Objective:To investigate the effect of the embryo cryopreservation duration on pregnancy and obstetric outcome.Methods:A retrospective cohort study of 2 662 frozen-thawed embyro tranfer (FET) cycles was conducted in the Reproductive Medicine Center, Department of Obstetrics and Gynecology, Tianjin Medical University General Hospital from January 2016 to December 2020. According to embryo cryopreservation duration, the patients were divided into group A (≤1 year, n=2 115), group B (>1 years and ≤3 years, n=319), group C (>3 years and ≤6 years, n=174), and group D (>6 years, n=54). We used the propensity score matching (PSM) to match the baseline data of oocyte retrieval age of the other three groups according to group D at a ratio of 1∶3. Clinical and obstetric outcomes were compared among the four groups. Multiple logistic regression analysis was used to analyze the effect of oocyte retrieval age, embryo transfer age, the duration of embryo cryopreservation, endometrial preparation scheme, endometrial thickness, the number of transferred embryos and the number of high-quality embryos on pregnancy and live birth outcome. Results:1) Before PSM, there were significant differences in the maternal age at oocyte retrieval and embryo transfer and duration of embryo cryopreservation among the four groups(all P<0.001). 2) After PSM, the baseline characteristics of oocyte retrieval age reached a balance among the four groups. There were no statistical differences in the number of embryos transfer, the number of high-quality embryos, the transferred embryo stage, the endometrial regimen among the groups (all P>0.05). The clinical pregnancy rate [37.04% (20/54)] and the live birth rate [33.33% (18/54)] in group D were lower than those in group A [51.57% (82/159), 40.88% (65/159)], group B [50.00% (65/130), 40.77% (53/130)] and group C [49.59% (61/123), 39.02% (48/123)], but the difference was not statistically significant between the four groups ( P=0.310, P=0.781). There were no statistical differences among the four groups in the ratio of male to female newborns, gestational age, birth weight, preterm delivery rate, low birth weight rate, macrosomia rate, birth defects, and premature repture of membranes (all P>0.05). 3) Multiple logistic regression analysis showed that the number of high-quality embryos transferred affected the clinical pregnancy outcome (before PSM, OR=2.614, 95% CI: 2.168-3.151, P<0.001; after PSM, OR=1.984, 95% CI: 1.406-2.800, P<0.001) and live birth (before PSM, OR=2.708, 95% CI: 2.198-3.336, P<0.001; after PSM, OR=2.122, 95% CI: 1.474-3.053, P<0.001). The duration of embryo cryopreservation does not affect the clinical outcome and live birth (all P>0.05). Conclusion:The duration of embryo cryopreservation does not affect the clinical outcome and live birth, but large sample data are still needed to support this conclusion in the future.

A retrospective analysis was conducted on a case of recurrence during pregnancy of early-stage endometrial cancer (EEC) after fertility-preserving treatment, and literature review was conducted. The patient underwent two cycles of controlled ovarian stimulation and three cycles of frozen-thawed embryo transfer after fertility-preserving treatment, early abortion after the third transfer and meanwhile the recurrence of endometrial cancer was found. Fertility-preserving retreatment was given after multidisciplinary discussion based on the patient's fertility intention, ultrasound, pelvic magnetic resonance imaging and other examinations. After complete remission, the remaining cryopreserved embryos of the patient were tested for euploidy by preimplantation genetic testing, and the euploid embryo was transferred and delivered at term successfully. Fertility-preserving treatment for patients with EEC need comprehensive management to reduce the recurrence rate. Recurrent patients can choose fertility-preserving retreatment under a comprehensive evaluation.

Objective:To investigate the effect of the embryo cryopreservation duration on pregnancy and obstetric outcome.Methods:A retrospective cohort study of 2 662 frozen-thawed embyro tranfer (FET) cycles was conducted in the Reproductive Medicine Center, Department of Obstetrics and Gynecology, Tianjin Medical University General Hospital from January 2016 to December 2020. According to embryo cryopreservation duration, the patients were divided into group A (≤1 year, n=2 115), group B (>1 years and ≤3 years, n=319), group C (>3 years and ≤6 years, n=174), and group D (>6 years, n=54). We used the propensity score matching (PSM) to match the baseline data of oocyte retrieval age of the other three groups according to group D at a ratio of 1∶3. Clinical and obstetric outcomes were compared among the four groups. Multiple logistic regression analysis was used to analyze the effect of oocyte retrieval age, embryo transfer age, the duration of embryo cryopreservation, endometrial preparation scheme, endometrial thickness, the number of transferred embryos and the number of high-quality embryos on pregnancy and live birth outcome. Results:1) Before PSM, there were significant differences in the maternal age at oocyte retrieval and embryo transfer and duration of embryo cryopreservation among the four groups(all P<0.001). 2) After PSM, the baseline characteristics of oocyte retrieval age reached a balance among the four groups. There were no statistical differences in the number of embryos transfer, the number of high-quality embryos, the transferred embryo stage, the endometrial regimen among the groups (all P>0.05). The clinical pregnancy rate [37.04% (20/54)] and the live birth rate [33.33% (18/54)] in group D were lower than those in group A [51.57% (82/159), 40.88% (65/159)], group B [50.00% (65/130), 40.77% (53/130)] and group C [49.59% (61/123), 39.02% (48/123)], but the difference was not statistically significant between the four groups ( P=0.310, P=0.781). There were no statistical differences among the four groups in the ratio of male to female newborns, gestational age, birth weight, preterm delivery rate, low birth weight rate, macrosomia rate, birth defects, and premature repture of membranes (all P>0.05). 3) Multiple logistic regression analysis showed that the number of high-quality embryos transferred affected the clinical pregnancy outcome (before PSM, OR=2.614, 95% CI: 2.168-3.151, P<0.001; after PSM, OR=1.984, 95% CI: 1.406-2.800, P<0.001) and live birth (before PSM, OR=2.708, 95% CI: 2.198-3.336, P<0.001; after PSM, OR=2.122, 95% CI: 1.474-3.053, P<0.001). The duration of embryo cryopreservation does not affect the clinical outcome and live birth (all P>0.05). Conclusion:The duration of embryo cryopreservation does not affect the clinical outcome and live birth, but large sample data are still needed to support this conclusion in the future.

This paper summarized the clinical experience in treating ischemic stroke with jiao （角） medicine （triple-medicinal combinations）. Clinically， the combination of Roucongrong （Cistanche deserticola）-Shanyurou （Cornus officinalis）-Guijia （Testudinis Carapax et Plastrum） is used to nourish the kidneys and liver for disease mechanism of liver-kidney depletion， and foundation deficiency due to insufficient essence and blood； the combination of Xixiancao （Sigesbeckia orientalis）-Tianma （Gastrodia elata）-Gouteng （Uncaria rhynchophylla） is used to extinguish wind and eliminate dampness for treating numbness and swelling of limbs caused by ischemic stroke； the combination of Shichangpu （Acorus Tatarinowii）-Yuanzhi （Polygala tenuifolia）-Yujin （Curcumae Radix） is used to improve intelligence， refresh the brain， and clear the mind for treating cognitive impairment， memory loss， or speech difficulties caused by ischemic stroke； the combination of Banxia （Pinellia ternata）-Baizhu （Atractylodes macrocephala）- Tianma （Gastrodiae rhizoma） is used to dissolve phlegm and extinguish wind， unblock meridians and relieve dizziness for treating dizziness or headache caused by ischemic stroke； the combination of Danggui （Angelica sinensis radix）- Chuanxiong （Ligusticum chuanxiong）-Guijianyu （Euonymus alatus） is used to nourish and activate blood circulation， remove blood stasis and unblock meridians for treating weak limbs and activiry difficulty caused by ischemic stroke； the combination of Chaihu （Bupleurum chinense）-Zhiziz （Gardenia jasminoides）-Guanye Jinsitao （Hypericum perforatum） is used to soothe the liver and resolve constraint， cool the blood and calm the mind for treating emotional complications.

Xiang thinking is a cognitive approach that reflects the relationships between phenomena and their underlying principles by analyzing their external manifestations through methods such as analogy， reasoning， deduction， and symbolism. This article applied xiang thinking to analyze the etiology and pathogenesis of "wind， fire， phlegm， and blood stasis" in stroke， thereby exploring its impact on the principles of syndrome differentiation and treatment of this condition. Meanwhile， the article traced the construction process of xiang thinking， and interpreted the concept of "toxin pathogen" in traditional Chinese medicine from four perspectives， state， attribute， origin， and law. Furthermore， the relationship between the process of constructing xiang thinking and the origin of etiology， identification methods， pathogenesis evolution， and treatment strategies for stroke with syndrome of combined blood stasis and toxin was explored， so as to provide insights into research on the etiology and pathogenesis of stroke， as well as clinical diagnosis and treatment approaches.

BACKGROUND: Temozolomide (TMZ) resistance is a significant challenge in treating glioblastoma (GBM). Collagen remodeling has been shown to be a critical factor for therapy resistance in other cancers. This study aimed to investigate the mechanism of TMZ chemoresistance by GBM cells reprogramming collagens. METHODS: Key extracellular matrix components, including collagens, were examined in paired primary and recurrent GBM samples as well as in TMZ-treated spontaneous and grafted GBM murine models. Human GBM cell lines (U251, TS667) and mouse primary GBM cells were used for in vitro studies. RNA-sequencing analysis, chromatin immunoprecipitation, immunoprecipitation-mass spectrometry, and co-immunoprecipitation assays were conducted to explore the mechanisms involved in collagen accumulation. A series of in vitro and in vivo experiments were designed to assess the role of the collagen regulators prolyl 4-hydroxylase subunit alpha 1 (P4HA1) and yes-associated protein (YAP) in sensitizing GBM cells to TMZ. RESULTS: This study revealed that TMZ exposure significantly elevated collagen type I (COL I) expression in both GBM patients and murine models. Collagen accumulation sustained GBM cell survival under TMZ-induced stress, contributing to enhanced TMZ resistance. Mechanistically, P4HA1 directly binded to and hydroxylated YAP, preventing ubiquitination-mediated YAP degradation. Stabilized YAP robustly drove collagen type I alpha 1 ( COL1A1) transcription, leading to increased collagen deposition. Disruption of the P4HA1-YAP axis effectively reduced COL I deposition, sensitized GBM cells to TMZ, and significantly improved mouse survival. CONCLUSION P4HA1 maintained YAP-mediated COL1A1 transcription, leading to collagen accumulation and promoting chemoresistance in GBM.
Temozolomide ; Humans ; Glioblastoma/drug therapy* ; Animals ; Mice ; Cell Line, Tumor ; Drug Resistance, Neoplasm/genetics* ; YAP-Signaling Proteins ; Hydroxylation ; Dacarbazine/pharmacology* ; Adaptor Proteins, Signal Transducing/metabolism* ; Transcription Factors/metabolism* ; Collagen/biosynthesis* ; Collagen Type I/metabolism* ; Prolyl Hydroxylases/metabolism* ; Antineoplastic Agents, Alkylating/therapeutic use*

A retrospective analysis was conducted on a case of recurrence during pregnancy of early-stage endometrial cancer (EEC) after fertility-preserving treatment, and literature review was conducted. The patient underwent two cycles of controlled ovarian stimulation and three cycles of frozen-thawed embryo transfer after fertility-preserving treatment, early abortion after the third transfer and meanwhile the recurrence of endometrial cancer was found. Fertility-preserving retreatment was given after multidisciplinary discussion based on the patient's fertility intention, ultrasound, pelvic magnetic resonance imaging and other examinations. After complete remission, the remaining cryopreserved embryos of the patient were tested for euploidy by preimplantation genetic testing, and the euploid embryo was transferred and delivered at term successfully. Fertility-preserving treatment for patients with EEC need comprehensive management to reduce the recurrence rate. Recurrent patients can choose fertility-preserving retreatment under a comprehensive evaluation.

Objective:To investigate the effect of triglyceride-glucose index (TyG) on the severity of depression in patients with depression.Methods:The clinical data of 653 patients with depression admitted to Hebei General Hospital from January to December 2021 were retrospectively analyzed. The patients were categorized into mild-moderate depression group ( n=324) and severe depression group ( n=329) according to the 17-item Hamilton depression scale (HAMD-17) score. Patients' demographics and data on fasting plasma glucose (FPG), triglyceride (TG), total cholesterol, high-density lipoprotein, and low-density lipoprotein were extracted from the electronic medical records, and TyG was calculated. Statistical analyses were performed by SPSS 25.0 software.The Mann-Whitney U test was used to compare the differences between the two groups. Spearman correlation analysis and binary Logistic regression analysis were used to investigate the relationship between TyG level and depression severity. Results:(1) In the severe depression group, FPG( 956.9 (118.9) mg/L vs 865.0 (1 44.2) mg/L), TG(1 275.8 (1 027.8) mg/L vs 983.5 (766.4) mg/L), total cholesterol (2 007.0 (477.6) mg/L vs 1 730.5 (547.2) mg/L), high-density lipoprotein (514.3 (168.2) mg/L vs 464.0 (138.2) mg/L), low-density lipoprotein (1 264.5 (326.8) mg/L vs 1 088.6 (412.8) mg/L), and TyG (8.72 (0.77) vs 8.37 (0.78)) were higher than those in the mild-moderate depression group, and the differences were statistically significant (all P<0.05).(2) Both TyG level and HAMA score were positively correlated with HAMD-17 score ( r=0.231, 0.586, both P<0.05); (3) The results of binary logistic regression analysis showed that TyG ( B=1.116, OR=3.054, 95% CI=2.058-4.531, P<0.05) was a risk factor for the severity of depression in patients with depression. Conclusion:The higher the TyG, the more severe the severity of depression in patients. Insulin resistance may affect the severity of depression in patients with depression.

Recurrent hydatidiform moles refer to patients with at least two molar pregnancies. Mutations in NLRP7 and KHDC3L genes have been implicated in this disease. A pedigree with a history of recurrent hydatidiform mole who visited Tianjin Medical University General Hospital Reproductive Medicine Center, was selected as the study subject. Clinical data of the family member were collected, peripheral blood samples were taken from each member. Whole exon sequencing was carried out for the proband. Candidate genes were validated by Sanger sequencing of her family members. The whole exome sequencing showed that the proband had a homozygous mutation of c.2282G>A (p.Cys761Tyr) in the NLRP7 gene, the Sanger sequencing results were consistent with the results. Sanger sequencing results verified that the parents and her sisters carried heterozygous mutations. The proband obtained a clinical pregnancy through egg donation and intracytoplasmic sperm injection. Therefore, homozygous mutation of NLRP7 gene c.2282G>A (p.Cys761Tyr) is the genetic cause of recurrent hydatidiform mole. The discovery of this mutation broadens the spectrum of NLRP7 gene pathogenic variants and provide fertility guidance for such patients.

Objective:To explore the parameters of controlled ovarian stimulation (COS) on the occurrence of de novo chromosomal abnormalities in preimplantation genetic testing for structural rearrangements (PGT-SR) cycles. Methods:A retrospective analysis control study was performed on 70 PGT-SR cycles and 39 preimplantation genetic testing for monogenic (PGT-M) embryos in the Department of Obstetrics and Gynecology, Reproductive Medicine Center of Tianjin Medical University General Hospital from January 2023 to August 2024. The correlation between de novo chromosomal abnormalities and ovarian stimulation protocol, duration and total dosage of gonadotropin (Gn) used, estradiol and progesterone levels on human chorionic gonadotropin (hCG) trigger day in COS were analyzed. Results:1) Biopsies were performed on 341 blastocysts in the PGT-SR group and 196 blastocysts in the PGT-M group. There was a significant difference in aneuploid rate of blastocyst between PGT-SR and PGT-M groups [62.1% (205/330) vs. 30.2% (58/192), P<0.001]. There was no significant difference in the incidence of de novo chromosomal abnormalities, between PGT-SR and PGT-M groups ( P>0.05). 2) After adjusting for couples' age and blastocyst grade, there were no significant differences in the incidence of de novo chromosomal abnormalities among different ovarian stimulation protocols, different duration and total dosage of Gn used, different estradiol and progesterone levels on hCG trigger day (all P>0.05). 3) There were no significant differences the incidence of de novo whole, fragment and complex chromosomal abnormalities among different ovarian stimulation protocols, different duration and total dosage of Gn used, different estradiol and progesterone levels on hCG trigger day (all P>0.05). Conclusion:Different ovarian stimulation protocols, duration and total dosage of Gn used, estrogen and progesterone levels on hCG trigger day don't affect the whole de novo chromosomal abnormalities, de novo whole, fragment, complex chromosomal abnormalities in patients with structural chromosomal abnormalities.