ObjectiveTo analyze the effects of the progestin-primed ovarian stimulation （PPOS） protocol on embryo euploidy rate and clinical pregnancy outcomes in infertile patients. MethodsWomen who underwent Preimplantation genetic testing for aneuploidy （PGT-A） cycles were selected as study participants （a total of 656 cycles and 3 081 blastocysts）. Participants were divided into two age groups （≤35 years and >35 years） and further stratified by ovarian stimulation protocol： the Progestin-Primed Ovarian Stimulation （PPOS） group （n=48 and 60， respectively）， the Luteal Phase Long Protocol （LP） group （n=160 and 57， respectively）， and the Gonadotropin-Releasing Hormone Antagonist Protocol （AP） group （n=220 and 111， respectively）. Baseline characteristics， ovarian stimulation outcomes， and embryo development parameters were compared among the three protocols within each age group. Additionally， clinical pregnancy outcomes of the first frozen embryo transfer （FET） cycle were compared. The primary outcome measure was the embryo euploidy rate. Results① In the ≤35 years age group， baseline follicle-stimulating hormone （bFSH） levels were significantly higher in the PPOS group compared to the LP and AP groups， and the bFSH/bLH ratio was significantly higher in the PPOS group than in the AP group （P < 0.05）. In the >35 years age group， bFSH levels in both the PPOS and AP groups were significantly higher than in the LP group （P < 0.05）.② In the ≤35 years group， there were no significant differences in the rates of metaphase II （MII） oocytes， 2-pronuclei （2 PN） zygotes， cleavage， 2 PN cleavage， blastocyst formation， high-quality embryos， or embryo euploidy between the PPOS group and either the LP or AP groups. However， the PPOS group showed significantly lower values for the following parameters compared to the other two groups： total oocytes retrieved， number of MII oocytes， number of 2 PN zygotes， number of cleaved embryos， number of 2 PN cleaved embryos， number of blastocysts formed， number of high-quality embryos， number of high-grade blastocysts， number of transferable embryos， number of cryopreserved embryos， number of biopsied blastocysts， number of euploid embryos， and the rate of obtaining at least one euploid embryo. In the >35 years group， no significant differences were observed among the PPOS， LP， and AP groups in the rates of MII oocytes， 2 PN cleavage， blastocyst formation， or in the number of euploid embryos， euploidy rate， and the rate of obtaining at least one euploid embryo. However， the PPOS group had significantly lower numbers of total oocytes retrieved， MII oocytes， 2 PN zygotes， cleaved embryos， 2 PN cleaved embryos， blastocysts formed， transferable embryos， and cryopreserved embryos compared to the LP group （P<0.05）. The high-quality embryo rate was significantly lower in the PPOS group than in the AP group （P<0.05）. The numbers of high-quality embryos， high-grade blastocysts， and biopsied blastocysts were significantly lower in the PPOS group than in both the LP and AP groups （P<0.05）. Notably， the 2 PN fertilization rate was significantly higher in the PPOS group than in the AP group， and the cleavage rate was significantly higher in the PPOS group than in both the LP and AP groups （P<0.05）.③ No significant differences were found among the three groups in the biochemical pregnancy rate， clinical pregnancy rate， live birth rate， early miscarriage rate， and late miscarriage rate following the first FET cycle. ConclusionCompared to the other two protocols， the PPOS protocol does not significantly affect embryo euploidy or clinical pregnancy rates. However， in freeze-all cycles with PGT-A， the PPOS protocol does not reduce the rate of chromosomally normal embryos but may decrease the total number of available embryos. It may not be the optimal choice for younger women， but it can be considered as a viable option for women of advanced maternal age.

Objectives:To investigate the clinical value of cardiac magnetic resonance imaging(CMR)feature-tracking strain analysis in risk stratification of diabetic heart failure with preserved ejection fraction(HFpEF).Methods:In this retrospective study,a total of 215 patients with diabetic HFpEF who underwent CMR at Chinese Academy of Medical Sciences Fuwai Hospital from January 2012 to December 2018 were included.Myocardial strain parameters were calculated using CMR feature-tracking technology.Patients were followed up by medical records or telephone calls.Composite endpoint event,all-cause death or heart failure hospitalization during follow-up were recorded.Patients were divided into event group and event-free group.Univariable and multivariable Cox proportional hazard regression analyses were performed to determine the risk factors for the outcomes in diabetic HFpEF.The effects of hypertension and obesity on the prognosis of diabetic HFpEF patients and whether they affect the prognostic value of CMR feature-tracking strain analysis were also analyzed.Results:During a follow-up of(7.1±1.8)years,93(43.3%)patients had endpoint events(event group),including 28 all-cause deaths and 65 heart failure hospitalization.Compared with the event-free group(n=122),patients in the event group had significantly lower left ventricular ejection fraction,higher prevalence and extent of late gadolinium enhancement,and significantly reduced global longitudinal strain(GLS),global circumferential strain,global radial strain,and global systolic longitudinal strain rate(all P<0.05).The absolute GLS value was significantly lower in event group than in event-free group,regardless of the presence of hypertension and obesity.Multivariate Cox regression analysis showed that estimated glomerular filtration rate(HR=0.983,95%CI:0.972-0.993,P=0.001),left atrial volume index(HR=1.015,95%CI:1.005-1.026,P=0.004),and GLS(HR=1.142,95%CI:1.060-1.231,P<0.001)were independent risk factors for adverse cardiovascular events in diabetic HFpEF patients.However,adjusted N-terminal pro-brain natriuretic peptide was not an independent prognostic factor.The cut-offvalue of GLS to predict outcome was-14.09%from ROC curve analysis.The Kaplan-Meier curve showed that in patients with and without hypertension and obesity,patients with the GLS>-14.09%had lower event-free survival compared to patients with GLS≤-14.09%(all P<0.05),and the ability of GLS to predict adverse outcomes was not affected by hypertension and obesity.Conclusions:GLS obtained by CMR feature-tracking strain analysis is an independent predictor of adverse outcomes in diabetic HFpEF,and its ability to predict adverse outcomes is independent of hypertension and obesity.

Objective To explore the relevant factors for infection in patients with non-small cell lung cancer(NSCLC)during chemotherapy period,and construct a prediction model.Methods 387 NSCLC chemotherapy pa-tients who admitted to a hospital from May 2020 to January 2023 were selected as the modeling set.They were di-vided into an infection group and a control group based on the occurrence of infection during chemotherapy period.General data,diagnosis and treatment information,and biochemical examination results of patients were collected for univariate analysis.Items with statistically significant differences were included in logistic regression analysis,and factors related to infection were screened out.A infection risk prediction model for NSCLC chemotherapy pa-tients was constructed using the RMS package in R-based software.The discrimination and consistency of the model in infection prediction were validated through the area under the curve(AUC)of the receiver operating characteristic(ROC)curve and the calibration curve.Clinical benefits were evaluated through the decision curve analysis(DCA).A total of 165 NSCLC chemotherapy patients who admitted to the hospital from February 2023 to October 2024 were included as the validation set,and external validation of the model was conducted.Results Among the 387 patients in the modeling set,93 cases developed infection during chemotherapy period,with an infection rate of 24.03％.The main infection sites were respiratory system(39.79％)and digestive system(24.73％).There were statistically significant differences in age,combined chronic respiratory disease,tumor-node-metastasis-based(TNM)staging system,chemotherapy cycle,combined radiotherapy,episode number of invasive procedures,and glucocorticoid use between two groups of patients in the modeling set(all P＜0.05).Logistic regression analysis showed 6 major risk factors for co-infection in NSCLC chemotherapy patients,namely age,TNM stage Ⅲ-Ⅳ,long chemotherapy cycle,combined radiotherapy,more than 2 episodes of invasive procedures,and glucocorticoid use.A risk prediction model for the infection in NSCLC chemotherapy patients was constructed using the 6 predictive indi-cators.The results showed that the AUCs of the modeling set and the validation set were 0.792 and 0.773,respec-tively.The predicted probability of infection was close to the actual probability.The HL test of goodness of fit of the modeling set showed x2 value of 8.760 and P value of 0.316,and those of the modeling set were 9.013 and 0.287,respectively.DCA revealed a high clinical benefit of the model.Conclusion A nomogram prediction model based on age,TNM stage,chemotherapy cycle,combined radiotherapy,episodes of invasive procedures,and glu-cocorticoid use can effectively predict co-infection in NSCLC chemotherapy patients.

Objective To explore the relevant factors for infection in patients with non-small cell lung cancer(NSCLC)during chemotherapy period,and construct a prediction model.Methods 387 NSCLC chemotherapy pa-tients who admitted to a hospital from May 2020 to January 2023 were selected as the modeling set.They were di-vided into an infection group and a control group based on the occurrence of infection during chemotherapy period.General data,diagnosis and treatment information,and biochemical examination results of patients were collected for univariate analysis.Items with statistically significant differences were included in logistic regression analysis,and factors related to infection were screened out.A infection risk prediction model for NSCLC chemotherapy pa-tients was constructed using the RMS package in R-based software.The discrimination and consistency of the model in infection prediction were validated through the area under the curve(AUC)of the receiver operating characteristic(ROC)curve and the calibration curve.Clinical benefits were evaluated through the decision curve analysis(DCA).A total of 165 NSCLC chemotherapy patients who admitted to the hospital from February 2023 to October 2024 were included as the validation set,and external validation of the model was conducted.Results Among the 387 patients in the modeling set,93 cases developed infection during chemotherapy period,with an infection rate of 24.03％.The main infection sites were respiratory system(39.79％)and digestive system(24.73％).There were statistically significant differences in age,combined chronic respiratory disease,tumor-node-metastasis-based(TNM)staging system,chemotherapy cycle,combined radiotherapy,episode number of invasive procedures,and glucocorticoid use between two groups of patients in the modeling set(all P＜0.05).Logistic regression analysis showed 6 major risk factors for co-infection in NSCLC chemotherapy patients,namely age,TNM stage Ⅲ-Ⅳ,long chemotherapy cycle,combined radiotherapy,more than 2 episodes of invasive procedures,and glucocorticoid use.A risk prediction model for the infection in NSCLC chemotherapy patients was constructed using the 6 predictive indi-cators.The results showed that the AUCs of the modeling set and the validation set were 0.792 and 0.773,respec-tively.The predicted probability of infection was close to the actual probability.The HL test of goodness of fit of the modeling set showed x2 value of 8.760 and P value of 0.316,and those of the modeling set were 9.013 and 0.287,respectively.DCA revealed a high clinical benefit of the model.Conclusion A nomogram prediction model based on age,TNM stage,chemotherapy cycle,combined radiotherapy,episodes of invasive procedures,and glu-cocorticoid use can effectively predict co-infection in NSCLC chemotherapy patients.

Objective:To investigate the feasibility and clinical effects of ultra early enteral nutrition (≤24 h) in critically ill children supported by extracorporeal membrane oxygenation (ECMO).Methods:A retrospective cohort study was conducted. Clinical data of 43 critically ill children who received ECMO support in the pediatric intensive care unit (PICU) of Shanghai Children′s Hospital from January 2016 to December 2023 were collected, including general information, nutritional support modalities, and enteral nutrition tolerance. Based on the timing of enteral nutrition initiation, patients were divided into the within 24 h enteral nutrition group and the after 24 h enteral nutrition group. Nutritive indicators, nutritional intake, duration of ECMO support, duration of mechanical ventilation duration, and mortality rates were compared between the 2 groups using the two independent sample t test, Mann-Whitney U test, χ2 test and Fisher′s exact test. Results:Among the 43 children, 25 were male and 18 were female, with an age of 47 (18, 97) months. There were no statistically significant differences between the within 24 h enteral nutrition group (21 cases) and the after 24 h enteral nutrition group (22 cases) in terms of age, body mass index Z score, total protein, albumin, hemoglobin levels before ECMO support, duration of ECMO support, duration of mechanical ventilation, length of PICU stay, number of enteral nutrition intolerance events, number of enteral nutrition interruption, or mortality rate (all P>0.05). The protein intake adequacy rate during ECMO support was higher in the within 24 h enteral nutrition group than in the after 24 h enteral nutrition group (0 (0, 21%) vs. 0 (0, 0), U=175.00, P<0.05). Conclusions:Ultra early enteral nutrition is safe for children supported by ECMO. Initiating enteral nutrition within 24 h can increase the proportion of days with adequate protein intake in ECMO children without increasing the occurance of enteral nutrition intolerance or interruptions.

Objective:To comprehensively evaluate the changes in pulmonary artery hemodynamics in patients with repaired tetralogy of Fallot (rTOF) using four-dimensional flow (4D Flow) MRI, and to explore the value of viscous energy loss (EL) as an evaluation parameter of the right heart in patients with rTOF.Methods:A total of 30 rTOF patients who were prospectively admitted at Fuwai Hospital between October 2017 and November 2019, and 19 healthy controls who were prospectively recruited on March 2023, were enrolled in this study. All participants underwent a comprehensive 4D Flow MRI evaluation, and indicators of comparison between the two groups including quantitative flow analysis, wall shear stress (WSS) assessment, and EL evaluation in four planes: the right ventricular outflow tract (RVOT), main pulmonary artery (MPA), right pulmonary artery (RPA), and left pulmonary artery (LPA). The correlation between EL and traditional right ventricular (RV) function parameters, as well as WSS, was analyzed.Results:The RV function was generally decreased in rTOF patients, with an RV ejection fraction of 41.42 (35.85, 43.33) %. Compared with healthy controls, the volumes of backward flow, peak velocities, and both axial and circumferential WSS at the RVOT, MPA, RPA, and LPA were significantly increased in rTOF patients (all P<0.05). The EL in the pulmonary artery was extremely low in healthy controls, with the maximum EL values for the MPA-RPA and MPA-LPA segments during cardiac cycle being 0.51 (0.42, 0.73) and 0.68 (0.40, 0.94) mW, respectively. However, in rTOF patients, the EL values were as high as 63.63 (35.35, 82.15) and 56.41 (34.96, 88.76) mW, respectively. There was a significant moderate negative correlation between EL and RV ejection fraction, and a moderate to high positive correlation between EL with RV volume index, regurgitation fraction, as well as peak velocities (all P<0.05). Additionally, there was a significant positive correlation between EL and axial and circumferential WSS, with the correlation coefficients at MPA ranging from 0.67 to 0.88 (all P<0.05). Conclusions:Disordered flow in the pulmonary artery is common in patients with rTOF and should not be overlooked. The extensive viscous EL is closely associated with traditional RV function parameters and WSS. EL is expected to become an crucial parameter for evaluating right heart function in rTOF patients.

Objective:To observe the application of biofeedback instrument in patients with Alzheimer's disease(AD)and the effect of that on cognitive conversion of them.Methods:A total of 150 AD patients who admitted to Shanghai Mental Health Center from February 2022 to February 2024 were selected.The patients were divided into the observation group(75 cases)and the control group(75 cases)according to randomized numerical table.The control group received medicine treatment combined with conventional training,while the observation group received the treatment with biofeedback instrument on the basis of control group.The application effect and cognitive conversion of two groups were compared.Results:After treatment,the compliance rate and satisfaction rate of family's members for treatment results in observation group were higher than those in control group,and the differences of them between two groups were significant(x2=15.213,6.313,8.451,P＜0.05).Compared with the various indicators of two groups before the biofeedback instrument was applied,they were improved after it was applied.The β-wave and sensorimotor rhythm(SMR)-wave of electroencephalogram,Mini-Mental State Examination(MMSE)scores,Montreal Cognitive Assessment(MoCA)scores of observation group were higher than those of control group,and the θ-wave and the scores of Activity of Daily Living Scale(ADL)were lower than those of control group,and the differences of them between two groups were significant(t=6.094,5.315,3.973,4.447,6.362,6.869,P＜0.05),respectively.There was no significant difference in the rate of adverse reactions between the two groups(P＞0.05).Conclusion:The application of biofeedback instrument in AD patients can promote cognitive conversion and improve self-care ability,which has higher safety.

As a novel form of cell death, ferroptosis is mainly regulated by the accumulation of soluble iron ions in the cytoplasm and the production of lipid peroxides and is closely associated with several diseases, including acute kidney injury, ischemic reperfusion injury, neurodegenerative diseases, and cancer. The term "immunosuppression" refers to various factors that can directly harm immune cells' structure and function and affect the synthesis, release, and biological activity of immune molecules, leading to the insufficient response of the immune system to antigen production, failure to successfully resist the invasion of foreign pathogens, and even organ damage and metabolic disorders. An immunosuppressive phase commonly occurs in the progression of many ferroptosis-related diseases, and ferroptosis can directly inhibit immune cell function. However, the relationship between ferroptosis and immunosuppression has not yet been published due to their complicated interactions in various diseases. Therefore, this review deeply discusses the contribution of ferroptosis to immunosuppression in specific cases. In addition to offering new therapeutic targets for ferroptosis-related diseases, the findings will help clarify the issues on how ferroptosis contributes to immunosuppression.
Ferroptosis/immunology* ; Humans ; Immune Tolerance/immunology* ; Animals ; Immunosuppression Therapy ; Iron/metabolism* ; Neoplasms/immunology*

Objective:To investigate the feasibility and clinical effects of ultra early enteral nutrition (≤24 h) in critically ill children supported by extracorporeal membrane oxygenation (ECMO).Methods:A retrospective cohort study was conducted. Clinical data of 43 critically ill children who received ECMO support in the pediatric intensive care unit (PICU) of Shanghai Children′s Hospital from January 2016 to December 2023 were collected, including general information, nutritional support modalities, and enteral nutrition tolerance. Based on the timing of enteral nutrition initiation, patients were divided into the within 24 h enteral nutrition group and the after 24 h enteral nutrition group. Nutritive indicators, nutritional intake, duration of ECMO support, duration of mechanical ventilation duration, and mortality rates were compared between the 2 groups using the two independent sample t test, Mann-Whitney U test, χ2 test and Fisher′s exact test. Results:Among the 43 children, 25 were male and 18 were female, with an age of 47 (18, 97) months. There were no statistically significant differences between the within 24 h enteral nutrition group (21 cases) and the after 24 h enteral nutrition group (22 cases) in terms of age, body mass index Z score, total protein, albumin, hemoglobin levels before ECMO support, duration of ECMO support, duration of mechanical ventilation, length of PICU stay, number of enteral nutrition intolerance events, number of enteral nutrition interruption, or mortality rate (all P>0.05). The protein intake adequacy rate during ECMO support was higher in the within 24 h enteral nutrition group than in the after 24 h enteral nutrition group (0 (0, 21%) vs. 0 (0, 0), U=175.00, P<0.05). Conclusions:Ultra early enteral nutrition is safe for children supported by ECMO. Initiating enteral nutrition within 24 h can increase the proportion of days with adequate protein intake in ECMO children without increasing the occurance of enteral nutrition intolerance or interruptions.

Objective:To analyze the occurrence of metabolic dysfunction-associated fatty liver disease (MAFLD) and related inflammatory indicators in obstructive sleep apnea hypopnea syndrome (OSAHS) and explore the risk factors of MAFLD.Methods:A cross-sectional study. From January 2022 to October 2024,172 patients with sleep disorders were enrolled in the First Affiliated Hospital of Soochow University,including 38 patients with non-OSAHS,53 patients with mild OSAHS,37 patients with moderate OSAHS,and 44 patients with severe OSAHS. The occurrence of MAFLD was comprehensively judged from three aspects: metabolic dysfunction-associated fatty liver (MAFL),elevated liver enzymes,and liver fibrosis. The situation of MAFLD and the level of related inflammatory markers were compared among the four groups. Binary logistic regression was used to analyze the risk factors for MAFLD in OSAHS.Results:There were significant differences in the prevalence of MAFL,the percentage of elevated liver enzymes,and interleukin-6 and tumor necrosis factor-alpha levels among the four groups ( P<0.05). The differences of fibrosis-4 index and C-reactive protein among the four groups were not statistically significant ( P>0.05). Binary logistic regression showed that BMI,triglycerides,longest time of sleep apnea and tumor necrosis factor-alpha were the risk factors for MAFL ( P<0.05). BMI,glucose,and apnea-hypopnea index were the risk factors for elevated liver enzymes ( P<0.05). Conclusions:OSAHS is strongly associated with MAFLD,and the involvement of OSAHS in the occurrence and development of MAFLD may be related to obesity,lipid metabolism disorders,insulin resistance,inflammatory responses,and intermittent hypoxia.