ObjectiveTo investigate the effect of video-based educational intervention combined with maternal presence on perioperative adverse outcomes in preschool children undergoing general anesthesia， including cooperation in anesthesia induction， perioperative anxiety， pain and agitation during recovery. MethodsA total of 300 preschool children scheduled for general anesthesia in our hospital from June to December 2023 were randomly assigned to control group （n=150） and intervention group （n=150）. The control group received routine recovery care. For the intervention group， in addition to routine recovery care， a preoperative visit was scheduled one day before surgery. During this visit， mothers were guided to watch anesthesia videos with their children. During the waiting period in the operating room and 30 minutes after awakening， the mothers were guided to accompany the children for more than 30 minutes. Recovery conditions were recorded using the surgical anesthesia information system， and the children’s anesthetic induction compliance， perioperative anxiety， pain， and agitation were evaluated and recorded using the modified Yale Preoperative Anxiety Scale （m-YPAS）， the Induction Compliance Scale （ICC）， the Children’s Pain Behavior Scale （FLACC）， and the Pediatric Agitation and Emergence Delirium Scale （PAED）. ResultsOn the preoperative visit day， there were no statistically significant differences in baseline data between the two groups （P > 0.05）. For perioperative anxiety， the m-YPAS scores of the intervention group were significantly lower than those of the control group， both when entering the operating room waiting area （35.27±6.48 vs. 41.79±6.68， P < 0.05） and 30 minutes after postoperative recovery （20.13±7.05 vs. 35.75±9.51， P < 0.05）. In terms of anesthesia induction cooperation， the ICC scores of the intervention group were significantly lower than those of the control group （1.84±0.95 vs. 3.17±0.62， P < 0.05）， and the proportion of good induction cooperation was significantly higher than that of the control group （24.00% vs. 12.67%， P < 0.05）. There was no significant difference in awakening duration between the two groups， but the intervention group had a significantly shorter length of stay in the post-anesthesia care unit than the control group （0.90±0.29 hours vs. 1.29±0.42 hours， P < 0.001）. For perioperative agitation， the PAED scores of the intervention group were significantly lower than those of the control group （entering in the operating room waiting area： 8.5 vs. 9.2， P < 0.05； 30 minutes after postoperative recovery： 4.2 vs. 7.8， P < 0.05）. In terms of pain scores， the FLACC scores of the intervention group were also significantly lower than those of the control group， both when entering the operating room waiting area （ 5.3 vs. 6.7， P < 0.05； 30 minutes after postoperative recovery： 2.1 vs. 4.9， P < 0.05）. ConclusionsVideo-based educational intervention combined with maternal presence reduces the perioperative anxiety， pain and agitation of preschool children undergoing general anesthesia， and improved the compliance of anesthesia induction. It is recommended to promote this intervention measure in clinical practice.

Objective:To investigate the clinical effect of Paris polyphylla var. yunnanensis oral care solution in the prevention of ventilator-associated pneumonia (VAP) in patients with endotracheal intubation in ICU, and to provide reference for continuing to explore the best oral care solution of traditional Chinese medicine for preventing VAP. Methods:Randomized controlled experiment was used. Fifty patients with tracheal intubation admitted to the ICU of the Affiliated Hospital of Yunnan University from May 2022 to February 2023 were selected by convenient sampling method. The patients were divided into control group and observation group with 25 cases in each group by random number table method. The control group was treated with Xipayi mouth rinse for oral care, and the observation group was treated with self-made Paris polyphylla var. yunnanensis oral care solution for oral care. The incidence of VAP, clinical efficacy of oral care, leukocyte and procalcitonin after 7 days of intervention were observed, the mechanical ventilation time and ICU hospitalization time were recorded in the two groups. Results:All patients completed the study. There were 19 males and 6 females in the control group with the age of (60.72±19.32) years old. There were 15 males and 10 females in the observation group with the age of (60.24±16.80) years old. The incidence of VAP after 7 days of intervention in the observation group was 12% (3/25), which was lower than that in the control group 36% (9/25). The difference between the two groups was statistically significant ( χ2=3.95, P<0.05). The total clinical effective rate of oral care after 7 days of intervention in the observation group was 88% (22/25), which was higher than that in the control group 68% (17/25). The difference between the two groups was statistically significant ( χ2=9.78, P<0.01). There was no significant difference in the level of the leucocyte and procalcitonin before and after 7 days of intervention between the two groups (all P>0.05). The mechanical ventilation time and ICU hospitalization time in the observation group were (6.92 ±3.89), (10.36±6.17) days respectively, which were lower than those in the control group (9.72±4.76), (12.12±4.87) days. The difference of mechanical ventilation time between the two groups was statistically significant (t=2.28, P<0.05). The ICU hospitalization time in the observation group was lower than that in the control group, but there was no significant difference between the two groups ( P>0.05). Conclusions:Paris polyphylla var. yunnanensis oral care solution can improve the oral condition of patients, reduce the incidence of VAP, shorten the time of mechanical ventilation, which has certain clinical value.

Objective:To investigate the clinical effect of Paris polyphylla var. yunnanensis oral care solution in the prevention of ventilator-associated pneumonia (VAP) in patients with endotracheal intubation in ICU, and to provide reference for continuing to explore the best oral care solution of traditional Chinese medicine for preventing VAP. Methods:Randomized controlled experiment was used. Fifty patients with tracheal intubation admitted to the ICU of the Affiliated Hospital of Yunnan University from May 2022 to February 2023 were selected by convenient sampling method. The patients were divided into control group and observation group with 25 cases in each group by random number table method. The control group was treated with Xipayi mouth rinse for oral care, and the observation group was treated with self-made Paris polyphylla var. yunnanensis oral care solution for oral care. The incidence of VAP, clinical efficacy of oral care, leukocyte and procalcitonin after 7 days of intervention were observed, the mechanical ventilation time and ICU hospitalization time were recorded in the two groups. Results:All patients completed the study. There were 19 males and 6 females in the control group with the age of (60.72±19.32) years old. There were 15 males and 10 females in the observation group with the age of (60.24±16.80) years old. The incidence of VAP after 7 days of intervention in the observation group was 12% (3/25), which was lower than that in the control group 36% (9/25). The difference between the two groups was statistically significant ( χ2=3.95, P<0.05). The total clinical effective rate of oral care after 7 days of intervention in the observation group was 88% (22/25), which was higher than that in the control group 68% (17/25). The difference between the two groups was statistically significant ( χ2=9.78, P<0.01). There was no significant difference in the level of the leucocyte and procalcitonin before and after 7 days of intervention between the two groups (all P>0.05). The mechanical ventilation time and ICU hospitalization time in the observation group were (6.92 ±3.89), (10.36±6.17) days respectively, which were lower than those in the control group (9.72±4.76), (12.12±4.87) days. The difference of mechanical ventilation time between the two groups was statistically significant (t=2.28, P<0.05). The ICU hospitalization time in the observation group was lower than that in the control group, but there was no significant difference between the two groups ( P>0.05). Conclusions:Paris polyphylla var. yunnanensis oral care solution can improve the oral condition of patients, reduce the incidence of VAP, shorten the time of mechanical ventilation, which has certain clinical value.

Objective:To evaluate the effect of Kuntai capsules combined with progestin-primed ovarian stimulation (PPOS) protocol on the ovarian response, laboratory parameters and embryo transfer outcomes of expected poor ovarian response (POR) patients undergoing invitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles. Methods:A retrospective cohort study was performed at Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital from June 2020 to July 2023. A total of 1 733 expected POR patients were enrolled and divided into the PPOS only group (control group) and the Kuntai capsules combined with PPOS regimen group (trial group). After a 1∶1 propensity score matching, 423 cases were included in each group. Further analyses and comparisons were made between the two groups, concerning the ovarian stimulation outcomes, embryo laboratory parameters and pregnancy rates after the first frozen-thawed embryo transfer cycles. The primary outcome measure was the number of oocytes retrieved.Results:No statistically significant difference was found in baseline characteristics after matching between the two groups (all P>0.05). Compared with control group, the number of oocytes retrieved did not differ significantly in the trial group ( P=0.295). The level of luteinizing hormone (LH) on the trigger day [3.3 (2.2, 5.0) U/L], the number of available blastocysts formed [1 (0, 1)] and the available blastocyst formation rate [46.2% (85/184)] in the trial group were significantly higher than those in control group [2.9 (1.9, 4.5) U/L, P=0.004; 0 (0, 1), P=0.034; 30.0% (48/160), P=0.002]. However, there were no significant differences in the duration and dosage of gonadotropin used, progesterone and estradiol levels on the trigger day, incidence of premature LH surge, number/rate of fertilized oocytes, number/rate of cleaved embryos, number/rate of high-quality embryos, as well as rate of unavailable embryos (all P>0.05). Compared with control group, the trial group demonstrated comparable implantation rate, clinical pregnancy rate, early miscarriage rate, ongoing pregnancy rate and live birth rate after the first frozen-thawed embryo transfer cycles (all P>0.05). Conclusion:Compared with the PPOS only regimen, the combination of Kuntai capsules and PPOS did not increase the number of oocytes retrieved but could increase the number and rate of available blastocysts formed in expected POR patients.

Objective:To explore the clinical application value of third-generation sequencing technology in preimplantation genetic testing (PGT) of an ATR-X syndrome pedigree with chromosomal microduplication.Methods:The study selected a pedigree with a suspected ATR-X syndrome child at Assisted Reproductive Center of Jiangxi Maternal and Child Health Hospital in October 2022. After chromosome copy number variation sequencing (CNV Seq) detection, it was found that the female carried a 550 kb heterozygous microrepeat with unclear clinical significance in the Xq21.1 region, which involved partial sequences of the ATRX gene. The third generation long read sequencing technology was used to detect the female genome sequence, determine the physical location of the insertion of the above repeat into the genome, clarify the pathogenicity of the repeat, and obtain a single nucleotide polymorphism (SNP) haplotype linked to the above micro repeat inheritance. After the couple's full informed consent, PGT was performed to assist pregnancy. One haploid embryo without pathogenic microduplication was selected for transfer. To verify the consistency with PGT test results, amniocentesis prenatal diagnosis was performed in the second trimester after successful pregnancy, and the fetus was followed up after birth. Results:The results of the third generation long read sequencing and Sanger sequencing verification showed that the Xq21.1 microrepeat carried by the female was inserted into the genome chrX: 76804463-76804464 (GRCh37/hg19), which is an intra tandem repeat of the ATRX gene, and it is predicted that it may cause damage to the normal function of the ATRX protein. After one cycle of PGT treatment, 27 oocytes were obtained and 13 blastocysts were successfully developed after intracytoplasmic sperm injection (ICSI). Through genetic testing, it was found that two blastocysts were haploid embryos without carrying the aforementioned pathogenic microduplication. After thawing and transferring one of the blastocysts, the pregnancy was achieved, and the prenatal diagnosis results of amniocentesis in the second trimester were consistent with the PGT results. In November 2023, at 39 +5 weeks of pregnancy, a female live baby was delivered by natural delivery, and she is in good health. Conclusion:The third-generation sequencing technology has significant advantages in PGT detection of clinically ambiguous microreplicates with functional deficiency due to its long read length characteristics. It can not only determine the location of microreplicates inserted into the genome and determine their pathogenicity, but also obtain SNP haplotypes that are linked to the target mutation, thus preparing for subsequent embryo detection.

Objective To investigate the effect of icariin on apoptosis of ovarian granulosa cells in rats with polycystic ovarian syndrome(PCOS)by regulating stromal cell-derived factor-1(SDF-1)/CXC chemokine receptor-4(CXCR4)signal axis.Methods Granular cells successfully isolated from ovarian tissue of rats in the PCOS model group were grouped into the PCOS group,the low-dose icariin group,the medium-dose icariin group,the high-dose icariin group,the Rr-SDF-1 group and the high-dose icariin+Rr-SDF-1 group.Granular cells successfully isolated from ovarian tissue of rats in the normal control group were taken as the control group.Enzyme-linked immunosorbent assay(ELISA)was applied to detect levels of follicle-stimulating hormone(FSH),testosterone(T)and luteinizing hormone(LH)in supernatant of ovarian granulosa cells.CCK-8 method and EdU staining were applied to detect granulosa cell proliferation.Flow cytometry was applied to detect granulosa cell apoptosis.Western blot assay was applied to detect the expression of Bcl-2 associated X(Bax),Cleaved aspartate-specific cysteine protease-3(Cleaved Caspase-3),SDF-1,and CXCR4 proteins in granulosa cells.Results Compared with the control group,the FSH level,OD450 value and EdU positive cell rate were decreased in the PCOS group,and T and LH levels,apoptosis rate,Bax,Cleaved Caspase-3,SDF-1 and CXCR4 protein expression increased(P＜0.05).Compared with PCOS group,the FSH level,OD450 value and EdU positive cell rate were increased sequentially in the icariin low,medium and high dose groups,T and LH levels,apoptosis rate,Bax,Cleaved Caspase-3,SDF-1 and CXCR4 protein expression levels were decreased sequentially,and change trends of corresponding indicators were opposite to the above in the Rr-SDF-1 group(P＜0.05).Compared with the high-dose icariin group,FSH level,OD450 value and EdU positive cell rate were decreased in the high-dose icariin+Rr-SDF-1 group,and T and LH levels,apoptosis rate,Bax,Cleaved Caspase-3,SDF-1 and CXCR4 protein expression levels were increased(P＜0.05).Conclusion Icariin may inhibit the apoptosis of ovarian granulosa cells in PCOS rats by inhibiting the SDF-1/CXCR4 signaling pathway.

Objective:To investigate the interaction between fibroblasts (Fb) and keratinocytes (KC) in the wound edge skin tissue of a diabetic foot patient and the mechanism.Methods:This was an experimental research. The wound edge skin tissue from a diabetic foot patient (male and 33 years old) admitted to the Department of Wound Repair of Liyuan Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology in August 2021 and from an acute foot injury patient (male and 50 years old) admitted to the Department of Hand Surgery of the hospital in September 2021 was collected. The single-cell transcriptome sequencing was performed to analyze the interaction between chemokine ligands of Fb subgroup and chemokine receptors of KC subgroup. The supernatant was collected after human foreskin fibroblast (HFF) was cultured routinely and with high concentration of glucose for 7 days as normal conditioned medium (CM) and high glucose CM, respectively. HaCaT cells were collected and divided into normal CM group cultured with normal CM and high glucose CM group cultured with high glucose CM, the scratch test was performed to calculate the cell migration rates at 24 and 48 h after scratch ( n=3). The content of cytokines in the two kinds of CM was detected by liquid suspension chip ( n=5). HFF was collected and divided into normal group cultured routinely and high glucose group cultured with high concentration of glucose for 7 days, and the mRNA expressions of C-X-C motif chemokine ligand 1 (CXCL1), CXCL2, CXCL8, and CXCL12 were detected by real-time fluorescence quantitative reverse transcription polymerase chain reaction ( n=6). HaCaT cells in normal CM group and high glucose CM group were collected to detect the protein expressions of C-X-C motif chemokine receptor 4 (CXCR4) in cells cultured for 48 h by Western blotting ( n=3). HaCaT cells were collected and divided into normal CM group, high glucose CM group, normal CM+CXCL12 group, and high glucose CM+CXCL12 group. The first two groups of cells were treated as before, and the latter two groups of cells were cultured with normal CM and high glucose CM containing recombinant human CXCL12, respectively. Scratch test was performed, and cell migration rates were calculated at 24 and 48 h after scratch ( n=3); the protein expression of CXCR4 in cells cultured for 48 h was detected by Western blotting ( n=3). Results:Compared with those in the wound edge skin tissue of acute foot injury, the interactions between chemokine ligands (CXCL1, CXCL2, CXCL3, CXCL8, and CXCL12) of Fb subgroup and chemokine receptors (CXCR2 and CXCR4) of KC subgroup were significantly weakened in the wound edge skin tissue of diabetic foot. At 24 and 48 h after scratch, the migration rates of HaCaT cells in high glucose CM group were significantly lower than those in normal CM group (with t values of 23.50 and 15.65, respectively, P<0.05). Compared with that in normal CM, the content of CXCL1 in high glucose CM was significantly increased ( P<0.05), and the content of CXCL12 was significantly decreased ( P<0.05). After 7 days of culture, compared with those in normal group, the mRNA expressions of CXCL1, CXCL2, and CXCL8 in HFF in high glucose group were significantly increased (with t values of 4.25, 4.98, and 10.04, respectively, P<0.05), while the mRNA expression of CXCL12 was significantly decreased ( t=4.10, P<0.05). After 48 h of culture, the CXCR4 protein expression in HaCaT cells in high glucose CM group was significantly lower than that in normal CM group ( t= 5.13, P<0.05). At 24 and 48 h after scratch, the migration rates of HaCaT cells in high glucose CM group were significantly lower than those in normal CM group and high glucose CM+CXCL12 group (with P values all <0.05); at 24 h after scratch, the migration rate of HaCaT cells in normal CM+CXCL12 group was significantly lower than that in normal CM group ( P<0.05); at 48 h after scratch, the migration rate of HaCaT cells in normal CM+CXCL12 group was significantly higher than that in high glucose CM+CXCL12 group ( P<0.05). At 48 h of culture, the CXCR4 protein expression of HaCaT cells in high glucose CM+CXCL12 group was 0.446±0.050, which was significantly higher than 0.247±0.010 in high glucose CM group ( P<0.05) and similar to 0.522±0.082 in normal CM+CXCL12 group ( P>0.05); the CXCR4 protein expression in HaCaT cells in normal CM group was 0.509±0.055, which was significantly higher than that in high glucose CM group ( P<0.05). Conclusions:The interactions between chemokine ligands of Fb subgroup and chemokine receptors of KC subgroup were significantly weakened in the wound edge skin tissue of diabetic foot. High glucose can inhibit CXCL12 secretion of HFF, and the stimulation of its cell culture supernatant can decrease HaCaT cell migration ability and CXCR4 expression. Exogenous CXCL12 protein can increase the CXCR4 protein expression in HaCaT cells and enhance the cell migration ability.

This article reports that a patient with bilateral ureterocutaneous stoma after radical cystectomy developed intermittent hematuria 2 years after surgery, and there were no abnormalities on bilateral renal artery and abdominal aortic angiography. After removal of the double J stent, a left common iliac artery ureteral fistula was seen on abdominal aortic angiography, and the patient immediately developed hemorrhagic shock. Abdominal aortic balloon occlusion and left common iliac artery stent grafting were performed in the emergency department. After the stent was deployed and the balloon deflated, no bleeding was observed, and the patient's heart rate and blood pressure stabilized. Follow-up angiography showed complete resolution of the fistula. This condition is rare and dangerous, but interventional treatment can quickly control bleeding, offering minimal surgical trauma and fast recovery.

Objective:To evaluate the effect of Kuntai capsules combined with progestin-primed ovarian stimulation (PPOS) protocol on the ovarian response, laboratory parameters and embryo transfer outcomes of expected poor ovarian response (POR) patients undergoing invitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles. Methods:A retrospective cohort study was performed at Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital from June 2020 to July 2023. A total of 1 733 expected POR patients were enrolled and divided into the PPOS only group (control group) and the Kuntai capsules combined with PPOS regimen group (trial group). After a 1∶1 propensity score matching, 423 cases were included in each group. Further analyses and comparisons were made between the two groups, concerning the ovarian stimulation outcomes, embryo laboratory parameters and pregnancy rates after the first frozen-thawed embryo transfer cycles. The primary outcome measure was the number of oocytes retrieved.Results:No statistically significant difference was found in baseline characteristics after matching between the two groups (all P>0.05). Compared with control group, the number of oocytes retrieved did not differ significantly in the trial group ( P=0.295). The level of luteinizing hormone (LH) on the trigger day [3.3 (2.2, 5.0) U/L], the number of available blastocysts formed [1 (0, 1)] and the available blastocyst formation rate [46.2% (85/184)] in the trial group were significantly higher than those in control group [2.9 (1.9, 4.5) U/L, P=0.004; 0 (0, 1), P=0.034; 30.0% (48/160), P=0.002]. However, there were no significant differences in the duration and dosage of gonadotropin used, progesterone and estradiol levels on the trigger day, incidence of premature LH surge, number/rate of fertilized oocytes, number/rate of cleaved embryos, number/rate of high-quality embryos, as well as rate of unavailable embryos (all P>0.05). Compared with control group, the trial group demonstrated comparable implantation rate, clinical pregnancy rate, early miscarriage rate, ongoing pregnancy rate and live birth rate after the first frozen-thawed embryo transfer cycles (all P>0.05). Conclusion:Compared with the PPOS only regimen, the combination of Kuntai capsules and PPOS did not increase the number of oocytes retrieved but could increase the number and rate of available blastocysts formed in expected POR patients.