ObjectiveTo investigate the mechanism of the modified of Bazhentang combined with Guishentang in improving pregnancy outcomes in mouse models of embryo implantation dysfunction by regulating T helper 1/T helper 2 （Th1/Th2） immune balance. MethodsEighty ICR female mice were randomly divided into four groups （n=20 per group） on gestational day 1 （GD1）： control， model， western medicine， and traditional Chinese medicine （TCM） groups. Except for the control group， all mice received mifepristone solution （0.2 mg/mouse） via oral gavage on GD4 to induce embryo implantation dysfunction. The TCM group received a water decoction of the modified of Bazhentang combined with Guishentang （20.8 g·kg^-1）， with the western medicine group administered dydrogesterone （3.9 mg·kg^-1）， and the control/model groups given equal volumes of saline. All treatments were administered once daily from GD1 until one day before sample collection. Outcomes included implantation site counts （macroscopic observation）， pregnancy rates， body weight， endometrial histopathology （hematoxylin-eosin staining）， uterine expression of T-box expressed in T cells （T-bet）， GATA-binding protein 3 （GATA3）， interferon gamma （IFN-γ）， and interleukin-4 （IL-4） at protein （Western blot） and mRNA （real-time polymerase chain reaction， Real-time PCR） levels， serum IFN-γ and IL-4 levels （enzyme-linked immunosorbent assay， ELISA）， and Th1/Th2 immune balance evaluated by calculating T-bet/GATA3 and IFN-γ/IL-4 ratios. ResultsCompared to the control group， the model group showed no significant change in pregnancy rate but exhibited a marked reduction in average implantation sites and body weight （P<0.01）. Histopathological analysis revealed endometrial abnormalities， including decreased glandular density， stromal compaction， and absence of nucleolar vacuoles. At the molecular level， uterine tissue in the model group demonstrated significantly upregulated expression of T-bet and IFN-γ （P<0.05， P<0.01）， alongside markedly downregulated GATA3 and IL-4 expression （P<0.05， P<0.01）. Serum analysis confirmed markedly elevated IFN-γ （P<0.01） and reduced IL-4 levels （P<0.01）， resulting in significantly increased T-bet/GATA3 and IFN-γ/IL-4 ratios （P<0.01）. Compared to the model group， pregnancy rates in all treatment groups showed no significant change. Implantation sites and body weight increased substantially （P<0.01）， with restored endometrial morphology characterized by enhanced glandular density， stromal edema， and reappearance of nucleolar vacuoles. Significant downregulation of T-bet and IFN-γ （P<0.01） and upregulation of GATA3 and IL-4 （P<0.05， P<0.01） in uterine tissue were observed. Serum IFN-γ levels were significantly reduced （P<0.05， P<0.01）， while IL-4 levels were significantly elevated （P<0.05）. The Th1/Th2 ratios were significantly decreased （P<0.01）. ConclusionThe modified of Bazhentang combined with Guishentang significantly enhances the number of embryo implantation sites in mice with embryo implantation dysfunction， potentially through modulating T-bet/GATA3 expression， restoring Th1/Th2 immune balance， and improving endometrial receptivity.

Objective To investigate the factors influencing international normalized ratio (INR)>3.0 in patients undergoing warfarin anticoagulation therapy after mechanical heart valve replacement. Methods A retrospective analysis was performed on the clinical data of patients who underwent mechanical heart valve replacement surgery and received warfarin anticoagulation therapy at West China Hospital of Sichuan University from January 1, 2011 to June 30, 2022. Based on the discharge INR values, patients were divided into two groups: an INR≤3.0 group and an INR>3.0 group. The factors associated with INR>3.0 at the time of discharge were analyzed. Results A total of 8901 patients were enrolled, including 3409 males and 5492 females, with a median age of 49.3 (43.5, 55.6) years. The gender, body mass index (BMI), New York Heart Association (NYHA) cardiac function grading, INR, glutamic oxaloacetic transaminase, and preoperative prothrombin time (PT) were statistically different between the two groups (P<0.05). Multivariate logistic regression analysis revealed that lower BMI, preoperative PT>15 s, and mitral valve replacement were independent risk factors for INR>3.0 at discharge (P<0.05). Conclusion BMI, preoperative PT, and surgical site are factors influencing INR>3.0 at discharge in patients undergoing warfarin anticoagulation therapy after mechanical heart valve replacement. Special attention should be given to patients with lower BMI, longer preoperative PT, and mitral valve replacement to avoid excessive anticoagulation therapy.

Objective:To investigate the risk factors for delirium after free flap reconstruction surgery in elderly patients with head and neck cancer.Methods:This study retrospectively collected clinical data from 309 elderly patients with head and neck cancer who underwent radical resection and free flap reconstruction surgery in the Department of Operation & Anesthesiology, College & Hospital of Stomatology, Guangxi Medical University from January 2018 to December 2022. Among them, there were 197 males (63.8%) and 112 females (36.2%), with an average age of (66.8±5.5) years old. Based on the delirium diagnostic criteria outlined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, patients were evaluated for postoperative delirium within one week after surgery. They were then divided into a delirium group ( n=75) and a non-delirium group ( n=234). Perioperative indicators potentially related to postoperative delirium, including age, gender, past medical history, tumor characteristics, hematological tests, perioperative sleep disturbances, surgical procedures, intraoperative fluid intake and output, anesthetic dosage, postoperative pain, etc, were collected from the relevant medical record system.Variables with P<0.05 were included in a multivariate Logistic regression model to screen for independent risk factors for delirium. Results:The incidence of delirium after free flap reconstruction surgery for head and neck cancer in elderly patients was 24.3% (75/309). Multivariate Logistic regression analysis showed that male gender ( OR=2.802, P=0.005), perioperative sleep disturbances ( OR=7.104, P<0.001), and moderate-to-severe postoperative pain ( OR=6.903, P<0.001) were risk factors for postoperative delirium. Conclusions:Male gender, perioperative sleep disturbances, and moderate-to-severe postoperative pain are independent risk factors for delirium in these patients.

Objective To investigate the effects of Bushen Shengjing Tiaohe Qixue Prescription on rats with diminished ovarian reserve(DOR)based on Wnt/β-catenin signaling pathway.Methods Totally 60 8-week-old SD female rats were randomly divided into control group,model group,estradiol valerate group and TCM low-,medium-and high-dosage groups,with 10 rats in each group.Except for the control group,the rats in the other groups were given a single intraperitoneal injection of cyclophosphamide 75 mg/kg to replicate the DOR rat model.From the next day of modeling,the corresponding drugs was administered for medication groups by gavage for 3 weeks.The general conditions of the rats were observed,ELISA was used to detect the contents of serum follicle-stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2),anti-mullerian hormone(AMH)and inhibin B(INHB),HE staining was used to observe the morphologic changes in ovarian tissue,Western blot was used to detect GSK3β,β-catenin,CyclinD1 and c-MYC protein expressions in ovarian tissues,immunohistochemical staining was used to observe β-catenin expression in ovarian tissue,RT-qPCR was used to detect Wnt1,Wnt2,Wnt4,GSK3β,β-catenin,CyclinD1 and c-MYC mRNA expression in ovarian tissue,transmission electron microscopy was used to observe ultrapathologic structure of ovarian granulosa cells.Results Compared with the control group,the rats in the model group had reduced intake of food and water,slow or even reduced body mass gain,and disturbed estrous cycle,the serum contents of FSH and LH increased(P<0.01),the contents of E2,AMH and INHB decreased(P<0.01);the number of follicles of all levels in ovarian tissue was reduced,and there was increased number of atretic follicles with disturbed arrangement of the granulosa cells;the expression of GSK3β protein in ovarian tissue increased(P<0.01),the expression of β-catenin,CyclinD1 and c-MYC protein decreased(P<0.05,P<0.01),and β-catenin positive expression decreased(P<0.01),the expression of Wnt1,Wnt2,Wnt4,β-catenin,CyclinD1 and c-MYC mRNA in ovarian tissue decreased(P<0.01),GSK3β mRNA expression was increased(P<0,01);organelles such as mitochondria and nuclei of ovarian granulosa cells were highly swollen and partially lysed.Compared with the model group,the rats in the administered group all had different degrees of body mass increase,partial restoration of the motility cycle,serum FSH and LH contents decreased,and serum E2,AMH and INHB contents increased(P<0.01,P<0.05);the number of follicles at all levels in ovarian tissue increased to varying degrees,and the atretic follicles were reduced;the expression of GSK3β protein in ovarian tissue decreased,β-catenin,CyclinD1 and c-MYC protein expressions increased,β-catenin positive expression increased,the expression of Wnt1,Wnt2,Wnt4,β-catenin,CyclinD1 and c-MYC mRNA in ovarian tissue increased,and GSK3β mRNA expression decreased,with statistical significance in estradiol valerate group and TCM high-dosage group(P<0.05,P<0.01);mitochondria,endoplasmic reticulum and other organelles of ovarian granulosa cells were mildly to moderately swollen.Conclusion Bushen Shengjing Tiaohe Qixue Prescription can improve ovarian function and regulate serum sex hormone levels in DOR model rats,and its mechanism might be related to the activation of Wnt/β-catenin signaling pathway.

Objective To evaluate the effect of target oriented infusion guided by stroke volume variation(SVV)in elderly lumbar surgery.Method From January to December 2023,80 elderly patients undergoing elective general anesthesia for prone lumbar surgery were divided into two groups by random number table method:SVV guidance target-oriented infusion group(SVV group)and conventional infusion group(conventional group),with 40 cases in each group.The amount of infusion,blood loss,urine volume and use of vasoactive drugs in the two groups were recorded.MAP,HR,blood lactate concentration(Lac),base residual value(BE),and PaO2 were recorded at the time of entry(T1),before cuticle(T2),1 hour after prone position(T3),and after surgery(T4).Pulmonary ultrasound examinations were performed at 4,8,12 and 24 hours after surgery,and B-line scores were calculated,as well as the incidence of cardiac insufficiency,nausea,vomiting,delirium and hospital stay at 24 hours after surgery.Result Compared with normal group,in group SVV,intraoperative infusion volume[(1123+532)ml],vascular active drug utilization rate(15.0％),postoperative each point B line score[(1.55±1.32),(1.22±0.94),(1.01±0.93),(1.07±0.90)]were reduced(P＜0.05).HR at T2～T4[(67±8,71±11,73±12)times/min]、PaO2 at T3,T4[(438±41,423±44)mmHg]were increased,Lac and BE at T2～T4 were(0.3±0.5,1.4±0.5,1.4±0.3)mmol/L.(0.3±0.6,0.3±1.0,0.3±1.1)was decreased(P＜0.05).There were no significant differences between the two groups in cardiac dysfunction,nausea,vomiting,delirium and hospital stay after a 24-hour postoperative period(P＞0.05).Conclusion SVV guided target oriented infusion in elderly lumbar surgery is beneficial to circulation stability and tissue perfusion,and reduces the production of lung water.

Objective:To explore the occupational adaptability of psychiatric medical caregivers from the perspective of a composite ecosystem.Methods:Using purposive sampling combining with snowball sampling and based on ecosystem theory, an interview outline was set up to conduct semi-structured interviews with psychiatric medical caregivers from October to December 2023. The Colaizzi 7-step analysis method was used to extract the themes.Results:Totally 15 psychiatric medical caregivers aged 44-61 years, 4 males and 11 females. There were three themes in the study: microsystems-changes in cognition, emotion, and physical and mental health; mid-level system-support and difficulties for families, hospitals, and nursing staff institutions; the macro system-social psychological support system was lacking.Conclusions:Psychiatric medical caregivers lack professional knowledge, have more negative emotions in their emotional experiences, and have a serious lack of mental health support systems. There are biases and misunderstandings towards them in society. It is recommended that managers pay attention to the physical and mental health of psychiatric caregivers and improve their work adaptability.

Objective:To investigate the risk factors for delirium after free flap reconstruction surgery in elderly patients with head and neck cancer.Methods:This study retrospectively collected clinical data from 309 elderly patients with head and neck cancer who underwent radical resection and free flap reconstruction surgery in the Department of Operation & Anesthesiology, College & Hospital of Stomatology, Guangxi Medical University from January 2018 to December 2022. Among them, there were 197 males (63.8%) and 112 females (36.2%), with an average age of (66.8±5.5) years old. Based on the delirium diagnostic criteria outlined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, patients were evaluated for postoperative delirium within one week after surgery. They were then divided into a delirium group ( n=75) and a non-delirium group ( n=234). Perioperative indicators potentially related to postoperative delirium, including age, gender, past medical history, tumor characteristics, hematological tests, perioperative sleep disturbances, surgical procedures, intraoperative fluid intake and output, anesthetic dosage, postoperative pain, etc, were collected from the relevant medical record system.Variables with P<0.05 were included in a multivariate Logistic regression model to screen for independent risk factors for delirium. Results:The incidence of delirium after free flap reconstruction surgery for head and neck cancer in elderly patients was 24.3% (75/309). Multivariate Logistic regression analysis showed that male gender ( OR=2.802, P=0.005), perioperative sleep disturbances ( OR=7.104, P<0.001), and moderate-to-severe postoperative pain ( OR=6.903, P<0.001) were risk factors for postoperative delirium. Conclusions:Male gender, perioperative sleep disturbances, and moderate-to-severe postoperative pain are independent risk factors for delirium in these patients.

Objective To evaluate the effect of target oriented infusion guided by stroke volume variation(SVV)in elderly lumbar surgery.Method From January to December 2023,80 elderly patients undergoing elective general anesthesia for prone lumbar surgery were divided into two groups by random number table method:SVV guidance target-oriented infusion group(SVV group)and conventional infusion group(conventional group),with 40 cases in each group.The amount of infusion,blood loss,urine volume and use of vasoactive drugs in the two groups were recorded.MAP,HR,blood lactate concentration(Lac),base residual value(BE),and PaO2 were recorded at the time of entry(T1),before cuticle(T2),1 hour after prone position(T3),and after surgery(T4).Pulmonary ultrasound examinations were performed at 4,8,12 and 24 hours after surgery,and B-line scores were calculated,as well as the incidence of cardiac insufficiency,nausea,vomiting,delirium and hospital stay at 24 hours after surgery.Result Compared with normal group,in group SVV,intraoperative infusion volume[(1123+532)ml],vascular active drug utilization rate(15.0％),postoperative each point B line score[(1.55±1.32),(1.22±0.94),(1.01±0.93),(1.07±0.90)]were reduced(P＜0.05).HR at T2～T4[(67±8,71±11,73±12)times/min]、PaO2 at T3,T4[(438±41,423±44)mmHg]were increased,Lac and BE at T2～T4 were(0.3±0.5,1.4±0.5,1.4±0.3)mmol/L.(0.3±0.6,0.3±1.0,0.3±1.1)was decreased(P＜0.05).There were no significant differences between the two groups in cardiac dysfunction,nausea,vomiting,delirium and hospital stay after a 24-hour postoperative period(P＞0.05).Conclusion SVV guided target oriented infusion in elderly lumbar surgery is beneficial to circulation stability and tissue perfusion,and reduces the production of lung water.

Objective To investigate the effects of Bushen Shengjing Tiaohe Qixue Prescription on rats with diminished ovarian reserve(DOR)based on Wnt/β-catenin signaling pathway.Methods Totally 60 8-week-old SD female rats were randomly divided into control group,model group,estradiol valerate group and TCM low-,medium-and high-dosage groups,with 10 rats in each group.Except for the control group,the rats in the other groups were given a single intraperitoneal injection of cyclophosphamide 75 mg/kg to replicate the DOR rat model.From the next day of modeling,the corresponding drugs was administered for medication groups by gavage for 3 weeks.The general conditions of the rats were observed,ELISA was used to detect the contents of serum follicle-stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2),anti-mullerian hormone(AMH)and inhibin B(INHB),HE staining was used to observe the morphologic changes in ovarian tissue,Western blot was used to detect GSK3β,β-catenin,CyclinD1 and c-MYC protein expressions in ovarian tissues,immunohistochemical staining was used to observe β-catenin expression in ovarian tissue,RT-qPCR was used to detect Wnt1,Wnt2,Wnt4,GSK3β,β-catenin,CyclinD1 and c-MYC mRNA expression in ovarian tissue,transmission electron microscopy was used to observe ultrapathologic structure of ovarian granulosa cells.Results Compared with the control group,the rats in the model group had reduced intake of food and water,slow or even reduced body mass gain,and disturbed estrous cycle,the serum contents of FSH and LH increased(P<0.01),the contents of E2,AMH and INHB decreased(P<0.01);the number of follicles of all levels in ovarian tissue was reduced,and there was increased number of atretic follicles with disturbed arrangement of the granulosa cells;the expression of GSK3β protein in ovarian tissue increased(P<0.01),the expression of β-catenin,CyclinD1 and c-MYC protein decreased(P<0.05,P<0.01),and β-catenin positive expression decreased(P<0.01),the expression of Wnt1,Wnt2,Wnt4,β-catenin,CyclinD1 and c-MYC mRNA in ovarian tissue decreased(P<0.01),GSK3β mRNA expression was increased(P<0,01);organelles such as mitochondria and nuclei of ovarian granulosa cells were highly swollen and partially lysed.Compared with the model group,the rats in the administered group all had different degrees of body mass increase,partial restoration of the motility cycle,serum FSH and LH contents decreased,and serum E2,AMH and INHB contents increased(P<0.01,P<0.05);the number of follicles at all levels in ovarian tissue increased to varying degrees,and the atretic follicles were reduced;the expression of GSK3β protein in ovarian tissue decreased,β-catenin,CyclinD1 and c-MYC protein expressions increased,β-catenin positive expression increased,the expression of Wnt1,Wnt2,Wnt4,β-catenin,CyclinD1 and c-MYC mRNA in ovarian tissue increased,and GSK3β mRNA expression decreased,with statistical significance in estradiol valerate group and TCM high-dosage group(P<0.05,P<0.01);mitochondria,endoplasmic reticulum and other organelles of ovarian granulosa cells were mildly to moderately swollen.Conclusion Bushen Shengjing Tiaohe Qixue Prescription can improve ovarian function and regulate serum sex hormone levels in DOR model rats,and its mechanism might be related to the activation of Wnt/β-catenin signaling pathway.

OBJECTIVE To understand the drug resistance among the acquired immune deficiency syndrome(AIDS)population who failed in the antiviral therapy from 2022 to 2023 and analyze the molecular network.METHODS The plasma specimens were collected from the population with viral load no less than 1000 cps/ml who received antiviral therapy for more than 6 months in Aksu area from 2022 to 2023,which were delivered to Aksu Regional Center for Disease Control and Prevention for test.MEGA5 and the Stanford University drug resistance database were employed to determine the subtypes and drug resistance after the sequences of human immunodefi-ciency virus type Ⅰ polymerase gene region(HIV-1pol)were obtained,and the molecular network was established by HIV-trace.RESULTS Totally 648 sequences of HIV-1pol region were obtained,CRF07_BC(97.69％)was the major subtype,and the drug resistance rate was 58.33％;the drug resistance rates to non-nucleoside reverse transcriptase inhibitor(NNRTI),nucleoside reverse transcriptase inhibitor(NRTI)and protease inhibitor(PI)were 51.70％,19.75％and8.64％,respectively.The univariate analysis showed that year(x2=6.341),age(x2=18.455)and route of infection(x2=14.061)had remarkable effects on the drug resistance among the population with failed ART(P＜0.05).Multivariate regression analysis indicated that the drug resistance rate was higher in 2022 than in 2023(95％CI:1.132 to 2.191),and the drug resistance rate was higher among the population aged less than 60 years old than among the population more than 6 years old(95％CI:3.647 to 70.268,95％CI:1.435 to 8.235,95％CI:1.061 to 6.164,re-spectively).With 1.5％of the genetic distance set as the threshold,the molecular network was established,the network access rate was 49.07％,77.14％of the clusters had drug-resistant mutation sites,and the male population was at higher risk of network access than the female population.CONCLUSIONS The drug resistance rate is relatively high among the AIDS population with failed ART,and the drug-resistant strains appear in clusters in the molecular network.It is neces-sary to further strengthen the monitoring of drug resistance and improve the quality of the follow-up so as to reduce the occurrence of drug resistance and transmission of virulent strains.