Objective:To investigate the independent clinical factors of live birth rate of the first frozen-thawed embryo transfer (FET) cycle after transcervical resection of adhesion (TCRA).Methods:A retrospective case-control study was conducted to analyze the clinical data of patients with intrauterine adhesion (IUA) who received FET in Reproductive Center of Reproductive and Genetic Hospital of CITIC-XIANGYA from January 2019 to June 2022 ( n=6 154). According to the severity of intrauterine adhesions in patients, they were classified into mild adhesions ( n=172), moderate adhesions ( n=5 723), and severe adhesions ( n=259). Based on the FET outcome, the patients were divided into live birth group and non-live birth group. The risk factors and protective factors of live birth were analyzed by multivariate logistic regression. Results:1) No independent factor of live birth was found in the mild IUA group. 2) In the moderate IUA group, the protective factors of live birth included secondary infertility ( OR=1.39, 95% CI: 1.07-1.80, P=0.015), hysteroscopic polypectomy ( OR=1.38, 95% CI: 1.05-1.83, P=0.023), No. of high-quality embryos transferred (one embryo: OR=1.58, 95% CI: 1.37-1.82, P<0.001; two embryos: OR=2.55, 95% CI: 1.80-3.64, P<0.001), two embryos transferred ( OR=1.77, 95% CI: 1.48-2.12, P<0.001), embryo stage (blastocyst transferred, OR=4.93, 95% CI: 3.68-6.63, P<0.001; blastocyst+cleavage transferred OR=1.90, 95% CI: 1.11-3.21, P=0.021), preimplantation genetic testing embryo ( OR=1.42, 95% CI: 1.19-1.69, P<0.001), endometrial thickness before transplantation ( OR=1.11, 95% CI: 1.07-1.15, P<0.001). Risk factors of live birth included female age ( OR=0.94, 95% CI: 0.92-0.96, P<0.001), infertility due to male factor ( OR=0.83, 95% CI: 0.71-0.96, P=0.011), combined repeated implantation failure ( OR=0.60, 95% CI: 0.42-0.87, P=0.007), combined unicornuate uterus/uterus didelphys ( OR=0.25, 95% CI: 0.06-0.79, P=0.033), American Fertility Society score ( OR=0.94, 95% CI: 0.89-0.98, P=0.010), No. of TCRA ( OR=0.83, 95% CI: 0.77-0.90, P<0.001), gonadotropin-releasing hormone agonists down-regulation combined with artificial cycle ( OR=0.56, 95% CI: 0.45-0.69, P<0.001), artificial cycle ( OR=0.62, 95% CI: 0.51-0.76, P<0.001). 3) In the severe IUA group, the risk factor of live birth was artificial cycle ( OR=0.25, 95% CI: 0.07-0.80, P=0.027). Conclusion:The clinical factors that affect the live birth outcome of the first FET cycle after TCRA have different results in patients with different degrees of adhesion. In patients with moderate adhesions, there are 17 clinical indicators that affect the live birth rate. In patients with severe adhesions, the artificial cycle is an independent factor affecting the live birth rate.

Objective:To investigate the independent clinical factors of live birth rate of the first frozen-thawed embryo transfer (FET) cycle after transcervical resection of adhesion (TCRA).Methods:A retrospective case-control study was conducted to analyze the clinical data of patients with intrauterine adhesion (IUA) who received FET in Reproductive Center of Reproductive and Genetic Hospital of CITIC-XIANGYA from January 2019 to June 2022 ( n=6 154). According to the severity of intrauterine adhesions in patients, they were classified into mild adhesions ( n=172), moderate adhesions ( n=5 723), and severe adhesions ( n=259). Based on the FET outcome, the patients were divided into live birth group and non-live birth group. The risk factors and protective factors of live birth were analyzed by multivariate logistic regression. Results:1) No independent factor of live birth was found in the mild IUA group. 2) In the moderate IUA group, the protective factors of live birth included secondary infertility ( OR=1.39, 95% CI: 1.07-1.80, P=0.015), hysteroscopic polypectomy ( OR=1.38, 95% CI: 1.05-1.83, P=0.023), No. of high-quality embryos transferred (one embryo: OR=1.58, 95% CI: 1.37-1.82, P<0.001; two embryos: OR=2.55, 95% CI: 1.80-3.64, P<0.001), two embryos transferred ( OR=1.77, 95% CI: 1.48-2.12, P<0.001), embryo stage (blastocyst transferred, OR=4.93, 95% CI: 3.68-6.63, P<0.001; blastocyst+cleavage transferred OR=1.90, 95% CI: 1.11-3.21, P=0.021), preimplantation genetic testing embryo ( OR=1.42, 95% CI: 1.19-1.69, P<0.001), endometrial thickness before transplantation ( OR=1.11, 95% CI: 1.07-1.15, P<0.001). Risk factors of live birth included female age ( OR=0.94, 95% CI: 0.92-0.96, P<0.001), infertility due to male factor ( OR=0.83, 95% CI: 0.71-0.96, P=0.011), combined repeated implantation failure ( OR=0.60, 95% CI: 0.42-0.87, P=0.007), combined unicornuate uterus/uterus didelphys ( OR=0.25, 95% CI: 0.06-0.79, P=0.033), American Fertility Society score ( OR=0.94, 95% CI: 0.89-0.98, P=0.010), No. of TCRA ( OR=0.83, 95% CI: 0.77-0.90, P<0.001), gonadotropin-releasing hormone agonists down-regulation combined with artificial cycle ( OR=0.56, 95% CI: 0.45-0.69, P<0.001), artificial cycle ( OR=0.62, 95% CI: 0.51-0.76, P<0.001). 3) In the severe IUA group, the risk factor of live birth was artificial cycle ( OR=0.25, 95% CI: 0.07-0.80, P=0.027). Conclusion:The clinical factors that affect the live birth outcome of the first FET cycle after TCRA have different results in patients with different degrees of adhesion. In patients with moderate adhesions, there are 17 clinical indicators that affect the live birth rate. In patients with severe adhesions, the artificial cycle is an independent factor affecting the live birth rate.

Objective By analyzing the causes of coding errors of lower extremity arteriosclerosis occlusion with throm-bosis and the endovascular intervention,explore the principle diagnosis and intervention coding rules to improve coding quality.Methods Inpatient medical records with the principle diagnosis codes of I70-I74 and I77 accompanied by endovascular interven-tional from January 1,2023 to December 31,2023 were retrieved from a tertiary hospital.A retrospective study was conducted to analyze the causes of coding errors.Results A total of 924 eligible cases were selected.There were 41 principle diagnosis cod-ing errors,with an error rate of 4.43％,among which the lower limb atherosclerosis coding had the highest error rate,accounting for 1.30％.There were 46 intervention coding errors,with an error rate of 4.98％,among which the percutaneous thrombectomy had the highest error rate.The main reason for coding errors was insufficient reading of medical record.Conclusion The coding error rate of the principle diagnosis of lower extremity arteriosclerosis occlusion and the endovascular intervention were relatively high.Therefore,it is necessary to continuously strengthen the training of clinicians and coders,including the coding rules and clinical knowledge of specialized disciplines,actively communicate between coders and clinicians,establish a quality control and assessment system,so as to improve the coding quality.

Objective By analyzing the causes of coding errors of lower extremity arteriosclerosis occlusion with throm-bosis and the endovascular intervention,explore the principle diagnosis and intervention coding rules to improve coding quality.Methods Inpatient medical records with the principle diagnosis codes of I70-I74 and I77 accompanied by endovascular interven-tional from January 1,2023 to December 31,2023 were retrieved from a tertiary hospital.A retrospective study was conducted to analyze the causes of coding errors.Results A total of 924 eligible cases were selected.There were 41 principle diagnosis cod-ing errors,with an error rate of 4.43％,among which the lower limb atherosclerosis coding had the highest error rate,accounting for 1.30％.There were 46 intervention coding errors,with an error rate of 4.98％,among which the percutaneous thrombectomy had the highest error rate.The main reason for coding errors was insufficient reading of medical record.Conclusion The coding error rate of the principle diagnosis of lower extremity arteriosclerosis occlusion and the endovascular intervention were relatively high.Therefore,it is necessary to continuously strengthen the training of clinicians and coders,including the coding rules and clinical knowledge of specialized disciplines,actively communicate between coders and clinicians,establish a quality control and assessment system,so as to improve the coding quality.

Performance appraisal of public hospitals have given a guidance for the development of public hospitals at all levels.A Class A tertiary hospital reviewed the problems in the development of the hospital at the present stage and focused on the following four aspects:①insufficient fine management;②No clear orientation of discipline development;③The bottleneck of the improvement of medical operation efficiency;④New challenges in the reform of payment mode.The tertiary hospital launched a fine management practice in May 2022,in order to solve the problems by taking the Department of Surgery as a pilot area,laying the foundation for fine management through information system construction,improving the efficiency of medical operation through management process optimization,improving the overall competitiveness of disciplines through the construction of sub-specialty and Discipline Alliance and adjusting the performance appraisal index system to play the role of performance incentives.The measures effectively improve the overall capacity and efficiency of hospital medical services and help the hospital to achieve high-quality development.

Objective:To investigate the clinical efficacy and possible mechanism of Sanjie analgesic capsule combined with levonorgestrel intrauterine birth control system in the treatment of adenomyosis with phlegm-stasis interjunction.Methods:Eighty-six cases of adenomyosis with phlegm-stasis interjunction were randomly divided into the observation group (44 cases) and the control group (42 cases). The control group was given levonorgestrel intrauterine birth control system treatment, and the observation group was given Sanjie analgesic capsule combined with levonorgestrel intrauterine birth control system treatment. After 6 months of treatment, the traditional Chinese medicine (TCM) syndrome scores, follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E 2), progesterone (P), vascular endothelial growth factor (VEGF), angiopoietin-2 (Ang-2), insulin like growth factor (IGF-1), transforming growth factor-β 1(TGF- β 1), clinical efficacy, adverse reactions were compared between the two groups. Results:After treatment, the TCM syndrome scores in the observation group was lower than that in the control group: (7.57 ± 1.23) scores vs. (9.32 ± 1.45) scores, there was statistical difference ( P<0.05). After treatment, the levels of FSH, LH, E 2, P in the observation group were lower than those in the control group: (5.54 ± 1.21) U/L vs. (7.62 ± 1.36) U/L, (4.43 ± 1.05) U/L vs. (6.14 ± 1.15) U/L, (83.54 ± 12.36) μg/L vs. (92.45 ± 11.56) μg/L, (9.64 ± 1.43) pmol/L vs. (11.36 ± 1.52) pmol/L, there were statistical differences ( P<0.05). After treatment, the levels of VEGF, Ang-2, IGF-1, TGF- β 1 in the observation group were lower than those in the control group: (114.32 ± 15.41) ng/L vs. (162.45 ± 16.32) ng/L, (156.14 ± 20.45) ng/L vs. (186.53 ± 22.36) ng/L, (135.21 ± 15.52) ng/L vs. (151.23 ± 16.21) ng/L, (13.43 ± 2.24) ng/L vs. (16.36 ± 2.51) ng/L, there were statistical differences ( P<0.05). After treatment, the clinical efficacy in the observation group was higher than that in the control group and the adverse reactions was lower than that in the control group: 84.09%(37/44) vs. 64.29%(27/42), 13.64%(6/44) vs. 33.33%(14/42), there were statistical differences ( χ2 = 4.73 and 4.67, P<0.05). Conclusions:For adenomyosis with phlegm-stasis interjunction, the combination of Sanjie analgesic capsule and levonorgestrel intrauterine birth control system can improve the clinical symptoms of patients, improve treatment effectiveness, and reduce the occurrence of adverse reactions, which may be related to factors such as inhibiting estrogen, progesterone and vascular associated growth factors.

Transdermal preparations can effectively avoid the first-pass effect and have good clinical medication compliance.Transfersomes(TF),as a novel deformable lipid vesicle with good skin penetration efficiency and encapsulation rate,exert their efficacy by maintaining stable plasma concentration in vivo.They are novel transdermal absorption preparations with great development prospects.This article summarized the current research on TF,including the preparation technology,evaluation indexes,and clinical application,and prospected its research prospects.

Objective To analyze the basic characteristics of 1885 inpatients with rare diseases in a 3A hospital from January 1 to December 31,2023,so as to provide reference for the management of diagnosis and treatment of rare diseases and the formulation of policies.Methods Based on the medical record homepage data of rare disease inpatients in a tertiary hospital in 2023,analyze the basic characteristics and hospitalization cost structure of rare disease inpatients.Results The hospital ad-mitted 1 885 inpatients with rare diseases in 2023,accounting for 0.81％of the total number of discharged patients,with a male-to-female ratio close to 1:1.Patients aged over 60 accounted for 45.57％,followed by patients aged 45-59(26.47％),patients aged 19-44(20.9％)ranked third,and patients under 18 accounted for less.Rare diseases cover 11 disease classification sys-tems and including 80 diseases,which accounts for 38.65％of the rare diseases in the catalogue.The top ten diseases accounted for 70.56％of the total number of patients,and the top three diseases were progressive fibrosing interstitial lung disease,idio-pathic pulmonary fibrosis and primary biliary cholangitis.Patients under 1 year old accounted for 0.08％,patients aged 2-18 years accounted for 5.19％,patients aged 19-44 years accounted for 19.55％,patients aged 45-59 years accounted for 26.62％,and patients over 60 years old accounted for 48.57％.There was a large difference in the male-female ratio in four diseases:idio-pathic pulmonary fibrosis,amyotrophic lateral sclerosis,Takayasu's arteritis,and primary biliary cholangitis.From the perspec-tive of cost structure,the top ten rare diseases account for a high proportion of diagnosis fees,medicine fees and consumables fees.Conclusion Patients account for a high proportion of rare disease inpatients in the hospital and have a wide coverage of disease types.The overall male-female ratio of patients with rare diseases is similar,but the characteristics of the diseases are dif-ferent.The characteristics of rare diseases determine the structural characteristics of hospitalization expenses.Hospitals should improve the discipline construction and provide more resources for the diagnosis and treatment of rare diseases.To make guide-lines for the diagnosis and treatment of rare diseases and strengthen the training of doctors,so as to realize the early diagnosis and treatment of rare diseases.The state should continue to promote access to medication for rare diseases.

Objective:To evaluate the effect of urethral stent tube irrigation in preventing postoperative complications in adolescents with hypospadias.Methods:A retrospective analysis was conducted using the clinical data of adolescents with hypospadias treated at the Department of Urology, Children’s Hospital of Chongqing Medical University, from April 2016 to July 2023. Patients were divided into control group and study group according to whether urethral stent tube was inserted in urethra during operation. All surgeries were performed by the same surgeon. For two days before surgery, patients were instructed to cleanse the surgical site daily with body wash and a 5% povidone-iodine solution. In the control group, patients received postoperative care with an indwelling urinary catheter. In the study group, in addition to the urinary catheter, a urethral stent tube was placed in the posterior urethra, and postoperative urethral irrigation with saline was performed. Postoperative complications, including wound infection, urethral fistula, urethral stricture, and urethral diverticulum, were monitored. Categorical data were expressed as frequencies and percentages and were analyzed using the χ2 test or Monte Carlo-based χ2 test. Continuous data with normal distribution are presented as Mean±SD and were analyzed using the t-test. Non-normally distributed continuous data were expressed as M ( Q1, Q3) and were analyzed using the Wilcoxon rank-sum test. P<0.05 was considered statistically significant. Results:A total of 76 patients were enrolled in the study, with 43 patients in the control group [median age 12.9(12.2, 13.7) years, reconstructed urethral length (3.88±1.86) cm] and 33 patients in the study group [median age 12.5(11.3, 14.1) years, reconstructed urethral length (3.30±1.45)cm]. Postoperatively, 32 patients (74.4%) in the control group experienced complications, including 24 cases (55.8%) of wound infection, 16 cases (37.2%) of urethral fistula, 6 cases (14.0%) of urethral stricture, and 2 cases (4.7%) of diverticulum. In the study group, only 1 patient (3.0%) developed both wound infection and urethral fistula. The incidence of wound infection, urethral fistula, and overall complications was significantly lower in the study group than in the control group (all P<0.01). Conclusion:Postoperative urethral stent irrigation in adolescents with hypospadias significantly reduces the incidence of wound infection and urethral fistula.

Objective To analyze the basic characteristics of 1885 inpatients with rare diseases in a 3A hospital from January 1 to December 31,2023,so as to provide reference for the management of diagnosis and treatment of rare diseases and the formulation of policies.Methods Based on the medical record homepage data of rare disease inpatients in a tertiary hospital in 2023,analyze the basic characteristics and hospitalization cost structure of rare disease inpatients.Results The hospital ad-mitted 1 885 inpatients with rare diseases in 2023,accounting for 0.81％of the total number of discharged patients,with a male-to-female ratio close to 1:1.Patients aged over 60 accounted for 45.57％,followed by patients aged 45-59(26.47％),patients aged 19-44(20.9％)ranked third,and patients under 18 accounted for less.Rare diseases cover 11 disease classification sys-tems and including 80 diseases,which accounts for 38.65％of the rare diseases in the catalogue.The top ten diseases accounted for 70.56％of the total number of patients,and the top three diseases were progressive fibrosing interstitial lung disease,idio-pathic pulmonary fibrosis and primary biliary cholangitis.Patients under 1 year old accounted for 0.08％,patients aged 2-18 years accounted for 5.19％,patients aged 19-44 years accounted for 19.55％,patients aged 45-59 years accounted for 26.62％,and patients over 60 years old accounted for 48.57％.There was a large difference in the male-female ratio in four diseases:idio-pathic pulmonary fibrosis,amyotrophic lateral sclerosis,Takayasu's arteritis,and primary biliary cholangitis.From the perspec-tive of cost structure,the top ten rare diseases account for a high proportion of diagnosis fees,medicine fees and consumables fees.Conclusion Patients account for a high proportion of rare disease inpatients in the hospital and have a wide coverage of disease types.The overall male-female ratio of patients with rare diseases is similar,but the characteristics of the diseases are dif-ferent.The characteristics of rare diseases determine the structural characteristics of hospitalization expenses.Hospitals should improve the discipline construction and provide more resources for the diagnosis and treatment of rare diseases.To make guide-lines for the diagnosis and treatment of rare diseases and strengthen the training of doctors,so as to realize the early diagnosis and treatment of rare diseases.The state should continue to promote access to medication for rare diseases.