ObjectiveTo compare the incidence of postoperative shivering between female patients undergoing gynecological and general surgery and to examine perioperative factors associated with postoperative shivering. MethodsThis retrospective study included 12 186 patients who underwent gynecological or general surgery between January 1， 2022， and March 15， 2024， of whom 10 884 female patients constituted the primary analysis population. Among the female patients， 1：1 nearest-neighbor propensity score matching was performed using a caliper of 0.02 on the raw propensity score scale， with exact matching on American Society of Anesthesiologists （ASA） physical status. After matching， the incidence of postoperative shivering was compared using the McNemar test. Conditional logistic regression stratified by matched pair was used to assess the associations of surgical categories and perioperative factors with postoperative shivering. ResultsBefore propensity score matching， the incidences of postoperative shivering were 2.98% （28/940） in the general surgery group and 4.94% （491/9 944） in the gynecological surgery group （P=0.007）. After matching， 881 matched pairs were obtained， and the absolute standardized mean differences （SMDs） for all covariates were < 0.10. The incidences of postoperative shivering were 3.06% （27/881） in the general surgery group and 4.99% （44/881） in the gynecological surgery group. The McNemar test without continuity correction yielded P=0.044， whereas the exact McNemar test showed a P value of 0.057. Unifactorial conditional logistic regression showed that gynecological surgery was associated with higher odds of postoperative shivering than general surgery ［odds ratio （OR）=1.63， 95% confidence interval （CI）： 1.01-2.63， P=0.046］. However， the association was not statistically significant in the multifactorial conditional logistic regression ［adjusted odds ratio （aOR）=1.62， 95%CI： 0.78-3.37， P=0.197］. Each 30-min increase in the duration of surgery was associated with 32% higher odds of postoperative shivering （aOR=1.32， 95%CI： 1.07-1.62， P=0.009）. Each 1 °C increase in the minimum intraoperative body temperature was associated with lower odds of postoperative shivering， although the association did not reach statistical significance （aOR=0.32， 95%CI： 0.10-1.02， P=0.053）. ConclusionAfter propensity score matching， the incidence of postoperative shivering was higher among female patients undergoing gynecological surgery than among those undergoing general surgery； however， neither the exact comparison nor the adjusted association reached statistical significance. A longer duration of surgery was associated with higher odds of postoperative shivering， whereas a higher minimum intraoperative body temperature may be associated with lower odds.

ObjectiveTo compare the incidence of postoperative shivering between female patients undergoing gynecological and general surgery and to examine perioperative factors associated with postoperative shivering. MethodsThis retrospective study included 12 186 patients who underwent gynecological or general surgery between January 1， 2022， and March 15， 2024， of whom 10 884 female patients constituted the primary analysis population. Among the female patients， 1：1 nearest-neighbor propensity score matching was performed using a caliper of 0.02 on the raw propensity score scale， with exact matching on American Society of Anesthesiologists （ASA） physical status. After matching， the incidence of postoperative shivering was compared using the McNemar test. Conditional logistic regression stratified by matched pair was used to assess the associations of surgical categories and perioperative factors with postoperative shivering. ResultsBefore propensity score matching， the incidences of postoperative shivering were 2.98% （28/940） in the general surgery group and 4.94% （491/9 944） in the gynecological surgery group （P=0.007）. After matching， 881 matched pairs were obtained， and the absolute standardized mean differences （SMDs） for all covariates were < 0.10. The incidences of postoperative shivering were 3.06% （27/881） in the general surgery group and 4.99% （44/881） in the gynecological surgery group. The McNemar test without continuity correction yielded P=0.044， whereas the exact McNemar test showed a P value of 0.057. Unifactorial conditional logistic regression showed that gynecological surgery was associated with higher odds of postoperative shivering than general surgery ［odds ratio （OR）=1.63， 95% confidence interval （CI）： 1.01-2.63， P=0.046］. However， the association was not statistically significant in the multifactorial conditional logistic regression ［adjusted odds ratio （aOR）=1.62， 95%CI： 0.78-3.37， P=0.197］. Each 30-min increase in the duration of surgery was associated with 32% higher odds of postoperative shivering （aOR=1.32， 95%CI： 1.07-1.62， P=0.009）. Each 1 °C increase in the minimum intraoperative body temperature was associated with lower odds of postoperative shivering， although the association did not reach statistical significance （aOR=0.32， 95%CI： 0.10-1.02， P=0.053）. ConclusionAfter propensity score matching， the incidence of postoperative shivering was higher among female patients undergoing gynecological surgery than among those undergoing general surgery； however， neither the exact comparison nor the adjusted association reached statistical significance. A longer duration of surgery was associated with higher odds of postoperative shivering， whereas a higher minimum intraoperative body temperature may be associated with lower odds.

Objective To explore the mechanism by which Wandai Decoction prevents and treats vulvovaginal candidiasis(VVC)of the spleen deficiency and excessive dampness type and restores the vaginal flora structure,and to identify the potential metabolic pathways involved using metagenomics and metabolomics.Methods Twenty VVC patients who met the inclusion criteria were randomly assigned to a Wandai Decoction group and a fluconazole group(n=10 in each group).Subjects in the fluconazole group were given a single oral dose of 150 mg fluconazole,while those in the Wandai Decoction group took the Wandai Decoction orally for 14 days.The vulvovaginal signs and symptoms(VSS)scores of both patient groups were evaluated before and after treatment.Vaginal secretions were collected before and after treatment.The Illumina sequencing and the liquid chromatography with tandem mass spectrometry(LC-MS/MS)platform were used to conduct metagenomic and metabolomics analyses of the vaginal secretions,respectively.Results The VSS score results showed that the VSS scores of both groups decreased after treatment compared with those before treatment(P＜0.01),and there was no statistically significant difference in the VSS scores between the two groups after treatment.Metagenomics results showed that,after treatment,the vaginal microbial communities in the Wandai Decoction group were of CST Ⅱ and Ⅴ types(predominated by Lactobacillus gasseri and Lactobacillus jensenii),while those in the fluconazole group were Lactobacillus_intestinalis and Streptococcus_sp._oral_taxon_431.KEGG functional enrichment analysis results showed that,in terms of the cell cycle and meiosis functions of Candida albicans,statistically significant differences between the Wandai Decoction and fluconazole groups were observed(P＜0.05).Metabolomic analysis identified 120 differential metabolites between the two groups after treatment.The results of KEGG metabolic pathway enrichment analysis of differential metabolites showed that the Wandai Decoction might be significantly superior to fluconazole in improving local vaginal metabolic pathways of α-linolenic acid,glycerophospholipid metabolism,pentose and glucuronic acid interconversion,and arachidonic acid.Conclusion The Wandai Decoction can improve the vaginal flora of VVC patients.It may be superior to fluconazole in the signaling pathways of the cell cycle and meiosis.The improvement of the vaginal flora by the Wandai Decoction may be associated with its effect on metabolic pathways of glycerophospholipid metabolism,pentose and glucuronic acid interconversion,and others in the vagina.

Objective: To investigate the therapeutic effect of bone marrow mesenchymal stem cells ( BMSCs) mod- ified by bone morphogenetic protein ( BMP) -2 gene combined with nano-hydroxyapatite ( nHA) / polyamide 66 ( PA66) on femoral nonunion in rats． Methods : Rat BMSCs were isolated and divided into the stent + BMSCs group，stent + BMSCs + rhBMP-2 group，and stent + BMSCs + Ad-BMP-2 group; human recombinant BMP-2 ( rh- BMP-2) or adenovirus-infected BMP-2 ( Ad-BMP-2) vector was transfected into BMSCs and loaded onto nHA / PA66 stent materials．Flow cytometry was used to detect that BMSCs expressed specific surface markers．Cell pro- liferation was detected by MTT assay，related bioactive factors［platelet-derived growth factor ( PDGF) ，transfor- ming growth factor-β ( TGF-β) ，vascular endothelial growth factor ( VEGF) ，fibroblast growth factor ( FGF) ，os- teocalcin ( OCN) ，osteonectin ( ON) ］were detected by ELISA，alkaline phosphatase ( ALP) activity was detec- ted，and cell growth and adhesion were observed by scanning electron microscopy ( SEM) ．In the atrophic nonun- ion model of SD rats，the stent + BMSCs + rhBMP-2 or stent + BMSCs + Ad-BMP-2 complex was implanted into the defect area，which was divided into the rhBMP-2 group and the Ad-BMP-2 group，and the therapeutic effect was e- valuated by X-ray and MicroCT． Results: The surface of the nHA / PA66 stent was smooth and porous，and BMSCs adhered well．Flow cytometry showed high expression of CD29 and CD90 and low expression of CD45 and CD34 in BMSCs．MTT showed that the cells proliferated rapidly after 72 h．Compared with the stent + BMSCs group and the stent + BMSCs + rhBMP-2 group，the ALP activity，the expressions of PDGF，TGF-β , VEGF，FGF，OCN，and ON in the stent + BMSCs + Ad-BMP-2 group were significantly up-regulated ( P＜0. 05) ．12 weeks after surgery， the stent complex in the Ad-BMP-2 group of rats was completely wrapped by newly formed cortical bone，and the surface was smooth and intact．X-ray showed that the complex in the Ad-BMP-2 group was completely wrapped by newly formed cortical bone，and the recovery degree was better than that in the rhBMP-2 group．Micro-CT results showed that compared with the rhBMP-2 group，the bone volume fraction，trabecular thickness，trabecular num- ber，bone mineral density，and bone mineral content in the Ad-BMP-2 group all increased 12 weeks after surgery ( P＜0. 05) ，and the trabecular separation level decreased ( P＜0. 05) ． Conclusion Ad-BMP-2-transfected BM- SCs combined with nHA / PA66 stent material can express bioactivity more effectively，provide a continuous and good microenvironment for the proliferation and differentiation of BMSCs，which is beneficial to promoting local os- teogenic activity and bone defect repair．

Objective To investigate the clinical efficacy of intracardiac echocardiography(ICE)guid-ance in transcatheter closure of latent patent foramen ovale(PFO)among divers.Methods From Jan 2023 to Nov 2024,36 young divers with PFO,who only had right-to-left shunt during Valsalva maneuver on right heart contrast echocardiography,were enrolled from No.971 Hospital of the PLA Navy.They were divided into ICE group and transthoracic echocardiography(TTE)group based on intraoperative imaging.Clinical data including baseline characteristics,echocardiographic findings,complications,procedure time,and radiation dose were recorded.Results All 36 patients(19 in TTE group and 17 in ICE group)had 100％immediate closure success rate.No vascular complications,postoperative pericardial effusion,device displacement or embolism occurred.ICE could guide wire passage through foramen ovale,significantly reducing total procedure time,fluoroscopy time,and radia-tion dose(P<0.05).Conclusion ICE enables precise closure of potent PFO in divers and decreases fluoroscopy time and radiation dose,showing significant clinical value.

Polycystic ovary syndrome(PCOS)is a complex disease that significantly impacts women's reproductive and metabolic health.The reprogramming of glucose metabolism points to fundamental changes in energy metabolism,which are central to the imbalance in energy metabolism,hormonal abnormalities,increasing insulin resistance,and chronic inflammatory states observed in PCOS.This represents a core pathological link in the pathogenesis of PCOS.The theory of"Spleen Qi to Dispersing Essence"provides a comprehensive overview of spleen function,essential for ensuring the normal operation of organs and the distribution of Qi,blood,and bodily fluids.It serves as a crucial theoretical support for the treatment of PCOS with traditional Chinese medicine.This article explores the role of regulating PCOS based on the theory of"Spleen Qi to Dispersing Essence"with a focus on the reprogramming of glucose metabolism.The mechanism of traditional Chinese medicinal treatments that assist Spleen Qi to Dispersing Essence is closely related to regulating glucose metabolism reprogramming,offering a novel research direction for the treatment of PCOS with TCM.

Objective To explore the mediating role of mindful attention and awareness in depressive symptoms and insomnia severity among patients with comorbid depression and insomnia.Methods A cross-sectional study was conducted,enrolling 267 patients with comorbid depression and insomnia who were treated in the outpatient Department of Medical Psychology of Second Affiliated Hospital of Army Medical University,from March to May 2024.Basic demographic and clinical data were collected using a general information questionnaire.Depressive symptom severity was measured via the Patient Health Questionnaire-9(PHQ-9),insomnia severity via the Insomnia Severity Index(ISI),perceived stress via the Perceived Stress Scale-10(PSS-10),and mindful attention and awareness via the Mindful Attention Awareness Scale(MAAS).Pearson correlation analysis was used to examine the correlations between depressive severity,insomnia severity,perceived stress,and mindful attention and awareness.Mediation analysis was performed using Process 4.1.Results The PHQ-9 score was(13.80±5.98)and the ISI score was(17.10±5.56)in the 267 patients.Pearson correlation analysis showed that depressive severity and insomnia severity were positively correlated with perceived stress(r=0.531,0.351,P<0.001)and negatively correlated with mindful attention and awareness(r=-0.373,-0.350,P<0.001).Mediation analysis using Process 4.1 indicated that the combined mediating effect of mindful attention and awareness and insomnia between perceived stress level and depressive level was 0.157,with a 95%confidence interval(CI)of 0.102～0.217,and the total mediating effect was significant(P<0.001).Conclusion Perceived stress directly positively affects depression and indirectly exacerbates depression through insomnia as a mediator,and mindful attention and awareness can weaken the promoting effect of perceived stress on insomnia.

Five new flavan-4-ol glycosides jixueqiosides A-E (1-5) and two new flavan glycosides jixueqiosides F and G (6 and 7), along with twelve known flavan-4-ol glycosides (8-19), were isolated from the roots of Pronephrium penangianum. Comprehensive spectral analyses, X-ray single-crystal diffraction, and theoretical electronic circular dichroism (ECD) calculations established structures and absolute configurations. A single crystal structure of flavan-4-ol glycoside (14) was reported for the first time, while the characteristic ECD and NMR data for all isolated flavan-4-ol glycosides (1-5 , 8-19) were analyzed, establishing a set of empirical rules. Activity screening of these isolates showed that 8 and 9 could inhibit the proliferation of MDA-MB-231 and MCF-7 cells with IC₅₀ values of 7.93 ? 2.85 ?mol?L^-1 and 5.87 ? 1.58 ?mol?L^-1 (MDA-MB-231), and 2.21 ? 1.38 ?mol?L^-1 and 3.52 ? 1.55 ?mol?L^-1 (MCF-7), respectively. Western blotting and flow cytometry analyses demonstrated that 8 and 9 dose-dependently induced apoptosis in MDA-MB-231 cells by up-regulating BAX, activating caspase-3 and down-regulating BCL-2. Additionally, compound 8 affected autophagy-related proteins, increasing the ratio of LC3-II/LC3-I and Beclin-1 levels to inhibit MDA-MB-231 cell proliferation. Moreover, anti-inflammatory studies indicated that 2, 3, 7, 13, 14, and 18 moderately inhibited tumor necrosis factor-a (TNF-a), interleukin-6 (IL-6), and nitric oxide (NO) release.
Humans ; Plant Roots/chemistry* ; Glycosides/isolation & purification* ; Anti-Inflammatory Agents/isolation & purification* ; Flavonoids/isolation & purification* ; Cell Proliferation/drug effects* ; Antineoplastic Agents, Phytogenic/isolation & purification* ; Molecular Structure ; Apoptosis/drug effects* ; Cell Line, Tumor ; Tumor Necrosis Factor-alpha/immunology* ; Drugs, Chinese Herbal/pharmacology* ; Interleukin-6/immunology* ; Animals ; Mice

Objective:To develop a comprehensive training curriculum to enhance the effective implementation of the national initiative promoting dementia care and prevention.Methods:The Delphi method was utilized in an expert consultation that included 44 participants.The initial draft of the training curriculum was developed based on the current state of dementia care and prevention.This draft was subsequently evaluated for its importance, feasibility, and ease of dissemination.Experts offered targeted modifications and additional recommendations.Results:The recovery rate of the expert consultation questionnaire was 95.5%, with a recovery validity rate of 90.9%.The expert authority coefficient was 0.91, and the Kendall's coordination coefficient( W)for expert scoring was 0.316, with a significance level of P<0.001.Four course modules were ultimately identified: the foundation of memory clinic work, the complete management practice skills, group counseling techniques for caregivers, and practical skills for caregivers.The importance of these modules was rated with a mean of 4.92 to 4.95, and the coefficient of variation ranged from 0.044 to 0.063.Each module had a mean value of 4.92 to 4.95, with a coefficient of variation of 0.044 to 0.063; the mean value for practicality was between 4.78 and 4.92, with a coefficient of variation of 0.055 to 0.098; and the mean value for ease of generalization ranged from 4.28 to 4.65, with a coefficient of variation from 0.140 to 0.203.The four modules comprised a total of 55 specific course content items, with the mean value for each item ranging from 4.76 to 5.00 and a coefficient of variation from 0.000 to 0.121.The mean value of usefulness assigned to each entry ranged from 4.55 to 4.98, with a coefficient of variation from 0.031 to 0.150.Additionally, the mean value for ease of propagation assigned to each entry ranged from 4.00 to 4.83, with a coefficient of variation from 0.091 to 0.245. Conclusions:The developed training curriculum, which comprises four course modules and 55 items, demonstrated consistently high levels of importance, practicality, and ease of dissemination.These findings indicate that the curriculum is well-aligned with national initiatives aimed at enhancing dementia care and prevention.

Polycystic ovary syndrome(PCOS)is one of the main causes of ovulatory dysfunction-induced female infertility.The dysfunction of the hypothalamic-pituitary-ovarian axis(HPOA)is a key factor promoting reproductive damage and metabolic abnormalities in PCOS.This article explored the correlation between HPOA dysfunction and the pathogenesis of heart-kidney disharmony in TCM based on Ye Tianshi's theory of"simultaneous upper and lower diseases,treating the middle energizer".It is believed that the treatment of PCOS should aim at restoring the ascending and descending of qi in the middle energizer,with the main therapeutic approach being soothing the liver and strengthening the spleen,which can provide ideas for the clinical treatment of PCOS.