Childhood simple obesity has become a significant public health issue in China. Modern medicine primarily relies on lifestyle interventions and often suffers from poor long-term compliance， while pharmacological options are limited and associated with potential adverse effects. Traditional Chinese Medicine （TCM） has a long history in the prevention and management of this condition， demonstrating eight distinct advantages， including systematic theoretical foundation， diversified therapeutic approaches， definite therapeutic efficacy， high safety profile， good patient compliance， comprehensive intervention strategies， emphasis on prevention， and stepwise treatment protocols. Additionally， TCM is characterized by six distinctive features： the use of natural medicinal substances， non-invasive external therapies， integration of medicinal dietetics， simple exercise regimens， precise syndrome differentiation， and diverse dosage forms. By combining internal and external treatments， TCM facilitates individualized regimen adjustment and holistic regulation， demonstrating remarkable effects in improving obesity-related metabolic indicators， regulating constitutional imbalance， and promoting healthy behaviors. However， challenges remain， such as inconsistent operational standards， insufficient high-quality clinical evidence， and a gap between basic research and clinical application. Future efforts should focus on accelerating the standardization of TCM diagnosis and treatment， conducting multicenter randomized controlled trials， and fostering interdisciplinary integration， so as to enhance the scientific validity and international recognition of TCM in the prevention and treatment of childhood obesity.

Objective·To monitor postoperative blood glucose(BG)and blood lipids(BL)at multiple time points in pediatric patients undergoing liver transplantation(LT)and to analyze the influencing factors.Methods·An observational study was conducted,including pediatric LT patients from the Hepatic Surgery Department of Renji Hospital,Shanghai Jiao Tong University School of Medicine.Blood samples were collected one day before surgery and on days 1,7,and 14 after surgery.Basic patient information and laboratory indicators were recorded,including complete blood count(CBC),cytochrome P450(CYP)genotyping,tacrolimus dosage(TD),tacrolimus serum drug level(TSDL),fasting blood glucose(FBG),2-hour postprandial blood glucose(PBG),and biochemical testing for liver transplantation(BTLT).BTLT included the following indicators:total protein(TP),albumin(ALB),alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(AKP),transglutaminase(GGT),direct bilirubin(DBil),total bilirubin(TBil),creatinine(Cr),triglyceride(TAG),total cholesterol(TC),prothrombin time(PT),and international normalized ratio(INR).The t-test or Mann-Whitney U test was used to analyze factors influencing PBG,Cox regression analysis was used to analyze factors influencing FBG,and logistic regression analysis was used to analyze factors influencing TC.Results·A total of 82 pediatric LT patients were included,with 45 males(54.9%)and 37 females(45.1%).The average age was 7 months,average height was 65 cm,and average body weight was 7.15 kg.FBG[(6.54±1.71)mmol/L]and PBG[(7.42±2.19)mmol/L]reached their highest values on the first postoperative day and gradually decreased to normal levels.There were 59 patients in the normal FBG and PBG groups and 23 in the abnormal groups.TAG[(0.93±0.63)mmol/L]and TC[(1.91±1.08)mmol/L]reached their lowest values on the first postoperative day and then slowly increased.The t-test indicated that TP(P=0.050),AKP(P=0.020),GGT(P=0.002),TC(P=0.017),and TD(P=0.028)showed statistically significant differences between the normal and abnormal PBG groups.Cox regression analysis showed that gender(HR=0.501,95%CI 0.184?1.361),age(HR=0.972,95%CI 0.876?1.079),height(HR=1.012,95%CI 0.903?1.135),body weight(HR=1.067,95%CI 0.720?1.579),and blood type(A type HR=1.294,95%CI 0.464?3.612;B type HR=1.303,95%CI 0.456?3.723;AB type HR=1.520,95%CI 0.310?7.441)did not significantly affect the BG's time change process.Logistic regression analysis showed that the patient's CYP(1×3 OR=9.332,95%CI 0.960?90.719;3×3 OR=18.083,95%CI 1.414?231.219)was a factor influencing TC.Conclusion·TD is a factor influencing PBG on the first postoperative day,and the patient's CYP is a factor influencing TC on the same day.

Objective·To monitor postoperative blood glucose(BG)and blood lipids(BL)at multiple time points in pediatric patients undergoing liver transplantation(LT)and to analyze the influencing factors.Methods·An observational study was conducted,including pediatric LT patients from the Hepatic Surgery Department of Renji Hospital,Shanghai Jiao Tong University School of Medicine.Blood samples were collected one day before surgery and on days 1,7,and 14 after surgery.Basic patient information and laboratory indicators were recorded,including complete blood count(CBC),cytochrome P450(CYP)genotyping,tacrolimus dosage(TD),tacrolimus serum drug level(TSDL),fasting blood glucose(FBG),2-hour postprandial blood glucose(PBG),and biochemical testing for liver transplantation(BTLT).BTLT included the following indicators:total protein(TP),albumin(ALB),alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(AKP),transglutaminase(GGT),direct bilirubin(DBil),total bilirubin(TBil),creatinine(Cr),triglyceride(TAG),total cholesterol(TC),prothrombin time(PT),and international normalized ratio(INR).The t-test or Mann-Whitney U test was used to analyze factors influencing PBG,Cox regression analysis was used to analyze factors influencing FBG,and logistic regression analysis was used to analyze factors influencing TC.Results·A total of 82 pediatric LT patients were included,with 45 males(54.9%)and 37 females(45.1%).The average age was 7 months,average height was 65 cm,and average body weight was 7.15 kg.FBG[(6.54±1.71)mmol/L]and PBG[(7.42±2.19)mmol/L]reached their highest values on the first postoperative day and gradually decreased to normal levels.There were 59 patients in the normal FBG and PBG groups and 23 in the abnormal groups.TAG[(0.93±0.63)mmol/L]and TC[(1.91±1.08)mmol/L]reached their lowest values on the first postoperative day and then slowly increased.The t-test indicated that TP(P=0.050),AKP(P=0.020),GGT(P=0.002),TC(P=0.017),and TD(P=0.028)showed statistically significant differences between the normal and abnormal PBG groups.Cox regression analysis showed that gender(HR=0.501,95%CI 0.184?1.361),age(HR=0.972,95%CI 0.876?1.079),height(HR=1.012,95%CI 0.903?1.135),body weight(HR=1.067,95%CI 0.720?1.579),and blood type(A type HR=1.294,95%CI 0.464?3.612;B type HR=1.303,95%CI 0.456?3.723;AB type HR=1.520,95%CI 0.310?7.441)did not significantly affect the BG's time change process.Logistic regression analysis showed that the patient's CYP(1×3 OR=9.332,95%CI 0.960?90.719;3×3 OR=18.083,95%CI 1.414?231.219)was a factor influencing TC.Conclusion·TD is a factor influencing PBG on the first postoperative day,and the patient's CYP is a factor influencing TC on the same day.

Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired clonal hematopoietic stem cell disease caused by abnormal expression of glycosylphosphatidylinositol (GPI) on the cell membrane due to mutations in the phosphatidylinositol glycan class A(PIGA) gene. It is commonly characterized by intravascular hemolysis, repeated thrombosis, and bone marrow failure, as well as multiple systemic involvement symptoms such as renal dysfunction, pulmonary hypertension, swallowing difficulties, chest pain, abdominal pain, and erectile dysfunction. Due to the rarity of PNH and its strong heterogeneity in clinical manifestations, multidisciplinary collaboration is often required for diagnosis and treatment. Peking Union Medical College Hospital, relying on the rare disease diagnosis and treatment platform, has invited multidisciplinary clinical experts to form a unified opinion on the diagnosis and treatment of PNH, and formulated the Expert Consensus of Multidisciplinary Diagnosis and Treatment for Paroxysmal Nocturnal Hemoglobinuria (2024), with the hope of promoting the standardization of PNH diagnosis and treatment.

Objective To study anatomical structures of the maxillary second molars(MSM)roots and canals and the relationship between root apices and the maxillary sinus.Methods Cone beam computed tomography imaging data of 526 MSM from 263 patients were evaluated retrospectively.The patient age,number of roots and canals,number of fused roots,type of root canal curvature,and anatomical relationship to the sinus floor were all documented and analyzed.Results It was found that the majority of MSM had three roots(59.1%),and the incidence of three root canals with three roots was the highest(47.3%).Fused roots were found in 192(36.5%)of the teeth examined.Palatal root canals of two-root,two-canal,and three-root,three-canal teeth had more curvature in the buccolingual direction than in the mesiodistal direction.The mesial buccal roots of MSM with three roots tended to extend into the max-illary sinus and the palatine roots of the three-rooted MSM tended to separate from the maxillary sinus.The distance between MSM and the sinus floor increased with age(P＜0.05).Conclusion The root and canal shape of MSM varies widely among a sample of individu-als.

Objective:To explore the risk factors of postpartum hemorrhage in parturients undergoing vaginal delivery with a second child and establish a risk prediction model.Methods:Using the convenient sampling method, a total of 2 500 parturients undergoing vaginal delivery with a second child who underwent regular prenatal examinations at Peking University Third Hospital from July 2019 to March 2023 were selected as the research objects. According to the amount of blood loss, parturients with blood loss greater than or equal to 500 ml within 24 hours after delivery were selected as the case group ( n=278), while parturients with blood loss less than 500 ml within 24 hours after delivery in the same period were selected as the control group ( n=2 222). Univariate analysis and binomial Logistic regression were used to analyze the influencing factors of postpartum hemorrhage in parturients with vaginal delivery with a second child. Based on the selected risk factors, a nomogram prediction model was established using R software, and the consistency of the model was tested. Results:The incidence of postpartum hemorrhage in 2 500 parturients undergoing vaginal delivery with a second child was 11.12% (278/2 500). Binomial Logistic regression analysis showed that in in vitro fertilization-embryo transfer, pre-delivery body mass index, lateral perineal incision, neonatal weight, placenta previa, placenta implantation and manual extraction of placenta were the influencing factors for postpartum hemorrhage in parturients undergoing vaginal delivery with a second child ( P<0.05). According to the influencing factors, a nomogram model was established to predict the probability of postpartum hemorrhage in women who gave birth to a second child. The C- index of the prediction model was 0.706, the area under the receiver operating characteristic curve was 0.706, and the χ 2 value of the Hosmer-Lemeshow goodness-of-fit test was 7.720 ( P=0.461) . Conclusions:In vitro fertilization embryo transfer, pre-delivery body mass index, perineal lateral resection, neonatal weight, placenta previa, placental implantation and manual extraction of placenta are risk factors for postpartum hemorrhage in parturients undergoing vaginal delivery for a second child. The prediction model constructed based on risk factors has certain accuracy and clinical value for predicting postpartum hemorrhage in parturients with vaginal delivery of a second child.

Objective:To study the effect of in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) on ovarian responsiveness during ovulation induction and pregnancy outcome in elderly patients with polycystic ovary syndrome (PCOS). Methods:A retrospective cohort study was conducted, and 201 elderly women with PCOS who underwent IVF/ICSI for the first time in the Reproductive Medical Center of Peking University Third Hospital from January 1, 2016 to December 31, 2018 were selected as PCOS group. According to the 1∶1 matching principle, selected 201 elderly patients with non-PCOS menstrual regularity who entered the cycle at the same time as the elderly PCOS patients and underwent IVF/ICSI for the first time due to tubal factors alone named control group. The first three thawing cycles of this egg retrieval cycle were selected. Due to the higher incidence of ovarian hyperstimulation syndrome and the number of aging PCOS patients undergoing embryo freezing, the thawing cycles of the elderly PCOS patients were more than those of control group. A total of 215 cycles in PCOS group and 124 cycles in control group were used to analyze the clinical data and IVF/ICSI laboratory data.Results:1) Between PCOS group and control group, anti-Müllerian hormone (AMH) and antral follicle count (AFC) were significantly different [(7.66±4.62) μg/L vs. (1.89±1.44) μg/L, P=0.005; 26.44±8.06 vs. 9.33±4.05, P<0.001]; the rate of high-quality embryos in PCOS group was higher than that in control group [58.04% (1281/2207) vs. 57.20% (743/1299), P=0.005]. 2) The dosage of gonadotropin (Gn) used during ovulation induction in PCOS group was less than that in control group [(2 090.17±909.74) U vs. (2 969.14±1 101.79) U, P=0.009], but the number of oocytes retrieval was more than that in control group (15.17±8.35 vs. 9.51±5.83, P<0.001). The clinical pregnancy rate, the miscarriage rate, the ectopic pregnancy rate and the cumulative live birth rate of PCOS group were not significantly different from those of control group (all P>0.05). 3) Age, body mass index (BMI), testosterone level, ovulation stimulation program and the number of transferred embryos were the independent influencing factors of the clinical pregnancy rate ( P=0.028, P=0.004, P=0.027, P=0.014, P<0.001); BMI and the number of transferred embryos were the independent influencing factors of the live birth rate ( P=0.008, P<0.001). Conclusion:1) Elderly PCOS patients have higher follicle reserve. 2) The cumulative live birth rate can more truly reflect the fertility window of elderly PCOS patients. The cumulative live birth rate of elderly PCOS patients is significantly better than that of control group with the increase of age; the reproductive window of PCOS patients is longer than that of non-PCOS patients. 3) For elderly patients, the laboratory results should be improved as soon as possible, the waiting time in the early stage of the IVF/ICSI cycle should be shortened as much as possible, and assisted reproductive treatment should be performed as soon as possible to obtain better pregnancy outcomes.

Objective:To study the effect of in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) on ovarian responsiveness during ovulation induction and pregnancy outcome in elderly patients with polycystic ovary syndrome (PCOS). Methods:A retrospective cohort study was conducted, and 201 elderly women with PCOS who underwent IVF/ICSI for the first time in the Reproductive Medical Center of Peking University Third Hospital from January 1, 2016 to December 31, 2018 were selected as PCOS group. According to the 1∶1 matching principle, selected 201 elderly patients with non-PCOS menstrual regularity who entered the cycle at the same time as the elderly PCOS patients and underwent IVF/ICSI for the first time due to tubal factors alone named control group. The first three thawing cycles of this egg retrieval cycle were selected. Due to the higher incidence of ovarian hyperstimulation syndrome and the number of aging PCOS patients undergoing embryo freezing, the thawing cycles of the elderly PCOS patients were more than those of control group. A total of 215 cycles in PCOS group and 124 cycles in control group were used to analyze the clinical data and IVF/ICSI laboratory data.Results:1) Between PCOS group and control group, anti-Müllerian hormone (AMH) and antral follicle count (AFC) were significantly different [(7.66±4.62) μg/L vs. (1.89±1.44) μg/L, P=0.005; 26.44±8.06 vs. 9.33±4.05, P<0.001]; the rate of high-quality embryos in PCOS group was higher than that in control group [58.04% (1281/2207) vs. 57.20% (743/1299), P=0.005]. 2) The dosage of gonadotropin (Gn) used during ovulation induction in PCOS group was less than that in control group [(2 090.17±909.74) U vs. (2 969.14±1 101.79) U, P=0.009], but the number of oocytes retrieval was more than that in control group (15.17±8.35 vs. 9.51±5.83, P<0.001). The clinical pregnancy rate, the miscarriage rate, the ectopic pregnancy rate and the cumulative live birth rate of PCOS group were not significantly different from those of control group (all P>0.05). 3) Age, body mass index (BMI), testosterone level, ovulation stimulation program and the number of transferred embryos were the independent influencing factors of the clinical pregnancy rate ( P=0.028, P=0.004, P=0.027, P=0.014, P<0.001); BMI and the number of transferred embryos were the independent influencing factors of the live birth rate ( P=0.008, P<0.001). Conclusion:1) Elderly PCOS patients have higher follicle reserve. 2) The cumulative live birth rate can more truly reflect the fertility window of elderly PCOS patients. The cumulative live birth rate of elderly PCOS patients is significantly better than that of control group with the increase of age; the reproductive window of PCOS patients is longer than that of non-PCOS patients. 3) For elderly patients, the laboratory results should be improved as soon as possible, the waiting time in the early stage of the IVF/ICSI cycle should be shortened as much as possible, and assisted reproductive treatment should be performed as soon as possible to obtain better pregnancy outcomes.

Polycystic ovary syndrome (PCOS) is the most common endocrine dysfunction in women of childbearing age. It is considered to be a heterogeneous, multi-faceted disease with polycystic ovarian changes, hyperandrogenism, and endocrine. Clinical features such as dysfunction and metabolic syndrome, due to the presence of ovulation dysfunction, seriously affect the fertility of women with PCOS. With the increase of age, the fertility decline of females is mainly related to factors such as the decrease in the number and quality of follicles, the decrease in the number of available embryos, the decrease in transplant rate and the increase in abortion rate. The existing literature does not agree on the fertility window of elderly PCOS patients. This paper reviews several literatures and discusses the reproductive window problems of elderly PCOS patients.

BACKGROUND: Perioperative treatment has become an increasingly important aspect of the management of patients with non-small cell lung cancer (NSCLC). Small-scale clinical studies performed in recent years have shown improvements in the major pathological remission rate after neoadjuvant therapy, suggesting that it will soon become an important part of NSCLC treatment. Nevertheless, neoadjuvant immunotherapy may be accompanied by serious adverse reactions that lead to delay or cancelation of surgery, additional illness, and even death, and have therefore attracted much attention. The purpose of the clinical recommendations is to form a diagnosis and treatment plan suitable for the current domestic medical situation for the immune-related adverse event (irAE). METHODS: This recommendation is composed of experts in thoracic surgery, oncologists, thoracic medicine and irAE related departments (gastroenterology, respirology, cardiology, infectious medicine, hematology, endocrinology, rheumatology, neurology, dermatology, emergency section) to jointly complete the formulation. Experts make full reference to the irAE guidelines, large-scale clinical research data published by thoracic surgery, and the clinical experience of domestic doctors and publicly published cases, and repeated discussions in multiple disciplines to form this recommendation for perioperative irAE. RESULTS: This clinical recommendation covers the whole process of prevention, evaluation, examination, treatment and monitoring related to irAE, so as to guide the clinical work comprehensively and effectively. CONCLUSIONS Perioperative irAE management is an important part of immune perioperative treatment of lung cancer. With the continuous development of immune perioperative treatment, more research is needed in the future to optimize the diagnosis and treatment of perioperative irAE.