Guided by the classical theory of "the liver being the general and the spleen being the defender"， this study explores the intrinsic relationship between the pathogenesis of hepatic fibrosis （HF） and immune-metabolic reprogramming. It is proposed that the pathogenesis of HF in traditional Chinese medicine demonstrates a high degree of biological correspondence to the modern medical concept of the immune-metabolic interaction network. Specifically， immune homeostasis imbalance is analogous to the failure of the spleen's defense and malnourishment of the liver collaterals； lipid metabolic disorder and inflammatory infiltration correspond to the wood constraint， earth congestion， and phlegm-dampness turbid accumulation； "heat-transformation brewing toxin" promotes glycolytic reprogramming and， together with "healthy qi deficiency and stasis binding" leads to microenvironment deterioration. Accordingly， a micro-level syndrome differentiation and treatment strategy is proposed， which emphasizes on enriching earth and nourishing wood， consolidating defense and moistening collaterals to restore immune homeostasis， soothing the liver and activating the spleen， dispelling dampness and eliminate turbidity to correct lipid metabolic disorder， clearing heat and removing toxins， reinforcing healthy qi and resolving stasis to intervene in glycolytic reprogramming and the inflammatory microenvironment， thereby ameliorating the progression of HF.

Objective: To analyze serum anti-Müllerian hormone (AMH) level and its influencing factors among female undergoing premarital and preconception examinations, so as to provide the evidence for optimizing reproductive health management measures. Methods: Female who received free premarital and preconception examinations and voluntarily underwent serum AMH testing at Women and Children's Health Center of Gongshu District, Hangzhou City from January 2022 to April 2025 were selected as study subjects. Demographic information and reproductive history were collected through questionnaire survey. Venous blood was collected to detect thyroid-stimulating hormone (TSH), alanine aminotransferase, hemoglobin (Hb), and AMH levels. The original AMH values did not follow a normal distribution, but followed a normal distribution after natural logarithm transformation, recorded as ln (AMH). Pearson correlation analysis was used to analyze the correlation between variables, and multiple linear regression model was used to analyze the influencing factors for ln (AMH) levels among female undergoing premarital and preconception examinations. Results: A total of 1 073 females undergoing premarital and preconception examinations were surveyed, with a mean age of (29.43±3.30) years. There were 959 females without pregnancy (89.38%) and 1 042 females without full-term live birth history (97.11%). The median AMH level was 3.85 (interquartile range, 3.63) ng/mL, and the mean ln (AMH) level was 1.27±0.75. The ln (AMH) levels were higher in females without pregnancy and without full-term live birth history (both P<0.05). The ln (AMH) level was negatively correlated with age (r=-0.260) and TSH (r=-0.093), and positively correlated with Hb (r=-0.260, -0.093, and 0.073, all P<0.05). Multiple linear regression analysis showed that age (β′=-0.253) and TSH (β′=-0.103) were statistically associated with ln (AMH) levels among female undergoing premarital and preconception examinations (both P<0.05). The associations of other variables with ln (AMH) levels were not statistically significant (all P>0.05). Conclusions Age and TSH level are influencing factors for AMH levels among female undergoing premarital and preconception examinations. AMH levels among female undergoing premarital and preconception examinations decrease with increasing age and increasing TSH level.

BACKGROUND: Circadian syndrome (CircS) may be closely linked to lifestyle, psychological, and occupational factors, but evidence is lacking. This study aimed to explore complex associations between lifestyle, psychological and occupational factors and CircS among employed people in southwestern China. METHODS: In this study, network analysis was used to identify complex associations between lifestyle, psychological and occupational factors and CircS in employed people from the Chinese Cohort of Working Adults (CCWA). The centrality of each variable was estimated by strength centrality index, which was calculated by the sum of edge weights connected to the variable. Bridge in the network was identified as the variables in the top 80 th percentile of overall bridge strength, which was defined as the most strongly connected variables across lifestyle, psychological and occupational factors and CircS. The differences were assessed in network structures between subgroups divided by the median score of the variable with the strongest bridge strengthen. RESULTS: Among 31,105 participants from CCWA, 5213 (16.76%) had CircS. In the constructed network, anxiety (edge weights: 0.28), smoking (edge weights: 0.15), drinking (edge weights: 0.10), perceived noise at work (edge weights: 0.08), and implicit health attitude (edge weights: -0.02) were directly related to CircS, with 83.31% of the variance for CircS explained by these neighboring factors. Anxiety was the most central variable (strength centrality: 1.20) in the network and the strongest bridge (bridge strength: 0.84) connecting all domains of variables. A stronger association between anxiety and CircS was observed in the network of participants with more severe anxiety (edge weight: 0.23) than those with less severe anxiety (edge weight: 0.03). CONCLUSION Anxiety had the strongest association with CircS and was the central factor with the highest strength centrality, also the bridge with the highest bridge strength in the network.
Humans ; Male ; Female ; Adult ; China ; Middle Aged ; Life Style ; Chronobiology Disorders/epidemiology*

Objective To understand the current situation as well as the implementation of infection prevention and control measures against bacterial contamination of external and vaginal ultrasound probes in medical institutions(MIs),and explore the risk of ultrasound probe-related infection under current prevention and control measures.Methods Through on-site sampling,external ultrasound probes from 179 MIs and vaginal ultrasound probes from 83 MIs in 15 prefecture-level cities in Henan Province underwent quantitative bacterial detection,and the implemen-tation of relevant infection prevention and control measures was assessed using questionnaire survey.Results A to-tal of 513 ultrasound probe specimens were detected.Bacterial detection rate and exceedance rate of the disinfected vaginal ultrasound probes were 18.02％(20/111)and 2.70％(3/111),respectively,which were both lower than external ultrasound probes(40.05％[161/402]and 5.22％[21/402],respectively).Bacterial detection rate of dis-infected specimens was lower than that of the towel-wiping group([33.86％,149/440]vs[50.00％,27/54],x2=5.46,P=0.019).Bacterial detection rate of the quaternary ammonium salt disinfectant group was lower than that of the alcohol disinfectant group([17.31％,18/104]vs[40.63％,128/315],x2=18.74,P＜0.001).The quali-fied rates of specimens using different disinfection methods and with different probe types showed no statistically significant differences(all P＞0.05).The implementation rates of"single disinfection for every use"for external ul-trasound probes and vaginal ultrasound probes were 60.34％(108/179)and 70.54％(79/112),respectively.The disinfectants used were mainly quaternary ammonium salts(57.27％)and alcohols(36.36％).The coupling agents used for external and vaginal ultrasound examinations were mainly large packaged products for multiple time use,accounting for 93.85％and 57.89％,respectively.33.33％(56/168)of external ultrasound coupling agents and 20.00％(11/55)of vaginal ultrasound coupling agents were used for more than 7 days.In vaginal ultrasound exa-minations,the usage rates of disinfectant coupling agents and sterile coupling agents were 28.42％(27/95)and 14.74％(14/95),respectively.In vaginal ultrasound examinations,50.00％(56/112)of MIs used condoms as probe co-vers,and 45.54％(51/112)used sound-transmission ultrasound isolation membranes.60.55％(66/109)of MIs didn't change gloves after cleaning and disinfecting the vaginal ultrasound probe and before examination.Conclusion Ultrasound probes have cross infection risks in key processes such as reprocessing(disinfection/sterilization),phy-sical barrier use,coupling agent selection,and glove replacement.It is urgent to develop and implement standar-dized ultrasound probe infection prevention and control technical specifications based on evidence-based research.

Objective:To examine the clinical features and genetic profiles of patients with thyroid peroxidase(TPO) gene mutations and provide diagnostic guidance for clinicians.Methods:A retrospective review of four patients with TPO mutations treated at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, from January 2014 to December 2023. Data on demographics, clinical manifestation, genotypes, treatment, and prognosis of these patients were analyzed.Results:Two males and two females, aged 13 to 27 years at diagnosis, presented with goiter as the initial symptom, with three cases menifesting during puberty. Laboratory findings showed mildly elevated or upper-limit-normal serum thyroid-stimulating hormone(TSH) levels, significantly increased free triiodothyronine/free thyroxine(FT 3/FT 4) ratios, and elevated thyroglobulin(TG) levels. Genetic testing revealed compound heterozygous pathogenic or likely pathogenic TPO mutations. Despite regular levothyroxine(L-T 4) therapy, goiter persisted. Three patients required thyroidectomy due to cosmetic or compressive symptoms, with pathology showing follicular hyperplasia. Conclusion:TPO mutations are characterized by adolescent-onset goiter, elevated FT 3/FT 4 ratios, and normal to high TSH. Genetic testing confirms the diagnosis. L-T 4 offers limited improvement, and surgery is often needed.

Objective:To examine the clinical features and genetic profiles of patients with thyroid peroxidase(TPO) gene mutations and provide diagnostic guidance for clinicians.Methods:A retrospective review of four patients with TPO mutations treated at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, from January 2014 to December 2023. Data on demographics, clinical manifestation, genotypes, treatment, and prognosis of these patients were analyzed.Results:Two males and two females, aged 13 to 27 years at diagnosis, presented with goiter as the initial symptom, with three cases menifesting during puberty. Laboratory findings showed mildly elevated or upper-limit-normal serum thyroid-stimulating hormone(TSH) levels, significantly increased free triiodothyronine/free thyroxine(FT 3/FT 4) ratios, and elevated thyroglobulin(TG) levels. Genetic testing revealed compound heterozygous pathogenic or likely pathogenic TPO mutations. Despite regular levothyroxine(L-T 4) therapy, goiter persisted. Three patients required thyroidectomy due to cosmetic or compressive symptoms, with pathology showing follicular hyperplasia. Conclusion:TPO mutations are characterized by adolescent-onset goiter, elevated FT 3/FT 4 ratios, and normal to high TSH. Genetic testing confirms the diagnosis. L-T 4 offers limited improvement, and surgery is often needed.

Objective To understand the current situation as well as the implementation of infection prevention and control measures against bacterial contamination of external and vaginal ultrasound probes in medical institutions(MIs),and explore the risk of ultrasound probe-related infection under current prevention and control measures.Methods Through on-site sampling,external ultrasound probes from 179 MIs and vaginal ultrasound probes from 83 MIs in 15 prefecture-level cities in Henan Province underwent quantitative bacterial detection,and the implemen-tation of relevant infection prevention and control measures was assessed using questionnaire survey.Results A to-tal of 513 ultrasound probe specimens were detected.Bacterial detection rate and exceedance rate of the disinfected vaginal ultrasound probes were 18.02％(20/111)and 2.70％(3/111),respectively,which were both lower than external ultrasound probes(40.05％[161/402]and 5.22％[21/402],respectively).Bacterial detection rate of dis-infected specimens was lower than that of the towel-wiping group([33.86％,149/440]vs[50.00％,27/54],x2=5.46,P=0.019).Bacterial detection rate of the quaternary ammonium salt disinfectant group was lower than that of the alcohol disinfectant group([17.31％,18/104]vs[40.63％,128/315],x2=18.74,P＜0.001).The quali-fied rates of specimens using different disinfection methods and with different probe types showed no statistically significant differences(all P＞0.05).The implementation rates of"single disinfection for every use"for external ul-trasound probes and vaginal ultrasound probes were 60.34％(108/179)and 70.54％(79/112),respectively.The disinfectants used were mainly quaternary ammonium salts(57.27％)and alcohols(36.36％).The coupling agents used for external and vaginal ultrasound examinations were mainly large packaged products for multiple time use,accounting for 93.85％and 57.89％,respectively.33.33％(56/168)of external ultrasound coupling agents and 20.00％(11/55)of vaginal ultrasound coupling agents were used for more than 7 days.In vaginal ultrasound exa-minations,the usage rates of disinfectant coupling agents and sterile coupling agents were 28.42％(27/95)and 14.74％(14/95),respectively.In vaginal ultrasound examinations,50.00％(56/112)of MIs used condoms as probe co-vers,and 45.54％(51/112)used sound-transmission ultrasound isolation membranes.60.55％(66/109)of MIs didn't change gloves after cleaning and disinfecting the vaginal ultrasound probe and before examination.Conclusion Ultrasound probes have cross infection risks in key processes such as reprocessing(disinfection/sterilization),phy-sical barrier use,coupling agent selection,and glove replacement.It is urgent to develop and implement standar-dized ultrasound probe infection prevention and control technical specifications based on evidence-based research.

AIM:To investigate the changes of retinal microcirculation after phacoemulsification and the influencing factors of visual acuity.METHODS: Retrospective analysis. A total of 264 cataract patients(264 eyes)who underwent phacoemulsification in our hospital from January 2022 to December 2022 were selected as the study objects. Patients were divided into < 0.3 group(66 eyes)and ≥0.3 group(198 eyes)according to the recovery of best corrected visual acuity(BCVA)at 3 mo after surgery. The changes of retinal microcirculation indexes were compared before and after treatment. Logistic regression and LASSO regression models were used to screen the influencing factors of postoperative BCVA. A nomogram prediction model of postoperative BCVA was constructed and verified. A restricted cubic spline Logistic regression model was established to analyze the dose-response relationship between end-diastolic velocity(EDV), peak systolic velocity(PSV)and the risk of BCVA recovery.RESULTS: At 3 mo postoperatively, EDV and PSV were significantly improved compared with those before treatment, and resistance index(RI)levels were significantly lower than those before treatment(all P<0.05). Preoperative EDV, PSV, aqueous humor cell grade, fundus lesion grade, advanced age and Emery grade were influencing factors for poor BCVA recovery after phacoemulsification in cataract patients(P<0.05). The AUC before and after validation of the nomogram model by Bootstrap method were 0.869(95%CI: 0.815-0.903)and 0.866(95%CI: 0.802-0.895), respectively. The sensitivity was 88.36% and 88.27%, and the specificity was 91.82% and 91.78%, respectively. Restricted cubic spline model analysis showed no nonlinear dose-response relationship between EDV and PSV levels and the risk of poor BCVA recovery in either male or female(P>0.05).CONCLUSION: After phacoemulsification, retinal microcirculation in cataract patients improved significantly. EDV, PSV, aqueous humor cell grade, fundus lesion grade, advanced age and Emery grade are all factors influencing poor BCVA recovery after cataract surgery.

Objective To study the invasive histopathological features of papillary thyroid carcinoma(PTC)with tall cell variant(TCV).Methods A retrospective analysis of 19 170 cases of PTC in Ruijin Hospital,Shanghai Jiao Tong University School of Medicine from January 2018 to May 2023 was performed to analyze and the clinicopathological features between TCV-PTC group and classic PTC(cPTC)group.Results Pathological results showed 1 380 cases in TCV-PTC group and 15 578 cases in cPTC group.TCV-PTC had higher proportion and(or)mean value in patients'age,extraglandular invasion,nerve invasion,vascular invasion,maximum diameter of cancer focus,multifocality,lymph node metastasis and BRAF mutation,but the proportion of patients with coexistent Hashimoto's thyroiditis was lower than cPTC,and all results had significant difference(P<0.05).Conclusions Compared with the cPTC,TCV-PTC has stronger local invasive characteristics and lymph node metastasis rate,which provides the basis for the subsequent clinical treatment.