ObjectiveTo investigate the correlation between neutrophil-to-lymphocyte ratio （NLR）， platelet-to-lymphocyte ratio （PLR）， systemic immune-inflammation index （SII） and the severity of intrauterine adhesions （IUA）. MethodsThe retrospective study included 380 patients who underwent transcervical resection of adhesions （TCRA） from December 2019 to March 2025. Based on the American Fertility Society （AFS） classification， patients were divided into mild （n=61）， moderate （n=225）， and severe （n=94） groups. NLR， PLR， and SII were calculated from preoperative blood tests. Statistical analyses included Kruskal-Wallis test and ordinal Logistic regression. ResultsNLR， PLR， and SII were significantly higher in the severe IUA group compared to the mild group （P<0.05）， with SII showing the strongest predictive ability （OR=1.004， P=0.001）. The number of intrauterine procedures was an independent risk factor （OR=1.27/level， P=0.016）. The predictive model ［Logit（P）=-0.676+0.241×operation times+0.004×SII］ effectively identified severe IUA cases. ConclusionInflammatory markers （particularly SII） are correlated with IUA severity and may serve as non-invasive tools for clinical assessment.

ObjectiveTo evaluate the pregnancy outcomes of assisted reproductive technology （ART） in women with a history of thyroid cancer who retained fertility intentions after completing cancer treatment. MethodsA retrospective analysis was performed on 61 patients with a history of thyroid cancer who underwent in vitro fertilization/intracytoplasmic sperm microinjection and embryo transfer （IVF/ICSI-ET）. These patients were included as the case group. A total of 122 non-cancer patients who received ART during the same period were selected as the control group using 1∶2 matching based on age and oocyte retrieval time. Baseline characteristics， outcomes of the first ART cycle， and cumulative pregnancy outcomes were compared between the two groups. ResultsThere was no significant difference in the basic data， the total amount of gonadotropin （Gn） and the days of use between the case group and the control group （P>0.05）. However， the case group had significantly fewer retrieved oocytes， mature oocytes （MII）， lower fertilization and cleavage rates， and fewer transferable and high-quality embryos， as well as fewer embryos transferred during the first cycle （P < 0.05）. However， there was no significant difference in the rate of first embryo implantation and first clinical pregnancy between the two groups （P>0.05）. In the analysis of cumulative outcomes， the two groups did not show statistically significant differences in the cumulative pregnancy rate， clinical pregnancy rate per transfer cycle， the number of oocyte retrieval cycles required per live birth， the number of embryo transfer cycles required per live birth， and the number of embryos used for each live birth （P>0.05）. However， the cumulative live birth rate was significantly lower in the case group compared to the control group （P=0.005）. ConclusionAfter treatment for thyroid cancer， when ART is used to help pregnant women， the pregnancy outcome is comparable to that of women without tumors. Individualized reproductive management and timely fertility preservation strategies are recommended to optimize reproductive outcomes in this population.

OBJECTIVE: To investigate the current status of clinical genetics specialization development and the diagnostic and therapeutic capabilities for hereditary diseases across medical institutions in Shanghai, and to assess the necessity and feasibility of establishing training bases for clinical genetics specialists. METHODS: By employing a cross-sectional survey design, the Clinical Genetics Committee of Shanghai Medical Association has conducted questionnaire surveys from March to April 2025 across 54 healthcare institutions in Shanghai (including 33 tertiary hospitals and 21 secondary hospitals). The survey involved administrative departments and medical personnel from 15 clinical specialties. The survey has covered current genetic disease diagnosis and treatment practices, relevant and specialised disease types, genetic department establishment, testing capabilities, personnel teams, and training requirements. RESULTS: The results revealed that 78.0% of clinical departments surveyed had treated patients with hereditary disorders. Shanghai possesses diagnostic and therapeutic expertise for over 95% of hereditary diseases listed in its rare disease catalogue, reflecting both the practical clinical demand for such conditions and the city's overall diagnostic and therapeutic strengths in this field. Nevertheless, significant disparities exist in the development of genetics departments across different tiers of healthcare institutions. Resources for genetic testing capabilities (including molecular, cellular, and biochemical testing) are also unevenly distributed across different tiers of hospitals. The survey further revealed that only 26.0% of departments believe that their current physician structure fully meets the diagnostic and treatment demands. Over 90% of departments consider standard training for clinical genetic specialists necessary, with 74.0% expressing willingness to participate in establishing training bases. Based on above findings and thorough deliberation, the Clinical Genetics Committee of the Shanghai Medical Association proposes advancing specialist training and discipline development through establishing a standard training system. The committee has drafted a three-year training protocol featuring a "joint training"-centered model, recommending a pilot-first, dynamically optimized strategy for steadily advancing training base development. CONCLUSION Shanghai faces substantial demand for genetic disease diagnosis and treatment, yet exhibits shortcomings in clinical genetics specialization development, resource allocation, and talent pipeline cultivation. To establish a standard training system holds significant practical importance and is underpinned by a broad demand.
Humans ; China ; Surveys and Questionnaires ; Genetic Diseases, Inborn/genetics* ; Cross-Sectional Studies ; Genetics, Medical/education* ; Genetic Testing

Primary biliary cholangitis （PBC） is an autoimmune liver disease characterized by intrahepatic cholestasis， while fatigue is a common symptom of PBC that significantly affects the quality of life of patients. The pathogenesis of fatigue is complex and may be associated with the factors such as cholestasis-induced inflammation， gut microbiota dysbiosis， brain structural and functional abnormalities， and mitochondrial dysfunction. At present， first-line therapies and liver transplantation have a limited effect in alleviating fatigue， and there is still a lack of standardized comprehensive assessment system. Emerging drugs and non-pharmaceutical interventions， including lifestyle modifications， have shown potential application prospects. This article systematically reviews the research advances in the clinical manifestations， pathogenesis， clinical assessment， and intervention of fatigue in PBC patients， in order to provide a reference for optimizing treatment strategies and promoting the research and development of new therapies.

ObjectiveTo observe the clinical efficacy of Anshen Buxin Gao in patients with coronary artery disease （CAD） complicated with somatization disorder after percutaneous coronary intervention （PCI）， as well as its effect on heart rate variability （HRV）. MethodsA total of 96 patients with somatization disorder after PCI were selected and randomized into control and treatment groups （48 cases）. On the basis of standardized Western medical treatment for CAD， the control group received Dailixin， while the treatment group received Dailixin combined with Anshen Buxin Gao. The somatic symptom scale （SSS）， generalized anxiety disorder 7-item scale （GAD-7）， patient health questionnaire-9 （PHQ-9）， and self-rating scale of sleep （SRSS） scores in both groups were recorded before and after treatment. The traditional Chinese medicine symptom efficacy， HRV， and incidence of adverse drug reactions were observed. ResultsA total of 90 patients completed the trial， encompassing 45 patients in the control group and 45 patients in the treatment group. Baseline characteristics between the two groups showed no statistically significant differences， indicating comparability. After treatment， both groups exhibited reductions in SSS， GAD-7， and PHQ-9 scores （P<0.05）， and the treatment group outperformed the control group in alleviating somatic symptoms and anxiety-depression symptoms （P<0.05）. The control group did not achieve a significant reduction in SRSS score， whereas the treatment group effectively lowered the SRSS score （P<0.05）. Regarding traditional Chinese medicine symptom efficacy， the total response rate in the treatment group was 91.1% （41/45）， which was higher than that （71.1%， 32/45） in the control group （Z=-2.663， P<0.05）. Both groups improved HRV in patients with somatization disorder， and the treatment group showed greater improvement （P<0.05）. There were no serious clinical adverse events during the study period. The incidence of adverse reactions in the treatment group was 6.7% （3/45）， which was lower than that （14/45， 31.10%） in the control group （χ²=7.252， P<0.05）. ConclusionThe addition of Anshen Buxin Gao to Dailixin therapy significantly alleviates the clinical symptoms and improves the sleep quality， treatment efficacy， and HRV in patients with CAD complicated with somatization disorder after PCI， while reducing the adverse effects associated with Dailixin alone. This approach demonstrates considerable clinical value and warrants further promotion.

Objective: To explore the relationship between positive parenting styles and academic emotions in junior high school students, as well as the chain mediation effects of parent-child communication and peer relationships, providing a theoretical basis for family education interventions. Methods: Using stratified cluster random sampling, 1 063 students from four junior high schools in a city in Anhui Province were selected for questionnaire surveys, form March to April, 2025. Core variables were measured using the Short form Parenting Style Scale, Adolescent Parent-Child Communication Scale, Peer Relationship Scale, and Adolescent Academic Emotion Questionnaire. Group comparison was conducted using t-test or analysis of variance, and Pearson correlation analysis was used to examine the correlation between positive parenting styles, peer relationships, parent-child communication and positive academic emotions. Multiple linear regression analysis was used to examine the effects of positive parenting styles, peer relationships and parent-child communication on positive academic emotions. A mediation effect model and Bootstrap method were employed to test the chain mediation effects. Results: Students who were class leaders, had parents with higher education levels, or came from intact families scored significantly higher on positive academic emotions ( t/F =7.23, 13.73, 10.67, 4.45, all P < 0.01 ). Positive parenting styles, peer relationships, and parent-child communication were all positively correlated with positive academic emotions ( r =0.45, 0.41, 0.38), and all three positively predicted positive academic emotions ( β =0.24, 0.23, 0.12) (all P < 0.01 ). Further analysis showed that positive parenting styles directly predicted positive academic emotions ( β =0.40) and also indirectly influenced academic emotions through parent-child communication ( β =0.07), peer relationships ( β =0.05), and the chain mediation path of "parent-child communication → peer relationships" ( β =0.04) (all P <0.05), with the total indirect effect accounting for 40.55%. Conclusion Positive parenting styles enhance junior high school students academic emotions through the chain mediation path of "parent-child communication → peer relationships", providing theoretical support for interventions within the educational ecosystem.

Objective To investigate the therapeutic effects of modified Lizhong Decoction on gastric and duodenal ulcers(GDU)of the spleen-stomach cold deficiency type,as well as its influence on gastric function and inflammatory mediators.Methods From April 2023 to May 2025,patients diagnosed with gastric dyspepsia of the spleen and stomach cold deficiency type at Nanyang First People's Hospital were randomly assigned to either the Western medicine group(n=53)or the combined therapy group(n=53).The Western medicine group received oral rabeprazole sodium enteric-coated tablets and sucralfate suspension,while the combined therapy group received the same Western medication regimen plus modified Lizhong Decoction.Both groups underwent a 6-week treatment course.Outcomes including clinical efficacy after 6 weeks,gastric mucosal morphology scores,gastric function,levels of inflammatory mediators,mucosal repair-related factors,oxidative stress markers,quality of life before and after treatment,and treatment safety were compared between the two groups.Results The total effective rate in the combined group after 6 weeks of treatment was significantly higher than that in the Western medicine group(P<0.05).After 6 weeks of treatment,both groups showed reduced mucosal thickness,inflammatory cell infiltration,glandular density scores,and decreased serum levels of cholecystokinin(CCK),motilin(MTL),gastrin(GAS),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),nuclear factor-κB(NF-κB),and malondialdehyde(MDA)compared to baseline,with greater reductions observed in the combined group(P<0.05).Additionally,serum levels of calcitonin gene-related peptide(CGRP),trefoil factor 1(TFF1),epidermal growth factor(EGF),epidermal growth factor receptor(EGFR),and superoxide dismutase(SOD),as well as quality-of-life scores across multiple domains,were significantly increased from baseline in both groups,with the combined group showing superior improvements(P<0.05).During the treatment period,the incidence of adverse reactions was 11.32%in the combined group and 5.66%in the Western medicine group,with no statistically significant difference between the two groups(P>0.05).Conclusion Modified Lizhong Decoction demonstrated a definite therapeutic effect on GDU of the spleen and stomach cold deficiency type,effectively improving gastric mucosal morphology,enhancing gastric function,suppressing inflammatory responses and oxidative stress,promoting the secretion of mucosal repair-related factors,improving patients'quality of life,and exhibiting favorable safety.

Objective:To explore the effect of target-oriented management of regional cerebral oxygen saturation (rScO 2) monitoring on gastrointestinal surgery in elderly patients with fragile brain function. Methods:A total of 60 elderly patients with fragile brain functional surgery admitted to Changzhi People′s Hospital from January 2022 to December 2022 were divided into the study group and the conventional group by the random number table method, each group with 30 cases, rScO 2 monitoring target-oriented management and conventional anesthesia monitoring management were given respectively during the operation. The levels of mean arterial pressure (MAP), blood gas analysis and cerebral oxygen metabolism indexes were compared between the two groups at different time points. Postoperative recovery related indexes and the incidence of postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) were recorded and compared between the two groups. Results:The level of MAP at 30 min after anesthesia in the study group was significantly higher than that in the conventional group: (90.50 ± 6.03) mmHg vs. (82.05 ± 6.10) mmHg, 1 mmHg = 0.133 kPa, there was statistical difference ( P<0.05). The levels of blood lactic acid (Lac) and blood glucose (GLU) at 60 min and immediately after surgery in the study group were lower than those in the conventional group: (1.45 ± 0.48) mmol/L vs. (1.90 ± 0.51) mmol/L, (1.34 ± 0.42) mmol/L vs. (1.65 ± 0.46) mmol/L; (7.17 ± 0.90) mmol/L vs. (7.62 ± 0.76) mmol/L, (6.70 ± 0.87) mmol/L vs. (7.11 ± 0.67) mmol/L, there were statistical differences ( P<0.05). The jugular veinoxygen content (CjvO 2) at 60 min after operation in the study group was higher than that in the conventional group: (98.16 ± 20.34) ml/L vs. (85.32 ± 18.54) ml/L; cerebral extraction rate of oxygen (CERO 2) and the internal jugular veno-arterial blood lactic acid difference (Djv-aLac) were lower than those in the conventional group: (33.00 ± 7.86)% vs. (40.52 ± 9.05)%, (0.15 ± 0.05) mmol/L vs. (0.21 ± 0.07) mmol/L, there were statistical differences ( P<0.05). The recovery time, tracheal extubation time and hospital stay in the study group were lower than those in the conventional group: (12.25 ± 2.00) min vs. (15.00 ± 3.14) min, (14.00 ± 2.34) min vs. (20.12 ± 4.37) min, (9.00 ± 1.13) d vs. (9.65 ± 1.25) d, there were statistical differences ( P<0.05). The POD incidence in the study group was lower than that in the conventional group: 6.67%(2/30) vs. 26.67%(8/30), there was statistical difference ( χ2 = 4.32, P<0.05). The incidence of POCD within 1 week after surgery had no statistical difference between the two groups ( P>0.05). Conclusions:rScO 2 monitoring and target-oriented management can better maintain the stability of hemodynamics and cerebral oxygen metabolism in elderly patients with fragile brain function, and can improve blood gas analysis index, reduce the occurrence of postoperative POD and other cognitive abnormalities, which is beneficial to their postoperative outcome.

Objective To identify predictive indicators for unscheduled rehospitalisation within 3 months in patients of oral endotracheal intubation(OEI)with ultrasound gray level co-occurrence matrix(GLCM)and develop a corresponding risk assessment system for the purpose to reduce the event of unscheduled rehospitalisation.Methods A total of 260 OEI patients who underwent extubation in a Tier-IIIA hospital between October 2023 and May 2024 were enrolled by convenience sampling.Patients were divided into a rehospitalisation group and a non-rehospitalisation group according to the event of unscheduled rehospitalisation within 3 months after discharge.Demographic data and laboratory test report,ultrasound morphological indicators and GLCM of rectus femoris muscle were collected on day-1 and day-7 after extubation.Multivariate logistic regression analysis and Framingham risk function were used to identify independent risk factors for unscheduled rehospitalisation within 3 months.A risk assessment system for unscheduled rehospitalisation within 3 months was subsequently developed.Predictive accuracy were evaluated using receiver operating characteristic(ROC)curve and area under the curve(AUC),and Hosmer-Lemeshow test.Results Toally 224 patients were included.The incidence of unplanned rehospitalization within 3 months in patients with oral tracheal intubation was 35.71%(80/224).The independent risk factors for unscheduled rehospitalisation within 3 months in OEI patients were identified as age≥60,nutrition risk screening2002≥3,shock index≥1.0,duration of mechanical ventilation≥251 hours,rectus femoris cross-sectional area≤1.41cm2,angular second moment≤0.71,the proportion change rate of ratio of rectus femoris on quadriceps femoeis for 0 on day-7 after extubation.The risk assessment system exhibited an AUC of 0.791(95%CI:0.707～0.875,P<0.001),with a sensitivity of 75.02%and a specificity of 67.33%.The Hosmer-Lemeshow value was 2.581(P=0.630),and the optimal cut-off value was determined at 3.Conclusion The developed risk assessment system demonstrates a satisfactory predictive performance.It provides a valuable reference for clinical assessment of the patients who had unscheduled rehospitalisation within 3 months in OEI patients.

Objective To explore the effect of ultrasound-guided individualized respiratory management on pulmonary ventilation in neonates with severe respiratory diseases in neonatal intensive care unit(NICU).Methods A total of 96 children with severe respiratory disease in NICU of the hospital were selected as research subjects.According to the random number table method,they were divided into the observation group and the control group,with 48 cases in each group.The control group was treated with routine respiratory management,and the observation group was treated with severe ultrasound-guided individualized nursing management on the basis of the control group.The clinical indexes,blood gas analysis and respiratory dynamics indexes including arterial partial pressure of oxygen[p(O2)],partial pressure of carbon dioxide[p(CO2)],arterial blood pH,airway resistance,chest lung compliance and severity of disease[pediatric critical illness score(PCIS),simple neonatal acute physiology score II(SNAP-II)]and occurrence of complications were compared between the two groups before and after intervention.Results The mechanical ventilation time,antipyretic time,white blood cell count(WBC)recovery time,ICU stay and hospitalization time were significantly shorter in the observation group than those in the control group(P＜0.05).After intervention,p(O2),pH and chest lung compliance were significantly increased in the two groups(P＜0.05),while p(CO2)and airway resistance were significantly decreased(P＜0.05).Moreover,the improvement was better in the observation group than that of the control group.After intervention,the PCIS scores were significantly increased in both groups(P＜0.05),while the SNAP-II scores were significantly reduced(P＜0.05),and the improvement was better in the observation group than that of the control group(P＜0.05).The total complication rate was significantly lower in the observation group than that in the control group(P＜0.05).Conclusion Severe ultrasound-guided individualized respiratory management can significantly enhance the pulmonary ventilation of NICU children with severe respiratory disease,improve the blood oxygen status and accelerate the improvement of disease condition.