Poor ovarian response (POR) is a pathological condition in which the ovary responds poorly to gonadotropins,and is a major constraint on the unsatisfactory outcome of in vitro fertilization-embryo transfer (IVF-ET). Follicular growth,development,maturation,and expulsion are all affected by the yin-yang balance between heart and kidney,as well as the elevation exchange. If the heart and kidney essence and blood are insufficient,water and fire are out of harmony,and qi movement is not smooth,fewer high-quality follicles will be recruited and acquired during the ovarian stimulation cycle,resulting in a low transferable embryo rate and unacceptable pregnancy result. Sympathetic treatment of heart and kidney should be based on the following principles at different stages of the IVF-ET cycle:replenishing the heart,kidney,essence,and blood before entering the cycle,in order to nourish the essence and assist in the growth of the follicles;nourishing renal water,and clearing heart fire during the pituitary down-regulation period,in order to lessen the negative effects of the down-regulation medicinals;regulating the depression of the heart,liver,spleen,and kidney meridians during the follicle's retrieval period,in order to encourage the smooth release of the ova;and warming heart and kidney fire to improve endometrial tolerance during the implantation period. The application of the theory of intercourse of heart and kidney to elucidate the pathogenesis of POR is critical to the development of clinical strategies for fertility enhancement,as well as providing new ideas for the clinical application of traditional Chinese medicine in the field of reproduction.

Objective To investigate the spatiotemporal distribution characteristics and potential influencing factors of newly diagnosed echinococcosis cases in Qinghai Province from 2016 to 2022, so as to provide insights into the formulation of the echinococcosis control strategy in Qinghai Province. Methods The number of individuals screened for echinococcosis, number of newly diagnosed echinococcosis cases, number of registered dogs and number of stray dogs were captured from the annual reports of echinococcosis control program in Qinghai Province from 2016 to 2022, and the detection of newly diagnosed echinococcosis cases was calculated. The number of populations, precipitation, temperature, wind speed, sunshine hours, average altitude, number of year-end cattle stock, number of year-end sheep stock, gross domestic product (GDP) per capita, and number of village health centers in each county (district) of Qinghai Province were captured from the Qinghai Provincial Statistical Yearbook, and county-level electronic maps in Qinghai Province were downloaded from the National Platform for Common Geospatial Information Services. The software ArcGIS 10.8 was used to map the distribution of newly diagnosed echinococcosis cases in Qinghai Province, and the spatial autocorrelation analysis of newly diagnosed echinococcosis cases was performed. In addition, the spacetime scan analyses of number of individuals screened for echinococcosis, number of newly diagnosed echinococcosis cases and geographical coordinates in Qinghai Province were performed with the software SaTScan 10.1.2, and the spatial stratified heterogeneity of the detection of newly diagnosed echinococcosis cases was investigated with the software GeoDetector. Results A total of 6 569 426 residents were screened for echinococcosis in Qinghai Province from 2016 to 2022, and 5 924 newly diagnosed echinococcosis cases were found. The detection of newly diagnosed echinococcosis cases appeared a tendency towards a decline over years from 2016 to 2022 (χ² = 11.107, P < 0.01), with the highest detection in Guoluo Tibetan Autonomous Prefecture in 2017 (82.12/10⁵). There were spatial clusters in the detection of newly diagnosed echinococcosis cases in Qinghai Province from 2016 to 2018 (Moran’s I = 0.34 to 0.65, all Z values > 1.96, all P values < 0.05), and the distribution of newly diagnosed echinococcosis cases appeared random distribution from 2019 to 2022 (Moran’s I = −0.09 to 0.04, all Z values < 1.96, all P values > 0.05). Local spatial autocorrelation analysis showed high-high clusters and low-low clusters in the detection of new diagnosed echinococcosis cases in Qinghai Province from 2016 to 2022, and space-time scan analysis showed that the first most likely cluster areas of newly diagnosed echinococcosis cases in Qinghai Province from 2016 to 2022 were mainly distributed in Yushu Tibetan Autonomous Prefecture and Guoluo Tibetan Autonomous Prefecture. GeoDetector-based analysis of the driving factors for the spatial stratified heterogeneity of detection of newly diagnosed echinococcosis cases in Qinghai Province showed that average altitude, number of village health centers, number of cattle and sheep stock, GDP per capita, annual average sunshine hours, and annual average temperature had a strong explanatory power for the spatial distribution of newly diagnosed echinococcosis cases, with q values of 0.630, 0.610, 0.600, 0.590, 0.588, 0.537 and 0.526, respectively. Conclusions The detection of newly diagnosed echinococcosis cases appeared a tendency towards a decline in Qinghai Province over years from 2016 to 2022, showing spatial clustering. Targeted control measures are required in cluster areas of newly diagnosed echinococcosis cases for further control of the disease.

Background Anxiety and depression are common perinatal mental health issues that often occur together and can have serious negative effects on both maternal and infant health. Objective To examine the relationships between lifestyle factors and comorbid anxiety and depression (CAD) among pregnant women in Shanghai. Methods The study estimated the prevalence of CAD during the first, second, and third trimesters of pregnancy using the Self-rating Anxiety Scale (SAS) and Center for Epidemiological Studies-Depression (CES-D) based on data from the China National Birth Cohort (CNBC) embryonic-derived diseases with assisted reproductive technology (ART) sub-cohort. Information on demographics, sleep status, nutritional intake, and exercise during each trimester was collected through self-made questionnaires, the Pittsburgh Sleep Quality Index (PSQI), and the Food Frequency Questionnaire (FFQ). Lifestyle factors (such as sleep status, nutritional intake, and exercise during each trimester) were analyzed using logistic regression and generalized linear mixed models (GLMM) to determine their impacts on the prevalence of CAD (yes or no) among pregnant women. Results A total of 2876 pregnant women were included in this study. The prevalence of CAD was 10.6% (305), 3.6% (103), and 5.5% (159) in the first, second, and third trimesters of pregnancy, respectively. The logistic regression analysis revealed that poor sleep quality throughout the entire pregnancy were statistically associated with an increased prevalence of CAD, and the odds ratios (OR) with 95% confidence intervals (CI) were 2.817 (1.845, 4.301), 2.840 (1.855, 4.347), and 9.316 (5.835, 14.876) for the first, second, and third trimesters, respectively, when compared to good sleep quality. Additionally, compared to an intake frequency of 7 times per week, the frequency of egg intake ≤3 times per week in the first trimester (OR=2.025, 95%CI: 1.197, 3.425) and the frequency of egg intake of 4–6 times per week (OR=1.896, 95%CI: 1.117, 3.216) or ≤3 times per week (OR=1.906, 95%CI: 1.082, 3.357) in the third trimester were associated with an increased risk of CAD (P<0.05). Moreover, when compared to a frequency of exercise >3 times per week, never or almost never exercising in the second trimester (OR=2.218, 95%CI: 1.220, 4.035) was associated with an increased risk of CAD (P<0.05). The GLMM analysis also demonstrated a significant association between poor sleep quality, lower exercise frequency, or lower intake frequency of vegetables, eggs, or milk and an increased risk of CAD (P<0.05). Conclusion The prevalence of CAD among pregnant women in Shanghai follows a U-shaped distribution, with the highest rate occurring in early pregnancy and the lowest rate in mid-pregnancy. Factors such as poor sleep quality, inadequate intake of vegetables, eggs, or milk, and lack of exercise during pregnancy may increase the risk of CAD. Implementing lifestyle interventions during pregnancy could potentially reduce the risk of mental health problems and improve the overall health of both mothers and babies.

This article focuses on the differentiation and treatment of primary Sj?gren's syndrome(pSS)based on the spleen fire theory.The connotation of the spleen fire theory is discussed,and the differences between spleen fire and other visceral fire such as yin fire are distinguished.The correlation between spleen fire theory and pSS is explained,and it is believed that spleen deficiency,lack of power to transport and transform,spleen failure to raise nutritious substances,stagnation transforming into fire are the key to its path-ogenesis;the pathological transformation of pSS is characterized by the long-term damage of spleen soil to other organs,resulting in the stasis of collaterals.Invigorating the spleen and replenishing qi,removing fire and moistening dryness,generating fluid and unblocking collaterals are the main treatment methods,which provide ideas and methods for the traditional Chinese medicine differentiation and treatment of pSS.

Objective To construct clinical imaging model,radiomics model,and a combined model based on the above two for predicting lymph node metastasis(LNM)of colon cancer(CC),and to compare the diagnostic performance of each model.Methods The data from 328 CC patients confirmed by surgical pathology were analyzed retrospectively,including 156 with LNM.All patients were randomly divided into training group(229 cases)and validation group(99 cases)at a ratio of 7∶3.The difference of clinical imaging indicators were compared between groups and a clinical imaging model for diagnosing LNM was constructed.The tumor three-dimensional volume of interest(VOI)was used for radiomics feature extraction,and after dimensionality reduction and selection,8 features were obtained to construct the Radiomics score(Radscore).A combined model of clinical imaging indicators and Radscore was built.The diagnostic performance of each model for LNM was compared,and the calibration and clinical benefit of the optimal model were evaluated.Results There were statistical differences in clinical imaging indicators between the two groups:carcinoembryonic antigen(CEA),CA199,tumor long diameter,and lymph node short diameter(P＜0.05).The area under the curve(AUC)of the clinical imaging model,radiomics model,and combined model were 0.721,0.814,0.854(training group),and 0.744,0.732,0.808(validation group),respectively.The AUC of the combined model was the highest,and both the training and validation groups were higher than that of the clinical imaging model(P＜0.05).The combined model demonstrated higher calibration,with a clinical benefit from decision curve analysis(DCA)threshold range of 0.09 to 0.91.Conclusion The nomogram constructed based on clinical imaging indicators and CT radiomics holds high value in diagnosing LNM of CC.

Objective To explore the application effect of the Roy adaptation model in continuing care for patients with acute-ST segment elevation myocardial infarction(STEMI)after interventional treatment.Methods A total of 120 STEMI patients who received emergency percutaneous coronary intervention at Henan Chest Hospital from March 2020 to February 2022 were selected as the research subjects.Patients were randomly divided into the observation group and the control group by using a random number table method,with 60 patients in each group.After discharge,patients in the control group received routine continuing care intervention,while patients in the observation group received continuing care based on Roy's adaptation model.Before and at 1 year of intervention,the posttraumatic growth level of patients in the two groups was evaluated by using the posttraumatic growth inventory(PTGI),the adherence to antiplatelet and anticoagulant medication of patients in the two groups was evaluated with the medication adherence questionnaire(MAQ),and the quality of life of patients in the two groups was evaluated with the China questionnaire of quality of life in patients with cardiovascular diseases(CQQC).Patients in the two groups were followed up for 1 year.The major adverse cardiac events(MACE)that occurred within 1 year were recorded.Results The proportion of patients with strong adherence in the observation group was significantly higher than that in the control group(x2=9.969,P＜0.05).Before the intervention,there was no significant difference in the PTGI and CQQC scores of patients between the observation group and the control group(P＞0.05).At 1 year of intervention,the PTGI and CQQC scores of patients in both groups were significantly higher than those before intervention,and the PTGI and CQQC scores of patients in the observation group were significantly higher than those in the control group(P＜0.05).The total incidence of MACE in the control group and the observation group was 23.33％(14/60)and 8.33％(5/60),respectively.The total inci-dence of MACE in the observation group was significantly lower than that in the control group(P＜0.05).Conclusion The Roy adaptation model can significantly improve the patient's posttraumatic growth level and secondary preventive medication adherence in continuing care after STEMI intervention treatment,reducing the occurrence of MACE and improving the quality of life.

Objective:To investigate the effect of traditional Chinese medicine (TCM) lotion on incidence of postoperative infection and recurrence of refractory paronychia.Methods:Seventy-eight patients with intractable paronychia who received treatment at Hangzhou Third People's Hospital from January 2019 to November 2022 were included in this study. The patients were randomly divided into the povidone-iodine group ( n = 39) and the TCM lotion group ( n = 39) using the random number table method. Both groups underwent matrixectomy via a lateral incision and rhomboid flap excision surgery. Prior to the procedure, the povidone-iodine group received treatment with a 5% povidone-iodine solution, whereas the TCM lotion group was administered a TCM lotion containing Scutellaria barbata, Verbena, Lonicera japonica, Viola, Rheum palmatum, Atractylodes, Glauber's salt, Phellodendron, red peony root, Glycyrrhiza uralensis, and Magnolia officinalis. Both groups underwent treatment until the patients fulfilled the surgical indications and were subsequently observed for a period of 6 months post-surgery. The clinical efficacy was evaluated 1 month after the surgical intervention. A comparative analysis was conducted to assess the postoperative duration of redness and swelling, pus discharge, granulation, and pain resolution between the two groups. Additionally, the postoperative occurrence of wound-dressing adhesion, the status of wound healing, pain intensity at 1 and 3 days post-surgery, the incidence of infection at 1 week post-surgery, and the recurrence rates at 1 and 6 months post-surgery, were compared between the two groups. Results:At 1 month post-surgery, the total effective rate in the TCM lotion group was 92.31% (36/39), which was significantly higher than that in the povidone-iodine group [71.79% (28/39), χ2 = 4.26, P < 0.05]. The postoperative durations of redness and swelling, pus discharge, granulation, and pain resolution in the TCM lotion group were (5.66 ± 0.58) days, (3.64 ± 0.55) days, (8.42 ± 1.58) days, and (3.36 ± 0.32) days, respectively, which were significantly shorter than those in the povidone-iodine group [(6.73 ± 0.65) days, (4.56 ± 0.48) days, (9.77 ± 2.56) days, (3.89 ± 0.48) days, t = 7.67, 7.87, 2.80, 5.73, all P < 0.05]. The proportion of mild adhesion between the wound and dressing was significantly higher, while the proportion of severe adhesion was significantly lower, compared with the povidone-iodine group ( Z = 4.64, both P < 0.05). The durations of postoperative pain, the time to redness resolution, and wound healing time in the TCM lotion group were (4.22 ± 1.73) days, (3.02 ± 1.16) days, and (11.84 ± 2.50) days, which were significantly shorter than those in the povidone-iodine group [(8.53 ± 2.48) days, (5.20 ± 2.31) days, (13.32 ± 2.86) days, t = 8.90, 5.26, 2.43, all P < 0.001]. At 3 days post-surgery, pain scores in each group were significantly lower than the respective scores at 1 day post-surgery. At 1 and 3 days post-surgery, pain scores in the TCM lotion group were (3.30 ± 0.18) points and (2.28 ± 0.23) points, respectively, which were significantly lower than the respective scores in the povidone-iodine group [(3.61 ± 0.29) points, (2.52 ± 0.33) points, t = 5.67, 3.72, both P < 0.05]. There were no significant differences in the incidence of infection at 1 week post-surgery and the recurrence of refractory paronychia at 1 and 6 months post-surgery between the two groups (all P > 0.05). Conclusion:The combination of TCM lotion and matrixectomy through a lateral incision and rhomboid flap excision surgery for the treatment of refractory paronychia can help shorten pre-operative treatment time, minimizes postoperative wound-dressing adhesion, promote wound healing, alleviate postoperative pain, and decrease the incidence of infection and recurrence of refractory paronychia, demonstrating superior efficacy compared with treatment with a 5% povidone-iodine solution.

Objective To analyze the clinical characteristics of pulmonary nocardiosis misdiagnosed as pulmonary tuberculosis and the causes of misdiagnosis, aiming to improve the diagnosis and treatment of the disease. Methods　Clinical data were collected from 18 cases of pulmonary nocardiosis misdiagnosed as pulmonary tuberculosis admitted to Beijing Chest Hospital (1 case), Hebei Chest Hospital (15 cases), the 5th Hospital of Shijiazhuang (1 case), and the 1st Hospital of Xinji (1 case) from October 2018 to June 2024, and the clinical manifestations, laboratory tests, imaging, treatment process, disease outcomes, and the causes of misdiagnosis were retrospectively analyzed. Results Among the 18 patients, there were 10 males and 8 females, with a median age of (59±14) years. All of the cases had the common clinical manifestations of cough and sputum. Seventeen cases had underlying disease, including 1 case with AIDS, 1 case with diabetes, 2 cases with obsolete pulmonary tuberculosis, 2 cases with chronic obstructive pulmonary disease, and 14 cases with bronchiectasis. Sputum or bronchoalveolar lavage fluid samples from 18 patients were cultured positive on Columbia blood plates, Roche medium, or MGIT 960, identifying 11 cases of Nocardia farcinica, 1 case of Nocardia otitidiscaviarum, and 6 cases of Nocardia cyriacigeorgica. All of the 18 patients received treatment with trimethoprim-sulfamethoxazole, 14 in 18 receiving combination therapy, resulting in 8 cures, 8 improvements, and 2 deaths. The reasons for misdiagnosis included: When an infectious disease in patients with long-term expectoration could not be controlled initially, the diagnosis of pulmonary tuberculosis would often be made clinically, and the patients would be given anti-tuberculosis therapy; insufficient understanding of the knowledge of Nocardia by laboratory physicians and doctors; the laboratory physicians neglected the importance of the judgment of Nocardia morphology by Gram staining; the bacterial culture period was usually 48 hours, while Nocardia grew slowly, resulting in missed detections; MGIT 960 culture and Roche culture had long cultivation period, which could increase the positive rate of Nocardia, but fewer units were carrying out such cultivation; insufficient understanding of the morphology differences between cultured Nocardia and Nocardia in the original specimen resulted in misjudgment. Conclusions Pulmonary nocardiosis is easily misdiagnosed as pulmonary tuberculosis. For patients, who have long-term expectoration, with hypoimmunity, or diseases that damage the lung structure such as bronchiectasis, if the response of conventional treatment is poor, Nocardia infection should be considered; Medical staff should enhance their understanding of Nocardia and pay more attention to the microscopic examination of Gram staining, weak acid-fast staining, and culture of sputum; Timely treatment following the diagnosis of nocardiosis can significantly improve the prognosis.

OBJECTIVE: To summarize the effectiveness of the temporal island flap pedicled with the perforating branch of zygomatic orbital artery for repairing defects after periocular malignant tumor resection. METHODS: Between January 2015 and December 2020, 15 patients with periocular malignant tumors were treated. There were 5 males and 10 females with an average age of 62 years (range, 40-75 years). There were 12 cases of basal cell carcinoma and 3 cases of squamous carcinoma. The disease duration ranged from 5 months to 10 years (median, 2 years). The size of tumors ranged from 1.0 cm×0.8 cm to 2.5 cm×1.5 cm, without tarsal plate invasion. After extensive resection of the tumors, the left defects in size of 2.0 cm×1.5 cm to 3.5 cm×2.0 cm were repaired with the temporal island flap pedicled with the perforating branch of zygomatic orbital artery via subcutaneous tunnel. The size of the flaps ranged from 3.0 cm×1.5 cm to 5.0 cm×2.0 cm. The donor sites were separated subcutaneously and sutured directly. RESULTS: All flaps survived after operation and the wounds healed by first intention. The incisions at donor sites healed by first intention. All patients were followed up 6-24 months (median, 11 months). The flaps were not obviously bloated, the texture and color were basically the same as the surrounding normal skin, and the scars at recipient sites were not obviously. There was no complication such as ptosis, ectropion, or incomplete closure of the eyelids and recurrence of tumor during follow-up. CONCLUSION The temporal island flap pedicled with the perforating branch of zygomatic orbital artery can repair the defects after periorbital malignant tumors resection and has the advantages of reliable blood supply, flexible design, and good morphology and function.
Male ; Female ; Humans ; Middle Aged ; Plastic Surgery Procedures ; Skin Transplantation ; Soft Tissue Injuries/surgery* ; Treatment Outcome ; Surgical Flaps ; Arteries/surgery* ; Carcinoma, Squamous Cell/surgery* ; Skin Neoplasms/surgery* ; Perforator Flap/blood supply*

OBJECTIVE: To analyze variant of LDLR gene in a patient with familial hypercholesterolemia (FH) in order to provide a basis for the clinical diagnosis and genetic counseling. METHODS: A patient who had visited the Reproductive Medicine Center of the First Affiliated Hospital of Anhui Medical University in June 2020 was selected as the study subject. Clinical data of the patient was collected. Whole exome sequencing (WES) was applied to the patient. Candidate variant was verified by Sanger sequencing. Conservation of the variant site was analyzed by searching the UCSC database. RESULTS: The total cholesterol level of the patient was increased, especially low density lipoprotein cholesterol. A heterozygous c.2344A>T (p.Lys782*) variant was detected in the LDLR gene. Sanger sequencing confirmed that the variant was inherited from the father. CONCLUSION The heterozygous c.2344A>T (p.Lys782*) variant of the LDLR gene probably underlay the FH in this patient. Above finding has provided a basis for genetic counseling and prenatal diagnosis for this family.
Humans ; Cholesterol, LDL/genetics* ; Heterozygote ; Hyperlipoproteinemia Type II/genetics* ; Mutation ; Pedigree ; Phenotype ; Receptors, LDL/genetics*