Objective To investigate the predictive value of serum human epididymis protein 4(HE4)levels in primary Sj?gren's syndrome(pSS)patients for renal injury.Methods A retrospective analysis of 77 pSS patients admitted to the Second People's Hospital of Yichang from September 2021 to August 2023 was performed,including 43 cases of renal injury group 34 instances of non-renal injury group,and 54 healthy physical examination subjects(HCs)as control group.Fasting peripheral venous blood(4ml)was collected to detect the serum levels of HE4,Cys-C,TNF-α,CR,C3,C4,immunoglobulin,Anti-SSA,Anti-SSB and other indicators,and analyzed the value of HE4 in the early diagnosis of kidney injury in pSS patients.Results Compared with HCs,the pSS patients had increased levels of HE4(120.02±103.86 pmol/L vs 57.5±16.52 pmol/L),Cys-C(1.30±0.81mg/L vs 0.87±014 mg/L),and the differences were statistically significant(t=4.382,3.860,all P<0.05).The serum levels of HE4,CR and TNF-α in the renal damage group were higher than those in the non-renal damage group,and the differences were statistically significant(t/χ2=2.552～4.371,all P<0.05).Pearson correlation analysis showed that,the levels of serum HE4,Cys-C,CR and TNF-α were all positively correlated with renal damage in pSS(r=0.287～0.546,all P<0.05).Logistic regression analysis showed that elevated serum HE4 level might be an independent risk factor for inducing renal damage in pSS(Wald χ2=11.932,P<0.05).Receiver operating characteristic(ROC)curve analysis showed that the best cut-offvalue of serum HE4 for the diagnosis of pSS renal damage was 70.46pmol/L,the maximum Youden index was 0.625,AUC(95%CI)=0.876(0.799～0.954).Conclusion The serum HE4 level in patients with pSS is positively correlated with renal injury and has predictive value for the occurrence of renal injury.

Objective:To investigate the effect of the transfer of blastocysts that have not re-expanded after 2-4 h of thawing on pregnancy and neonatal outcomes.Methods:A retrospective cohort study was performed to analyze the clinical data from 2 428 vitrified frozen-thawed single blastocyst transfer cycles at the Reproductive Medicine Center of the 901st Hospital of the Joint Logistics Support Force of PLA between January 2015 and March 2024. Based on the re-expansion status of the blastocoel cavity after thawing, the cycles were divided into group A (110 non-re-expanded) and group B (2 318 re-expanded). After propensity score matching, there were 109 cycles in each group. Pregnancy and neonatal outcomes between the two groups were compared.Results:Before propensity score matching, there were statistical differences in percentage of good-quality blastocyst transfer, percentage of degree 4 blastocyst, percentage of endometriosis and others in reasons for infertility between the two groups (all P<0.05). After propensity score matching, there were no statistical differences in baseline characteristics between the two groups (all P>0.05). The clinical pregnancy rate [27.52% (30/109)], the ongoing pregnancy rate [21.10% (23/109)] and the live birth rate [19.27% (21/109)] in group A were all significantly lower than those in group B [61.47% (67/109), 51.38% (56/109), 47.70% (52/109), all P<0.001]. Neonatal outcomes showed no statistically significant differences between the two groups in terms of birth weight, neonatal length, malformation rate, monozygotic twin rate and male neonatal rate (all P>0.05). Conclusion:Transfer of non-re-expanded blastocysts after thawing may reduce clinical pregnancy rate but does not negatively affect neonatal outcomes.

Objective:To investigate the effect of the transfer of blastocysts that have not re-expanded after 2-4 h of thawing on pregnancy and neonatal outcomes.Methods:A retrospective cohort study was performed to analyze the clinical data from 2 428 vitrified frozen-thawed single blastocyst transfer cycles at the Reproductive Medicine Center of the 901st Hospital of the Joint Logistics Support Force of PLA between January 2015 and March 2024. Based on the re-expansion status of the blastocoel cavity after thawing, the cycles were divided into group A (110 non-re-expanded) and group B (2 318 re-expanded). After propensity score matching, there were 109 cycles in each group. Pregnancy and neonatal outcomes between the two groups were compared.Results:Before propensity score matching, there were statistical differences in percentage of good-quality blastocyst transfer, percentage of degree 4 blastocyst, percentage of endometriosis and others in reasons for infertility between the two groups (all P<0.05). After propensity score matching, there were no statistical differences in baseline characteristics between the two groups (all P>0.05). The clinical pregnancy rate [27.52% (30/109)], the ongoing pregnancy rate [21.10% (23/109)] and the live birth rate [19.27% (21/109)] in group A were all significantly lower than those in group B [61.47% (67/109), 51.38% (56/109), 47.70% (52/109), all P<0.001]. Neonatal outcomes showed no statistically significant differences between the two groups in terms of birth weight, neonatal length, malformation rate, monozygotic twin rate and male neonatal rate (all P>0.05). Conclusion:Transfer of non-re-expanded blastocysts after thawing may reduce clinical pregnancy rate but does not negatively affect neonatal outcomes.

Objective To investigate the predictive value of serum human epididymis protein 4(HE4)levels in primary Sj?gren's syndrome(pSS)patients for renal injury.Methods A retrospective analysis of 77 pSS patients admitted to the Second People's Hospital of Yichang from September 2021 to August 2023 was performed,including 43 cases of renal injury group 34 instances of non-renal injury group,and 54 healthy physical examination subjects(HCs)as control group.Fasting peripheral venous blood(4ml)was collected to detect the serum levels of HE4,Cys-C,TNF-α,CR,C3,C4,immunoglobulin,Anti-SSA,Anti-SSB and other indicators,and analyzed the value of HE4 in the early diagnosis of kidney injury in pSS patients.Results Compared with HCs,the pSS patients had increased levels of HE4(120.02±103.86 pmol/L vs 57.5±16.52 pmol/L),Cys-C(1.30±0.81mg/L vs 0.87±014 mg/L),and the differences were statistically significant(t=4.382,3.860,all P<0.05).The serum levels of HE4,CR and TNF-α in the renal damage group were higher than those in the non-renal damage group,and the differences were statistically significant(t/χ2=2.552～4.371,all P<0.05).Pearson correlation analysis showed that,the levels of serum HE4,Cys-C,CR and TNF-α were all positively correlated with renal damage in pSS(r=0.287～0.546,all P<0.05).Logistic regression analysis showed that elevated serum HE4 level might be an independent risk factor for inducing renal damage in pSS(Wald χ2=11.932,P<0.05).Receiver operating characteristic(ROC)curve analysis showed that the best cut-offvalue of serum HE4 for the diagnosis of pSS renal damage was 70.46pmol/L,the maximum Youden index was 0.625,AUC(95%CI)=0.876(0.799～0.954).Conclusion The serum HE4 level in patients with pSS is positively correlated with renal injury and has predictive value for the occurrence of renal injury.

BackgroundThe development of executive function in adolescents is influenced by many environmental factors. Previous studies have found that perceived stress is closely related to executive function， whereas its role in the mediation of executive function remains poorly studied. ObjectiveTo explore the role of negative affect and self-hate in mediating the relationship between perceived stress and executive function in adolescents， so as to assist the improvement of executive function in adolescents. MethodsQuestionnaires were administered to 7 734 adolescents from five junior and five senior high schools in Rizhao city， Shandong province from 1 to 30 May 2022. Data were collected using a self-made questionnaire， and adolescents were assessed using Perceived Stress Scale （PSS）， Behavior Rating Inventory of Executive Function-Self Report Version （BRIEF-SR）， Patient Health Questionnaire （PHQ-4） and Self-Hate Scale （SHS）. Spearman correlation analysis was conducted to examine the correlation between variables. A Bootstrap method was chosen to examine the mediation effect of self-hate and negative affect on the relationship between perceived stress and executive function in adolescents. ResultsA total of 7 012 （90.66%） valid questionnaires were retrieved. BRIEF-SR score was positively correlated with PSS， PHQ-4 and SHS scores （r=0.564， 0.653， 0.597， P<0.01）. PSS score was positively correlated with PHQ-4 and SHS scores （r=0.615， 0.531， P<0.01）. PHQ-4 score was positively correlated with SHS score （r=0.566， P<0.01）. The value of mediation effect of perceived stress on executive function was 0.574 （95% CI： 0.555~0.594）. Self-hate （indirect effect value of 0.160， 95% CI： 0.145~0.175） and negative affect （indirect effect value of 0.143， 95% CI： 0.129~0.158）， separately from each other， mediated the relationship between perceived stress and executive function， and a chained mediation effect of self-hate and negative affect was also documented （indirect effect value of 0.065， 95% CI： 0.058~0.073）， accounting for 27.87%， 24.91% and 11.32% of the total effect， respectively. ConclusionThe perceived stress of adolescents may be a influencing factor of the executive function. Additionally， perceived stress can either directly affect executive function or indirectly through the separate or chained mediation via negative affect and self-hate.

Objective:To explore the impact of adverse childhood experience on self-injury behavior and the mediating role of self hating in adolescents.Methods:A cross-sectional survey was conducted in 6 high schools and 5 middle schools in Shandong Province from August 1 to December 31, 2022, using the adverse childhood experience questionnaire, self-hating scale and non-suicidal self-injury behavior rating questionnaire for adolescents. A total of 7 313 questionnaires were collected, of which 6 948 were valid. SPSS 22.0 software was used for Spearman correlation analysis, and biased-corrected non-parametric percentile Bootstrap method was used to test the significance of mediating effect.Results:(1) The scores of adverse childhood experience(4.0(2.0, 6.0)), self-hating (22.0 (13.0, 29.0)) and self-injury behavior (12.0 (7.0, 19.0)) in adolescents with self-injury behavior were higher than those without self-injury behavior(0(0, 2.0), 2.0(0, 9.0), 0(0, 1.0)), and the differences were statistically significant ( Z=-21.700, -22.654, -29.519, all P<0.001). (2) Adverse childhood experience was positively correlated with self-hating ( r=0.46, P<0.01) and self-injury behavior ( r=0.47, P<0.01). Self-hating was positively correlated with self-injury behavior ( r=0.51, P<0.01). (3) Adverse childhood experience directly predicted self-injury behavior with a direct effect of 0.163 (95% CI =0.127-0.200, P<0.01)and the effect size of 53.80%(0.163/0.303).Adverse childhood experiences indirectly predicted self-injury behavior through self-hating, with an indirect effect of 0.140 (95% CI=0.122-0.160, P<0.001) and the effect size of 46.20%(0.140/0.303).The total effect was 0.303 (95% CI=0.270-0.336, P<0.001). Conclusions:There is a close relationship between adverse childhood experiences, self-hating and self-injury behavior in adolescents. Adverse childhood experiences can directly predict self-injury behavior, and can also indirectly affect self-injury behavior through self-hating.

Objective:To explore the mediating role of self-hating in the influence of adverse childhood experiences on adolescents' negative emotions.Methods:A questionnaire method was used to collect demographic variables, and 7 012 valid questionnaires were obtained from adolescents by applying the revised adverse childhood experiences questionnaire, patient health questionnaire-4, and self-hate scale from May 1 to May 30, 2022, in five high schools(90 classes) and five junior high schools(60 classes) in Rizhao city, Shandong province, China. Data entry and analysis were performed by SPSS 22.0 software.Mann-Whitney U test was used for the comparison between demographic variables and other variables, and the correlations between variables were expressed by Spearman correlation coefficient. AMOS 23.0 software was applied for testing the mediating and moderating effects of variables. Results:(1)There were significant positive correlations between adverse childhood experiences(0(2)) and negative emotion(3(10))( r=0.459, P<0.01), self-hating(2(4))( r=0.427, P<0.01). There were significant positive correlations between self-hating and negative emotion( r=0.566, P<0.01). (2) Self-hating played a mediating role between adverse childhood experience and adolescent negative emotion, and the mediating effect was 0.299, accounted for 61.27% of the total effect.(3) The mediating pathway of self-hated was moderated by gender, with girls' adverse childhood experiences( Bsimple=2.428, t=39.585, P<0.05) predicting self-hating more than boys( Bsimple=1.641, t=25.355, P<0.05). Conclusion:Adverse childhood experiences can predict adolescents' negative emotions, and self-disgusting can also affect adolescents' negative emotions.Gender plays a moderating role in the mediating pathway.

BACKGROUND: Red-cell transfusion is critical for surgery during the peri-operative period; however, the transfusion threshold remains controversial mainly owing to the diversity among patients. The patient's medical status should be evaluated before making a transfusion decision. Herein, we developed an individualized transfusion strategy using the West-China-Liu's Score based on the physiology of oxygen delivery/consumption balance and designed an open-label, multicenter, randomized clinical trial to verify whether it reduced red cell requirement as compared with that associated with restrictive and liberal strategies safely and effectively, providing valid evidence for peri-operative transfusion. METHODS: Patients aged >14 years undergoing elective non-cardiac surgery with estimated blood loss > 1000 mL or 20% blood volume and hemoglobin concentration <10 g/dL were randomly assigned to an individualized strategy, a restrictive strategy following China's guideline or a liberal strategy with a transfusion threshold of hemoglobin concentration <9.5 g/dL. We evaluated two primary outcomes: the proportion of patients who received red blood cells (superiority test) and a composite of in-hospital complications and all-cause mortality by day 30 (non-inferiority test). RESULTS: We enrolled 1182 patients: 379, 419, and 384 received individualized, restrictive, and liberal strategies, respectively. Approximately 30.6% (116/379) of patients in the individualized strategy received a red-cell transfusion, less than 62.5% (262/419) in the restrictive strategy (absolute risk difference, 31.92%; 97.5% confidence interval [CI]: 24.42-39.42%; odds ratio, 3.78%; 97.5% CI: 2.70-5.30%; P <0.001), and 89.8% (345/384) in the liberal strategy (absolute risk difference, 59.24%; 97.5% CI: 52.91-65.57%; odds ratio, 20.06; 97.5% CI: 12.74-31.57; P <0.001). No statistically significant differences were found in the composite of in-hospital complications and mortality by day 30 among the three strategies. CONCLUSION: The individualized red-cell transfusion strategy using the West-China-Liu's Score reduced red-cell transfusion without increasing in-hospital complications and mortality by day 30 when compared with restrictive and liberal strategies in elective non-cardiac surgeries. TRIAL REGISTRATION ClinicalTrials.gov, NCT01597232.
Humans ; Adult ; Postoperative Complications ; Erythrocyte Transfusion/adverse effects* ; Blood Transfusion ; Hospitals ; Hemoglobins/analysis*

Objective:To investigate the clinical value of single embryo transfer for the patients with gonadotropin-releasing hormone (GnRH) antagonist protocol.Methods:The clinical data of the patients underwent in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) in Reproductive Medicine Center, the 901th Hospital of the Joint Logistics Support Force of PLA from January 2017 to March 2021 were retrospectively analyzed in this cohort study. According to the days of embryo development and No. of embryos, patients were divided into day 3 (D3) single top-quality cleavage-stage embryo transfer group (single top-quality embryo group), D3 double top-quality cleavage-stage embryo transfer group (double top-quality embryos group), and single blastocyst transfer group. In fresh cycles, there were 301 patients in single top-quality embryo group, 253 patients in double top-quality embryos group and 127 patients in single blastocyst group in frozen-thawed embryo transfer (FET) cycles,there were 84 patients in single top-quality embryo group, 136 patients in double top-quality embryos group and 396 patients in single blastocyst group in first FET cycles after all embryos frozen,there were 69 patients in single top-quality group and 161 patients in single blastocyst group. The rates of clinical pregnancy, implantation, multiple pregnancy, early abortion and ongoing pregnancy in the fresh and FET cycles were compared among single top-quality embryo group, double top-quality embryos group and single blastocyst group. Also, the rates of clinical pregnancy, implantation, multiple pregnancy, early abortion and ongoing pregnancy of single top-quality embryo transfer and single blastocyst transfer were compared between the fresh cycle and the first FET cycle. One-way ANOVA and chi-square test were used in this study. Results:There were no significant difference in duration of infertility, body mass index (BMI), the levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, anti-Müllerian hormone (AMH), gonadotropin (Gn) and the numbers of oocytes retrieved among all the groups (all P>0.05). There were no significant differences in the rates of clinical pregnancy, implantation, multiple pregnancy, early abortion and ongoing pregnancy between single top-quality embryo group and single blastocyst group (all P>0.05) in fresh cycle, while the clinical pregnancy rate [46.18% (139/301)], the ongoing pregnancy rate [40.86% (123/301)] and the multiple pregnancy rate [0% (0/139)] in single top-quality embryo group were significantly lower than those in double top-quality embryos group [58.89% (149/253), P<0.001; 52.17% (132/253), P<0.001; 30.20% (45/149), P<0.001], with the similar implantation rate between the two groups ( P>0.016 7). The rates of clinical pregnancy, implantation and ongoing pregnancy were comparable between single top-quality embryo group and double top-quality embryos group in FET cycle ( P>0.016 7), while which were all significantly lower than those in single blastocyst group [62.88% (249/396), P<0.001; 63.89% (253/396), P<0.001; 55.30% (219/396), P<0.001]. The multiple pregnancy rate of double top-quality embryos group [20.37% (11/54)] was significantly higher than that of single top-quality embryo group [0% (0/27), P=0.013] in FET cycle. The ongoing pregnancy rate of the single top-quality embryo transfer in first FET cycle [27.54% (19/69)] was significantly lower than that in fresh cycle [40.86% (123/301), P=0.040], while the clinical pregnancy rate [63.35% (102/161)] and the implantation rate [63.98% (103/161)] of single blastocyst transfer in first FET cycle were significantly higher than those in fresh cycle [50.39% (64/127), P=0.027; 51.97% (66/127), P=0.040]. Conclusion:The clinical outcomes of D3 single top-quality cleavage-stage embryo transfer were similar to D5 single blastocyst transfer in fresh cycle, while the clinical outcomes of single blastocyst transfer in FET cycle were better compared with fresh cycle for the patients with GnRH antagonist protocol. Single embryo transfer can significantly reduce the multiple pregnancy rate of IVF/ICSI .

Objective:To investigate the clinical value of single embryo transfer for the patients with gonadotropin-releasing hormone (GnRH) antagonist protocol.Methods:The clinical data of the patients underwent in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) in Reproductive Medicine Center, the 901th Hospital of the Joint Logistics Support Force of PLA from January 2017 to March 2021 were retrospectively analyzed in this cohort study. According to the days of embryo development and No. of embryos, patients were divided into day 3 (D3) single top-quality cleavage-stage embryo transfer group (single top-quality embryo group), D3 double top-quality cleavage-stage embryo transfer group (double top-quality embryos group), and single blastocyst transfer group. In fresh cycles, there were 301 patients in single top-quality embryo group, 253 patients in double top-quality embryos group and 127 patients in single blastocyst group in frozen-thawed embryo transfer (FET) cycles,there were 84 patients in single top-quality embryo group, 136 patients in double top-quality embryos group and 396 patients in single blastocyst group in first FET cycles after all embryos frozen,there were 69 patients in single top-quality group and 161 patients in single blastocyst group. The rates of clinical pregnancy, implantation, multiple pregnancy, early abortion and ongoing pregnancy in the fresh and FET cycles were compared among single top-quality embryo group, double top-quality embryos group and single blastocyst group. Also, the rates of clinical pregnancy, implantation, multiple pregnancy, early abortion and ongoing pregnancy of single top-quality embryo transfer and single blastocyst transfer were compared between the fresh cycle and the first FET cycle. One-way ANOVA and chi-square test were used in this study. Results:There were no significant difference in duration of infertility, body mass index (BMI), the levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, anti-Müllerian hormone (AMH), gonadotropin (Gn) and the numbers of oocytes retrieved among all the groups (all P>0.05). There were no significant differences in the rates of clinical pregnancy, implantation, multiple pregnancy, early abortion and ongoing pregnancy between single top-quality embryo group and single blastocyst group (all P>0.05) in fresh cycle, while the clinical pregnancy rate [46.18% (139/301)], the ongoing pregnancy rate [40.86% (123/301)] and the multiple pregnancy rate [0% (0/139)] in single top-quality embryo group were significantly lower than those in double top-quality embryos group [58.89% (149/253), P<0.001; 52.17% (132/253), P<0.001; 30.20% (45/149), P<0.001], with the similar implantation rate between the two groups ( P>0.016 7). The rates of clinical pregnancy, implantation and ongoing pregnancy were comparable between single top-quality embryo group and double top-quality embryos group in FET cycle ( P>0.016 7), while which were all significantly lower than those in single blastocyst group [62.88% (249/396), P<0.001; 63.89% (253/396), P<0.001; 55.30% (219/396), P<0.001]. The multiple pregnancy rate of double top-quality embryos group [20.37% (11/54)] was significantly higher than that of single top-quality embryo group [0% (0/27), P=0.013] in FET cycle. The ongoing pregnancy rate of the single top-quality embryo transfer in first FET cycle [27.54% (19/69)] was significantly lower than that in fresh cycle [40.86% (123/301), P=0.040], while the clinical pregnancy rate [63.35% (102/161)] and the implantation rate [63.98% (103/161)] of single blastocyst transfer in first FET cycle were significantly higher than those in fresh cycle [50.39% (64/127), P=0.027; 51.97% (66/127), P=0.040]. Conclusion:The clinical outcomes of D3 single top-quality cleavage-stage embryo transfer were similar to D5 single blastocyst transfer in fresh cycle, while the clinical outcomes of single blastocyst transfer in FET cycle were better compared with fresh cycle for the patients with GnRH antagonist protocol. Single embryo transfer can significantly reduce the multiple pregnancy rate of IVF/ICSI .