Objective:To investigate the effect of pre-pregnancy body mass index (BMI) on the cumulative live birth rate (CLBR) and perinatal outcomes in women with polycystic ovary syndrome (PCOS) undergoing first in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI).Methods:The clinical data of 1 013 patients with PCOS who received first IVF/ICSI treatment in Reproductive Medicine Center, Henan Provincial People′s Hospital from January 2017 to June 2020 were retrospectively analyzed. According to BMI China standard, they were divided into: normal weight group (18.5≤BMI<24.0 kg/m 2, 388 cases), overweight group (24.0≤BMI<28.0 kg/m 2, 367 cases), obese group (BMI≥28.0 kg/m 2, 258 cases). The effect of BMI on CLBR was analyzed by univariate analysis, multivariate logistic regression analysis and smooth curve fitting. The role of homeostasis model assessment of insulin resistance index (HOMA-IR) in the process of BMI on CLBR was analyzed by mediation analysis. Results:Among three groups, female age, basal level of follicle stimulating hormone, type of infertility and ovulation induction regimens were similar (all P>0.05). The infertility duration, basal testosterone level, HOMA-IR, the ovulation induction time and the total gonadotropin dosage increased with BMI (all P<0.01), anti-Müllerian hormone, basal luteinizing hormone level, the number of retrieved oocytes and available embryos decreased with BMI (all P<0.05). CLBR decreased with BMI increasing [84.08% (301/358) vs 74.26% (251/338) vs 71.88% (161/224); P<0.001]. The incidence of hypertensive disorder in pregnancy was highest in obese group, while premature rupture of membranes rate, premature delivery rate, low birth weight rate and macrosomia birth rate were the lowest in normal weight group. After adjusting for confounding factors, both smooth curve fitting and multiple logistic regression analysis revealed a significant trend: CLBR declined with increasing BMI ( OR=0.93, 95% CI: 0.89-0.97; P=0.002), with a reduction of 41% ( OR=0.59, 95% CI: 0.39-0.91; P=0.020) in overweight group, and a reduction of 48% ( OR=0.52, 95% CI: 0.32-0.83; P=0.010) in obese group. HOMA-IR mediated the effect of BMI on CLBR by 27.5% ( P<0.05). Conclusions:High BMI before IVF/ICSI in PCOS patients negatively impacts CLBR and raises maternal and infant risks during pregnancy and the perinatal period. 27.5% of the effect of BMI on CLBR is mediated by HOMA-IR. Thus, PCOS patients should manage their BMI and enhance insulin sensitivity prior to pregnancy.

Objective:To identify different subtypes of patients with preeclampsia(PE)through clinical liver function index data-driven the cluster analysis,to explore the correlation between liver function of different sub-types and pregnancy complications.Methods:From January 2012 to December 2022,the general data of 2230 sin-gleton pregnant women with PE who underwent prenatal examination and delivered in Fujian Maternity and Child Health Hospital were collected.Using 13 liver function indexes before delivery as baseline variables,all included subjects were classified into subtypes by cluster method.The clinical characteristics of different subtypes of PE patients were compared.Single-factor Logistic regression was used to analyze the risk of pregnancy complications among subtypes.Results:PE patients were divided into 3 subgroups that represented different characteristics of patients' liver function.The first subtype(n=1065)exhibited abnormal liver enzymology index characterized by in-creased alkaline phosphatase(ALP)level.The second subtype(n=648)showed abnormal bilirubin metabolism index with the highest levels of total bilirubin(TBIL),direct(DBIL)and indirect bilirubin(IBIL).The third subtype(n=517)had abnormal liver enzymology indexes with elevated alanine aminotransferase(ALT)and aspartate aminotransferase(AST)levels,abnormal bile acid detection indexes with elevated total bile acid(TBA)levels,and abnormal liver synthesis function indexes with decreased total protein(TP),albumin(ALB),and globulin lev-els(GLB).Significant differences were observed among the three subtypes in age,severe PE,anemia,cardiac dysfunction,and renal dysfunction(P＜0.05).Single-factor Logistic regression demonstrated that the third sub-type had significantly higher risks of intrahepatic cholestasis of pregnancy,fetal growth restriction,premature rup-ture of membranes,and preterm birth compared to the first and second subtypes(P＜0.05),as well as a higher risk of placental abruption than the second subtype(P＜0.05).The first subtype had higher risks of placental ab-ruption and fetal growth restriction than the second subtype(P＜0.05).Conclusions:Cluster analysis could be used to subclassify PE patients by liver function characteristics,so as to identify the occurrence of pregnancy complications.The results had significance for understanding the heterogeneity of PE and promoting individualized management.

Objective:To identify different subtypes of patients with preeclampsia(PE)through clinical liver function index data-driven the cluster analysis,to explore the correlation between liver function of different sub-types and pregnancy complications.Methods:From January 2012 to December 2022,the general data of 2230 sin-gleton pregnant women with PE who underwent prenatal examination and delivered in Fujian Maternity and Child Health Hospital were collected.Using 13 liver function indexes before delivery as baseline variables,all included subjects were classified into subtypes by cluster method.The clinical characteristics of different subtypes of PE patients were compared.Single-factor Logistic regression was used to analyze the risk of pregnancy complications among subtypes.Results:PE patients were divided into 3 subgroups that represented different characteristics of patients' liver function.The first subtype(n=1065)exhibited abnormal liver enzymology index characterized by in-creased alkaline phosphatase(ALP)level.The second subtype(n=648)showed abnormal bilirubin metabolism index with the highest levels of total bilirubin(TBIL),direct(DBIL)and indirect bilirubin(IBIL).The third subtype(n=517)had abnormal liver enzymology indexes with elevated alanine aminotransferase(ALT)and aspartate aminotransferase(AST)levels,abnormal bile acid detection indexes with elevated total bile acid(TBA)levels,and abnormal liver synthesis function indexes with decreased total protein(TP),albumin(ALB),and globulin lev-els(GLB).Significant differences were observed among the three subtypes in age,severe PE,anemia,cardiac dysfunction,and renal dysfunction(P＜0.05).Single-factor Logistic regression demonstrated that the third sub-type had significantly higher risks of intrahepatic cholestasis of pregnancy,fetal growth restriction,premature rup-ture of membranes,and preterm birth compared to the first and second subtypes(P＜0.05),as well as a higher risk of placental abruption than the second subtype(P＜0.05).The first subtype had higher risks of placental ab-ruption and fetal growth restriction than the second subtype(P＜0.05).Conclusions:Cluster analysis could be used to subclassify PE patients by liver function characteristics,so as to identify the occurrence of pregnancy complications.The results had significance for understanding the heterogeneity of PE and promoting individualized management.

Objective:To investigate the effect of pre-pregnancy body mass index (BMI) on the cumulative live birth rate (CLBR) and perinatal outcomes in women with polycystic ovary syndrome (PCOS) undergoing first in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI).Methods:The clinical data of 1 013 patients with PCOS who received first IVF/ICSI treatment in Reproductive Medicine Center, Henan Provincial People′s Hospital from January 2017 to June 2020 were retrospectively analyzed. According to BMI China standard, they were divided into: normal weight group (18.5≤BMI<24.0 kg/m 2, 388 cases), overweight group (24.0≤BMI<28.0 kg/m 2, 367 cases), obese group (BMI≥28.0 kg/m 2, 258 cases). The effect of BMI on CLBR was analyzed by univariate analysis, multivariate logistic regression analysis and smooth curve fitting. The role of homeostasis model assessment of insulin resistance index (HOMA-IR) in the process of BMI on CLBR was analyzed by mediation analysis. Results:Among three groups, female age, basal level of follicle stimulating hormone, type of infertility and ovulation induction regimens were similar (all P>0.05). The infertility duration, basal testosterone level, HOMA-IR, the ovulation induction time and the total gonadotropin dosage increased with BMI (all P<0.01), anti-Müllerian hormone, basal luteinizing hormone level, the number of retrieved oocytes and available embryos decreased with BMI (all P<0.05). CLBR decreased with BMI increasing [84.08% (301/358) vs 74.26% (251/338) vs 71.88% (161/224); P<0.001]. The incidence of hypertensive disorder in pregnancy was highest in obese group, while premature rupture of membranes rate, premature delivery rate, low birth weight rate and macrosomia birth rate were the lowest in normal weight group. After adjusting for confounding factors, both smooth curve fitting and multiple logistic regression analysis revealed a significant trend: CLBR declined with increasing BMI ( OR=0.93, 95% CI: 0.89-0.97; P=0.002), with a reduction of 41% ( OR=0.59, 95% CI: 0.39-0.91; P=0.020) in overweight group, and a reduction of 48% ( OR=0.52, 95% CI: 0.32-0.83; P=0.010) in obese group. HOMA-IR mediated the effect of BMI on CLBR by 27.5% ( P<0.05). Conclusions:High BMI before IVF/ICSI in PCOS patients negatively impacts CLBR and raises maternal and infant risks during pregnancy and the perinatal period. 27.5% of the effect of BMI on CLBR is mediated by HOMA-IR. Thus, PCOS patients should manage their BMI and enhance insulin sensitivity prior to pregnancy.

Objective:To analyze the changing trends of the epidemic characteristics of human brucellosis in Hangzhou City, and to provide a basis for further formulating prevention and control measures.Methods:The epidemic data of brucellosis in Hangzhou City from 2004 to 2021 were collected from the "China Disease Control and Prevention Information System" and the annual reports, compilations and summaries of prevention and control work of brucellosis in Hangzhou City, and the epidemiological characteristics and trends of brucellosis cases in Hangzhou City from 2004 to 2009, 2010 to 2015, and 2016 to 2021 were compared and analyzed.Results:A total of 186 cases of brucellosis were diagnosed in Hangzhou City from 2004 to 2021, with an average annual incidence rate of 0.151/100 000, ranging from 0.016/100 000 to 0.286/100 000. The incidence rate showed a stage-by-stage upward trend from 2004 to 2009, 2010 to 2015, and 2016 to 2021 ( Z = 3.15, P = 0.002). The age of onset of brucellosis cases was predominantly 18 - 60 years old, accounting for 78.49% (146/186). The male-to-female ratio was 2.10∶1.00 (126∶60). The occupational and non-occupational populations accounted for 62.90% (117/186) and 37.10% (69/186), respectively, with the proportion of non-occupational cases in the three stages being 28.57%, 23.29% and 51.76%, showing an increasing trend (χ 2trend = 9.85, P = 0.002). The regional distribution was dominated by Yuhang District, accounting for 55.91% (104/186), followed by Jianggan District (9.14%, 17/186) and Fuyang District (7.53%, 14/186). The number of brucellosis epidemic counties (cities, districts) increased from 6 to 9. The seasonal analysis showed that the proportion of cases from January to June decreased from 84.93% (23/28) from 2004 to 2009 to 54.12% (46/85) from 2016 to 2021. The proportion of infection from outside the province in the three stages was 0, 10.96% and 27.38%, respectively, showing an upward trend (χ 2trend = 18.16, P < 0.001), the main infected areas were Henan Province, Heilongjiang Province, and Inner Mongolia Autonomous Region. In clinical symptoms and signs, the incidence of muscle and joint pain and low back pain increased from 60.71% (17/28) and 10.71% (3/28) from 2004 to 2009, respectively, to 83.53% (71/85) and 25.88% (22/85) from 2016 to 2021, both showing an upward trend (χ 2trend = 9.92, 4.67, P = 0.002, 0.031). Conclusions:The incidence of human brucellosis in Hangzhou City is on the rise, and the number of cases of non-occupational population has increased significantly in recent years. The sheep breeding places have gradually become the high incidence areas of brucellosis in Hangzhou City. It is recommended to strengthen the promotion and education of knowledge on brucellosis prevention among the general public, and focus on actively monitoring human brucellosis in high-risk areas.

Objective:To explore the safety and efficacy of prophylactic superdrainage using superficial inferior epigastric vein (SIEV) in delayed single-pedicled deep inferior epigastric perforator (DIEP) flap breast reconstruction.Methods:The clinical data of all patients who underwent single-pedicle DIEP flap delayed breast reconstruction in Department of Comprehensive Breast Plasty Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from May 2018 to August 2022 were retrospectively analyzed. According to whether SIEV-internal thoracic vein anastomosis was performed, they were divided into superdrainaged group and non-superdrainaged group. The diameter of SIEV and the time required for anastomosis were recorded. The total operation time, flap ischemia time, hospital stay, the rates of flap diffuse congestion, overall complications and second operation were compared between the two groups. The relative risks of flap diffuse congestion, complications and second operation were calculated. SPSS 24.0 software was used for data analysis. Measurement data was expressed as Mean±SD, independent sample t test was used for analysis. Counting data was expressed as %, and χ2 test was used for analysis. P<0.05 was considered statistically significant. Results:A total of 45 patients were included, including 26 patients in the non-superdrainaged group and 19 patients in the superdrainaged group. The total operation time was (7.7±1.9) h and (8.4±1.5) h, the flap ischemia time was (89.5±10.4) min and (92.6±12.3) min, and the hospital stay was (6.6±1.8) d and (6.6±2.0) d, respectively. There were no significant differences ( P>0.05). In the superdrainaged group, the diameter of SIEV was (2.5±0.3) mm, and manual suture was used. The time required for anastomosis of one SIEV was (12.2±2.3) min. The rates of diffuse congestion, recipient site complications, donor site complications and second operation were 7.7%(2/26), 15.4%(4/26), 7.7%(2/26) and 15.4%(4/26) in the non-superdrainaged group, and 0(0/19), 5.3%(1/19), 10.5%(2/19) and 5.3%(1/19) in the superdrainaged group, respectively. There were no significant differences between the two groups ( P>0.05). The relative risks were 3.7, 2.9, 0.7 and 2.9, respectively. Conclusion:Prophylactic superdrainage using SIEV is safe and effective. It can minimize the potential rate of diffuse venous congestion and secondary surgery, and not at the expense of increased flap ischemia time and abdominal complications in the meanwhile.

In deep inferior epigastric perforator (DIEP) flap breast reconstruction, diffuse venous congestion caused by non-pedicle causes, such as lack of effective communication between deep and superficial venous systems, is very rare. In this paper, a case of young woman who underwent DIEP breast reconstruction after breast cancer mastectomy was reported. Imaging findings showed the absence of bilateral dominant perforators and the lack of communication between the deep and superficial venous system. During operation, the superficial inferior epigastric vessels were dissected in advance. Indocyanine green angiography showed arterial perfusion insufficiency and venous congestion.The flap was successfully salvaged by supercharging/draining with superficial inferior epigastric vessels, preserving the abdominal function of the young patient to the greatest extent.

Objective:This study aimed to explore the clinical application value of the indication selection criteria for bi-pedicled deep inferior epigastric arterial perforator flap(DIEP) versus pedicled transverse rectus abdominis myocutaneous flap(TRAM) combined with DIEP for breast reconstruction.Methods:The clinical data of patients who underwent delayed bi-pedicled abdominal flap breast reconstruction after breast cancer surgery in the Department of Oncoplastic and Reconstructive Breast Surgery and Department of Mammoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences from January 2008 to April 2022 were retrospectively analyzed. According to the indications for each procedure, corresponding blood supply source was selected. Subsequently, patients were divided into two groups: bi-pedicled DIEP group and pedicled TRAM+ DIEP combined flap group according to the type of blood supply source. The indication selection criteria for pedicled TRAM+ DIEP combined flap was as follows: lack of two groups of recipient vessels; no dominant perforator in the abdominal donor site; previous abdominal liposuction or abdominal surgery with large dissection range and severe scar; patients were unable to tolerate prolonged surgery or had high risk factors for microsurgery. A comparison of breast reconstruction surgery characteristics was conducted between the two groups. Independent-samples t-test, rank sum test, Chi-square test and Fisher’s exact probability method were used to analyze various data including age, body mass index (BMI), time interval between breast cancer surgery and breast reconstruction surgery, history of radiotherapy, history of chemotherapy, history of smoking, history of lower abdominal surgery, history of hypertension, original surgical incision type, length and width of flap, hospitalization length, preoperative and postoperative conditions, as well as postoperative complications. Statistical significance was defined at P<0.05. Results:A total of 54 patients who underwent unilateral breast reconstruction were included in this study with a mean age of 42.2 years (range, 30-59 years). The pedicled TRAM+ DIEP combined flap group consisted of 21 patients with a mean age of 42.7 years (range, 33-56 years) while the bi-pedicled DIEP group comprised 33 patients with a mean age of 41.8 years (30-59 years). Out of the 54 patients, a total of 38 were eventually followed up, comprising 14 in the pedicled TRAM+ DIEP combined flap group and 24 in the bi-pedicled DIEP group. The average follow-up duration for the pedicled TRAM+ DIEP combined flap group was 42 months (range, 6-69 months). Abdominal bulge occurred in one patient, while another patient experienced abdominal hernia. The average follow-up duration for the bi-pedicled DIEP group was 47 months (6-179 months), with no reported cases of abdominal bulge or abdominal hernia. There were no statistically significant differences observed between the two groups regarding age, BMI, time interval between breast cancer surgery and breast reconstruction surgery, history of radiotherapy or chemotherapy, history of smoking, history of lower abdominal surgery, history of hypertension, original surgical incision type, length and width of flap, hospitalization length or time to ambulation (all P>0.05). However, there was a statistically significant difference noted in duration of surgery between the pedicled TRAM+ DIEP combined flap group and bi-pedicled DIEP group [6.0(5.5-6.5) hours vs. 8.5(8.0-8.8) hours] ( P<0.01). Comparison analysis revealed no statistically significant differences in terms of partial flap necrosis (0/21 vs. 1/33), abdominal incision dehiscence (2/21 vs. 2/33), abdominal bulge (1/14 vs. 0 /24) or abdominal hernia (1/1 vs. 0/24) between the two groups ( P>0.05). Conclusion:For patients who needed bilateral vascular pedicled lower abdominal wall for breast reconstruction, utilizing a pedicled TRAM+ DIEP combined flap did not increase surgical complication risks. The proposed indication selection criteria for using a pedicled TRAM + DIEP combined flap outlined in this study could serve as guidance when choosing methods for bi-pedicled abdominal flap breast reconstruction.

OBJECTIVE To analyze the current situation of pediatric drug use under centralized drug procurement， and to provide reference for the subsequent design of pediatric drug centralized procurement rules. METHODS The comparative analysis method was used to analyze the problems in the centralized procurement， clinical use and supply of pediatric drugs from the aspects of centralized procurement selection results and actual use of pediatric drugs， price difference and online prices of pediatric drugs. The solutions were put forward to optimize the centralized procurement and pricing rules of pediatric drugs. RESULTS & CONCLUSIONS The demands for pediatric drugs in China were increasing， but the supply of marketed pediatric drugs was insufficient （including insufficient coverage of disease fields， insufficient varieties， insufficient suitable dosage forms for children， insufficient specifications for children， etc.）， and the development of pediatric drugs was relatively difficult. After merging the dosage forms of centralized procurement according to the medical insurance list， some suitable dosage forms and specifications for children couldn’t be selected， resulting in a shortage of clinical pediatric medication. Relevant enterprises’ enthusiasm for developing and producing pediatric drugs and participating in online competitions had decreased. There was also the problem of underpricing of pediatric drugs under the drug price difference ratio rule. It is recommended that when conducting centralized drug procurement， special drugs for children should be grouped separately for centralized procurement based on attributes and the population covered by the indications. The specifications of suitable pediatric drugs that were not selected are converted into the agreed purchase quantity of medical institutions in a certain proportion. It is necessary to further optimize the pricing rules for pediatric specialized drugs， ensure a certain profit margin for such drugs， increase the willingness of production enterprises to research， develop and supply drugs， and thus ensure the use and supply of pediatric drugs.

AIM: To analyze the effect of full-femtosecond small incision lenticule extraction(SMILE)on the treatment of high myopia based on propensity score matching.METHODS: A total of 48 cases(48 eyes)of high myopia patients who underwent SMILE surgery in our hospital from May 2019 to May 2021 were selected as the observation group, and 48 cases(48 eyes)of high myopia patients who underwent FS-LASIK surgery were matched using propensity score matching as the control group. Follow up for 6mo after surgery, the changes in cylindrical, central corneal thickness, uncorrected visual acuity(UCVA), corneal endothelial cell related indicators [percentage of hexagonal endothelial cells(6A), coefficient of variation(CV)of endothelial cell area, central corneal endothelial cell density(ECD)] and corneal biomechanical indicators [simulated Goldman intraocular pressure(IOPg), corneal hysteresis(CH), corneal resistance factor(CRF), corneal compensated intraocular pressure(IOPcc)] between the two groups were compared, and the incidence of complications in both groups of patients was recorded.RESULTS: Both groups of patients showed significant improvements in cylindrical and UCVA at 3 and 6mo after surgery, as well as decreased central corneal thickness, corneal endothelial cells, and corneal biomechanics related indicators. The changes in the observation group were more significant(all P<0.05). During the follow-up period, there was no significant difference in the incidence of complications between the observation group and the control group(8% vs. 17%, P>0.05).CONCLUSION: SMILE has a definite effect on patients with high myopia and is helpful to improve visual acuity.