OBJECTIVES: According to the World Health Organization (WHO), infertility rates have been steadily rising worldwide. Identifying risk factors for contrast agent reflux into the myometrium during hysterosalpingo-contrast sonography (HyCoSy) is of clinical significance in reducing this complication and improving infertility treatment. However, there is currently no standardized pre-evaluation method for predicting intra-myometrial contrast reflux, with clinical assessment often relying on physician experience and patient symptoms. This study aims to identify imaging risk factors for contrast agent reflux into the myometrium using four-dimensional (4D) HyCoSy and to construct a nomogram-based predictive model to assist in clinical decision-making. METHODS: A retrospective analysis was conducted on 1 274 infertile women who underwent 4D HyCoSy at the Women and Children's Hospital of Hunan and the the Third Xiangya Hospital of Central South University from January 1, 2020, to December 15, 2022. Patients were divided into a reflux group (n=234) and a non-reflux group (n=1 040) based on the presence of intra-myometrial contrast reflux. Univariate and multivariable Logistic regression analyses were used to identify significant predictors, which were then used to construct a nomogram model. Internal validation was performed using 500 bootstrap resamples. RESULTS: The age of the reflux group was significantly higher than that of the non-reflux group [(31.82±5.27) years vs (30.66±4.83) years, P=0.001 1]. Primary infertility was more common in the non-reflux group (50.96%), while secondary infertility dominated in the reflux group (76.50%), with 72.65% having a history of gynecological surgery (P<0.001). Abnormal menstrual volume and discomfort during the procedure were more common in the reflux group, while the non-reflux group tolerated higher contrast agent doses (P<0.001). Imaging differences included endometrial thickness, tubal wall smoothness, and peritoneal contrast dispersion, with the non-reflux group showing thicker endometrium and smoother, more patent tubes. The nomogram model yielded an area under the curve (AUC) of 0.854, indicating good predictive performance. The AUC of the decision curve analysis (DCA) for internal validation of the model was 0.737. When the threshold probability for contrast agent reflux into the myometrium ranged from 0.05 to 0.95, the maximum net benefit reached 0.18. The net benefit of applying the nomogram predictive model exceeded that of either full intervention or no intervention, indicating that the model demonstrates good clinical predictive performance. CONCLUSIONS The nomogram model, based on infertility type, endometrial thickness, contrast agent dose, and discomfort symptoms, effectively predicts intra-myometrial contrast agent reflux after 4D HyCoSy. It provides a valuable tool for clinicians to implement early preventive measures and reduce the risk of contrast leakage and associated complications.
Humans ; Female ; Nomograms ; Contrast Media/adverse effects* ; Retrospective Studies ; Adult ; Ultrasonography/methods* ; Hysterosalpingography/methods* ; Infertility, Female/diagnostic imaging* ; Myometrium/diagnostic imaging* ; Risk Factors

Objectives:To evaluate the impact of hemoglobin concentration on 5-year cardiovascular mortality in patients with hypertrophic obstructive cardiomyopathy(HOCM).Methods:This study retrospectively analyzed 325 non-surgically treated HOCM patients hospitalized at Fuwai Hospital from October 2009 to December 2014.Baseline information was compared between patients with or without cardiac death.The impact of hemoglobin concentration on 5-year cardiovascular mortality in HOCM patients was analyzed.Results:The median follow-up time was(43.55±19.70)months.During the follow-up period,a total of 29 patients(8.9%)experienced cardiac death.Univariate Cox regression analysis demonstrated that hemoglobin concentration was significantly associated with 5-year cardiac mortality in HOCM patients(P<0.001).After adjusting for potential cardiovascular risk factors in multivariate Cox regression analysis,hemoglobin concentration(P=0.011)remained negatively associated with 5-year cardiac mortality in HOCM patient.HOCM patients with decreased hemoglobin level faced a 3.118-fold increase in 5-year cardiac mortality(HR=4.118,95%CI:1.114-14.822,P=0.030).Kaplan-Meier survival analysis showed that HOCM patients with decreased hemoglobin levels had a significantly higher risk of 5-year cardiac mortality(log-rank test,χ2=24.38,P<0.001).Conclusions:Lower hemoglobin concentration is an independent risk factor for 5-year cardiac mortality in patients with HOCM.Compared to patients with normal hemoglobin levels,HOCM patients with decreased hemoglobin level face a 3-fold increase in 5-year cardiac mortality.

Objective:To observe the effectiveness and safety of the application of Wei nasal jet tube(WNJT)in anesthesia induction for patients with extensive facial burns.Methods:A total of 60 patients who underwent multiple systemic scab removal and skin graft-ing surgery in our hospital from July 2021 to July 2023 were enrolled in this study.The patients were 18-60 years of age,with a body mass index of 18-29 kg/m2,ASA II or III,and Mallampati I-III.Using a random number table method,the patients were divided into WNJT ventilation group(W group)and mask ventilation group(M group),with 30 cases in each group.Before anesthesia induction,WNJT was inserted into one side of the nasal cavity for hand controlled normal frequency supraglottic jet ventilation in group W pa-tients,while oxygen ventilation was administered to group M patients through conventional two-hand clasped face masks.After 5 min,tracheal intubation was performed under a visual laryngoscope.The mean amplitude of diaphragm fluctuations,end expiratory carbon dioxide partial pressure(PETCO2),and blood oxygen saturation(SpO2)measured by ultrasound were recorded during spontaneous respi-ration at 5 min of oxygenation and nitrogen removal(T0),as well as at 1 min(T1),2 min(T2),3 min(T3),4 min(T4),and 5 min(T5,im-mediately before intubation)of anesthetic induction.Arterial blood gas(PaO2 and PaCO2)at T0 and T5 were measured.Heart rate(HR)and mean arterial pressure(MAP)were recorded at T0-T5 in both groups of patients.The occurrence of postoperative pharyngeal pain,facial or mandibular angle bleeding,gastrointestinal bloating,and nasal mucosal bleeding were recorded in both groups of pa-tients.Results:At T0,there were no statistically significant differences in mean amplitude of diaphragm fluctuations,HR,MAP,PaO2,PaCO2,PETCO2,and SpO2 between the two groups of patients.At T1-T5,the HR and MAP of patients in the W group were significantly lower than those in the M group(P<0.05).At T5,the PaO2 of patients in the W group was significantly higher than that in the M group,while the PaCO2 and PETCO2 were significantly lower than those in the M group(P<0.05).However,the difference in SpO2 was not sta-tistically significant.The W group had less facial or mandibular angle bleeding and postoperative gastrointestinal bloating than the M group,and the differences were statistically significant(P<0.05).There were no statistically significant differences between the two groups of patients in postoperative pharyngitis and nasal mucosal bleeding(P>0.05).Conclusion:During general anesthesia induction in patients with extensive facial burns,WNJT has the advantages of good ventilation effect,high safety,less complications such as gas-trointestinal bloating and facial or mandibular angle bleeding,and more stable hemodynamics.WNJT has good application prospects in clinical anesthesia.

Objective To investigate the influence of ultrasound-guided bilateral quadratus lumborum-pudendal nerve block combined with general anesthesia on analgesic effect after laparoscopic radical resection of colorectal cancer.Methods A total of 76 patients with laparoscopic radical resection of colorectal cancer from January 2025 to May 2025 were included.By using the single-double number method,they were divided into block general anesthesia group(double number,n=38)and conventional general anesthesia group(single number,n=38).The block general anesthesia group was treated with ultrasound-guided bilateral quadratus lumborum-pudendal nerve block combined with general anesthesia,while the conventional general anesthesia group was given conventional general anesthesia regimen.The anesthesia recovery indexes,hemodynamic indexes[heart rate(HR),mean arterial pressure(MAP),and saturation of peripheral oxygen(SpO2)]before anesthesia,at the time of skin incision,skin suture,and the end of surgery,as well as the Visual Analogue Scale(VAS)score of pain at rest and activity and Riker Sedation-Agitation Scale score at 3,12,24,and 48 h after surgery,and levels of inflammatory factors and pain stress indexes before surgery and at 24 h after surgery were compared between the two groups.The adverse anesthesia reactions in the two groups were observed.Results The remifentanil dosage,sufentanil dosage,agitation rate,general anesthesia recovery time,first exhaust time,and remedial analgesia utilization rate in the block general anesthesia group were significantly lower or shorter than those in the conventional general anesthesia group(P<0.05).The HR and MAP were lower in the block general anesthesia group than those in the conventional general anesthesia group at the time of skin incision,skin suture,and the end of surgery(P<0.05),and there was no significant difference in SpO2(P>0.05).The VAS scores at rest and activity in the block general anesthesia group at 3,12,and 48 h after surgery were lower than those in the conventional general anesthesia group(P<0.05),and the Riker Sedation-Agitation Scale scores at 24 and 48 h after surgery were lower than those in the conventional general anesthesia group(P<0.05).At 24 h after surgery,the levels of interleukin-6,cortisol,and adrenocorticotropic hormone in the block general anesthesia group were lower than those in the conventional general anesthesia group(P<0.05).The total incidence rates of adverse anesthesia reactions in the block general anesthesia group[7.9%(3/38)]was significantly lower than that in the conventional general anesthesia group[26.3%(10/38),P=0.033].Conclusions The application of ultrasound-guided bilateral quadratus lumborum-pudendal nerve block combined with general anesthesia during laparoscopic radical resection of colorectal cancer has good analgesic and sedative effects.It has small influence on hemodynamics,reduces the dosages of opioids,relieves the inflammatory stress response,and reduces the adverse reactions.

Objective:To explore the impact and mechanism of organizational career management on the career growth of managers in public hospitals, and to provide a reference basis for optimizing human resource management in public hospitals.Methods:A questionnaire survey was conducted among 489 hospital managers from 15 public hospitals in 8 cities in the central region of China. The structural equation model was used to verify the relationship between organizational career management, person-organization fit and career growth.Results:The total average score of organizational career management of public hospital managers in the surveyed area was (3.70±0.92), the total average score of career growth was (3.42±0.87), and the total average score of person-organization fit was (3.75±0.90). Fair promotion, provision of career information, and vocational training in organizational career management all significantly and positively affected person-organizational fit ( P<0.05). Career training ( β=0.241, P<0.05) and fair promotion ( β=0.239, P<0.01) directly promoted career growth. As tested for mediating effects, person-organization fit mediated career self-perception ( β=0.140, P<0.05) and career information provision ( β=0.119, P<0.05). Conclusions:Organizational career management has a positive promoting effect on the career growth of managers in public hospitals. Improving the career management of managers in public hospitals and promoting the fit between individuals and hospitals can effectively improve their career growth level.

Objectives:To evaluate the impact of hemoglobin concentration on 5-year cardiovascular mortality in patients with hypertrophic obstructive cardiomyopathy(HOCM).Methods:This study retrospectively analyzed 325 non-surgically treated HOCM patients hospitalized at Fuwai Hospital from October 2009 to December 2014.Baseline information was compared between patients with or without cardiac death.The impact of hemoglobin concentration on 5-year cardiovascular mortality in HOCM patients was analyzed.Results:The median follow-up time was(43.55±19.70)months.During the follow-up period,a total of 29 patients(8.9%)experienced cardiac death.Univariate Cox regression analysis demonstrated that hemoglobin concentration was significantly associated with 5-year cardiac mortality in HOCM patients(P<0.001).After adjusting for potential cardiovascular risk factors in multivariate Cox regression analysis,hemoglobin concentration(P=0.011)remained negatively associated with 5-year cardiac mortality in HOCM patient.HOCM patients with decreased hemoglobin level faced a 3.118-fold increase in 5-year cardiac mortality(HR=4.118,95%CI:1.114-14.822,P=0.030).Kaplan-Meier survival analysis showed that HOCM patients with decreased hemoglobin levels had a significantly higher risk of 5-year cardiac mortality(log-rank test,χ2=24.38,P<0.001).Conclusions:Lower hemoglobin concentration is an independent risk factor for 5-year cardiac mortality in patients with HOCM.Compared to patients with normal hemoglobin levels,HOCM patients with decreased hemoglobin level face a 3-fold increase in 5-year cardiac mortality.

Objective To investigate the influence of ultrasound-guided bilateral quadratus lumborum-pudendal nerve block combined with general anesthesia on analgesic effect after laparoscopic radical resection of colorectal cancer.Methods A total of 76 patients with laparoscopic radical resection of colorectal cancer from January 2025 to May 2025 were included.By using the single-double number method,they were divided into block general anesthesia group(double number,n=38)and conventional general anesthesia group(single number,n=38).The block general anesthesia group was treated with ultrasound-guided bilateral quadratus lumborum-pudendal nerve block combined with general anesthesia,while the conventional general anesthesia group was given conventional general anesthesia regimen.The anesthesia recovery indexes,hemodynamic indexes[heart rate(HR),mean arterial pressure(MAP),and saturation of peripheral oxygen(SpO2)]before anesthesia,at the time of skin incision,skin suture,and the end of surgery,as well as the Visual Analogue Scale(VAS)score of pain at rest and activity and Riker Sedation-Agitation Scale score at 3,12,24,and 48 h after surgery,and levels of inflammatory factors and pain stress indexes before surgery and at 24 h after surgery were compared between the two groups.The adverse anesthesia reactions in the two groups were observed.Results The remifentanil dosage,sufentanil dosage,agitation rate,general anesthesia recovery time,first exhaust time,and remedial analgesia utilization rate in the block general anesthesia group were significantly lower or shorter than those in the conventional general anesthesia group(P<0.05).The HR and MAP were lower in the block general anesthesia group than those in the conventional general anesthesia group at the time of skin incision,skin suture,and the end of surgery(P<0.05),and there was no significant difference in SpO2(P>0.05).The VAS scores at rest and activity in the block general anesthesia group at 3,12,and 48 h after surgery were lower than those in the conventional general anesthesia group(P<0.05),and the Riker Sedation-Agitation Scale scores at 24 and 48 h after surgery were lower than those in the conventional general anesthesia group(P<0.05).At 24 h after surgery,the levels of interleukin-6,cortisol,and adrenocorticotropic hormone in the block general anesthesia group were lower than those in the conventional general anesthesia group(P<0.05).The total incidence rates of adverse anesthesia reactions in the block general anesthesia group[7.9%(3/38)]was significantly lower than that in the conventional general anesthesia group[26.3%(10/38),P=0.033].Conclusions The application of ultrasound-guided bilateral quadratus lumborum-pudendal nerve block combined with general anesthesia during laparoscopic radical resection of colorectal cancer has good analgesic and sedative effects.It has small influence on hemodynamics,reduces the dosages of opioids,relieves the inflammatory stress response,and reduces the adverse reactions.

Objective:To explore the impact and mechanism of organizational career management on the career growth of managers in public hospitals, and to provide a reference basis for optimizing human resource management in public hospitals.Methods:A questionnaire survey was conducted among 489 hospital managers from 15 public hospitals in 8 cities in the central region of China. The structural equation model was used to verify the relationship between organizational career management, person-organization fit and career growth.Results:The total average score of organizational career management of public hospital managers in the surveyed area was (3.70±0.92), the total average score of career growth was (3.42±0.87), and the total average score of person-organization fit was (3.75±0.90). Fair promotion, provision of career information, and vocational training in organizational career management all significantly and positively affected person-organizational fit ( P<0.05). Career training ( β=0.241, P<0.05) and fair promotion ( β=0.239, P<0.01) directly promoted career growth. As tested for mediating effects, person-organization fit mediated career self-perception ( β=0.140, P<0.05) and career information provision ( β=0.119, P<0.05). Conclusions:Organizational career management has a positive promoting effect on the career growth of managers in public hospitals. Improving the career management of managers in public hospitals and promoting the fit between individuals and hospitals can effectively improve their career growth level.

Objective An exploratory study of the mechanisms for achieving successful aging at work of clinicians in public hospitals by applying grounded theory and proposing appropriate management recommendations.Methods 24 medical staff from 5 public hospitals in Hubei and Shandong Provinces were interviewed in semi-structured interviews by using purposive sampling methods from June to August in 2023.The interview records were coded,analyzed and integrated with grounded theory.Results Through open coding,spindle coding and selective coding,204 original concepts,47 categories,16 main categories and 5 core category related to model of the mechanism for achieving successful aging at work of clinicians.Conclusion Successful aging at work of senior clinicians encompasses five main areas:physical and mental health,work adaptation,relationships and legacy,internal and external compensation,and value realization.Organizational support factors,individual job crafting affect successful aging at work of senior clinicians by meeting the psychological needs,achieving effective resource management,and promoting person-job matching;individual characteristic factors play a moderating role;job crafting mediates the effect of organizational support factors on successful aging at work among clinicians.

Objective To explore the changes and significane of USP20 and HIF-α expression in breast cancer.Methods Following transfection of shRNA-USP20 lentivirus into breast cancer MDA-MB-231 cells,the gene and protein expression levels of USP20 were detected using fluorescence quantitative PCR and Western Blot.Subsequently,the overexpression of USP20 was observed to determine its effect on HIF-α expression.Similarly,siRNA-USP20 was used to knock down USP20 in breast cancer MDA-MB-231 cells,followed by detection of gene and protein expression levels using fluorescence quantitative PCR and Western Blot.The subsequent changes in HIF-α expression were then examined.Rusults The positive expression rates of USP20 and HIF-α in breast cancer tissues were 69.6%and 46.83%,respectively,while they were negatively expressed in the adjacent normal tissues,with statistically significant differences(P＜0.01).The positive expressions of USP20 and HIF-α were predomi-nantly observed in the cytoplasm of breast cancer tissue,with a smaller amount present in the nucleus.There was a significant positive correlation between USP20 and HIF-α in breast cancer.Following transfection of shRNA-USP20 lentivirus into MDA-MB-231 cells,both the protein and gene expression levels of USP20 significantly increased(P＜0.01).Over-expression of USP20 did not affect HIF-α mRNA levels but led to a significant increase in HIF-α protein expression(P＜0.01).Conversely,siRNA-USP20 interference resulted in a significant decrease in both the protein and gene expression levels of USP20(P＜0.01),without affecting HIF-α mRNA levels;however,it caused a notable reduction in HIF-α protein expression(P＜0.01).Conclusion The expression of USP20 exhib-ited a significant positive correlation with HIF-α in breast cancer.Overexpression of USP20 led to a substantial increase in HIF-α protein expression,while knock-down of the USP20 gene resulted in a significant decrease in HIF-α protein levels.Therefore,it can be inferred that USP20 may exert its influence on the development of breast cancer through modulation of HIF-α expression,thereby providing crucial experimental evidence for clinical treat-ment,prognosis,and further investigations.