Primary biliary cholangitis （PBC） is an autoimmune liver disease characterized by intrahepatic cholestasis， while fatigue is a common symptom of PBC that significantly affects the quality of life of patients. The pathogenesis of fatigue is complex and may be associated with the factors such as cholestasis-induced inflammation， gut microbiota dysbiosis， brain structural and functional abnormalities， and mitochondrial dysfunction. At present， first-line therapies and liver transplantation have a limited effect in alleviating fatigue， and there is still a lack of standardized comprehensive assessment system. Emerging drugs and non-pharmaceutical interventions， including lifestyle modifications， have shown potential application prospects. This article systematically reviews the research advances in the clinical manifestations， pathogenesis， clinical assessment， and intervention of fatigue in PBC patients， in order to provide a reference for optimizing treatment strategies and promoting the research and development of new therapies.

ObjectiveTo evaluate the pregnancy outcomes of assisted reproductive technology （ART） in women with a history of thyroid cancer who retained fertility intentions after completing cancer treatment. MethodsA retrospective analysis was performed on 61 patients with a history of thyroid cancer who underwent in vitro fertilization/intracytoplasmic sperm microinjection and embryo transfer （IVF/ICSI-ET）. These patients were included as the case group. A total of 122 non-cancer patients who received ART during the same period were selected as the control group using 1∶2 matching based on age and oocyte retrieval time. Baseline characteristics， outcomes of the first ART cycle， and cumulative pregnancy outcomes were compared between the two groups. ResultsThere was no significant difference in the basic data， the total amount of gonadotropin （Gn） and the days of use between the case group and the control group （P>0.05）. However， the case group had significantly fewer retrieved oocytes， mature oocytes （MII）， lower fertilization and cleavage rates， and fewer transferable and high-quality embryos， as well as fewer embryos transferred during the first cycle （P < 0.05）. However， there was no significant difference in the rate of first embryo implantation and first clinical pregnancy between the two groups （P>0.05）. In the analysis of cumulative outcomes， the two groups did not show statistically significant differences in the cumulative pregnancy rate， clinical pregnancy rate per transfer cycle， the number of oocyte retrieval cycles required per live birth， the number of embryo transfer cycles required per live birth， and the number of embryos used for each live birth （P>0.05）. However， the cumulative live birth rate was significantly lower in the case group compared to the control group （P=0.005）. ConclusionAfter treatment for thyroid cancer， when ART is used to help pregnant women， the pregnancy outcome is comparable to that of women without tumors. Individualized reproductive management and timely fertility preservation strategies are recommended to optimize reproductive outcomes in this population.

Objective:To investigate the value of human epididymal protein 4(HE4)combined with two-dimensional(2D)ultrasound for vagina in diagnosing the pathological classification of ovarian cancer and predicting its prognosis.Methods:The clinical data of a total of 100 patients with ovarian cancer who admitted to Hengshui Maternal and Child Health Care Hospital and Hengshui People's Hospital from April 2018 to July 2023 were retrospectively analyzed,including 98 cases with epithelial ovarian cancer and 2 cases with non-epithelial ovarian cancer.The fasting venous blood pre operation of patients was extracted in morning.The serum HE4 level was detected by enzyme-linked immunosorbent assay(ELISA).The 2D ultrasound examination was performed one week before surgery to measure the resistance index(RI),pulse index(PI),peak systolic flow velocity(PSV)and end-diastolic flow velocity(EDV)of ovarian artery.All patients were followed up immediately after they completed the last chemotherapy.All of patients were divided into a death group(n=27)and a survival group(n=73)according to their survival situation.Cox regression risk model was used to analyze prognostic influence factors of patients with ovarian cancer.Results:The serum HE4 level[449.37(28.57,2 382.24)]pmol/L in patients with epithelial ovarian cancer was significantly higher than that[55.38(17.33,79.64)]pmol/L in patients with non-epithelial ovarian cancer(U=24.752,P＜0.05).The RI,PSV and PI of ultrasonic parameters of patients with epithelial ovarian cancer were higher than those of patients with non-epithelial ovarian cancer(t=3.640,2.152,2.588,P＜0.05),respectively.The area under curve(AUC)of the receiver operating characteristic(ROC)curve of HE4 combined with 2D ultrasound for vagina was 0.936(95%CI:0.821-1.000)in identifying epithelial and non-epithelial ovarian cancer,which was larger than that of alone each examination.The ratio of the age≥60 years old,the ratio of the III-IV staging of Federation International of Gynecology and Obstetrics(FIGO),and the ratio of existing surrounding infiltration in the death group were all higher than those in the survival group,and the serum HE4 level[528.75(34.79,1 932.43)]pmol/L was higher than that[138.23(21.49,872.59)]pmol/L of the survival group,and the difference was significant(U=25.963,P＜0.05).The PSV and EDV values of the death group were all larger than those of the survival group(t=10.844,17.744,P＜0.05),and the RI and PI were all less than those of the survival group(t=19.085,13.099,P＜0.05).FIGO Ⅲ-Ⅳ staging,surrounding infiltration,HE4 level≥398.74 pmol/L,RI＜0.31,PI＜0.54,PSV≥26.12 cm/s,EDV≥16.47 cm/s were all risk factors for the prognosis of patients with ovarian cancer(HR=2.682,2.347,2.296,2.518,2.235,2.124,1.958,P＜0.05).Conclusion:HE4 combined with 2D ultrasound for vagina can improve the diagnostic accuracy of pathological classification for ovarian cancer,and can be used as an important tool to predict the prognosis of patients with ovarian cancer.

Objective:To investigate the value of human epididymal protein 4(HE4)combined with two-dimensional(2D)ultrasound for vagina in diagnosing the pathological classification of ovarian cancer and predicting its prognosis.Methods:The clinical data of a total of 100 patients with ovarian cancer who admitted to Hengshui Maternal and Child Health Care Hospital and Hengshui People's Hospital from April 2018 to July 2023 were retrospectively analyzed,including 98 cases with epithelial ovarian cancer and 2 cases with non-epithelial ovarian cancer.The fasting venous blood pre operation of patients was extracted in morning.The serum HE4 level was detected by enzyme-linked immunosorbent assay(ELISA).The 2D ultrasound examination was performed one week before surgery to measure the resistance index(RI),pulse index(PI),peak systolic flow velocity(PSV)and end-diastolic flow velocity(EDV)of ovarian artery.All patients were followed up immediately after they completed the last chemotherapy.All of patients were divided into a death group(n=27)and a survival group(n=73)according to their survival situation.Cox regression risk model was used to analyze prognostic influence factors of patients with ovarian cancer.Results:The serum HE4 level[449.37(28.57,2 382.24)]pmol/L in patients with epithelial ovarian cancer was significantly higher than that[55.38(17.33,79.64)]pmol/L in patients with non-epithelial ovarian cancer(U=24.752,P＜0.05).The RI,PSV and PI of ultrasonic parameters of patients with epithelial ovarian cancer were higher than those of patients with non-epithelial ovarian cancer(t=3.640,2.152,2.588,P＜0.05),respectively.The area under curve(AUC)of the receiver operating characteristic(ROC)curve of HE4 combined with 2D ultrasound for vagina was 0.936(95%CI:0.821-1.000)in identifying epithelial and non-epithelial ovarian cancer,which was larger than that of alone each examination.The ratio of the age≥60 years old,the ratio of the III-IV staging of Federation International of Gynecology and Obstetrics(FIGO),and the ratio of existing surrounding infiltration in the death group were all higher than those in the survival group,and the serum HE4 level[528.75(34.79,1 932.43)]pmol/L was higher than that[138.23(21.49,872.59)]pmol/L of the survival group,and the difference was significant(U=25.963,P＜0.05).The PSV and EDV values of the death group were all larger than those of the survival group(t=10.844,17.744,P＜0.05),and the RI and PI were all less than those of the survival group(t=19.085,13.099,P＜0.05).FIGO Ⅲ-Ⅳ staging,surrounding infiltration,HE4 level≥398.74 pmol/L,RI＜0.31,PI＜0.54,PSV≥26.12 cm/s,EDV≥16.47 cm/s were all risk factors for the prognosis of patients with ovarian cancer(HR=2.682,2.347,2.296,2.518,2.235,2.124,1.958,P＜0.05).Conclusion:HE4 combined with 2D ultrasound for vagina can improve the diagnostic accuracy of pathological classification for ovarian cancer,and can be used as an important tool to predict the prognosis of patients with ovarian cancer.

Objective:To observe changes in intestinal flora in children with anorexia and the effects of pediatric Tuina(Chinese therapeutic massage)on their intestinal flora,and to explore the relationship between alterations in intestinal flora and anorexia,as well as the therapeutic mechanisms of pediatric Tuina in treating children with anorexia.Methods:A total of 60 healthy children who underwent physical examinations were recruited as the blank group.One hundred and twenty children with anorexia were randomly divided into a Tuina group and a medication group,with 60 children in each group,according to the random number table method.The blank group received no intervention;the Tuina group was treated with pediatric Tuina therapy;the medication group was treated with Jian Wei Xiao Shi(stomach-invigorating and digestion-promoting)tablets.Both groups underwent continuous treatment for 7 d as one course,with a 1-day rest period between courses,for a total of 4 courses.Fecal samples were collected from the three groups.The intestinal flora was detected using the 16S rDNA method.Results:Before treatment,compared to the blank group,the abundance of Firmicutes in the Tuina and medication groups was significantly lower(P<0.05).After treatment,the abundance of Firmicutes in the Tuina group was significantly increased compared to before treatment(P<0.05),with no significant difference compared to the blank group(P>0.05);in the medication group,there was a trend of increased abundance of Firmicutes,but there was no significant difference compared to that before treatment in the same group(P>0.05),and the difference compared to the blank group remained significant(P<0.05).Before treatment,compared to the blank group,the abundance of Faecalibacterium prausnitzii(F.prausnitzii)in the Tuina and medication groups was significantly lower(P<0.05).After treatment,the abundance of F.prausnitzii in the Tuina group was significantly increased compared to before treatment(P<0.05),with no significant difference compared to the blank group(P>0.05);in the medication group,there was a trend of increased abundance of F.prausnitzii,but no significant difference was showed compared to before treatment in the same group(P>0.05),and the differences compared to the blank and Tuina groups were significant(P<0.05).Before treatment,compared to the blank group,the abundance of Eubacterium in the Tuina and medication groups was significantly lower(P<0.05);after treatment,the abundance of Eubacterium in both Tuina and medication groups was significantly increased compared to that before treatment(P<0.05),with no significant difference compared to the blank group(P>0.05).Before treatment,compared to the blank group,the abundance of Roseburia in the Tuina and medication groups was significantly lower(P<0.05);after treatment,the abundance of Roseburia in both Tuina and medication groups was significantly increased compared to that before treatment(P<0.05),with no significant difference compared to the blank group(P>0.05).Conclusion:The reduction of beneficial intestinal flora may be involved in the pathogenesis of pediatric anorexia.Pediatric Tuina can promote the recovery of intestinal flora balance by increasing the abundance of beneficial flora.

Objective To explore the feasibility of phase-contrast CT for three-dimensional visualization of in vitro intrahepatic vessels and necrotic foci in mouse model of acute liver injury(ALI).Methods Six clean grade male wild-type C57BL/6 mice were randomly divided into model group and control group(each n=3).The mice in model group were fed with overdose of acetaminophen to induce ALI,while those in control group were fed with the same amount of distilled water.After 24 h,the mice were all sacrificed,the livers were harvested and then fixed and dehydrated.Phase-contrast CT images of in vitro liver were acquired,sectional and three-dimensional images were reconstructed.The effect of phase-contrast CT for displaying the outline of liver and internal vessels and necrotic foci were observed,the maximum diameter and volume of necrotic foci were quantitatively analyzed,and the results of phase-contrast CT were compared with pathological findings.Results The original projection and sectional images of phase-contrast CT clearly showed the outline of in vitro liver and internal vasculatures.Necrotic foci within the liver were found in model group,but not in control group.The findings of phase-contrast CT corresponded accurately to those of pathology.Three-dimensional reconstruction images of phase-contrast CT clearly displayed intrahepatic portal vein system and hepatic vein system in both groups,and discontinuous punctate necrotic foci within the liver were found in model group,mainly distributed around hepatic vein,with a median maximum diameter of 18.50 μm and a median volume of 5 870.11 μm3,but was not observed in control group.Conclusion Phase-contrast CT could be used in three-dimensional visualization of intrahepatic vessels and necrotic foci of in vitro liver in mouse model of ALI.

Objective To investigate the effects of Demodex infection on clinical symptoms,signs,and tear MMP-9 levels in patients with meibomian gland dysfunction(MGD).Methods A total of 680 patients with MGD were selected from our hospital,including 162 males and 518 females,with an average age of(45.05±15.41)years old.The patients were divided into two groups based on the presence of Demodex mite infestation:the Demodex positive group(340 cases)and the Demodex negative group(340 cases).All patients underwent evaluations using the OSDI questionnaire,SPEED questionnaire,eyelid margin alteration score,corneal fluorescein staining score,tear MMP-9 measurement,meibomian gland orifice score,meibomian gland excretion ability score,meibomian gland secretion score,meibomian gland loss score,tear film breakup time(BUT),and Schirmer I tear secretion test.The differences in these indicators between the two groups were compared.Results SPEED questionnaire score:Demodex positive group:(7.68±2.80),Demodex negative group:(6.28±1.99).There was a statistically significant difference between the two groups(t=2.582,P=0.012).Eyelid margin alteration score:Demodex positive group:(3.63±1.53),Demodex negative group:(2.85±0.77).A statistically significant difference was observed(t=2.861,P=0.006).Corneal fluorescein staining score:Demodex positive group:(2.25±1.86),Demodex negative group:(1.08±1.33).There was a statistically significant difference(t=3.247,P=0.002).Tear MMP-9 content:Demodex positive group:(30.76±43.14)ng/mL,Demodex negative group:(12.36±12.10)ng/mL.A statistically significant difference was found(t=2.598,P=0.013).No statistically significant differences were observed between the Demodex positive and negative groups in meibomian gland orifice score,meibomian gland excretion ability score,meibomian gland secretion score,meibomian gland loss score,BUT,tear secretion examination,and age comparison(P>0.05).Conclusions Demodex mite infestation in patients with MGD exhibits significant differ-ences across various clinical indicators,notably in SPEED questionnaire scores,eyelid margin alterations,corneal fluorescein staining,and tear MMP-9 levels.These changes are associated with mechanisms including inflammatory responses,cellular damage,and immune dysregulation.Demodex mite infestation may significantly influence the clinical progression of MGD by exacerbating inflammation and symptom severity,potentially playing a crucial role in disease development.

Mental health records have been well utilized in various industries or groups both within and outside the mili-tary.However,due to insufficient attention,lack of technology,and poor talent stability,the effectiveness of mental health re-cords is low.This article investigates psychological cadres during a major task to understand the current situation of the establish-ment and use of mental health records in the military.It finds that there is a phenomenon of"building but not flowing,storing but not using",and identifies issues such as inconsistent standards,poor circulation,insufficient content,and disordered manage-ment.Based on this,the article discusses the safeguards and basic content for the construction of mental health records.The dis-cussion concludes that mental health record content should include general information about officers and soldiers,the develop-ment of psychological services,records of psychological rehabilitation(including psychological measurement results,etc.),and other supplementary materials(such as physical health status,personal life history,etc.).It is necessary to standardize mental health measurement,mental health education,mental health training,psychological counseling interviews,psychiatric assess-ment,and psychiatric rehabilitation.Support must be provided in terms of systems,personnel,and technology,and a dynamic management and use mechanism and information security control responsibilities must be implemented.This will promote the or-derly development of military mental health work and,in turn,ensure the mental health of officers and soldiers.

Objective:To investigate the efficacy of radiotherapy in patients with advanced esophageal cancer receiving first-line chemoimmunotherapy.Methods:A retrospective analysis was conducted on the data of 137 patients with Stage Ⅳ esophageal squamous cell carcinoma (ESCC) treated at our hospital from January 2018 to May 2023. These patients were divided into two groups: a group treated with first-line chemoimmunotherapy combined with radiotherapy (chemoimmunotherapy + radiotherapy group, n = 43) and a group treated with only chemoimmunotherapy ( n = 94). Inverse probability of treatment weighting (IPTW) was applied to balance baseline characteristics between the groups. With overall survival (OS) and progression-free survival (PFS) as study endpoints, the survival data were analyzed using the Kaplan-Meier method, the log-rank test, and the Cox regression method. Results:Before calibration, the chemoimmunotherapy + radiotherapy group significantly outperformed the sole chemoimmunotherapy group in median PFS (13.6 months vs. 7.0 months; HR: 0.501, 95% CI: 0.309-0.811, P = 0.005). After calibration using the COX proportional-hazards model for age, gender, Eastern Cooperative Oncology Group (ECOG) performance status, smoking history, T/N/M stage, and tumor location, the chemoimmunotherapy + radiotherapy group still had significant advantages in PFS (14.7 months vs. 7.0 months; HR: 0.441, 95% CI: 0.261-0.745, P = 0.002). IPTW analysis further confirmed this trend (13.9 months vs. 7.0 months; HR: 0.492, 95% CI: 0.304-0.795, P < 0.001). Specifically, the median OS of the chemoimmunotherapy + radiotherapy group demonstrated significant improvement in all analyses: pre-calibration (29.5 months vs. 18.0 months; HR: 0.507, 95% CI: 0.297-0.867, P = 0.013), after calibration using the Cox model (27.5 months vs. 16.7 months; HR: 0.470, 95% CI: 0.266-0.830, P = 0.009), and after calibration using IPTW (29.5 months vs. 16.9 months; HR: 0.448, 95% CI: 0.262-0.764, P < 0.001). Conclusions:The combination of radiotherapy and first-line chemoimmunotherapy can significantly improve survival outcomes of patients with advanced ESCC, suggesting its potential as a standard treatment strategy.

A retrospective analysis was conducted on data from five patients comprehensively diagnosed with emphysematous osteomyelitis (EO) based on clinical, imaging, microbiological culture, and surgical findings at Hebei Medical University Third Hospital from December 2020 to May 2024. Among these five cases, there were three males and two females, aged between 11 and 69 years. Three patients had infection risk factors (two with diabetes and one with anemia), while two had no documented risk factors in their medical history. All patients presented with fever, localized pain at the infection site, and elevated inflammatory markers. Site of incidence: EO affected the lumbar spine in three cases, the ilium in one case, and the femur in one case. Pathogenic microorganisms: The causative agents included Klebsiella pneumoniae (two cases), Escherichia coli (one case), Burkholderia cepacia (one case), and a mixed infection of Staphylococcus aureus and Acinetobacter baumannii (one case). Imaging findings: Among the three patients who underwent X-ray examinations, one showed normal results, while two exhibited bone destruction. CT scans of all five cases revealed the characteristic "pumice sign" without periosteal reaction or osteosclerosis. MRI, performed on four patients, demonstrated bone destruction, swelling of surrounding soft tissues, and soft tissue abscess formation. Treatment and outcomes: Four patients underwent surgical debridement combined with perioperative antibiotic therapy. Of these, three recovered well, while one achieved good infection control but suffered severe joint destruction. One patient died after treatment was discontinued. The clinical and laboratory findings of EO resemble those of common acute osteomyelitis; however, EO has distinct imaging characteristics. Timely diagnosis, aggressive surgical debridement, and strong, targeted antibiotic therapy can result in favorable outcomes. Conversely, delayed diagnosis and treatment may lead to severe complications or death.