Obstructive sleep apnea(OSA)is a dis-order characterized by chronic intermittent hypoxia and sleep fragmentation,usually manifested by ob-struction of the upper respiratory tract,resulting in sleep fragmentation,intermittent hypoxia,and hy-percapnia.OSA and significant comorbidities are as-sociated with perioperative complications.Opioids,as the most commonly used pain relievers,may fur-ther affect perioperative pain management in OSA and comorbidities.Studies have shown that OSA patients are more susceptible to the respiratory de-pressant effects of opioids.OSA also increases the risk of opioid-induced respiratory depression.There-fore,understanding the effects and mechanisms of opioids on OSA has important clinical significance for optimizing drug use,improving prognosis,and reducing respiratory adverse events.This article aims to review the effects of opioids on OSA and their relationship.

Objective:To investigate the alterations in brain functional activity before and after chemotherapy in breast cancer patients with chemotherapy-related cognitive impairment (CRCI) using resting-state functional magnetic resonance imaging (rs-fMRI) and their relations with cognitive impairment.Methods:A prospective observational study was performed; female breast cancer patients with CRCI admitted to Department of Oncology, Affiliated Hospital 6 of Nantong University were recruited, and age- and education level-matched female healthy controls were chosen. Before and one month after chemotherapy, statuses of cognitive function, depression and anxiety in breast cancer patients with CRCI were evaluated by Montreal cognitive assessment (MoCA), functional assessment of cancer therapy-cognitive function (FACT-cog), self-rating depression scale (SDS), and self-rating anxiety scale (SAS); subsequently, conventional MRI and resting-state functional magnetic resonance imaging (rs-fMRI) were conducted. The healthy controls accepted MoCA, SDS, and SAS, followed by conventional MRI and rs-fMRI. Differences in clinical data and amplitude of low-frequency fluctuation (ALFF, rs-fMRI brain spontaneous neural activity index) were compared between breast cancer patients with CRCI before chemotherapy and healthy controls, and in the breast cancer patients with CRCI between before and after chemotherapy. Taking the brain regions with significant differences in ALFF before and after chemotherapy in breast cancer patients with CRCI as seed points, the difference in whole-brain functional connectivity (FC) before and after chemotherapy was compared in breast cancer patients with CRCI. Pearson or Spearman correlation tests were used to analyze the correlations of ALFF and FC in brain regions with significant differences in ALFF with cognitive function scores in breast cancer patients with CRCI.Results:(1) A total of 22 breast cancer patients with CRCI and 22 healthy controls were enrolled. Compared with the healthy controls, the breast cancer patients with CRCI before chemotherapy had significantly higher SDS and SAS scores ( P<0.05). Compared with breast cancer patients with CRCI before chemotherapy, the breast cancer patients with CRCI after chemotherapy had significantly lower MoCA, FACT-cog-perceived cognitive impairment, FACT-cog-comment from others on cognitive function, and FACT-cog-perceived cognitive ability ( P<0.05). (2) Compared with those before chemotherapy, breast cancer patients with CRCI after chemotherapy exhibited significantly increased ALFF in the right precuneus, right middle occipital gyrus, and left superior frontal gyrus, while statistically decreased FC in the right middle occipital gyrus-left middle temporal gyrus, right precentral gyrus-right middle temporal gyrus, and left superior frontal gyrus-left fusiform gyrus ( P<0.05). (3) ALFF in the right precentral gyrus in breast cancer patients with CRCI after chemotherapy was negatively correlated with difference value of FACT-cog before and after chemotherapy ( r=-0.497, P=0.018) and difference value of PCA before and after chemotherapy ( r s=-0.436, P=0.042); FC in the left superior frontal gyrus-left fusiform gyrus was positively correlated with score of FACT-cog-perceived cognitive impairment ( r=0.621, P=0.002). Conclusion:Chemotherapy induces compensatory enhancement of spontaneous neural activity in multiple brain regions in breast cancer patients with CRCI, accompanied by FC disruption at specific brain areas, which are associated with cognitive impairment.

Objective:To systematically evaluate predictive models for stress urinary incontinence (SUI) in pregnant and postpartum women, providing a reference for model development, application, and promotion.Methods:A comprehensive literature search was conducted in PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, and China Biology Medicine disc for studies on SUI predictive models in pregnant and postpartum women. The search period was from database inception to September 30, 2024. Two researchers independently screened the literature and extracted data according to inclusion and exclusion criteria. The risk of bias in the predictive models was assessed using the prediction model risk of bias assessment tool.Results:A total of 23 studies were included, covering 31 predictive models for SUI, with a combined sample size of 14 473 women. Among them, six models focused on predicting SUI in pregnant women, while 25 models were developed for postpartum SUI. The predictive factors identified in these models were categorized into nine groups, including: general information for pregnant and postpartum women, delivery data, neonatal data, past history, abortion history, lifestyle data, pelvic floor muscle screening results, 2D and 3D ultrasound data, and serological indicators. Among these, age, mode of delivery, parity, body mass index, history of SUI, and neonatal weight were widely recognized as key predictive factors. External validation was performed in five studies. Five studies showed good applicability and low bias risk, except for one study that had limitations in both bias risk and applicability, and the remaining studies exhibited a high risk of bias but demonstrated good applicability.Conclusions:The methodological quality of SUI predictive models for pregnant and postpartum women needs further improvement. External validation remains insufficient. Future model development should be based on large-sample, prospective studies, incorporating appropriate predictive factors and stratifying SUI risk in different populations to enhance clinical applicability.

ObjectiveTo establish the multi-technique characteristic profiles of Alumen by X-ray diffraction（XRD）， Fourier-transform infrared spectroscopy（FTIR） and thermogravimetric-differential thermal analysis（TG-DTA）， and to explore the spectral characteristics for rapid identification of Alumen and its potential adulterant， Ammonium alum. MethodsA total of 27 batches of Alumen samples from 8 production regions were collected for preliminary identification based on visual characteristics. The PDF standard cards of XRD were used to differentiate Alumen from A. alum， and the XRD characteristic profiles of Alumen were established， and then the common peaks were screened. Based on hierarchical clustering analysis（HCA） and orthogonal partial least squares-discriminant analysis（OPLS-DA）， the characteristic information that could be used for identification of Alumen was selected with variable importance in the projection（VIP） value>1. FTIR characteristic profiles of Alumen were established， and key wavenumbers for identification were screened by HCA and OPLS-DA with VIP value>1. Meanwhile， the thermogravimetric differences between Alumen and A. alum were analyzed by TG-DTA， and the thermogravimetric traits that could be used for identification were screened. ResultsAlumen and A. alum could not be effectively distinguished by traits alone. However， by comparing the PDF standard cards of XRD， 15 batches of Alumen and 12 batches of A. alum could be distinguished. In the XRD profiles， 10 characteristic peaks were confirmed， corresponding to diffraction angles of 14.560°， 24.316°， 12.620°， 32.122°， 17.898°， 34.642°， 27.496°， 46.048°， 40.697° and 21.973°. In the FTIR profiles， 4 wavenumber ranges（399.193-403.050， 1 186.010-1 471.420， 1 801.190-2 620.790， 3 612.020-3 997.710 cm^-1） and 12 characteristic wavenumbers（1 428.994， 1 430.922， 1 432.851， 1 434.779， 1 436.708， 1 438.636， 1 440.565， 1 442.493， 1 444.422， 1 446.350， 1 448.279， 1 450.207 cm^-1） were identified. In the TG-DTA profiles， there were characteristic decomposition peaks of ammonium ion and mass reduction features near 555.34 ℃ for A. alum. These characteristics could serve as important criteria for distinguishing the authenticity of Alumen. ConclusionXRD， FTIR and TG-DTA can be used to rapidly detect Alumen and A. alum， and combined with the discriminant features selected through chemometrics， the rapid and accurate identification of Alumen and A. alum can be achieved. The research findings provide new approaches for the rapid identification of Alumen.

ObjectiveTo investigate the processing technology of calcined Haematitum based on the concept of quality by design（QbD） and to assess its health risk. MethodsTaking whole iron content， Fe²⁺ dissolution content and looseness as critical quality attributes（CQAs）， and calcination temperature， calcination time， spreading thickness and particle size as critical process parameters（CPPs） determined by the failure mode and effect analysis（FMEA）， the processing technology of calcined Haematitum was optimized by orthogonal test combined with analytic hierarchy process-criteria importance through intercriteria correlation（AHP-CRITIC） hybrid weighting method. The contents of heavy metals and harmful elements were determined by inductively coupled plasma mass spectrometry， and the health risk assessment was carried out by daily exposure（EXP）， target hazard quotient（THQ） and lifetime cancer risk（LCR）， and the theoretical value of the maximum limit was deduced. ResultsThe optimal processing technology for calcined Haematitum was calcination at 650 ℃， calcination time of 1 h， particle size of 0.2-0.5 cm， spreading thickness of 1 cm， and vinegar quenching for 1 time［Haematitum-vinegar（10：3）］. The contents of 5 heavy metals and harmful elements in 13 batches of calcined Haematitum were all decreased with reductions of up to 5-fold. The cumulative THQ of 2 batches of samples was>1， while the cumulative THQ of all batches of Haematitum was>1. The LCR of As in 1 batches of Haematitum was 1×10^-6-1×10^-4， and the LCR of the rest was<1×10^-6， and the LCRs of calcined Haematitum were all<1×10^-6， indicating that the carcinogenic risk of calcined Haematitum was low， but special attention should still be paid to Haematitum medicinal materials. Preliminary theoretical values of the maximum limits of Cu， As， Cd， Pb and Hg were formulated as 1 014， 25， 17， 27， 7 mg·kg^-1. ConclusionThe optimized processing technology of calcined Haematitum is stable and feasible， and the contents of heavy metals and harmful elements are reduced after processing. Preliminary theoretical values of the maximum limits of Cu， As， Cd， Pb and Hg are formulated to provide a scientific basis for the formulation of standards for the limits of harmful elements in Haematitum.

ObjectiveTo establish the multi-technique characteristic profiles of Alumen by X-ray diffraction（XRD）， Fourier-transform infrared spectroscopy（FTIR） and thermogravimetric-differential thermal analysis（TG-DTA）， and to explore the spectral characteristics for rapid identification of Alumen and its potential adulterant， Ammonium alum. MethodsA total of 27 batches of Alumen samples from 8 production regions were collected for preliminary identification based on visual characteristics. The PDF standard cards of XRD were used to differentiate Alumen from A. alum， and the XRD characteristic profiles of Alumen were established， and then the common peaks were screened. Based on hierarchical clustering analysis（HCA） and orthogonal partial least squares-discriminant analysis（OPLS-DA）， the characteristic information that could be used for identification of Alumen was selected with variable importance in the projection（VIP） value>1. FTIR characteristic profiles of Alumen were established， and key wavenumbers for identification were screened by HCA and OPLS-DA with VIP value>1. Meanwhile， the thermogravimetric differences between Alumen and A. alum were analyzed by TG-DTA， and the thermogravimetric traits that could be used for identification were screened. ResultsAlumen and A. alum could not be effectively distinguished by traits alone. However， by comparing the PDF standard cards of XRD， 15 batches of Alumen and 12 batches of A. alum could be distinguished. In the XRD profiles， 10 characteristic peaks were confirmed， corresponding to diffraction angles of 14.560°， 24.316°， 12.620°， 32.122°， 17.898°， 34.642°， 27.496°， 46.048°， 40.697° and 21.973°. In the FTIR profiles， 4 wavenumber ranges（399.193-403.050， 1 186.010-1 471.420， 1 801.190-2 620.790， 3 612.020-3 997.710 cm^-1） and 12 characteristic wavenumbers（1 428.994， 1 430.922， 1 432.851， 1 434.779， 1 436.708， 1 438.636， 1 440.565， 1 442.493， 1 444.422， 1 446.350， 1 448.279， 1 450.207 cm^-1） were identified. In the TG-DTA profiles， there were characteristic decomposition peaks of ammonium ion and mass reduction features near 555.34 ℃ for A. alum. These characteristics could serve as important criteria for distinguishing the authenticity of Alumen. ConclusionXRD， FTIR and TG-DTA can be used to rapidly detect Alumen and A. alum， and combined with the discriminant features selected through chemometrics， the rapid and accurate identification of Alumen and A. alum can be achieved. The research findings provide new approaches for the rapid identification of Alumen.

ObjectiveTo investigate the processing technology of calcined Haematitum based on the concept of quality by design（QbD） and to assess its health risk. MethodsTaking whole iron content， Fe²⁺ dissolution content and looseness as critical quality attributes（CQAs）， and calcination temperature， calcination time， spreading thickness and particle size as critical process parameters（CPPs） determined by the failure mode and effect analysis（FMEA）， the processing technology of calcined Haematitum was optimized by orthogonal test combined with analytic hierarchy process-criteria importance through intercriteria correlation（AHP-CRITIC） hybrid weighting method. The contents of heavy metals and harmful elements were determined by inductively coupled plasma mass spectrometry， and the health risk assessment was carried out by daily exposure（EXP）， target hazard quotient（THQ） and lifetime cancer risk（LCR）， and the theoretical value of the maximum limit was deduced. ResultsThe optimal processing technology for calcined Haematitum was calcination at 650 ℃， calcination time of 1 h， particle size of 0.2-0.5 cm， spreading thickness of 1 cm， and vinegar quenching for 1 time［Haematitum-vinegar（10：3）］. The contents of 5 heavy metals and harmful elements in 13 batches of calcined Haematitum were all decreased with reductions of up to 5-fold. The cumulative THQ of 2 batches of samples was>1， while the cumulative THQ of all batches of Haematitum was>1. The LCR of As in 1 batches of Haematitum was 1×10^-6-1×10^-4， and the LCR of the rest was<1×10^-6， and the LCRs of calcined Haematitum were all<1×10^-6， indicating that the carcinogenic risk of calcined Haematitum was low， but special attention should still be paid to Haematitum medicinal materials. Preliminary theoretical values of the maximum limits of Cu， As， Cd， Pb and Hg were formulated as 1 014， 25， 17， 27， 7 mg·kg^-1. ConclusionThe optimized processing technology of calcined Haematitum is stable and feasible， and the contents of heavy metals and harmful elements are reduced after processing. Preliminary theoretical values of the maximum limits of Cu， As， Cd， Pb and Hg are formulated to provide a scientific basis for the formulation of standards for the limits of harmful elements in Haematitum.

Objective:To search, evaluate, and summarize evidence regarding strategies to promote pelvic floor muscle contraction (PFMC) function in postpartum women, providing a basis for clinical practice.Methods:A comprehensive search was conducted in computer decision support systems, guideline websites, relevant professional association websites, and English and Chinese databases for evidence related to strategies to promote PFMC function in postpartum women. The sources included guidelines, expert consensus, evidence summaries, systematic reviews, and original studies, with the search period from June 2014 to January 2025. Two researchers independently assessed the quality of the included articles and extracted data for the evidence summary.Results:A total of 24 articles were included: nine guidelines, five expert consensus, three evidence summaries, two systematic reviews, and five original studies. The evidence was summarized across four domains: screening and assessment, team building, intervention strategies, and outcome evaluation, resulting in 25 key pieces of evidence.Conclusions:This study summarizes the best evidence for strategies to promote PFMC function in postpartum women, providing scientific and rigorous evidence for clinical practice. It supports the development of effective training programs to enhance postpartum women's quality of life.

Obstructive sleep apnea(OSA)is a dis-order characterized by chronic intermittent hypoxia and sleep fragmentation,usually manifested by ob-struction of the upper respiratory tract,resulting in sleep fragmentation,intermittent hypoxia,and hy-percapnia.OSA and significant comorbidities are as-sociated with perioperative complications.Opioids,as the most commonly used pain relievers,may fur-ther affect perioperative pain management in OSA and comorbidities.Studies have shown that OSA patients are more susceptible to the respiratory de-pressant effects of opioids.OSA also increases the risk of opioid-induced respiratory depression.There-fore,understanding the effects and mechanisms of opioids on OSA has important clinical significance for optimizing drug use,improving prognosis,and reducing respiratory adverse events.This article aims to review the effects of opioids on OSA and their relationship.

Objective To explore the value of transvaginal ultrasound five-view method for diagnosing fetal congenital heart disease(CHD)in early pregnancy of high-risk pregnancy.Methods Totally 428 singleton fetuses at 11-13+6 weeks of gestation in high-risk pregnancies were prospectively enrolled.Fetal cardiac examinations were performed using two-dimensional grey scale imaging combined with CDFI via transabdominal ultrasound method,transvaginal ultrasound five-view method(upper abdominal transverse view,four-chamber view,three-vessel and trachea[3VT]view,ventricular outflow tract view and bilateral subclavian artery view)and transvaginal ultrasound two-view method(four-chamber view and 3VT view).Taken results of pregnant metaphase or late pregnancy fetal echocardiography,post-abortion pathology or postnatal neonatal echocardiography as gold standards,the diagnostic performances of the above 3 methods for diagnosing fetal CHD in early pregnancy were compared.Results CHD was diagnosed in 120(120/428,28.04％)fetuses.Transvaginal ultrasound five-view method made 11 false positives and 19 false negatives,with sensitivity,specificity,positive predictive value and negative predictive values for diagnosing fetal CHD in the first trimester of high-risk pregnancy of 84.17％,96.43％,90.18％and 93.99％,respectively,which were all significantly higher than of transvaginal ultrasound two-view method(70.83％,91.88％,77.27％and 88.99％)and transabdominal ultrasound method(72.50％,91.23％,76.32％and 89.49％;all P＜0.05).Conclusion Transvaginal ultrasound five-view method could be used to effectively diagnose fetal CHD in the first trimester of high-risk pregnancy.