpful to improve the therapeutic effect of elderly patients with pelvic prolapse, improve their psychological state, pelvic floor electrophysiological indexes and pelvic floor muscle function.

Objective:To investigate the role of serotonergic (5-HT) neurons activation in the dorsal raphe nucleus (DRN) in heat-induced seizures and its influence on breathing patterns in Scn1a + /- mice. Methods:24-day-old male Scn1a + /- mice were used for experiments, and sudden unexpected death in epilepsy(SUDEP) model was established through heat induction for 5 consecutive days. (1) Fluoxetine intervention experiment: 20 male mice were randomly divided into model group( n=10) and fluoxetine group ( n=10) according the weight-matched method. The fluoxetine group received intraperitoneal injection of fluoxetine (10 mg/kg) 45 min before heat induction each day for 5 consecutive days, while the model group received equal volume of 0.9% NaCl solution. (2) Chemogenetic activation experiment: 20 male mice were randomly divided into vector control group( n=10) and chemogenetic activation group ( n=10) according the weight-matched method. Empty vector or rAAV-TPH2-hM3d(Gq)-EGFP-WPREs was stereotaxically injected into DRN 14 d prior to seizure induction, and deschloroclozapine (5 mg/kg) was intraperitoneally injected 30 min before heat induction. Seizure characteristics and survival were assessed through video monitoring, and respiratory parameters were monitored. Immunofluorescence was used to detect colocalization of tryptophan hydroxylase 2(TPH2) and c-Fos in DRN. Statistical analysis was performed using SPSS 24.0 and GraphPad Prism 9.0. The independent sample t-test or Mann-Whitney test was used for inter-group comparison. Results:(1) In the fluoxetine intervention experiment: the survival rates between the model group and fluoxetine group showed no statistically significant difference ( χ2=2.23, P>0.05). As for the frequency of grade Ⅳ seizures, the model group (1.50(1.25, 2.35)min) demonstrated higher frequency than the fluoxetine group (0.43(0.20, 0.67)min) ( t=-3.40, P<0.05).With respect to respiratory parameters, the model group demonstrated shorter expiratory time ((0.10±0.02) s) and inspiratory time ((0.15±0.02) s) compared to the fluoxetine group ((0.16±0.05) s, (0.19±0.04) s) ( t=-3.47, -3.73, both P<0.01). The respiratory rate in the model group ((269.96±44.84) times/min) was significantly higher compared to the fluoxetine group ((195.04±52.37) times/min) ( t=3.44, P<0.01). The tidal volume in the model group ((0.10±0.02) mL) was significantly lower than the fluoxetine group ((0.13±0.04) mL) ( t=-2.19, P<0.05).The number of TPH2+ /c-Fos+ co-expressing cells in the model group (11.00±4.00) was lower than that in the fluoxetine group (33.00±8.39)( t=-4.16, P<0.05). (2) In the chemogenetic activation experiment: compared to the vehicle group, the chemogenetic activation group demonstrated significantly enhanced survival rates ( χ2=5.83, P<0.05). As for the frequency of grade Ⅴ seizures, the vehicle group (2.11(1.62, 3.44) times/min) showed higher frequency compared to the chemogenetic activation group (0.81(0.00, 1.62) times/min) ( t=18.00, P<0.05). In terms of respiratory parameters, the vehicle group showed shorter expiratory time ((0.10±0.01) s) and inspiratory time ((0.14±0.01) s) compared to the chemogenetic activation group ((0.12±0.01) s, (0.15±0.01) s) ( t=-2.78, -2.50, both P<0.05). The respiratory rate in the vehicle group ((208.37±9.73) times/min) was significantly higher than the chemogenetic activation group ((191.85±8.83) times/min) ( t=3.98, P<0.01). The tidal volume in the vehicle group ((0.09±0.01) mL) was significantly lower than the chemogenetic activation group ((0.12±0.02) mL) ( t=-4.77, P<0.001).The number of TPH2+ /c-Fos+ co-expressing cells in the vehicle group (9.00±3.46) was lower than that in the chemogenetic activation group (43.00±11.02)( t=-5.20, P<0.01). Conclusion:Specific activation of serotonergic neurons in the DRN can ameliorate heat-induced epileptic symptoms, improve respiratory function, and prolong survival time in Scn1a + /- mice.

Objective To establish normal reference values of video head impulse test(vHIT)for civil avia-tion student pilots to provide a reference basis for the accurate assessment of the vestibular function of civil aviation student pilots.Methods Forty civil aviation student pilots in the theoretical training phase were randomly selected for vHIT.The average gain of the vestibulo-ocular reflex(VOR)and the asymmetry ratios of the semicircular ca-nals were compared.Results The VOR values for the right horizontal,anterior,and posterior semicircular canals were 1.05±0.07,0.92±0.13,0.81±0.09,respectively.For the left horizontal,anterior,and posterior semicir-cular canals,the values were 1.00±0.06,0.85±0.10,0.86±0.10,respectively.There was no compensatory sac-cade in any of the subjects.The asymmetry ratios of bilateral horizontal,left anterior-right posterior,and right an-terior-left posterior semicircular canals were 5.56％±3.64％,9.65％±4.74％,8.68％±7.07％,respectively.Conclusion This study establishes vHIT normal reference values for civil aviation student pilots,providing an ob-jective basis for their selection and vestibular function evaluation.

Objective:To compare pregnancy outcomes between patients undergoing combined hysteroscopy and hysterosalpingo-contrast sonography (HyCoSy) versus hysteroscopy alone prior to intrauterine insemination, and to evaluate the safety and clinical value of the combined procedure in the diagnosis and treatment of infertility.Methods:A retrospective analysis was conducted on clinical data from 385 patients who underwent hysteroscopy at Peking University Third Hospital between October 1, 2020 and September 30, 2022, and subsequently received their first cycle of artificial insemination with donor sperm (AID) within six months. Pregnancy outcomes were compared between the group receiving combined hysteroscopy with four-dimensional HyCoSy (hysteroscopy+4D-HyCoSy group) and the group receiving hysteroscopy alone (hysteroscopy group). Multivariate logistic regression was used to analyze factors influencing pregnancy outcomes after AID.Results:Among the 385 patients included, 79 achieved clinical pregnancy. The clinical pregnancy rate (24.9%, 53/213) and live birth rate (21.1%, 45/213) in the hysteroscopy+4D-HyCoSy group were significantly higher than those in the hysteroscopy group [15.1% (26/172) and 12.8% (22/172), respectively; all P<0.05]. There was no significant difference in tubal patency between the two groups ( P>0.05); however, the time interval from tubal patency assessment to intrauterine insemination was significantly longer in the hysteroscopy group compared to the hysteroscopy+4D-HyCoSy group (median: 4.0 vs 2.0 months; P<0.001). Multivariate analysis showed that double insemination significantly increased clinical pregnancy rate compared to single insemination ( OR=2.42, 95% CI: 1.02-5.72; P=0.044). An interval exceeding 6 months between tubal patency assessment and intrauterine insemination was identified as a risk factor for reduced clinical pregnancy ( OR=0.35, 95% CI: 0.14-0.92; P=0.047). Additionally, neither the time interval from hysteroscopy to intrauterine insemination nor hysteroscopic findings and pathological diagnoses had significant effects on clinical pregnancy rates (all P>0.05). Conclusions:The combination of hysteroscopy and HyCoSy provides a safe and efficient approach for fertility assessment in infertile patients and improves clinical pregnancy rate and live birth rate in intrauterine insemination cycles. Hysteroscopy is recommended for patients with suspected endometrial or intrauterine abnormalities. If no previous tubal patency assessment has been performed or the last assessment was more than six months prior, combined hysteroscopy and HyCoSy may be considered to enhance the likelihood of clinical pregnancy.