Objective To investigate the prevalence of Clonorchis sinensis human infections in Congjiang County, Guizhou Province in 2023, so as to provide insights into formulation of the clonorchiasis control strategy. Methods Congjiang County was divided into eastern, western, southern, northern and central areas according to the geographical locations, and one township was randomly sampled from each area. Then, each administrative village was randomly sampled from each township, and 200 permanent residents over 3 years of age were randomly sampled from each village. Participants’ stool samples were collected for detection of C. sinensis eggs with the Kato-Katz technique (two slides for each stool sample), and the prevalence and intensity of C. sinensis infections were calculated. In addition, the risk factors of clonorchiasis were identified among participants using a questionnaire survey. Results A total of 1 001 residents were included, and the prevalence of C. sinensis infections was 16.28% (163/1 001), with mild infections as the predominant category of infection intensity [73.01% (119/163)]. The prevalence rates of C. sinensis human infections were 30.50% (61/200), 1.50% (3/200), 30.35% (61/201), 12.50% (25/200), and 6.50% (13/200) at five survey sites, respectively (χ² = 107.03, P < 0.05), and there was a significant difference in the prevalence of C. sinensis infections between men [22.44% (112/499)] and women [10.16% (51/502)] (χ² = 27.71, P < 0.05). The prevalence of C. sinensis infections was relatively high among participants at ages of 60 to 70 years [26.14% (23/88)], public servants [46.15% (6/13)], and Han ethnic participants [33.33% (5/15)]. The prevalence of C. sinensis infections was higher among participants with a habit of consuming raw or un-dercooked freshwater fish and shrimp [22.06% (90/408)] than among those without the habit [12.31% (73/593)] (χ² = 16.85, P < 0.05), and there was no significant difference in the prevalence of C. sinensis infections between participants with [13.99% (41/293)] and without separation of raw and cooked chopping boards [17.23% (122/708)] (χ² = 1.59, P > 0.05). In addition, the prevalence of C. sinensis infections was 8.70% (2/23) and 16.46% (161/978) among participants with and without fever complicated by discomfort in the right upper abdomen during the past half year (χ² = 0.99, P > 0.05). Conclusions The prevalence of C. sinensis human infections was high in Congjiang County, Guizhou Province in 2023, and infections predominantly occurred among young and middle-aged men. Intensified health education among high-risk residents and alteration of dietary habits of consuming raw or undercooked freshwater fish or shrimp are recommended to reduce the prevalence of C. sinensis human infections.

Definitive chemoradiotherapy (dCRT) has become a cornerstone in the treatment of locally advanced esophageal cancer; however, local control remains suboptimal, and persistent lesions or locoregional recurrences after treatment are not uncommon. For patients without distant metastases but with local failure, whether surgical intervention can still offer curative potential remains a major clinical dilemma. Salvage esophagectomy (SE) offers potential long-term survival for selected patients, but this procedure is performed in the context of severe fibrosis, impaired local blood supply, and obscured anatomical planes following chemoradiotherapy, resulting in significantly higher perioperative risk compared to primary esophagectomy. Consequently, controversies exist regarding patient selection, preoperative restaging, choice of surgical approach, extent of lymphadenectomy, gastrointestinal reconstruction, and perioperative management. In recent years, with the refinement of restaging modalities such as PET/CT, the accumulation of experience in high-volume centers, and emerging evidence from clinical studies, the clinical role of SE has gradually shifted from a "high-risk salvage measure" to a "selective curative strategy aimed at achieving long-term survival in carefully selected patients". Nevertheless, standardized guidelines for patient selection, technical approaches, and perioperative management are still lacking. Based on current evidence and clinical experience, experts organized by the Integrated Esophageal Cancer Committee of Chinese Anti-Cancer Association systematically reviewed key issues regarding SE, including its definition, indications, preoperative evaluation, choice of surgical approach, lymphadenectomy, gastrointestinal reconstruction, and perioperative management, and formulated a Chinese expert consensus. This consensus aims to provide guidance for standardized assessment, appropriate referral, individualized surgical decision-making, and optimized perioperative management of patients with locoregional failure after dCRT. Ultimately, this will increase the likelihood of R0 resection, reduce the risk of severe complications, and promote the safer, more judicious, and standardized implementation of SE in high-risk scenarios.

ObjectiveTo explore the therapeutic mechanism of Buchong Tiaojing prescription for rats with diminished ovarian reserve （DOR） from the perspectives of nucleotide-binding oligomerization domain （NOD）-like receptor protein 3 （NLRP3） inflammasome and ferroptosis. MethodsA total of 48 female SD rats were randomly divided into a normal group， a model group， low， medium， and high dose groups of Buchong Tiaojing prescription， and an MCC950 group， with eight rats in each group. Except the normal group， all the other groups were injected subcutaneously on the back of the neck with D-galactose to prepare the DOR rat model. From the 15th day of modeling， the rats in the low， medium， and high dose groups of Buchong Tiaojing prescription were subjected to gavage daily at doses of 14.4， 28.8， 57.6 g·kg^-1， respectively. Rats in the MCC950 group were injected intraperitoneally with MCC950 at a dose of 10 mg·kg^-1， once every other day. The interventions of all the groups lasted for 4 weeks. The estrous cycle of the rats was observed with vaginal exfoliated cell smear. Hematoxylin-eosin （HE） staining was performed to observe the development of follicles and corpus luteum in the ovary. Enzyme-linked immunosorbent assay （ELISA） was performed to detect the levels of serum sex hormones and interleukin-1β （IL-1β）. Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） and Western blot assay were performed to detect the mRNA and protein expression of NLRP3 inflammasome， acyl-CoA synthetase long-chain family member 4 （ACSL4）， transferrin receptor 1 （TFR1）， and glutathione peroxidase 4 （GPX4）， and oxidative stress kits were used to detect ovarian superoxide dismutase （SOD） and malondialdehyde （MDA） levels. ResultsDuring the experiment， one rat died in the high dose group of Buchong Tiaojing prescription， and a total of 47 rats were finally included in the index tests and statistics. Compared with those in the normal group， rats in the model group had significantly disturbed estrous cycles， increased number of atretic follicles， and significant disorder of serum sex hormones. The mRNA and protein expression of NLRP3 inflammasome， ACSL4， and TFR1 in ovarian tissue was up-regulated （P<0.01）， while that of GPX4 was significantly down-regulated （P<0.01）. The SOD content in the ovary was decreased significantly， while the MDA level was increased （P<0.01）. After drug intervention， the estrous cycle of rats was basically resumed， and the follicles at all levels were more structurally intact and significantly increased in number. Additionally， the levels of serum sex hormones and IL-1β were significantly improved. The mRNA and protein expression of NLRP3 inflammasome， ACSL4， and TFR1 were down-regulated， while that of GPX4 was significantly up-regulated， and the ovarian oxidative stress was alleviated （P<0.05， P<0.01）， especially in the high dose group of Buchong Tiaojing prescription and the MCC950 group. ConclusionInflammatory injury and ferroptosis occur in the ovaries of DOR rats， and the Buchong Tiaojing prescription is able to inhibit ovarian NLRP3 inflammasome， alleviate the degree of ovarian ferroptosis， and improve ovarian reserve.

Objective To investigate the application value of procalcitonin(PCT),neutrophil-to-lym-phocyte ratio(NLR)and C-reactive protein to albumin ratio(CAR)in the short-term prognosis of the pa-tients with severe community acquired pneumonia(SCAP).Methods A total of 225 patients with communi-ty-acquired pneumonia(CAP)treated in this hospital from July 2021 to December 2022 were selected as the study subjects and divided into the SCAP group and non-SCAP group.Then the patients with SCAP were di-vided into the survival group and death group according to their survival state in 28 d.The general data and re-lated laboratory indexes were collected.NLR and CAR were calculated.The binary logistic regression was a-dopted to analyze the risk factors of death on 28 d for the SCAP patients.The receiver operating characteristic(ROC)curve was drawn and the area under the curve(AUC)was calculated to evaluate the predictive value of relevant indicators.Results The age,levels of PCT,NLR,CAR,WBC and NEU,and the proportion of cor-onary heart disease in the SCAP group were higher than those in the non-SCAP group,while the levels of LYM and ALB were lower than those in the non-SCAP group,and the differences were statistically significant(P＜0.05).The age,levels of PCT,NLR,CAR,WBC and NEU,and the proportion of COPD in the death group were higher than those in the survival group,while the levels of LYM and ALB were lower than those in the survival group,and the differences were statistically significant(P＜0.05).The binary logistic regres-sion analysis showed that the age(OR=1.069,95％CI:1.020-1.120),chronic obstructive pulmonary dis-ease(OR=5.633,95％CI:2.019-15.712),PCT(OR=1.045,95％CI:1.002-1.090)and CAR(OR=2.170,95％CI:1.616-2.915)were the independent influencing factor for the death on 28 d in the patients with SCAP.The ROC curve analysis indicated that AUC,sensitivity and specificity of PCT,NLR and CAR combined detection were superior to those of detection alone,having good predictive value.Conclusion PCT,NLR and CAR have a certain predictive value for death within 28 d in the patients with SCAP.The combined detection has better predictive efficiency.

Combined small cell lung cancer (CSCLC) is a cancer that mixes small cell lung cancer (SCLC) with non-small cell lung cancer (NSCLC) components according to the World Health Organization's 2015 New Pathologic Classification of Lung Cancer. Composed of a mixture of SCLC and NSCLC components, CSCLC is classified as a subtype of SCLC in neuroendocrine tumors. Currently, research on SCLC mainly focuses on single-component pure SCLC, with relatively few studies on CSCLC, which is clinically rare and has no standardized treatment protocols and lacks a unified perception of the clinicopathological features and prognostic predictive indexes of CSCLC. Further observation of efficacy and prognosis is needed. We report the treatment course of a case of CSCLC and provide a literature review of the current status of research on CSCLC.
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Humans ; Small Cell Lung Carcinoma/diagnostic imaging* ; Lung Neoplasms/diagnostic imaging* ; Male ; Middle Aged

Objective To investigate the prevalence of human soil-transmitted nematode infections in Congjiang County, Guizhou Province in 2023, so as to provide insights into soil-transmitted nematodiasis prevention and control in the county. Methods Congjiang County was divided into 5 areas according to geographical locations, and one township was randomly sampled from each area, followed by one administrative village randomly sampled from each township as the survey site. Two hundred permanent residents without deworming during the past three months were randomly sampled from each survey site using the random cluster sampling method. Participants’ fecal samples were collected, soil-transmitted nematode eggs were detected using the KatoKatz technique and the prevalence of human soil-transmitted nematode infections was compared among participants. Mild, moderate and severe soil-transmitted nematode infections were classified according to eggs per gram (EPG), and the proportions of mild, moderate and severe infections were estimated. In addition, participants’ family status and household sanitary toilets construction were investigated using questionnaires. Results A total of 1 001 participants were included at 5 survey sites in Congjiang County, and the overall prevalence of soil-transmitted nematode infections was 19.08% (191/1 001). The prevalence rates of Ascaris lumbricoides and hookworm infections were 2.30% (23/1 001) and 1.90% (19/1 001), with all egg-positives identified as mild infections, and the prevalence of Enterobius vermicularis infections was 0.10% (1/1 001). The prevalence of Trichuris trichiura infections was 15.78% (158/1 001) among participants, and there was a significant difference in the prevalence among survey villages (χ² = 123.345, P < 0.001), with the highest prevalence detected in Liujia Village (39.00%), followed by in Longjiang Village (18.00%). There was an age-specific prevalence rate of T. trichiura infections among participants (χ² = 166.050, P < 0.001), and the highest prevalence was detected among participants at ages of 10 to 19 years (48.19%), followed by at ages of over 70 years (14.53%) and 50 to 59 years (13.04%). There was an occupation-specific prevalence rate of T. trichiura infections among participants (χ² = 74.134, P < 0.001), and the highest prevalence was detected among students (32.32%), followed by among workers/migrant workers (10.34%) and farmers (10.12%). There was an educational level-specific prevalence rate of T. trichiura infections among participants (χ² = 28.761, P < 0.001), and the highest prevalence was detected among participants with an educational level of primary school (21.60%), followed by among illiterate participants (12.03%). There was an ethnicity-specific prevalence rate of T. trichiura infections among participants (χ² = 42.193, P < 0.001). The proportions of mild, moderate and severe T. trichiura infections were 76.58% (121/158), 14.56% (23/158) and 3.16% (5/158), and all severe infections were identified among primary school students. T. trichiura infections were detected in 123 families, and there were 27 families (21.95%) in which two and more family members were identified with T. trichiura infections. A total of 1 001 valid questionnaires were recovered, and the prevalence rates of T. trichiura infections were 14.69% (139/964) and 34.55% (19/55) in families with and without sanitary toilets (χ² = 15.410, P < 0.001). Conclusions The prevalence of soil-transmitted nematode infections was relatively high in Congjiang County, Guizhou Province in 2023, and the T. trichiura infections was notably serious. Intensified soil-transmitted nematodiasis control measures are recommended targeting primary school students, middle-aged and elderly farmers and migrant workers.

Objective:To investigate the significance of menstrual abnormalities in polycystic ovary syndrome (PCOS) for the prediction of future combined metabolic syndrome (MS) and compare the differences in intestinal flora structure between patients with MS and those without.Methods:A case-control study was used to select 111 patients with PCOS who attended the outpatient clinic of the Department of Obstetrics and Gynecology of Jinshan Hospital affiliated to Fudan University between February 2021 and December 2023, and they were divided into the group of PCOS not combined with MS ( n=74, recorded as the NMS group) and the group of PCOS combined with MS ( n=37, recorded as the MS group). The menstrual-related information and stool specimens of all cases were collected to analyze the menstrual characteristics of the two groups and their predictive significance for PCOS combined with MS; and the intestinal flora of the two groups were analyzed by 16S rDNA high-throughput sequencing. Results:The age of menstrual changes [(23.47±4.73) years], time of menstrual changes occurring after menarche [(9.85±5.11) years], and duration of menstrual changes [(3.43±2.78) years] in the NMS group were statistically significantly different when compared with those in the MS group [(20.71±3.61) years, P=0.020; (7.04±3.34) years, P=0.025; (7.63±3.47) years, P<0.001]. The rate of menstrual abnormality, scanty menstruation and amenorrhea were higher in the MS group than in the NMS group, and the difference in the ratio of the composition of the menstrual pattern between the two groups was statistically significant ( P=0.036). The differences in the rates of menstrual abnormalities 8 years later after menarche between the two groups were statistically significant (all P<0.05), and the ORs from 8 to 13 years after menarche were 2.76 (95% CI: 1.07-7.11), 3.68 (95% CI: 1.28-10.56), 3.27 (95% CI: 1.13-9.41), 3.07 (95% CI: 1.06-8.87), 4.20 (95% CI: 1.16-15.21), 11.57 (95% CI: 1.48-90.49), respectively; the difference in the rate of menstrual abnormality between the two groups with menstrual alteration duration of more than 4 years was also statistically significant (all P<0.05), and the ORs for menstrual alteration duration of 4-9 years were 8.89 (95% CI: 2.14-36.99), 11.88 (95% CI: 3.07-46.02), 16.56 (95% CI: 4.15-66.13), 11.25 (95% CI: 2.88-32.95), 7.80 (95% CI: 2.04-29.84), and 10.00 (95% CI: 1.91-52.48), respectively. The α-diversity index of intestinal flora was lower in the MS group than in the NMS group, but the difference was not statistically significant ( P>0.05). At the phylum level, there was a statistically significant difference in the abundance of intestinal flora between the two groups ( P<0.001), the abundance of Bacteroidetes was lower in the MS group than in the NMS group, and the abundance of the Firmicutes was similar in the two groups. At the genus level, there was a statistically significant difference in the abundance of intestinal flora between the two groups ( P<0.001), the abundance of Bifidobacterium decreased and the abundance of Streptococcus and Escherichia increased in the MS group compared with those in the NMS group. Conclusion:Abnormal menstruation 8 years later after menarche in patients with PCOS is predictive of future MS, and its predictive effect increases with age, but does not change significantly with the duration of disease in abnormal menstruation. The structure of the intestinal flora of patients with MS in PCOS is indeed significantly different from that of those without MS.

Objective:To investigate the significance of menstrual abnormalities in polycystic ovary syndrome (PCOS) for the prediction of future combined metabolic syndrome (MS) and compare the differences in intestinal flora structure between patients with MS and those without.Methods:A case-control study was used to select 111 patients with PCOS who attended the outpatient clinic of the Department of Obstetrics and Gynecology of Jinshan Hospital affiliated to Fudan University between February 2021 and December 2023, and they were divided into the group of PCOS not combined with MS ( n=74, recorded as the NMS group) and the group of PCOS combined with MS ( n=37, recorded as the MS group). The menstrual-related information and stool specimens of all cases were collected to analyze the menstrual characteristics of the two groups and their predictive significance for PCOS combined with MS; and the intestinal flora of the two groups were analyzed by 16S rDNA high-throughput sequencing. Results:The age of menstrual changes [(23.47±4.73) years], time of menstrual changes occurring after menarche [(9.85±5.11) years], and duration of menstrual changes [(3.43±2.78) years] in the NMS group were statistically significantly different when compared with those in the MS group [(20.71±3.61) years, P=0.020; (7.04±3.34) years, P=0.025; (7.63±3.47) years, P<0.001]. The rate of menstrual abnormality, scanty menstruation and amenorrhea were higher in the MS group than in the NMS group, and the difference in the ratio of the composition of the menstrual pattern between the two groups was statistically significant ( P=0.036). The differences in the rates of menstrual abnormalities 8 years later after menarche between the two groups were statistically significant (all P<0.05), and the ORs from 8 to 13 years after menarche were 2.76 (95% CI: 1.07-7.11), 3.68 (95% CI: 1.28-10.56), 3.27 (95% CI: 1.13-9.41), 3.07 (95% CI: 1.06-8.87), 4.20 (95% CI: 1.16-15.21), 11.57 (95% CI: 1.48-90.49), respectively; the difference in the rate of menstrual abnormality between the two groups with menstrual alteration duration of more than 4 years was also statistically significant (all P<0.05), and the ORs for menstrual alteration duration of 4-9 years were 8.89 (95% CI: 2.14-36.99), 11.88 (95% CI: 3.07-46.02), 16.56 (95% CI: 4.15-66.13), 11.25 (95% CI: 2.88-32.95), 7.80 (95% CI: 2.04-29.84), and 10.00 (95% CI: 1.91-52.48), respectively. The α-diversity index of intestinal flora was lower in the MS group than in the NMS group, but the difference was not statistically significant ( P>0.05). At the phylum level, there was a statistically significant difference in the abundance of intestinal flora between the two groups ( P<0.001), the abundance of Bacteroidetes was lower in the MS group than in the NMS group, and the abundance of the Firmicutes was similar in the two groups. At the genus level, there was a statistically significant difference in the abundance of intestinal flora between the two groups ( P<0.001), the abundance of Bifidobacterium decreased and the abundance of Streptococcus and Escherichia increased in the MS group compared with those in the NMS group. Conclusion:Abnormal menstruation 8 years later after menarche in patients with PCOS is predictive of future MS, and its predictive effect increases with age, but does not change significantly with the duration of disease in abnormal menstruation. The structure of the intestinal flora of patients with MS in PCOS is indeed significantly different from that of those without MS.

Based on the characteristics of postoperative gynaecological diseases， Lingnan LUO's Gynaecology has summarized the idea of "eliminating abdominal mass to help pregnancy"， and applied the elimination method in the postoperative gynaecological treatment to promote rehabilitation， prevent recurrence， and regulate menstruation in a sequential manner， which is divided into three phases of diagnosis and treatment. The first stage of postoperative rehabilitation （2 weeks after surgery） is based on the pathogenesis of profuse deficiency， profuse stasis， and easy to retain pathogens， and the treatment should focus on tonifying the positive qi and eliminating abdominal mass at the same time， commonly used in modified Sijunzi Dcoction （四君子汤） and Shenghua Dcoction （生化汤）. In the second stage of postoperative rehabilitation （2 weeks to 2-3 months after surgery）， the pathogenesis is mainly kidney deficiency and blood stasis， which should be treated by tonifying kidney and supplement essence， eliminate blood stasis and eliminate abdominal mass， and commonly use the Guishen Pill （归肾丸） with herbs that invigorating blood， dissolving stasis， and clearing the collaterals. Postoperative sequential menstrual regulation and fertility promotion stage （after the end of the postoperative rehabilitation stage， the normal anatomy of the uterine cavity and pelvis is basically restored） adopts cyclic sequential therapy， according to the characteristics of the pathogenesis of the different periods of menstruation in phases， always tonifying kidney and regulating menstruation， eliminating abdominal mass， and attaches importance to the application of four methods of eliminating abdominal mass， including invigorating blood and dissolving stasis， moving qi to resolve constraint， dissolving phlegm and dispelling dampness， resolving accumulation and removing stagnation.

Threatened abortion is a common disease of obstetrics and gynecology and one of the diseases responding specifically to traditional Chinese medicine （TCM）. The China Association of Chinese Medicine organized experts in TCM obstetrics and gynecology， Western medicine obstetrics and gynecology， and pharmacology to deeply discuss the advantages of TCM and integrated Chinese and Western medicine treatment as well as the medication plans for threatened abortion. After discussion， the experts concluded that chromosome， endocrine， and immune abnormalities were the key factors for the occurrence of threatened abortion， and the Qi and blood disorders in thoroughfare and conception vessels were the core pathogenesis. In the treatment of threatened abortion， TCM has advantages in preventing miscarriages， alleviating clinical symptoms and TCM syndromes， relieving anxiety， regulating reproductive endocrine and immune abnormalities， personalized and diversified treatment， enhancing efficiency and reducing toxicity， and preventing the disease before occurrence. The difficulty in diagnosis and treatment of threatened abortion with traditional Chinese and Western medicine lies in identifying the predictors of abortion caused by maternal factors and the treatment of thrombophilia. Recurrent abortion is the breakthrough point of treatment with integrated traditional Chinese and Western medicine. It is urgent to carry out high-quality evidence-based medicine research in the future to improve the modern diagnosis and treatment of threatened abortion with TCM.