Objective To explore the correlation between thyroid autoimmunity(TAI)and gestational diabetes mellitus(GDM)in Chinese euthyroid women.Methods A total of 508 euthyroid women were enrolled in the cross-sectional study,who performed their entire clinical/biological workup and oral glucose tolerance test(OGTT)from the department of Gynecology and Endocrinology of the Beijing Obstetrics and Gynecology Hospital,Capital Medical University from June 2023 to June 2024.At median 8(6-10)weeks of gestation,thyroid-stimulating hormone(TSH),free thyroxine(fT4),and thyroid peroxidase antibodies(TPOAb)were measured,baseline characteristics were recorded,and an OGTT was performed between 24 and 28 weeks of pregnancy.According to the OGTT results,they were divided into GDM group(n=169)and non GDM group(n=339).Thyroid parameters,the demographic and obstetric parameters,and the prevalence of TAI were compared with two groups.The factors associated with GDM were analyzed with multivariate Logistic regression analysis.Results The age,body mass index(BMI),and proportion of obese women before pregnancy in the GDM group were all significantly higher than those in the non-GDM group,with statistically significant differences(P<0.001).The proportion of pregnant women over 30 years old in the GDM group was significantly higher than that in the non-GDM group(59.17%vs 6.79%,χ2=168.667,P<0.001).The proportion of obese mothers(BMI≥28 kg/m2)before pregnancy in the GDM group was 24.26%,which was significantly higher than that in the non-GDM group(8.26%)(χ2=24.599,P<0.001).The incidence of TAI in the GDM group was 54.44%,while it was 15.93%in the non-GDM group.The difference between the two groups was statistically significant(χ2=81.659,P<0.001).The results of Logistic regression analysis showed that maternal age over 30 years and pre-pregnancy obesity increased the risk of GDM occurrence in TAI women by 6.08 times(OR=6.08,95%CI 3.61-10.25,P<.001).Conclusion Among early pregnancy women with normal thyroid function,as age increases during follow-up(especially over 30 years old),pre-pregnancy BMI increases(especially in obese individuals),and those with pre-pregnancy TAI,the risk of developing GDM during pregnancy significantly increases.It is necessary to explore preventive strategies for GDM in euthyroid TAI women,with a view to improving adverse pregnancy outcomes.

Objective To investigate the curative effect of letrozole combined with Zi Gui Nv Zhen Capsules on patients with polycystic ovary syndrome(PCOS)complicated by thin endometrial infertility.Methods 140 patients with PCOS who met the diagnosis of endometrial thin infertility(endometrial thickness<0.8 cm and no pregnancy for 1 year without contraception)were recruited and randomly assigned to the control group and the experimental group for 3 cycles of treatment.The control group was given letrozole 2.5 mg/d on the 3rd day of menstruation,estradiol valerate 2 mg/d on the 8-10th day of menstruation,and dydrogesterone 10 mg/d in sequence.The experimental group was treated with Zi Gui Nv Zhen Capsules on the basis of the control group.During 3 cycles of treatment,endometrial thickness(EMT),ovulation rate and cumulative pregnancy rate on the day of ovulation were examined.Results The EMT of the experiment group was significantly higher than that of the control group on the ovulation day of three cycles[(0.86±0.23)cm vs(0.71±0.15)cm;(0.83±0.26)cm vs(0.68±0.19)cm;(0.87±0.26)cm vs(0.71±0.11)cm],the cumulative pregnancy rate of experimental group was significantly higher than that of control group(44.3%vs 25.7%).There was no significant difference in ovulation rate between the two groups(P>0.05).Conclusion Our findings demonstrate that the combined use of Zi Gui Nv Zhen Capsule with basic conventional therapy significantly enhances endometrial thickness and improves pregnancy rates in PCOS patients with thin endometrium.

Objective:To explore the application value of right-opening single flap valvuloplasty based on tubular stomach in gastrointestinal reconstruction after laparoscopic proximal gastrectomy.Method:Use a linear cutting stapler to make a parallel curve from the angle of the stomach to the junction of the gastric fundus to remove the lesser curvature of the stomach, and detach the gastric body about 5 cm away from the tumor to create a tubular stomach. Use a marker pen to draw a C-shaped seromuscular flap area with a width of 2.5 cm and a height of 3.5 cm 1.5 cm below the residual stomach closure nail, and create a free muscle flap in the gap between the plasma muscle layer and the submucosal layer. Make a transverse incision of 3 cm at the lower edge of the mucosal bed, and intermittently suture the entire lower edge of the gastric wall with 3 stitches. Under laparoscopy, use 4-0 barbed wire to suture the 1 cm wide muscular layer at the top of the tubular stomach and the posterior wall of the esophagus about 5 cm away from the esophageal stump with 3 stitches. Push the upper end of the tubular stomach into the mediastinum, and then tighten the barbed wire to ensure a tight fit between the stomach and the posterior wall of the esophagus. Use an ultrasonic scalpel to remove the esophageal stump, suture the entire posterior wall of the esophagus with the gastric mucosa, and use barbed wire to suture the anterior wall from left to right. The anastomotic site is completely covered with a free muscle flap, and the barbed line is used to continuously suture the muscle flap along the C-shaped line to the gastric pulp muscle layer at the edge of the mucosal bed, embedding the anastomotic site and completing the reconstruction of the digestive tract.Results:Clinical data of 23 patients (18 from the First Affiliated Hospital of Wenzhou Medical University and 5 from the Quzhou Hospital affiliated with Wenzhou Medical University) who underwent laparoscopic proximal gastrectomy, tubular gastroesophageal anastomosis, and pure manual right flap reconstruction surgery for esophagogastric junction adenocarcinoma and proximal gastric cancer from October 2023 to August 2024. There were 15 males and 8 females, with an age of (65.3±7.7) years, the BMI was (22.9±2.8) kg/m 2. All patients in the group successfully completed the surgery, with a surgery time of (218.5±38.1) minutes, including (73.5±19.2) minutes for anastomosis, intraoperative blood loss of (64.5±15.4) ml, postoperative passage of gas on (3.4±0.5) days, first consumption of liquid food after surgery of (3.9±1.1) days, and postoperative hospital stay of (9.1±0.8) days. One patient developed anastomotic stenosis (grade I) after surgery, presenting with mild swallowing obstruction, which returned to normal after dietary adjustment, and there were no cases of secondary surgery. The median follow-up time for the entire group was 4.0 (0.7-7.0) months, during which there were no deaths or tumor recurrence or metastasis, no complications such as anastomotic stenosis or gastric emptying disorders, and no complaints of acid reflux or heartburn. At one month of postoperative follow-up, the reflux symptom index (RSI) score was (3.1±2.9) points, and at three months, the RSI score was (2.4±1.4) points. Conclusions:The application of right-opening single flap valvuloplasty based on tubular stomach for gastrointestinal reconstruction after laparoscopic proximal gastrectomy is safe,feasible,and has satisfactory short-term efficacy.

To summarize the nursing experience of a child with hypoplastic left heart syndrome undergoing modified total vena cava pulmonary artery anastomosis operation.Preoperative nursing points:to establish a multidisciplinary team to formulate the best surgical plan;implementation of pre-rehabilitation nursing to reduce the risk of surgery.Postoperative nursing points:precise volume management to ensure effective pulmonary circulation perfusion;to reduce pulmonary artery pressure and maintain effective cardiac output;early warning of high risk to prevent thrombosis;nutritional support should be strengthened and protein-losing enteropathy should be alert for its incidence.Phase Ⅰ cardiac rehabilitation training should be strengthened to improve cardiopulmonary function.After careful treatment and nursing care,the child recovered and was discharged on the 28 th day after surgery.

Objective To explore the correlation between thyroid autoimmunity(TAI)and gestational diabetes mellitus(GDM)in Chinese euthyroid women.Methods A total of 508 euthyroid women were enrolled in the cross-sectional study,who performed their entire clinical/biological workup and oral glucose tolerance test(OGTT)from the department of Gynecology and Endocrinology of the Beijing Obstetrics and Gynecology Hospital,Capital Medical University from June 2023 to June 2024.At median 8(6-10)weeks of gestation,thyroid-stimulating hormone(TSH),free thyroxine(fT4),and thyroid peroxidase antibodies(TPOAb)were measured,baseline characteristics were recorded,and an OGTT was performed between 24 and 28 weeks of pregnancy.According to the OGTT results,they were divided into GDM group(n=169)and non GDM group(n=339).Thyroid parameters,the demographic and obstetric parameters,and the prevalence of TAI were compared with two groups.The factors associated with GDM were analyzed with multivariate Logistic regression analysis.Results The age,body mass index(BMI),and proportion of obese women before pregnancy in the GDM group were all significantly higher than those in the non-GDM group,with statistically significant differences(P<0.001).The proportion of pregnant women over 30 years old in the GDM group was significantly higher than that in the non-GDM group(59.17%vs 6.79%,χ2=168.667,P<0.001).The proportion of obese mothers(BMI≥28 kg/m2)before pregnancy in the GDM group was 24.26%,which was significantly higher than that in the non-GDM group(8.26%)(χ2=24.599,P<0.001).The incidence of TAI in the GDM group was 54.44%,while it was 15.93%in the non-GDM group.The difference between the two groups was statistically significant(χ2=81.659,P<0.001).The results of Logistic regression analysis showed that maternal age over 30 years and pre-pregnancy obesity increased the risk of GDM occurrence in TAI women by 6.08 times(OR=6.08,95%CI 3.61-10.25,P<.001).Conclusion Among early pregnancy women with normal thyroid function,as age increases during follow-up(especially over 30 years old),pre-pregnancy BMI increases(especially in obese individuals),and those with pre-pregnancy TAI,the risk of developing GDM during pregnancy significantly increases.It is necessary to explore preventive strategies for GDM in euthyroid TAI women,with a view to improving adverse pregnancy outcomes.

Objective To investigate the curative effect of letrozole combined with Zi Gui Nv Zhen Capsules on patients with polycystic ovary syndrome(PCOS)complicated by thin endometrial infertility.Methods 140 patients with PCOS who met the diagnosis of endometrial thin infertility(endometrial thickness<0.8 cm and no pregnancy for 1 year without contraception)were recruited and randomly assigned to the control group and the experimental group for 3 cycles of treatment.The control group was given letrozole 2.5 mg/d on the 3rd day of menstruation,estradiol valerate 2 mg/d on the 8-10th day of menstruation,and dydrogesterone 10 mg/d in sequence.The experimental group was treated with Zi Gui Nv Zhen Capsules on the basis of the control group.During 3 cycles of treatment,endometrial thickness(EMT),ovulation rate and cumulative pregnancy rate on the day of ovulation were examined.Results The EMT of the experiment group was significantly higher than that of the control group on the ovulation day of three cycles[(0.86±0.23)cm vs(0.71±0.15)cm;(0.83±0.26)cm vs(0.68±0.19)cm;(0.87±0.26)cm vs(0.71±0.11)cm],the cumulative pregnancy rate of experimental group was significantly higher than that of control group(44.3%vs 25.7%).There was no significant difference in ovulation rate between the two groups(P>0.05).Conclusion Our findings demonstrate that the combined use of Zi Gui Nv Zhen Capsule with basic conventional therapy significantly enhances endometrial thickness and improves pregnancy rates in PCOS patients with thin endometrium.

To summarize the nursing experience of a child with hypoplastic left heart syndrome undergoing modified total vena cava pulmonary artery anastomosis operation.Preoperative nursing points:to establish a multidisciplinary team to formulate the best surgical plan;implementation of pre-rehabilitation nursing to reduce the risk of surgery.Postoperative nursing points:precise volume management to ensure effective pulmonary circulation perfusion;to reduce pulmonary artery pressure and maintain effective cardiac output;early warning of high risk to prevent thrombosis;nutritional support should be strengthened and protein-losing enteropathy should be alert for its incidence.Phase Ⅰ cardiac rehabilitation training should be strengthened to improve cardiopulmonary function.After careful treatment and nursing care,the child recovered and was discharged on the 28 th day after surgery.

Objective To investigate the effect and mechanism of curculigoside(CUR)on hippocampal neuron injury in epileptic rats.Methods Forty-eight rats were selected,and the epileptic rat models were established by induction with 35 mg/kg pentylenetetrazol.The epileptic rats were randomly divided into the epilepsy group,the epilepsy+low-dose CUR group(the epilepsy+CUR-L group),the epilepsy+high-dose CUR group(the epilepsy+CUR-H group),and the epilepsy+CUR-H+PI3K activator 740Y-P group(the epilepsy+CUR-H+740Y-P group),with 12 rats in each group.Another 12 rats that were intraperitoneally injected with the same amount of normal saline were taken as the control group.Four weeks after administration,the behavioral changes of rats in each group were observed.Nissl staining was applied to determine the neuronal changes in hippocampal tissue.Immunohistochemistry was applied to detect the number of microglia in hippocampal tissue.ELISA was applied to detect the levels of interleukin-6(IL-6),IL-1β,and gamma-aminobutyric acid(GABA)in hippocampal tissue.TUNEL staining was applied to analyze the level of neuronal apoptosis in hippocampal tissue.Western blot was applied to detect the phosphorylation levels of PI3K,Akt and mTOR in hippocampal tissue.Results Compared with the control group,the Racine score and the frequency of epileptic seizures in rats,and the number of microglia,level of IL-6,level of IL-1β,the apoptosis rate of neurons,and levels of p-PI3K/PI3K,p-Akt/Akt,p-mTOR/mTOR in hippocampal tissue in the epilepsy group were obviously increased(P<0.05),while the level of GABA in hippocampal tissue was obviously reduced(P<0.05),and the arrangement of neurons in hippocampal tissue was disordered,with neuronal loss.Compared with the epilepsy group,the Racine score,and the frequency of epileptic seizures in rats,and the number of microglia,levels of IL-6,levels of IL-1β,the apoptosis rates of neurons,and levels of p-PI3K/PI3K,p-Akt/Akt,p-mTOR/mTOR in hippocampal tissue in the epilepsy+CUR-L group and the epilepsy+CUR-H group were significantly decreased(P<0.05),while the levels of GABA in hippocampus tissue were significantly increased(P<0.05),the loss and necrosis of neurons in hippocampus tissue were decreased,and the disorder of cell arrangement was improved.Compared with the epilepsy+CUR-H group,the Racine score and the frequency of epileptic seizures in rats,and the number of microglia,level of IL-6,level of IL-1β,the apoptosis rate of neurons,and levels of p-PI3K/PI3K,p-Akt/Akt,p-mTOR/mTOR in hippocampal tissue in the epilepsy+CUR-H+740Y-P group were significantly increased(P<0.05),while the level of GABA in hippocampus tissue was significantly decreased(P<0.05),the loss and necrosis of hippocampal neurons increased,and the cell arrangement was disordered.Conclusion CUR may reduce hippocampal neuron damage in epileptic rats by downregulating the PI3K/Akt/mTOR signaling pathway.

Objective To investigate the effect and mechanism of curculigoside(CUR)on hippocampal neuron injury in epileptic rats.Methods Forty-eight rats were selected,and the epileptic rat models were established by induction with 35 mg/kg pentylenetetrazol.The epileptic rats were randomly divided into the epilepsy group,the epilepsy+low-dose CUR group(the epilepsy+CUR-L group),the epilepsy+high-dose CUR group(the epilepsy+CUR-H group),and the epilepsy+CUR-H+PI3K activator 740Y-P group(the epilepsy+CUR-H+740Y-P group),with 12 rats in each group.Another 12 rats that were intraperitoneally injected with the same amount of normal saline were taken as the control group.Four weeks after administration,the behavioral changes of rats in each group were observed.Nissl staining was applied to determine the neuronal changes in hippocampal tissue.Immunohistochemistry was applied to detect the number of microglia in hippocampal tissue.ELISA was applied to detect the levels of interleukin-6(IL-6),IL-1β,and gamma-aminobutyric acid(GABA)in hippocampal tissue.TUNEL staining was applied to analyze the level of neuronal apoptosis in hippocampal tissue.Western blot was applied to detect the phosphorylation levels of PI3K,Akt and mTOR in hippocampal tissue.Results Compared with the control group,the Racine score and the frequency of epileptic seizures in rats,and the number of microglia,level of IL-6,level of IL-1β,the apoptosis rate of neurons,and levels of p-PI3K/PI3K,p-Akt/Akt,p-mTOR/mTOR in hippocampal tissue in the epilepsy group were obviously increased(P<0.05),while the level of GABA in hippocampal tissue was obviously reduced(P<0.05),and the arrangement of neurons in hippocampal tissue was disordered,with neuronal loss.Compared with the epilepsy group,the Racine score,and the frequency of epileptic seizures in rats,and the number of microglia,levels of IL-6,levels of IL-1β,the apoptosis rates of neurons,and levels of p-PI3K/PI3K,p-Akt/Akt,p-mTOR/mTOR in hippocampal tissue in the epilepsy+CUR-L group and the epilepsy+CUR-H group were significantly decreased(P<0.05),while the levels of GABA in hippocampus tissue were significantly increased(P<0.05),the loss and necrosis of neurons in hippocampus tissue were decreased,and the disorder of cell arrangement was improved.Compared with the epilepsy+CUR-H group,the Racine score and the frequency of epileptic seizures in rats,and the number of microglia,level of IL-6,level of IL-1β,the apoptosis rate of neurons,and levels of p-PI3K/PI3K,p-Akt/Akt,p-mTOR/mTOR in hippocampal tissue in the epilepsy+CUR-H+740Y-P group were significantly increased(P<0.05),while the level of GABA in hippocampus tissue was significantly decreased(P<0.05),the loss and necrosis of hippocampal neurons increased,and the cell arrangement was disordered.Conclusion CUR may reduce hippocampal neuron damage in epileptic rats by downregulating the PI3K/Akt/mTOR signaling pathway.