OBJECTIVES: According to the World Health Organization (WHO), infertility rates have been steadily rising worldwide. Identifying risk factors for contrast agent reflux into the myometrium during hysterosalpingo-contrast sonography (HyCoSy) is of clinical significance in reducing this complication and improving infertility treatment. However, there is currently no standardized pre-evaluation method for predicting intra-myometrial contrast reflux, with clinical assessment often relying on physician experience and patient symptoms. This study aims to identify imaging risk factors for contrast agent reflux into the myometrium using four-dimensional (4D) HyCoSy and to construct a nomogram-based predictive model to assist in clinical decision-making. METHODS: A retrospective analysis was conducted on 1 274 infertile women who underwent 4D HyCoSy at the Women and Children's Hospital of Hunan and the the Third Xiangya Hospital of Central South University from January 1, 2020, to December 15, 2022. Patients were divided into a reflux group (n=234) and a non-reflux group (n=1 040) based on the presence of intra-myometrial contrast reflux. Univariate and multivariable Logistic regression analyses were used to identify significant predictors, which were then used to construct a nomogram model. Internal validation was performed using 500 bootstrap resamples. RESULTS: The age of the reflux group was significantly higher than that of the non-reflux group [(31.82±5.27) years vs (30.66±4.83) years, P=0.001 1]. Primary infertility was more common in the non-reflux group (50.96%), while secondary infertility dominated in the reflux group (76.50%), with 72.65% having a history of gynecological surgery (P<0.001). Abnormal menstrual volume and discomfort during the procedure were more common in the reflux group, while the non-reflux group tolerated higher contrast agent doses (P<0.001). Imaging differences included endometrial thickness, tubal wall smoothness, and peritoneal contrast dispersion, with the non-reflux group showing thicker endometrium and smoother, more patent tubes. The nomogram model yielded an area under the curve (AUC) of 0.854, indicating good predictive performance. The AUC of the decision curve analysis (DCA) for internal validation of the model was 0.737. When the threshold probability for contrast agent reflux into the myometrium ranged from 0.05 to 0.95, the maximum net benefit reached 0.18. The net benefit of applying the nomogram predictive model exceeded that of either full intervention or no intervention, indicating that the model demonstrates good clinical predictive performance. CONCLUSIONS The nomogram model, based on infertility type, endometrial thickness, contrast agent dose, and discomfort symptoms, effectively predicts intra-myometrial contrast agent reflux after 4D HyCoSy. It provides a valuable tool for clinicians to implement early preventive measures and reduce the risk of contrast leakage and associated complications.
Humans ; Female ; Nomograms ; Contrast Media/adverse effects* ; Retrospective Studies ; Adult ; Ultrasonography/methods* ; Hysterosalpingography/methods* ; Infertility, Female/diagnostic imaging* ; Myometrium/diagnostic imaging* ; Risk Factors

This paper interprets the disease name related to bi （痹） disease in traditional Chinese medicine （TCM） from the perspective of micropathological phenotypes in knee osteoarthritis （KOA）. By systematically reviewing classical TCM literature on the pathogenesis and clinical features of different subtypes such as damp-retention bi， bone bi， and tendon bi， and integrating these with current research on pathological subtypes of KOA including the synovitis type， cartilage-meniscus type， and subchondral bone type， the study explores the correlation between traditional disease terms and modern micropathological phenotypes. The author proposes subtype classifications of damp-retention bi corresponding to synovial inflammation， bone bi related to abnormal subchondral bone remodeling， and tendon bi representing cartilage and meniscus degeneration. This approach provides a microscopic biological explanation for TCM syndrome differentiation and offers new perspectives for advancing integrative diagnostic and therapeutic strategies in both Chinese and western medicine.

Objective To clarify the potential risk factors of disinfection and supply room,and explore the application effect of strengthening quality control management,so as to improve the service quality of disinfection and supply room and reduce the risk of medical accidents.Methods From January 2022 to December 2023,800 medical devices processed in a disinfection supply room were selected as the study subjects.They were randomly divided into two groups of 400 each:a control group receiv-ing conventional management and an observation group receiving enhanced quality control management.Statistical analysis was conducted on potential risk factors,and the work quality of the two groups was compared.Results Univariate and multivariate logistic regression analyses revealed that potential risk factors included insufficient professional competence of staff,deficiencies in the management system,infrequent departmental training,and a noisy work environment(P＜0.05).The observation group showed significantly higher qualified rates in various indicators,such as biological monitoring,compared to the control group(P＜0.05).Furthermore,the observation group experienced significantly fewer risk events than the control group(P＜0.05),indicating a statistically significant difference.Conclusion The primary potential risk factors in disinfection supply rooms in-clude systemic issues,staff quality,work environment,and training frequency.Addressing these factors by strengthening quality control management can improve staff professional competence,basic quality,and work attitude,thereby enhancing management quality,reducing the likelihood of risk events,and ultimately improving management safety.

Objective:To explore the activation characteristics and synergistic mode of lumbar and abdominal core muscle group during abdominal breathing training.Method:Thirty-two healthy college students were recruited and randomly divided into the control group and the experimental group with 16 cases in each group.The control group received stan-pile training,while the experimental group received abdominal breathing and stan-pile training 5 times a week for 8 weeks.The sur-face electromyography of the lumbar and abdominal core muscles was collected before and after the interven-tion.Non-negative matrix factorization(NMF)was used to extract extract muscle synergy patterns from the EMG data.Result:In terms of cooperative elements,the number of cooperative elements increased after intervention in both groups compared with baseline,but there was no significant difference in the number of cooperative ele-ments between the two groups before intervention(P>0.05),and there was a significant difference in the num-ber of cooperative elements after intervention(P<0.05).In terms of cooperative patterns,the cooperative pat-terns before intervention in the two groups were similar.After intervention,the cooperative patterns in the two groups were different,the control group showed coactivation of the right transversus abdominis,left internal oblique,right erector spinae,and bilateral multifidus throughout the breathing cycle.In contrast,the experimen-tal group exhibited pronounced activation of bilateral erector spinae and multifidus during inhalation,and bilater-al transversus abdominis,left external oblique,and left erector spinae during exhalation.The activation curves before intervention in the two groups were similar,and the activation curves after intervention in the two groups trended towards slowing down,with the time feature of the activation curve in the experimental group being more obvious.Conclusion:Abdominal breathing training can increase the number of cooperative tuples of the waist and abdo-men muscles,and the muscles perform efficient division of labor after training to form an adaptive coopera-tive mode.

Objective To establish a standardized supply model for ophthalmic surgical instruments using lean manage-ment methods,develop a formula for determining optimal instrument inventory levels,and improve the management efficiency of ophthalmic surgical instruments.Methods A total of 2,281 cataract instrument sets from January 2023 to December 2024 were analyzed.From January to December 2023(1 141 sets),conventional process management was implemented,while from January to December 2024(1 140 sets),a lean theory-based standardized model was applied.Key parameters including surgical time,sterilization workflow,and instrument management were recorded to establish the model.A quantitative analysis incorporating sur-gical time,turnover interval,transportation time,relaxation rate,cycle interval,and target instruments was conducted to derive the inventory formula.A two-month pilot study on cataract surgeries was performed to validate the model's feasibility.The inci-dence of special events before and after implementing the standardized model was compared.Results The formula-derived data aligned with clinical demands,demonstrating precise quantification of ophthalmic instrument sets and high process stability.The incidence of special events post-implementation was significantly lower than pre-implementation(P＜0.05).Conclusion The lean theory-based standardized supply model effectively enhances the management of ophthalmic surgical instruments.

Objective:To explore the activation characteristics and synergistic mode of lumbar and abdominal core muscle group during abdominal breathing training.Method:Thirty-two healthy college students were recruited and randomly divided into the control group and the experimental group with 16 cases in each group.The control group received stan-pile training,while the experimental group received abdominal breathing and stan-pile training 5 times a week for 8 weeks.The sur-face electromyography of the lumbar and abdominal core muscles was collected before and after the interven-tion.Non-negative matrix factorization(NMF)was used to extract extract muscle synergy patterns from the EMG data.Result:In terms of cooperative elements,the number of cooperative elements increased after intervention in both groups compared with baseline,but there was no significant difference in the number of cooperative ele-ments between the two groups before intervention(P>0.05),and there was a significant difference in the num-ber of cooperative elements after intervention(P<0.05).In terms of cooperative patterns,the cooperative pat-terns before intervention in the two groups were similar.After intervention,the cooperative patterns in the two groups were different,the control group showed coactivation of the right transversus abdominis,left internal oblique,right erector spinae,and bilateral multifidus throughout the breathing cycle.In contrast,the experimen-tal group exhibited pronounced activation of bilateral erector spinae and multifidus during inhalation,and bilater-al transversus abdominis,left external oblique,and left erector spinae during exhalation.The activation curves before intervention in the two groups were similar,and the activation curves after intervention in the two groups trended towards slowing down,with the time feature of the activation curve in the experimental group being more obvious.Conclusion:Abdominal breathing training can increase the number of cooperative tuples of the waist and abdo-men muscles,and the muscles perform efficient division of labor after training to form an adaptive coopera-tive mode.

Objective To establish a standardized supply model for ophthalmic surgical instruments using lean manage-ment methods,develop a formula for determining optimal instrument inventory levels,and improve the management efficiency of ophthalmic surgical instruments.Methods A total of 2,281 cataract instrument sets from January 2023 to December 2024 were analyzed.From January to December 2023(1 141 sets),conventional process management was implemented,while from January to December 2024(1 140 sets),a lean theory-based standardized model was applied.Key parameters including surgical time,sterilization workflow,and instrument management were recorded to establish the model.A quantitative analysis incorporating sur-gical time,turnover interval,transportation time,relaxation rate,cycle interval,and target instruments was conducted to derive the inventory formula.A two-month pilot study on cataract surgeries was performed to validate the model's feasibility.The inci-dence of special events before and after implementing the standardized model was compared.Results The formula-derived data aligned with clinical demands,demonstrating precise quantification of ophthalmic instrument sets and high process stability.The incidence of special events post-implementation was significantly lower than pre-implementation(P＜0.05).Conclusion The lean theory-based standardized supply model effectively enhances the management of ophthalmic surgical instruments.

Objective To clarify the potential risk factors of disinfection and supply room,and explore the application effect of strengthening quality control management,so as to improve the service quality of disinfection and supply room and reduce the risk of medical accidents.Methods From January 2022 to December 2023,800 medical devices processed in a disinfection supply room were selected as the study subjects.They were randomly divided into two groups of 400 each:a control group receiv-ing conventional management and an observation group receiving enhanced quality control management.Statistical analysis was conducted on potential risk factors,and the work quality of the two groups was compared.Results Univariate and multivariate logistic regression analyses revealed that potential risk factors included insufficient professional competence of staff,deficiencies in the management system,infrequent departmental training,and a noisy work environment(P＜0.05).The observation group showed significantly higher qualified rates in various indicators,such as biological monitoring,compared to the control group(P＜0.05).Furthermore,the observation group experienced significantly fewer risk events than the control group(P＜0.05),indicating a statistically significant difference.Conclusion The primary potential risk factors in disinfection supply rooms in-clude systemic issues,staff quality,work environment,and training frequency.Addressing these factors by strengthening quality control management can improve staff professional competence,basic quality,and work attitude,thereby enhancing management quality,reducing the likelihood of risk events,and ultimately improving management safety.

ObjectiveTo investigate the effects of Guizhi Jia Longgu Mulitang on the expression difference of interleukin-10 （IL-10） and tumor necrosis factor -α （TNF-α） in related organs of insomnia rats with sensory dysfunction dominated by lung and study the mechanism of Guizhi Jia Longgu Mulitang in improving insomnia. MethodSD rats were randomly divided into the blank group， model group， western medicine group， and traditional Chinese medicine （TCM） group， with 10 rats in each group. The rats were deprived of sleep by shallow water environment method in a long platform， and the modeling lasted for 42 d. The blank group and model group were given 0.05 mL·kg^-1 normal saline by gavage， and the western medicine group and TCM group were given drugs during modeling. To be specific， the western medicine group was given 0.105 mg·kg^-1 dexzopiclone tablet by gavage， while the TCM group was given 7 600 mg·kg^-1 Guizhi Jia Longgu Mulitang by gavage， both lasting for 28 days. After successful modeling， the Morris water maze experiment was performed on the 42nd day to detect the motion and spatial memory ability of rats. The levels of IL-10 and TNF-α in serum were detected by enzyme-linked immunosorbent assay （ELISA）. The protein expression of IL-10 and TNF-α in the lung and brain tissue of rats was detected by Western blot. The levels of IL-10 and TNF-α in the lung and brain tissue of rats were detected by immunohistochemistry. ResultCompared with the blank group， the sleep stages non-rapid eye movement ( NREM ) and rapid eye movement ( REM ) of the model group were significantly shortened （P<0.5， P<0.01）， and the wake stage was significantly increased （P<0.01）. The total time and distance of platform exploration were significantly increased （P<0.01）. In the target quadrant （the third quadrant）， the percentage of exploration time and the times of crossing the platform were significantly decreased （P<0.01）. ELISA results showed that the serum IL-10 level was significantly decreased （P<0.01）， and TNF-α level was significantly increased （P<0.01）. The results of Western blot showed that the protein expression of IL-10 in brain and lung tissue of rats was significantly decreased （P<0.01）， and the protein expression of TNF-α was significantly increased （P<0.01）. The results of immunohistochemistry showed that the expression of IL-10 in the brain and lung tissue of rats was significantly decreased （P<0.01）， and that of TNF-α was significantly increased （P<0.01）. Compared with the model group， the NREM stage and REM stage of the western medicine group and the TCM group were significantly increased （P<0.5， P<0.01）， and the wake stage was shortened （P<0.5）. The total time and distance of platform exploration were significantly decreased （P<0.01）. In the target quadrant （the third quadrant）， the percentage of exploration time and the times of crossing the platform were significantly increased （P<0.05， P<0.01）. The serum IL-10 level was significantly increased （P<0.01）， and the serum TNF-α level was significantly decreased according to the ELISA results （P<0.01）. The results of Western blot showed that the protein expression of IL-10 in brain tissue and lung tissue was significantly increased （P<0.01）， and the protein expression of TNF-α was significantly decreased （P<0.01）. The results of immunohistochemistry showed that the expression of IL-10 in brain tissue and lung tissue was significantly increased （P<0.05， P<0.01）， and the expression of TNF-α was significantly decreased （P<0.05， P<0.01）. ConclusionGuizhi Jia Longgu Mulitang can improve the expression of IL-10 and TNF-α in brain and lung tissue of insomnia rats with sensory dysfunction dominated by lung， prolong sleep time， and then improve insomnia. The mechanism may be related to improving the expression level of inflammatory factors.

Objective:To investigate the clinical characteristics of 130 children with severe SARS-CoV-2 infection in Yunnan province after the relaxation of non-pharmaceutical interventions, and analyze the risk factors for mortality.Methods:This study is a retrospective case summary that analyzed the demographic data, underlying diseases, clinical diagnoses, disease outcomes, and laboratory results of 130 children with severe COVID-19 infections admitted to nine top-tier hospitals in Yunnan Province from December 2022 to March 2023. According to the prognosis, the patients were divided into survival group and death group. The clinical and laboratory data between the two groups were compared, and the risk factors of death were evaluated. The χ2 test and Mann-Whitney U test were employed to compare between groups, while Spearman correlation test and multiple Logistic regression were used to analyze the risk factors for death. The predictive value of independent risk factors was evaluated by receiver operating characteristic curve. Results:The 130 severe patients included 80 males and 50 females with an onset age of 28.0 (4.5, 79.5) months. There were 97 cases in the survival group and 33 cases in the death group with no significant differences in gender and age between the two groups ( P>0.05). Twenty-five cases (19.2%) out of the 130 patients had underlying diseases, and the number with underlying diseases was significantly higher in death group than in survival group (36.4% (12/33) vs. 13.4%(13/97), χ2=8.36, P=0.004). The vaccination rate in the survival group was significantly higher than that in the death group (86.1% (31/36) vs. 7/17, χ2=9.38, P=0.002). A total of 42 cases (32.3%) of the 130 patients were detected to be infected with other pathogens, but there was no significant difference in the incidence of co-infection between the death group and the survival group (39.3%(13/33) vs. 29.9% (29/97), χ2=1.02, P>0.05). Among the 130 cases, severe respiratory cases were the most common 66 cases (50.8%), followed by neurological severe illnesses 34 cases (26.2%) and circulatory severe 13 cases (10%). Compared to the survival group, patients in the death group had a significantly higher levels of neutrophil, ferritin, procalcitonin, alanine aminotransferase, lactate dehydrogenase, creatine kinase isoenzyme, B-type natriuretic peptide, interleukin-6 and 10 (6.7 (4.0, 14.0) vs. 3.0 (1.6, 7.0)×10 9/L, 479 (298, 594) vs. 268 (124, 424) μg/L, 4.8 (1.7, 10.6) vs. 2.0 (1.1, 3.1) μg/L, 66 (20, 258) vs. 23 (15, 49) U/L, 464 (311, 815) vs. 304 (252, 388) g/L, 71(52, 110) vs. 24(15, 48) U/L, 484 (160, 804) vs. 154 (26, 440) ng/L, 43 (23, 102) vs. 19 (13, 27) ng/L, 216 (114, 318) vs. 86 (45, 128) ng/L, Z=-4.21, -3.67, -3.76, -3.31, -3.75, -5.74, -3.55, -4.65, -5.86, all P<0.05). The correlated indexes were performed by multivariate Logistic regression and the results showed that vaccination was a protective factor from death in severe cases ( OR=0.01, 95% CI 0-0.97, P=0.049) while pediatric sequential organ failure assessment (PSOFA) ( OR=3.31, 95% CI 1.47-7.47, P=0.004), neutrophil-to-lymphocyte ratio (NLR) ( OR=1.56, 95% CI 1.05-2.32, P=0.029) and D dimer ( OR=1.49, 95% CI 1.00-1.02, P=0.033) were independent risk factors for death (all P<0.05). The area under the curve of the three independent risk factors for predicting death were 0.86 (95% CI 0.79-0.94), 0.89 (95% CI 0.84-0.95) and 0.87 (95% CI 0.80-0.94), all P<0.001, and the cut-off values were 4.50, 3.66 and 4.69 mg/L, respectively. Conclusions:Severe SARS-CoV-2 infection can occur in children of all ages, primarily affecting the respiratory system, but can also infect the nervous system, circulatory system or other systems. Children who died had more severe inflammation, tissue damage and coagulation disorders. The elevations of PSOFA, NLR and D dimer were independent risk factors for death in severe children.