Objective:To explore the characteristics of brain functional connectivity changes associated with repetitive transcranial magnetic stimulation (rTMS) in adolescents with anhedonia symptoms, and to develop a predictive model of treatment efficacy based on baseline functional connectivity.Methods:A total of 88 adolescents (aged 13-18 years) with major depressive disorder and comorbid anhedonia, diagnosed according to the Diagnostic And Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), were enrolled in a randomized, double-blind, block-design trial. Participants received either active rTMS ( n=44) or sham stimulation ( n=44) for 15 consecutive days with individualized targeting. Resting-state functional magnetic resonance imaging (fMRI) data and clinical assessments were collected before and after the intervention. Brain regions were parcellated using the Brainnetome Atlas to construct whole-brain functional connectivity matrices. Linear mixed-effects models were used to identify functional connections showing significant group×time interaction effects. The percentage change in Snaith-Hamilton Pleasure Scale (SHAPS) scores (ΔSHAPS) served as the dependent variable in multiple regression analyses to examine the explanatory power of connectivity changes for treatment response. A connectome-based predictive modeling (CPM) approach was employed to predict individual treatment responses based on baseline functional connectivity with permutation testing used to validate model robustness. Results:Thirty-one functional connections showing significant group×time interaction ( F=6.67-15.69, all P<0.01) were identified between the active and sham stimulation groups, primarily involving the subcortical network (SCN), dorsal attention network (DAN), limbic network (LN), and default mode network (DMN). Changes in these connections accounted for 53% of the variance in ΔSHAPS (adjusted R2=0.53, F=4.574, P=0.001). The CPM model based on baseline connectivity showed strong predictive performance (10-fold cross-validation: r=0.65, R2=0.40, MAE=0.095, permutation P<0.001; leave-one-out cross-validation: r=0.74, R2=0.52, MAE=0.013, permutation P<0.001). Among the 59 predictive features, those originating from the LN contributed most substantially, particularly cross-network connections with the DMN and SCN. Correlation analyses revealed widespread associations between baseline predictive features and rTMS-induced connectivity changes, including significant negative correlations between baseline LN-DMN connectivity and post-treatment changes in DAN and subcortical connectivity. Conclusion:rTMS significantly alleviates anhedonia symptoms in adolescents with depression and induces widespread reconfiguration of functional connectivity across multiple brain networks. The CPM model based on baseline connectivity features effectively predicts rTMS treatment efficacy for anhedonia, providing new insights for individualized treatment strategies in adolescent depression.

Objective:To investigate the impact of Wenyang Ligong Decoction on pregnancy outcomes after transcervical resection of adhesions (TCRA) in patients with intrauterine adhesions (IUA).Methods:A retrospective cohort study was conducted to collect clinical data from 151 patients with IUA who underwent TCRA in the Reproductive Medicine Department of the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine between January 2020 and January 2023. Patients were divided into a Traditional Chinese medicine (TCM) group (79 patients) and a control group (72 patients) based on whether they received Wenyang Ligong Decoction after TCRA. The TCM group received estrogen and progesterone sequential therapy post-surgery, combined with Wenyang Ligong Decoction for 2-3 menstrual cycles. The control only received sequential treatment with estrogen and progesterone.Pregnancy outcomes one year after surgery were compared between the two groups. After adjusting for confounding factors using multivariate Cox regression analysis, the effect of Wenyang Ligong Decoction on pregnancy outcomes after TCRA in patients with IUA was observed.Results:The live birth rate [54.43%　(43/79)], the ongoing pregnancy rate [56.96% (45/79)], and the clinical pregnancy rate [52.03% (49/79)] were higher in the TCM group than in the control [26.39% (19/72), P<0.001; 30.56% (22/72), P=0.001;37.50% (27/72), P=0.003], with statistically significant differences. There were no statistically significant differences in early abortion rate and late abortion rate between the TCM group and the control (all P>0.05). According to the stratified analysis by preparation methods, in the natural conception group, the live birth rate [60.78% (31/51)], the ongoing pregnancy rate [62.75% (32/51)], and the clinical pregnancy rate [68.63% (35/51)] in the TCM group were significantly higher than those in control group [21.43% (12/56), P<0.001; 26.79% (15/56), P<0.001; 33.93% (19/56), P<0.001]; there were no statistically significant differences in early miscarriage rate and late miscarriage rate between the two groups (both P>0.05). In the assisted reproductive technology group, there were no statistically significant differences in live birth rate, ongoing pregnancy rate, clinical pregnancy rate, early miscarriage rate, and late miscarriage rate between the two groups (all P>0.05). According to the stratified analysis by age, in the <35-year-old patients, the live birth rate [66.00% (33/50)], the ongoing pregnancy rate [70.00% (35/50)], and the clinical pregnancy rate [74.00% (37/50)] in the TCM group were significantly higher than those in control group [41.30% (19/46), P=0.015; 47.83% (22/46), P=0.027; 54.35% (25/46), P=0.044]; there were no statistically significant differences in early miscarriage rate and late miscarriage rate between the two groups (both P>0.05). In the ≥35-year-old patients, the live birth rate [34.48% (10/29)], the ongoing pregnancy rate [34.48% (10/29)], and the clinical pregnancy rate [41.38% (12/29)] in the TCM group were significantly higher than those in control group [0%, P=0.001; 0%, P=0.001; 7.69% (2/26), P=0.004]; there were no statistically significant differences in early miscarriage rate and late miscarriage rate between the two groups (both P>0.05).Univariate Cox regression analysis showed that age, number of previous uterine cavity interventions, IUA score, degree of IUA, and endometrial thickness after TCRA were independent risk factors for live births, and age, IUA score, degree of IUA, intima thickness after TCRA, and treatment group were the influencing factors of persistent pregnancy (all P<0.05). After adjusting for confounding factors, multivariate Cox regression analysis showed that Wenyang Ligong Decoction significantly improved the live birth rate ( HR=3.19, 95% CI: 1.77-8.11, P=0.001) and the rate of continuous pregnancy ( HR=3.66, 95% CI: 1.80-7.48, P<0.001) in patients with IUA. Conclusion:Wenyang Ligong Decoction can significantly improve pregnancy outcomes after TCRA in patients with IUA.

Objective:To investigate the impact of Wenyang Ligong Decoction on pregnancy outcomes after transcervical resection of adhesions (TCRA) in patients with intrauterine adhesions (IUA).Methods:A retrospective cohort study was conducted to collect clinical data from 151 patients with IUA who underwent TCRA in the Reproductive Medicine Department of the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine between January 2020 and January 2023. Patients were divided into a Traditional Chinese medicine (TCM) group (79 patients) and a control group (72 patients) based on whether they received Wenyang Ligong Decoction after TCRA. The TCM group received estrogen and progesterone sequential therapy post-surgery, combined with Wenyang Ligong Decoction for 2-3 menstrual cycles. The control only received sequential treatment with estrogen and progesterone.Pregnancy outcomes one year after surgery were compared between the two groups. After adjusting for confounding factors using multivariate Cox regression analysis, the effect of Wenyang Ligong Decoction on pregnancy outcomes after TCRA in patients with IUA was observed.Results:The live birth rate [54.43%　(43/79)], the ongoing pregnancy rate [56.96% (45/79)], and the clinical pregnancy rate [52.03% (49/79)] were higher in the TCM group than in the control [26.39% (19/72), P<0.001; 30.56% (22/72), P=0.001;37.50% (27/72), P=0.003], with statistically significant differences. There were no statistically significant differences in early abortion rate and late abortion rate between the TCM group and the control (all P>0.05). According to the stratified analysis by preparation methods, in the natural conception group, the live birth rate [60.78% (31/51)], the ongoing pregnancy rate [62.75% (32/51)], and the clinical pregnancy rate [68.63% (35/51)] in the TCM group were significantly higher than those in control group [21.43% (12/56), P<0.001; 26.79% (15/56), P<0.001; 33.93% (19/56), P<0.001]; there were no statistically significant differences in early miscarriage rate and late miscarriage rate between the two groups (both P>0.05). In the assisted reproductive technology group, there were no statistically significant differences in live birth rate, ongoing pregnancy rate, clinical pregnancy rate, early miscarriage rate, and late miscarriage rate between the two groups (all P>0.05). According to the stratified analysis by age, in the <35-year-old patients, the live birth rate [66.00% (33/50)], the ongoing pregnancy rate [70.00% (35/50)], and the clinical pregnancy rate [74.00% (37/50)] in the TCM group were significantly higher than those in control group [41.30% (19/46), P=0.015; 47.83% (22/46), P=0.027; 54.35% (25/46), P=0.044]; there were no statistically significant differences in early miscarriage rate and late miscarriage rate between the two groups (both P>0.05). In the ≥35-year-old patients, the live birth rate [34.48% (10/29)], the ongoing pregnancy rate [34.48% (10/29)], and the clinical pregnancy rate [41.38% (12/29)] in the TCM group were significantly higher than those in control group [0%, P=0.001; 0%, P=0.001; 7.69% (2/26), P=0.004]; there were no statistically significant differences in early miscarriage rate and late miscarriage rate between the two groups (both P>0.05).Univariate Cox regression analysis showed that age, number of previous uterine cavity interventions, IUA score, degree of IUA, and endometrial thickness after TCRA were independent risk factors for live births, and age, IUA score, degree of IUA, intima thickness after TCRA, and treatment group were the influencing factors of persistent pregnancy (all P<0.05). After adjusting for confounding factors, multivariate Cox regression analysis showed that Wenyang Ligong Decoction significantly improved the live birth rate ( HR=3.19, 95% CI: 1.77-8.11, P=0.001) and the rate of continuous pregnancy ( HR=3.66, 95% CI: 1.80-7.48, P<0.001) in patients with IUA. Conclusion:Wenyang Ligong Decoction can significantly improve pregnancy outcomes after TCRA in patients with IUA.

Objective:To explore the characteristics of brain functional connectivity changes associated with repetitive transcranial magnetic stimulation (rTMS) in adolescents with anhedonia symptoms, and to develop a predictive model of treatment efficacy based on baseline functional connectivity.Methods:A total of 88 adolescents (aged 13-18 years) with major depressive disorder and comorbid anhedonia, diagnosed according to the Diagnostic And Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), were enrolled in a randomized, double-blind, block-design trial. Participants received either active rTMS ( n=44) or sham stimulation ( n=44) for 15 consecutive days with individualized targeting. Resting-state functional magnetic resonance imaging (fMRI) data and clinical assessments were collected before and after the intervention. Brain regions were parcellated using the Brainnetome Atlas to construct whole-brain functional connectivity matrices. Linear mixed-effects models were used to identify functional connections showing significant group×time interaction effects. The percentage change in Snaith-Hamilton Pleasure Scale (SHAPS) scores (ΔSHAPS) served as the dependent variable in multiple regression analyses to examine the explanatory power of connectivity changes for treatment response. A connectome-based predictive modeling (CPM) approach was employed to predict individual treatment responses based on baseline functional connectivity with permutation testing used to validate model robustness. Results:Thirty-one functional connections showing significant group×time interaction ( F=6.67-15.69, all P<0.01) were identified between the active and sham stimulation groups, primarily involving the subcortical network (SCN), dorsal attention network (DAN), limbic network (LN), and default mode network (DMN). Changes in these connections accounted for 53% of the variance in ΔSHAPS (adjusted R2=0.53, F=4.574, P=0.001). The CPM model based on baseline connectivity showed strong predictive performance (10-fold cross-validation: r=0.65, R2=0.40, MAE=0.095, permutation P<0.001; leave-one-out cross-validation: r=0.74, R2=0.52, MAE=0.013, permutation P<0.001). Among the 59 predictive features, those originating from the LN contributed most substantially, particularly cross-network connections with the DMN and SCN. Correlation analyses revealed widespread associations between baseline predictive features and rTMS-induced connectivity changes, including significant negative correlations between baseline LN-DMN connectivity and post-treatment changes in DAN and subcortical connectivity. Conclusion:rTMS significantly alleviates anhedonia symptoms in adolescents with depression and induces widespread reconfiguration of functional connectivity across multiple brain networks. The CPM model based on baseline connectivity features effectively predicts rTMS treatment efficacy for anhedonia, providing new insights for individualized treatment strategies in adolescent depression.

OBJECTIVE To understand the development status and existing problems of traditional Chinese medicine(TCM)pharmacists in public TCM hospitals in China,aiming to provide suggestions for the competent departments to formulate management policies for TCM pharmacists and promote the healthy development of TCM.METHODS The data on the number and professional titles of TCM pharmacists in public TCM hospitals in China from 2019 to 2023 were collected.Descriptive analysis was employed to analyze the number,distribution and professional titles of TCM pharmacists in public TCM hospitals across the country,and to measure the quantity shortfalls of the number of TCM pharmacists in these hospitals.RESULTS From 2019 to 2023,the number of TCM pharmacists in public TCM hospitals in China grew slowly,with an average annual growth rate of 2.56%.However,the proportion of TCM pharmacists to the total number of pharmacists in public TCM hospitals gradually decreased,with an average annual growth rate of-0.65%.In terms of hospital grades,the number of TCM pharmacists in tertiary public TCM hospitals showed positive growth,while those in secondary and primary public TCM hospitals showed negative growth.In terms of hospital types,the average annual growth rate of TCM pharmacists in TCM hospitals was 2.22%,in integrated Chinese and Western medicine hospitals it was 7.97%,and in ethnic minority medicine hospitals it was 2.74%.The development of TCM pharmacists in different provinces was uneven.The annual growth rate of TCM pharmacists in Guizhou exceeded 10%,while the growth rate in Hunan and Heilongjiang was negative.In 2023,the number of TCM pharmacists per thousand population in public TCM hospitals was 0.03,indicating a relatively low staffing level.The professional titles of TCM pharmacists in public TCM hospitals were mainly primary and intermediate,with a total of 67.33%.According to the calculation that the proportion of TCM pharmacists to pharmacists was not less than 60%,public TCM hospitals and hospitals of integrated TCM and Western medicine should be reconfigured with TCM pharmacists 6 212 and 1 288 people,respectively.CONCLUSIONS The number of TCM pharmacists in public TCM hospitals is growing slowly,with insufficient staffing levels,relatively low professional titles,and uneven distribution and development across provinces.It is suggested that relevant competent departments strengthen policy guidance,increase the attention given by the state level to TCM pharmacists,strengthen the construction of the talent team for TCM pharmacists,improve the quality and optimize the allocation of TCM pharmacist talents in order to promote the high-quality development of TCM services.

Dietary interventions are recommended by international guidelines as a simple, easy-to-implement non-pharmacological treatment option for polycystic ovary syndrome (PCOS) patients. Scientific and reasonable dietary intervention has attracted more and more attention, and a series of dietary patterns, including low-glycemic index diet, mediterranean diet, ketogenic diet, dietary approaches to stop hypertension, and time-limited diet, have been proved to reduce the weight of PCOS patients and improve reproductive endocrine disorders. This article described the existing dietary patterns to improve the clinical symptoms of reproductive endocrine disorders in women with PCOS and their mechanisms of action from both clinical and basic experimental studies, in order to improve the evidence for the application of dietary patterns in the treatment of PCOS and to provide optimal dietary recommendations for clinical management.

Objective:To observe the effect of Wenyang Huazhuo recipe (WYHZ) on pregnancy outcomes in patients with unexplained recurrent spontaneous abortion (URSA).Methods:A retrospective cohort study was used and 240 cases of pregnancy URSA patients with spleen kidney yang deficiency syndrome at the Reproductive Center, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine and Department of Gynaecology and Obstetrics, General Hospital of Tianjin Medial University from November 2018 to March 2022 were recruited. The patients were assigned to WYHZ group (120 cases) and control group (120 cases) based on whether accepting oral WYHZ from 3 months before pregnancy to 8-12 weeks after pregnancy regularly. Pregnancy outcomes, perinatal period outcomes and obstetric complications were compared between the two groups. Multivariate logistic regression were used to analyze the effect of WYHZ on pregnancy outcome.Results:The live birth rate and the clinical pregnancy rate in WYHZ group [86.67% (104/120), 90.00% (108/120)] were higher than those in control group [71.67% (86/120), P=0.004; 75.00% (90/120), P=0.002]. The early abortion rate in WYHZ group [10.08% (12/119)] was lower than that in control group [25.86% (30/116), P=0.002], the differences were statistically significant. There were no significant differences in perinatal outcome and incidence rate of obstetric complications between the two groups (all P>0.05). Multivariate logistic regression analysis showed that the application of WYHZ significantly improved the live birth rate ( OR=8.818, 95% CI: 3.556-21.871, P<0.001) and sustained pregnancy rate ( OR=11.261, 95% CI: 4.262-29.751, P<0.001) in URSA patients. Conclusion:WYHZ using before and during pregnancy can significantly improve the live birth rate and the clinical pregnancy rate of URSA patients with syndrome of yang deficiency of spleen and kidney, and improve their pregnancy outcomes.

Glucose transporters (GLUTs) are widely expressed in the endometrium, mediate glucose uptake, and regulate energy metabolism of endometrial stromal cells, as well as decidual immune metabolism and other related processes. GLUTs also interact with important signaling pathways during decidualization, affecting embryo implantation. In this paper, the aspects of GLUTs expression and mechanism during decidualization are reviewed in order to provide a theoretical basis for the prevention and treatment of infertility and pregnancy-related diseases.

The endometrial immune inflammatory microenvironment, composed of immune cells and cytokines, exhibits acute, low-grade, and transient pro-inflammatory characteristics during the embryo implantation window period. During this period, implantation capability is achieved by regulating blastocyst activation, promoting the endometrium to establish a receptive state, and mediating the positioning, adhesion, and invasion of the embryo. Abnormalities in the number and proportion of endometrial immune cells were associated with embryo implantation failure and altered characteristics of the immunoinflammatory microenvironment led to embryo implantation failure. The research progress on the mechanism of endometrial immunoinflammatory microenvironment regulating embryo implantation is now reviewed.

Dietary interventions are recommended by international guidelines as a simple, easy-to-implement non-pharmacological treatment option for polycystic ovary syndrome (PCOS) patients. Scientific and reasonable dietary intervention has attracted more and more attention, and a series of dietary patterns, including low-glycemic index diet, mediterranean diet, ketogenic diet, dietary approaches to stop hypertension, and time-limited diet, have been proved to reduce the weight of PCOS patients and improve reproductive endocrine disorders. This article described the existing dietary patterns to improve the clinical symptoms of reproductive endocrine disorders in women with PCOS and their mechanisms of action from both clinical and basic experimental studies, in order to improve the evidence for the application of dietary patterns in the treatment of PCOS and to provide optimal dietary recommendations for clinical management.