Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective:To investigate whether hysteroscopic transcervical resection of septum (TCRS) prior to in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) can improve cumulative live birth rates in patients with uterine septum. Methods:A retrospective cohort study was conducted to analyze data from 244 patients with partial uterine septum who underwent IVF/ICSI at the Reproductive Medicine Center of the Third Affiliated Hospital of Zhengzhou University between January 2016 and August 2022. The patients were divided into a surgical group ( n=171) and a non-surgical group ( n=73) based on whether TCRS was performed prior to IVF/ICSI. The clinical outcomes of IVF/ICSI in the two groups were analyzed, with the primary observation indicator being the cumulative live birth rate. Cox regression analysis was employed to identify determinants. Results:The age of patients in the operated group [(31.20±3.80) years] was younger than that in the non-operated group [(32.92±5.34) years, P=0.005], and the basal antral follicle count [17.0 (11.0, 24.0)] was higher than that in the non-operated group [14.0 (8.0, 21.5), P=0.039]. There were no significant differences in other baseline data (all P>0.05). The cumulative pregnancy rate [79.53% (136/171)] and the cumulative live birth rate [60.23% (103/171)] in the operated group during the 24-month follow-up period were significantly higher than those in the non-operated group [65.75% (48/73), P=0.022; 45.21% (33/73), P=0.030]. Compared with the operated group [296.0 (260.0, 430.0) d], the duration from the start of ovarian stimulation to the first live birth was significantly prolonged in the non-operated group [379.0 (329.5, 471.5) d, P<0.001]. Adjusted Cox-regression analysis showed that whether or not surgery was performed ( HR=1.683, 95% CI: 1.116-2.539, P=0.013) and the basal antral follicle count ( HR=1.032, 95% CI: 1.000-1.065, P=0.048) were independent factors affecting cumulative live birth rate. Conclusion:Performing TCRS before IVF/ICSI can improve cumulative live birth rates of patients with uterine septum.

Objective:To investigate whether hysteroscopic transcervical resection of septum (TCRS) prior to in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) can improve cumulative live birth rates in patients with uterine septum. Methods:A retrospective cohort study was conducted to analyze data from 244 patients with partial uterine septum who underwent IVF/ICSI at the Reproductive Medicine Center of the Third Affiliated Hospital of Zhengzhou University between January 2016 and August 2022. The patients were divided into a surgical group ( n=171) and a non-surgical group ( n=73) based on whether TCRS was performed prior to IVF/ICSI. The clinical outcomes of IVF/ICSI in the two groups were analyzed, with the primary observation indicator being the cumulative live birth rate. Cox regression analysis was employed to identify determinants. Results:The age of patients in the operated group [(31.20±3.80) years] was younger than that in the non-operated group [(32.92±5.34) years, P=0.005], and the basal antral follicle count [17.0 (11.0, 24.0)] was higher than that in the non-operated group [14.0 (8.0, 21.5), P=0.039]. There were no significant differences in other baseline data (all P>0.05). The cumulative pregnancy rate [79.53% (136/171)] and the cumulative live birth rate [60.23% (103/171)] in the operated group during the 24-month follow-up period were significantly higher than those in the non-operated group [65.75% (48/73), P=0.022; 45.21% (33/73), P=0.030]. Compared with the operated group [296.0 (260.0, 430.0) d], the duration from the start of ovarian stimulation to the first live birth was significantly prolonged in the non-operated group [379.0 (329.5, 471.5) d, P<0.001]. Adjusted Cox-regression analysis showed that whether or not surgery was performed ( HR=1.683, 95% CI: 1.116-2.539, P=0.013) and the basal antral follicle count ( HR=1.032, 95% CI: 1.000-1.065, P=0.048) were independent factors affecting cumulative live birth rate. Conclusion:Performing TCRS before IVF/ICSI can improve cumulative live birth rates of patients with uterine septum.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective:To explore the effect of body fat percent (BFP) on assisted reproductive outcomes in infertile women undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) and fresh embryo transfer. Methods:We analyzed clinical data on infertile women in a retrospective cohort study, who underwent IVF/ICSI and embryo transfer at the Reproductive Health Hospital of the Third Affiliated Hospital of Zhengzhou University from March 2022 to October 2023. The study subjects were divided into non-obese group (BFP<35%, 800 cases) and obese group (BFP≥35%, 742 cases) according to BFP. The baseline data, ovulation induction outcomes and clinical pregnancy outcomes were compared between the two groups.Results:1) The body mass index [BMI, 25.85 (24.22, 28.04) kg/m 2], basal testosterone [0.80 (0.45, 1.12) nmol/L], triglyceride [1.29 (1.03, 1.59) mmol/L], serum total cholesterol [4.55 (4.29, 4.81) mmol/L], low-density lipoprotein cholesterol [3.17 (2.90, 3.40) mmol/L], fasting glucose [5.40 (5.10, 5.75) mmol/L], fasting insulin [12.99 (9.01, 18.31) mU/L], homeostasis model assessment-insulin resistance [3.09 (2.14, 4.50)], antral follicle count [16.00 (11.00, 22.00)], the patients combined with polycystic ovary syndrome [9.4% (70/742)] in obese group were significantly higher than those in non-obese group [21.94 (20.32, 23.51) kg/m 2, P<0.001; 0.69 (0.43, 0.98) nmol/L, P<0.001; 1.00 (0.79, 1.21) mmol/L, P<0.001; 4.42 (4.19, 4.66) mmol/L, P<0.001; 2.91 (2.67, 3.15) mmol/L, P<0.001; 5.22 (5.00, 5.45) mmol/L, P<0.001; 11.30 (8.33, 14.82) mU/L, P<0.001; 2.61 (1.86, 3.48), P<0.001; 14.00 (10.00, 20.00) mmol/L, P<0.001; 4.8% (38/800), P<0.001]. Basal follicle-stimulating hormone [6.58 (5.64, 7.73) U/L], basal estradiol [133.01 (102.35, 171.56) pmol/L], basal luteinizing hormone [4.80 (3.62, 6.53) U/L] and high-density lipoprotein cholesterol [1.29 (1.17, 1.39) mmol/L] in obese group were significantly lower than those in non-obese group [6.91 (5.86, 8.33) U/L, P<0.001; 145.52 (105.23, 187.95) pmol/L, P=0.001; 5.16 (3.82, 6.94) U/L, P=0.022; 1.45 (1.36, 1.55) mmol/L, P<0.001]. 2) The initiated dosage of gonadotropin (Gn) used [187.50 (150.00, 225.00) U] and the total dosage of Gn used [2 481.25 (1 856.25, 3 225.00) U] in obese group were significantly higher than those in non-obese group [225.00 (175.00, 250.00) U, P<0.001; 2 925.00 (2 250.00, 3 675.00) U, P<0.001]. Serum estradiol level on the day of human chorionic gonadotropin (hCG) injection [8 984.00 (6 087.75, 11 978.25) pmol/L], luteinizing hormone level on the day of hCG injection [1.23 (0.87, 1.79) U/L], the rate of blastocyst formation [55.56% (33.33%, 75.00%)] in obese group were significantly lower than those in non-obese group [9 378.50 (6 528.50, 12 624.50) pmol/L, P=0.016; 1.37 (0.94, 2.01) U/L, P=0.001; 60.00% (37.86%, 80.00%), P=0.014]. 3) Sustained pregnancy rate in obese group [41.5% (308/742)] was lower than that in non-obese group [47.6% (381/800), P=0.016]. The number of embryo transfer, embryo transfer type, implantation rate, clinical pregnancy rate, abortion rate and live birth rate were not statistically significant between the two groups (all P>0.05). 4) BFP was not an independent factor of clinical pregnancy rate and live birth rate (all P>0.05). 5) The area under the curve (AUC) of BMI and BFP to predict clinical pregnancy was 0.509 and 0.518, and there was no significant difference between them (AUC difference=0.009, 95% CI: -0.010-0.028, P=0.376). The AUC of BMI and BFP for predicting live birth was 0.501 and 0.513, with no statistically significant difference (AUC difference=0.012, 95% CI: -0.007-0.030, P=0.221). Conclusion:High BFP can increase total dosage of Gn used, decrease blastocyst formation rate and continuous pregnancy rate.

Objective:To investigate the factors influencing patients' willingness to have a second child after obtaining their first singleton live birth by in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). Methods:The data of patients who achieved their first single live birth via IVF/ICSI at the Reproductive Health Hospital of the Third Affiliated Hospital of Zhengzhou University were collected between July 2016 and July 2021 in a retrospective cohort study. Until July 2023, the patients were divided into the returning group ( n=1 809) and the non-returning group ( n=5 824) according to whether they returned again to receive assisted reproduction treatment for the birth of a second child. The clinical data of the two groups were compared, and the factors affecting patients' willingness to have a second child were analyzed. Results:The characteristics of the two groups of patients were compared. Variables that were statistically significant after being included in the univariate analysis were employed to construct a multivariate logistic regression equation. The results indicated that the age of the female ( OR=0.93, 95% CI: 0.91-0.94, P<0.001), the duration of infertility ( OR=0.96, 95% CI: 0.93-0.98, P=0.002), male+female factors of infertility factor ( OR=0.82, 95% CI: 0.70-0.97, P=0.023) the previous reproductive history ( OR=0.33, 95% CI: 0.27-0.42, P<0.001), the method of assisted pregnancy ( OR=1.31, 95% CI: 1.11-1.55, P=0.001), the transplantation plan ( OR=0.83, 95% CI: 0.74-0.93, P=0.002), the mode of delivery ( OR=0.63, 95% CI: 0.55-0.71, P<0.001), pregnancy complications ( OR=0.70, 95% CI: 0.60-0.82, P<0.001), the presence or absence of remaining embryos ( OR=2.67, 95% CI: 2.24-3.19, P<0.001), the gender of the first live birth ( OR=0.40, 95% CI: 0.36-0.45, P<0.001), the degree of education ( OR=0.74, 95% CI: 0.64-0.85, P<0.001), and the type of household registration ( OR=0.74, 95% CI: 0.65-0.84, P<0.001) were the influencing factors of the second-child fertility intention of patients after obtaining the first singleton live birth through IVF/ICSI. Conclusion:The age of the female, the duration of infertility, the factors of infertility, the previous reproductive history, frozen-thawed embryo transfer, cesarean section, having pregnancy complications, the gender of the first live birth being a boy, having a high school education or above, and urban household registration are negatively correlated with the patients' return visits. ICSI-assisted pregnancy and having remaining embryos are positively correlated with the patients' return visits.

Objective:To explore the effect of body fat percent (BFP) on assisted reproductive outcomes in infertile women undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) and fresh embryo transfer. Methods:We analyzed clinical data on infertile women in a retrospective cohort study, who underwent IVF/ICSI and embryo transfer at the Reproductive Health Hospital of the Third Affiliated Hospital of Zhengzhou University from March 2022 to October 2023. The study subjects were divided into non-obese group (BFP<35%, 800 cases) and obese group (BFP≥35%, 742 cases) according to BFP. The baseline data, ovulation induction outcomes and clinical pregnancy outcomes were compared between the two groups.Results:1) The body mass index [BMI, 25.85 (24.22, 28.04) kg/m 2], basal testosterone [0.80 (0.45, 1.12) nmol/L], triglyceride [1.29 (1.03, 1.59) mmol/L], serum total cholesterol [4.55 (4.29, 4.81) mmol/L], low-density lipoprotein cholesterol [3.17 (2.90, 3.40) mmol/L], fasting glucose [5.40 (5.10, 5.75) mmol/L], fasting insulin [12.99 (9.01, 18.31) mU/L], homeostasis model assessment-insulin resistance [3.09 (2.14, 4.50)], antral follicle count [16.00 (11.00, 22.00)], the patients combined with polycystic ovary syndrome [9.4% (70/742)] in obese group were significantly higher than those in non-obese group [21.94 (20.32, 23.51) kg/m 2, P<0.001; 0.69 (0.43, 0.98) nmol/L, P<0.001; 1.00 (0.79, 1.21) mmol/L, P<0.001; 4.42 (4.19, 4.66) mmol/L, P<0.001; 2.91 (2.67, 3.15) mmol/L, P<0.001; 5.22 (5.00, 5.45) mmol/L, P<0.001; 11.30 (8.33, 14.82) mU/L, P<0.001; 2.61 (1.86, 3.48), P<0.001; 14.00 (10.00, 20.00) mmol/L, P<0.001; 4.8% (38/800), P<0.001]. Basal follicle-stimulating hormone [6.58 (5.64, 7.73) U/L], basal estradiol [133.01 (102.35, 171.56) pmol/L], basal luteinizing hormone [4.80 (3.62, 6.53) U/L] and high-density lipoprotein cholesterol [1.29 (1.17, 1.39) mmol/L] in obese group were significantly lower than those in non-obese group [6.91 (5.86, 8.33) U/L, P<0.001; 145.52 (105.23, 187.95) pmol/L, P=0.001; 5.16 (3.82, 6.94) U/L, P=0.022; 1.45 (1.36, 1.55) mmol/L, P<0.001]. 2) The initiated dosage of gonadotropin (Gn) used [187.50 (150.00, 225.00) U] and the total dosage of Gn used [2 481.25 (1 856.25, 3 225.00) U] in obese group were significantly higher than those in non-obese group [225.00 (175.00, 250.00) U, P<0.001; 2 925.00 (2 250.00, 3 675.00) U, P<0.001]. Serum estradiol level on the day of human chorionic gonadotropin (hCG) injection [8 984.00 (6 087.75, 11 978.25) pmol/L], luteinizing hormone level on the day of hCG injection [1.23 (0.87, 1.79) U/L], the rate of blastocyst formation [55.56% (33.33%, 75.00%)] in obese group were significantly lower than those in non-obese group [9 378.50 (6 528.50, 12 624.50) pmol/L, P=0.016; 1.37 (0.94, 2.01) U/L, P=0.001; 60.00% (37.86%, 80.00%), P=0.014]. 3) Sustained pregnancy rate in obese group [41.5% (308/742)] was lower than that in non-obese group [47.6% (381/800), P=0.016]. The number of embryo transfer, embryo transfer type, implantation rate, clinical pregnancy rate, abortion rate and live birth rate were not statistically significant between the two groups (all P>0.05). 4) BFP was not an independent factor of clinical pregnancy rate and live birth rate (all P>0.05). 5) The area under the curve (AUC) of BMI and BFP to predict clinical pregnancy was 0.509 and 0.518, and there was no significant difference between them (AUC difference=0.009, 95% CI: -0.010-0.028, P=0.376). The AUC of BMI and BFP for predicting live birth was 0.501 and 0.513, with no statistically significant difference (AUC difference=0.012, 95% CI: -0.007-0.030, P=0.221). Conclusion:High BFP can increase total dosage of Gn used, decrease blastocyst formation rate and continuous pregnancy rate.

Objective:To investigate the factors influencing patients' willingness to have a second child after obtaining their first singleton live birth by in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). Methods:The data of patients who achieved their first single live birth via IVF/ICSI at the Reproductive Health Hospital of the Third Affiliated Hospital of Zhengzhou University were collected between July 2016 and July 2021 in a retrospective cohort study. Until July 2023, the patients were divided into the returning group ( n=1 809) and the non-returning group ( n=5 824) according to whether they returned again to receive assisted reproduction treatment for the birth of a second child. The clinical data of the two groups were compared, and the factors affecting patients' willingness to have a second child were analyzed. Results:The characteristics of the two groups of patients were compared. Variables that were statistically significant after being included in the univariate analysis were employed to construct a multivariate logistic regression equation. The results indicated that the age of the female ( OR=0.93, 95% CI: 0.91-0.94, P<0.001), the duration of infertility ( OR=0.96, 95% CI: 0.93-0.98, P=0.002), male+female factors of infertility factor ( OR=0.82, 95% CI: 0.70-0.97, P=0.023) the previous reproductive history ( OR=0.33, 95% CI: 0.27-0.42, P<0.001), the method of assisted pregnancy ( OR=1.31, 95% CI: 1.11-1.55, P=0.001), the transplantation plan ( OR=0.83, 95% CI: 0.74-0.93, P=0.002), the mode of delivery ( OR=0.63, 95% CI: 0.55-0.71, P<0.001), pregnancy complications ( OR=0.70, 95% CI: 0.60-0.82, P<0.001), the presence or absence of remaining embryos ( OR=2.67, 95% CI: 2.24-3.19, P<0.001), the gender of the first live birth ( OR=0.40, 95% CI: 0.36-0.45, P<0.001), the degree of education ( OR=0.74, 95% CI: 0.64-0.85, P<0.001), and the type of household registration ( OR=0.74, 95% CI: 0.65-0.84, P<0.001) were the influencing factors of the second-child fertility intention of patients after obtaining the first singleton live birth through IVF/ICSI. Conclusion:The age of the female, the duration of infertility, the factors of infertility, the previous reproductive history, frozen-thawed embryo transfer, cesarean section, having pregnancy complications, the gender of the first live birth being a boy, having a high school education or above, and urban household registration are negatively correlated with the patients' return visits. ICSI-assisted pregnancy and having remaining embryos are positively correlated with the patients' return visits.

Objective: To investigate the influence of extending the waiting time on tumor regression after neoadjuvant chemoradiology (nCRT) in patients with locally advanced rectal cancer (LARC). Methods: Clinicopathological data from 728 LARC patients who completed nCRT treatment at the First Affiliated Hospital, Naval Medical University from January 2012 to December 2021 were collected for retrospective analysis. The primary research endpoint was the sustained complete response (SCR). There were 498 males and 230 females, with an age (M(IQR)) of 58 (15) years (range: 22 to 89 years). Logistic regression models were used to explore whether waiting time was an independent factor affecting SCR. Curve fitting was used to represent the relationship between the cumulative occurrence rate of SCR and the waiting time. The patients were divided into a conventional waiting time group (4 to <12 weeks, n=581) and an extended waiting time group (12 to<20 weeks, n=147). Comparisons regarding tumor regression, organ preservation, and surgical conditions between the two groups were made using the t test, Wilcoxon rank sum test, or χ² test as appropriate. The Log-rank test was used to elucidate the survival discrepancies between the two groups. Results: The SCR rate of all patients was 21.6% (157/728). The waiting time was an independent influencing factor for SCR, with each additional day corresponding to an OR value of 1.010 (95%CI: 1.001 to 1.020, P=0.031). The cumulative rate of SCR occurrence gradually increased with the extension of waiting time, with the fastest increase between the 9^th to <10^th week. The SCR rate in the extended waiting time group was higher (27.9%(41/147) vs. 20.0%(116/581), χ²=3.901, P=0.048), and the organ preservation rate during the follow-up period was higher (21.1%(31/147) vs. 10.7%(62/581), χ²=10.510, P=0.001). The 3-year local recurrence/regrowth-free survival rates were 94.0% and 91.1%, the 3-year disease-free survival rates were 76.6% and 75.4%, and the 3-year overall survival rates were 95.6% and 92.2% for the conventional and extended waiting time groups, respectively, with no statistical differences in local recurrence/regrowth-free survival, disease-free survival and overall survival between the two groups (χ²=1.878, P=0.171; χ²=0.078, P=0.780; χ²=1.265, P=0.261). Conclusions: An extended waiting time is conducive to tumor regression, and extending the waiting time to 12 to <20 weeks after nCRT can improve the SCR rate and organ preservation rate, without increasing the difficulty of surgery or altering the oncological outcomes of patients.

Objective:Based on UPLC-Q-Orbitrap HRMS and network pharmacology, the material basis, processing principle and molecular mechanism of bile processed Coptidis Rhizoma (BPRC) for reducing excess fire of liver and gallbladder were elucidated.Method:The chemical ingredients of BPRC were analyzed by UPLC-Q-Orbitrap HRMS. Chromatographic separation was achieved with 0.1% formic acid solution (A)-acetonitrile (B) as the mobile phase in gradient elution (0-20 min, 5%-80%B; 20-30 min, 80%-95%B; 30-30.1 min, 95%-5%B; 30.1-35 min, 95%-5%B). The flow rate was 0.2 mL·min^-1, electrospray ionization (ESI) was applied and operated in positive and negative ion modes, the acquisition range was m/z 100-1 500. Based on the clinical manifestations and pathogenic factors of excess fire of liver and gallbladder, the potential effective ingredients, targets and functional characteristics of BPRC were predicted and analyzed by online database. Based on the characteristics of the new active ingredients after processing, the processing principle of BPRC was investigated by network pharmacology.Result:A total of 19 ingredients in BPRC were identified, six of which were newly added cholic acids after processing. It was determined that the alkaloids, including worenine, epiberberine, jatrorrhizine, coptisine, berberrubine, berberine, palmatine and cholic acids, including glycohyodeoxycholic acid, taurohyodeoxycholic acid, glycochenodeoxycholic acid, hyodeoxycholic acid and taurochenodeoxycholic acid, were identified as material basis of BPRC. A total of 66 targets of reducing excess fire of liver and gallbladder of BPRC were screened. There were 16 common targets and multiple same signaling pathways between cholic acids and alkaloids of BPRC, and many lesions of excess fire of liver and gallbladder were target organs of cholic acids. By acting on some targets, including albumin (ALB), Caspase-3 (CASP3), mitogen-activated protein kinase 14 (MAPK14), glucocorticoid receptor (NR3C1) and other targets and some signaling pathways, including interleukin (IL)-17, phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt), MAPK and other pathways, BPRC could reduce excess fire of liver and gallbladder.Conclusion:BPRC has the characteristics of multi-component, multi-target and multi-pathway on reducing excess fire of liver and gallbladder. Bile and Coptidis Rhizoma have synergistic effect and bile can enhance the intensity of BPRC in lesions, which confirms the processing theory that the effect of BPRC on excess fire of liver and gallbladder enhance after being processed by bile.