The onset of pregnancy is marked by the formation of a zygote, while the culmination of gestation is manifested by the delivery of a fetus. Meanwhile, a successful pregnancy entails a meticulously coordinated sequence of events from embryo implantation to sustained decidualization of the uterus to placental development and childbirth. The decidual reaction, a pivotal process occurring within the endometrium during pregnancy, is finely regulated by sex steroids and cytokines. Notably, fibroblast growth factors (FGFs), particularly FGF2, play a critical role in this physiological cascade. Dysregulated FGF expression may trigger inadequate decidualization, precipitating a spectrum of adverse pregnancy outcomes, including preeclampsia, recurrent implantation failure, and miscarriage. Furthermore, the human decidua, distinct from most mammalian species and similar to great apes, undergoes regular cycles of formation and shedding, independent of the presence of the embryo in the endometrium. This process is also tightly controlled by various FGFs. In this review, we comprehensively compare diverse research decidualization models, delineate the trend of endometrial FGFs during the menstrual cycle, and provide a synopsis of endometrial diseases triggered by FGF dysregulation.
Humans ; Female ; Pregnancy ; Decidua/physiology* ; Animals ; Endometrium/physiology* ; Fibroblast Growth Factors/metabolism* ; Embryo Implantation ; Menstrual Cycle/physiology*

Idiopathic pulmonary fibrosis (IPF) is a progressive disease lacking effective therapy. Metformin, an antidiabetic medication, has shown promising therapeutic properties in preclinical fibrosis models; however, its precise cellular targets and associated mechanisms in fibrosis resolution remain incompletely defined. Most research on metformin's effects has focused on mesenchymal and inflammatory responses with limited attention to epithelial cells. In this study, we utilized Sftpc lineage-traced and Fgfr2b conditional knockout mice, along with BMP2/PPARγ and AMPK inhibitors, to explore metformin's impact on alveolar epithelial cells in a bleomycin-induced pulmonary fibrosis model and cell culture. We found that metformin increased the proliferation and differentiation of alveolar type 2 (AT2) cells, particularly the recently identified injury-activated alveolar progenitors (IAAPs)-a subpopulation characterized by low SFTPC expression but enriched for PD-L1. Single-cell RNA sequencing revealed a reduction in apoptosis among mature AT2 cells. Interestingly, metformin's therapeutic effects were not significantly affected by BMP2 or PPARγ inhibition, which blocked the lipogenic differentiation of myofibroblasts. However, Fgfr2b deletion in Sftpc lineage cells significantly impaired metformin's ability to promote fibrosis resolution, a process linked to AMPK signaling. In conclusion, metformin alleviates fibrosis by directly activating AT2 cells, especially the IAAPs, through a mechanism that involves AMPK and FGFR2b signaling, but is largely independent of BMP2/PPARγ pathways.

Objective:To design a novel model for experiments on in vitro irradiation with radioactive seeds using a treatment planning system (TPS) and 3D printing technology and to preliminarily validate the design scientific rigor of the model via experiments on isodose brachytherapy (BT) and external beam radiotherapy (EBRT) on glioma cells in mice. Methods:The TPS was employed to design the model′s shape and calculate the number and positions of radioactive seeds, and 3D printing technology was utilized to fabricate the experimental model. The GL261 cell line was selected for in vitro irradiation experiments, with the mice divided into the control, EBRT, and BT groups. Mice in the EBRT and BT groups were treated with EBRT and BT, respectively, at doses of 2, 4, and 6 Gy. Then, changes in their cell viability, proliferation, and the level of intracellular reactive oxygen species (ROS) were assessed. Results:The model for in vitro irradiation with radioactive seeds was successfully designed and fabricated. The single photon emission computed tomography (SPECT) verified a uniform radioactive distribution within the model, with no significant cold spots. The BT and EBRT groups displayed decreased cell viability with an increase in the radiation dose. Compared to the EBRT group, the BT group exhibited significantly reduced cell viability (51.33% vs. 22.00%, t = 10.94, P < 0.05) and clone counts (172.67 ± 13.11 vs. 53.67 ± 10.22, t = 8.73, P < 0.05), but a significantly increased level of ROS (102.52 ± 6.87 vs. 144.81 ± 6.01, t = -5.26, P < 0.05) at a dose of 6 Gy. Conclusions:An effective model of in vitro irradiation with radioactive seeds is designed based on TPS and 3D printing technology. This provides an experimental model tool and target for research on the BT and EBRT mechanisms.

Objective:To employ single-photon emission computed tomography (SPECT)/CT for isodose assignment in 125I brachytherapy, assess the correlation between photon counts and dose values, and develop a clinical γ-ray visualization model for 125I brachytherapy. Methods:125I radioactive seeds were filled into a self-made 3D printed stereotactic template to build a stereotactic model. The model was scanned by SPECT/CT for photon counts at 0.5, 1.0, 1.5, 2.0 cm from the outermost peripheral seeds, and the corresponding dose values were measured using the Treatment Planning System (TPS). The fitting curve for the photon counts and the dose values was plotted using SPSS 27.0 software. Results:The photon counts of γ rays at distances of 0.5, 1.0, 1.5, and 2.0 cm from the peripheral particles were 7 603.57±1 806.35, 4 018.26±1 315.72, 2 074.04±791.53, and 1 080.34±424.79, respectively, showing a significant difference ( F=743.72, P<0.01). The dose values (in Gy) in the TPS at distances of 0.5, 1.0, 1.5, and 2.0 cm from the peripheral particles were 208.05±37.57, 125.43±17.74, 86.76±17.67, and 61.55±14.39, respectively, which were significantly different ( F=930.46, P<0.01). The photon counts were linearly correlated with the dose values ( y=0.02 x+ 46.45, R2=81.2%, P<0.01). Conclusions:SPECT/CT-based γ-ray photon count detection can be used to assign doses for 125I brachytherapy, enabling the visualization of γ rays in 125I brachytherapy. This approach has a distinct advantage over TPS, laying the foundation for the establishment of an alternative system to TPS.

Objective:To design a novel model for experiments on in vitro irradiation with radioactive seeds using a treatment planning system (TPS) and 3D printing technology and to preliminarily validate the design scientific rigor of the model via experiments on isodose brachytherapy (BT) and external beam radiotherapy (EBRT) on glioma cells in mice. Methods:The TPS was employed to design the model′s shape and calculate the number and positions of radioactive seeds, and 3D printing technology was utilized to fabricate the experimental model. The GL261 cell line was selected for in vitro irradiation experiments, with the mice divided into the control, EBRT, and BT groups. Mice in the EBRT and BT groups were treated with EBRT and BT, respectively, at doses of 2, 4, and 6 Gy. Then, changes in their cell viability, proliferation, and the level of intracellular reactive oxygen species (ROS) were assessed. Results:The model for in vitro irradiation with radioactive seeds was successfully designed and fabricated. The single photon emission computed tomography (SPECT) verified a uniform radioactive distribution within the model, with no significant cold spots. The BT and EBRT groups displayed decreased cell viability with an increase in the radiation dose. Compared to the EBRT group, the BT group exhibited significantly reduced cell viability (51.33% vs. 22.00%, t = 10.94, P < 0.05) and clone counts (172.67 ± 13.11 vs. 53.67 ± 10.22, t = 8.73, P < 0.05), but a significantly increased level of ROS (102.52 ± 6.87 vs. 144.81 ± 6.01, t = -5.26, P < 0.05) at a dose of 6 Gy. Conclusions:An effective model of in vitro irradiation with radioactive seeds is designed based on TPS and 3D printing technology. This provides an experimental model tool and target for research on the BT and EBRT mechanisms.

Objective:To employ single-photon emission computed tomography (SPECT)/CT for isodose assignment in 125I brachytherapy, assess the correlation between photon counts and dose values, and develop a clinical γ-ray visualization model for 125I brachytherapy. Methods:125I radioactive seeds were filled into a self-made 3D printed stereotactic template to build a stereotactic model. The model was scanned by SPECT/CT for photon counts at 0.5, 1.0, 1.5, 2.0 cm from the outermost peripheral seeds, and the corresponding dose values were measured using the Treatment Planning System (TPS). The fitting curve for the photon counts and the dose values was plotted using SPSS 27.0 software. Results:The photon counts of γ rays at distances of 0.5, 1.0, 1.5, and 2.0 cm from the peripheral particles were 7 603.57±1 806.35, 4 018.26±1 315.72, 2 074.04±791.53, and 1 080.34±424.79, respectively, showing a significant difference ( F=743.72, P<0.01). The dose values (in Gy) in the TPS at distances of 0.5, 1.0, 1.5, and 2.0 cm from the peripheral particles were 208.05±37.57, 125.43±17.74, 86.76±17.67, and 61.55±14.39, respectively, which were significantly different ( F=930.46, P<0.01). The photon counts were linearly correlated with the dose values ( y=0.02 x+ 46.45, R2=81.2%, P<0.01). Conclusions:SPECT/CT-based γ-ray photon count detection can be used to assign doses for 125I brachytherapy, enabling the visualization of γ rays in 125I brachytherapy. This approach has a distinct advantage over TPS, laying the foundation for the establishment of an alternative system to TPS.

Objective:To evaluate the sample preparation proficiency and storage proficiency of 11 clinical biobanks in Beijing through simulated experiments, and to establish an assessment method for the quality comparability of biological samples.Methods:An exploratory research design was adopted. In November 2023, artificial composite serum quality control materials containing six recombinant human protein markers—recombinant human alanine aminotransferase (rhALT), recombinant human aspartate aminotransferase (rhAST), recombinant human creatine kinase (rhCK), recombinant human creatine kinase-MB (rhCK-MB), recombinant human B-type natriuretic peptide (rhBNP), and recombinant human troponin I (rhTNI)—were distributed to 11 clinical biobanks in Beijing City. Sample preparation and storage followed the standardized operating procedures. Proficiency differences were assessed through statistical analysis.Results:Three-way repeated measures ANOVA revealed all six protein markers showed a declining trend over storage time in ultra-low-temperature environments ( F values 11.68-4 179.66, all P<0.01). However, neither long-term/temporary refrigerator types ( F values 0.01-1.23, all P>0.05)nor placement locations within refrigerators significantly affected the stability of these six proteins ( F valus 0.03-1.47, all P>0.05). The biases in detection results for rhALT, rhAST, rhTNI, and rhBNP at different storage time points were within the allowable bias limits for each item, supporting their use as markers for protein stability in biobank samples. All 11 institutions passed the storage proficiency assessment. In the preparation proficiency assessment, deviations were observed in post-preparation sample results, with a notably high out-of-control rate for rhCK (36.36%). Conclusion:Sample preparation proficiency can serve as a quality control metric for clinical biobanks. Future external quality assessment systems for biobanks should focus on sample preparation rather than storage processes.

Objective:To investigate the current status of implementing medical insurance performance evaluation in the hospitals of China under the background of China Healthcare Security Diagnosis Related Groups (CHS-DRG) and Diagnosis-Intervention Packet (DIP) payment reform, explore the perspectives and recommendations of key department leaders (e.g., health insurance, medical affairs, pricing, and performance evaluation departments) regarding health insurance performance evaluation, analyze the influencing factors in its implementation, so as to provide references for hospitals to develop and refine health insurance performance evaluation strategies.Methods:A questionnaire was designed and distributed to hospitals across 31 provincial-level administrative regions in China from December 1 to 31, 2023. The survey targeted secondary and tertiary general or specialized hospitals. The main responsible persons from four functional departments, including medical insurance, healthcare, pricing, and performance, were invited to participate in the survey. Descriptive analysis was conducted on the questionnaire data, and the chi-square test was used for differential analysis of unordered categorical variables, while the Wilcoxon rank sum test was used for differential analysis of ordered categorical variables.Results:A total of 761 valid questionnaires were collected. Most respondents were health insurance department leaders (420, 55.19%). Among them, 741 respondents reported that their hospitals used CHS-DRG or DIP payment, with 258 indicating that their hospitals had already developed and implemented health insurance performance evaluation plans. A majority (685, 90.01%) expressed support for such initiatives. Influencing factor analysis revealed that hospital type, level, scope of health insurance management departments, and payment methods might impact the implementation of health insurance performance evaluation ( P<0.05). Conclusions:Few hospitals have currently adopted health insurance performance evaluation, underscoring the urgency to establish a scientific and reasonable evaluation plan as a robust tool for internal hospital management.

Objective:To analyze the cost and structural impact of the new technology"transhysteroscopic mechanical rotary excision of abnormal uterine tissues"on the DRG group of"surgery for intrauterine lesions"under the DRG payment method,and to provide clinical data for supporting the development of the exclusion policy for the new technology and new items.Methods:Cases in which transhysteroscopic mechanical rotary excision of abnormal uterine tissues was used in the gynecology day unit of the Peking Union Medcial College Hospital from March 2022 to November 2023,which were paid for under the DRG group of"surgery for intrauterine pathology",were retrospectively analyzed for the impact of the new technology on the cost and structure of the cases.Results:The price of"transhysteroscopic mechanical rotary excision of abnormal uterine tissues"in the Beijing Medical Service Price Item Specification is 8 000 yuan(Class C out-of-pocket expenses),which is higher than the payment standard of 6 866 yuan for the NE19 group,and the use of this new technology significantly increased the total hospitalization medical cost,the out-of-pocket ratio of the patients and the surgical cost,which led to an increase in the burden of the patients and the loss of the hospitals.Conclusion:"Transhysteroscopic mechanical rotary excision of abnormal uterine tissue"has the advantages of improving patients'prognosis and accelerating recovery,shortening operation time,avoiding intraoperative thermal injuries,and shortening the learning curve of doctors,etc.Policy makers should take into account cost control,patients'prognosis and the development of medical technology,scientifically and prudently formulate the exclusion policy of the new technology,reasonably determine the payment standard,and make good use of the exclusion policy and the payment standard.

Objective To explore the clinical significance of pulse pressure variability(PPV)in early prevention and diagnosis of prostate resection syndrome by observing the changes in PPV during transurethral resection of the prostate.Methods Eighty patients undergoing transurethral resection of the prostate(TURP)under general anesthesia from March to April 2023 were randomly divided into a control group and an observation group,with 40 patients in each group.The control group underwent routine monitoring of invasive blood pressure,while the observation group continued to monitor PPV in addition to invasive blood pressure monitoring.Observe and record the hemodynamic parameters,electrolyte Na+,K+,CL-,Changes in hemoglobin(Hb)and hematocrit(Hct),recording surgical time,intraoperative lavage fluid dosage,and occurrence of dilutive hyponatremia(TURS).Results One patient in the observation group experienced two unexplained drops in blood pressure and heart rate during surgery,and was diagnosed with TURS based on blood gas analysis.Among them,the observation group showed a decreasing trend in PPV with the prolongation of surgery time.PPV gradually decreased at 45～60 minutes after surgery,and at 90 minutes after surgery,PPV decreased significantly compared to preoperative levels.Among them,6 patients had a 50%decrease in PPV compared to preoperative levels.For patients with significantly reduced PPV,immediate treatment was given 10～20 mg of furosemide and 10 mg of dexamethasone.By the end of surgery,PPV had basically recovered to preoperative levels.Both groups of patients showed varying degrees of decrease in Na+,K+,Hct,and Hb levels.Conclusions PPV can reflect the volume status of patients.When PPV decreases by more than 50%compared to preoperative levels and there are unexplained hemodynamic changes and abnormal clinical manifestations during surgery,it is necessary to be vigilant and handle them promptly to reduce and prevent the occurrence of TURS.