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.

Degenerative retinoschisis(RS)is a common peripheral retinal degeneration that typically remains asymptomatic and follows a benign clinical course. However, its morphological resemblance to rhegmatogenous retinal detachment(RRD)presents a diagnostic challenge, as the two conditions demand fundamentally different management and carry distinct prognoses. Precise differentiation is therefore clinically imperative. Recent advances in multimodal imaging have substantially refined the diagnostic accuracy and differential assessment of degenerative RS, establishing spectral-domain optical coherence tomography(SD-OCT)as the definitive reference standard. When the disease progresses to progressive symptomatic schisis-related retinal detachment(PSSRD), prompt surgical intervention, including scleral buckling, pars plana vitrectomy, or a combined approach, is mandated to preserve visual function. Clinical decision-making must be individualized, with the surgical strategy carefully tailored to the specific characteristics of eachcase. This review provides a systematic synthesis of current evidence on the natural history, imaging hallmarks, and surgical management of degenerative RS and its complications, aiming to inform and optimize clinical practice.

Objective:To discuss the anti-tumor effect of low dose of methotrexate(MTX)combined with sorafenib(SFN)on the human osteosarcoma(OS),and to clarify the possible mechanism.Methods:Four types of human OS cells(143B cells,HOS cells,U2OS cells,and MG63 cells)were cultured in vitro.Western blotting method was used to detect the expression levels of vascular endothelial growth factor(VEGF)and vascular endothelial growth factor receptor 2(VEGFR2)proteins in the above four kinds of cells.The human OS xenograft model was established in the nude mice,and 20 successfully modeled BALB/C nude mice were randomly divided into control group(given 2％dimethyl sulfoxide+98％corn oil),low dose of MTX group(given 2 mng·kg-1 MTX),SFN group(given 15 mng·kg-1 SFN),and combined drug group(given 2 mng·kg-1 MTX+15 mng·kg-1 SFN);there were 5 mice in each group.The tumor volumes of the mice in various groups were detected and tumor growth curves were plotted;HE staining was used to observe the morphology of tumor tissue of the mice in various groups;immunohistochemistry was used to detect the positive expression rates of VEGFR2,proliferation marker Ki-67,and hypoxia-inducible factor-1(HIF-1)proteins in tumor tissue of the mice in various groups.The human OS 143B cells were divided into 0,0.125,0.250,0.500,1.000,2.000,and 4.000 μmol·L-1 MTX groups(given 0,0.125,0.250,0.500,1.000,2.000,and 4.000 μmol·L-1 MTX,respectively).CCK-8 method was used to detect the proliferation rates of the 143B cells in various groups,and half inhibityory concentration(IC50)was calculated;the concentration of MTX that had no effect on 143B cell survival was selected as low dose of MTX.The human OS 143B cells were divided into control and low dose of MTX groups(given 0 and 0.250 μmol·L-1 MTX).ELISA method was used to detect the levels of VEGF in the 143B cells in various groups.Results:Compared with 143B cells,the expression levels of VEGF and VEGFR2 proteins in the HOS cells,U2OS cells,and MG63 cells were significantly increased(P＜0.001).In the xenograft model,compared with control group,the tumor volumes of the mice in SFN group,and combined drug group were decreased(P＜0.001);compared with low dose of MTX group and SFN group,the tumor volume of the mice in combined drug group was decreased(P＜0.01).The immunohistochemical results showed that compared with control group,the positive expression rates of Ki-67,VEGFR2,and HIF-1 proteins in tumor tissue of the mice in combined drug group were significantly decreased(P＜0.05).The CCK-8 results showed that there was no change in the proliferation of the 143B cells treated with 0.25 μmol·L-1 MTX.The ELISA results showed that compared with control group,the level of VEGF in the 143B cells in MTX group was signyicantly decreased(P＜0.05).Conclusion:Low dose of MTX enhances the anti-tumor effect of SFN on the human OS,which may be due to the inhibition of VEGF secretion by the OS cells,thereby enhancing the anti-tumor effect of SFN on the human OS.

Hepatic fibrosis(HF)is an inevitable process for many chronic liver diseases to develop into liver cirrhosis and even liver cancer.More than 80%of hepatocellular carcinomas are formed after the process of chronic hepatitis,HF or liver cirrhosis.The immune microenvironment produced by inflammation and fi-brosis plays a significant role in promoting the occurrence and development of hepatocellular carcinoma.He-patic stellate cells(HSC),extracellular matrix(ECM),and fibroblasts are involved in the progression of HF by influencing innate immunity and adaptive immunity.This article,by analyzing the role of immune cells in HF,is expected to provide new intervention approaches and therapeutic targets for the clinical treatment of HF,thereby further enhancing the effectiveness of immunotherapy and offering safer and more effective treat-ment options for HF patients.

Objective To survey conflict occurrence in surrogate decision makers for respiratory intensive care unit(RICU)patients with mechanical ventilation and explore its influencing factors.Methods A total of 101 surrogate decision-makers of mechanical ventilation patients in RICU were subjected from the Second Affiliated Hospital of Army Medical University from June 2024 to December 2024 by convenience sampling.General data questionnaire,Preparation for Decision Making Scale and Decisional Conflict Scale were used to conduct questionnaire survey.One-way ANOVA,Pearson correlation analysis and multiple linear regression analysis were employed to identify the influencing factors.Results The total score of decision readiness was 64.14±22.35,the total score of decision conflict was 35.18±26.47,and the incidence of decision conflict was 69.31%in the participants.Univariate analysis showed that there were statistically differences in whether knowing about prognosis,relationship with patients,awareness of patients'ideas about treatment,and understanding of information related to mechanical ventilation among the participants(P<0.05).Pearson correlation analysis indicated that decision readiness was negatively correlated with decision conflict and its 3 dimensions(P<0.001).The results of multiple linear regression analysis revealed that understanding of information related to mechanical ventilation and decision readiness were influencing factors for the decision conflict of the participants(P<0.001).Conclusion The decision conflict level is quite higher in the surrogate decision makers for RICU patients with mechanical ventilation,and the level is negatively correlated with the understanding of mechanical ventilation related information and decision readiness.

Objective To explore the relationship between serum long non-coding RNA X-inactive specific transcript(LncRNA XIST)and microRNA-122-5p(miR-122-5p)expression and the severity of brain injury and prognosis in patients with sepsis-associated encephalopathy(SAE).Methods A total of 108 SAE patients(SAE group)and 52 patients with sepsis only(non-SAE group)admitted to the Ankang Hospital of Tradi-tional Chinese Medicine from January 2019 to December 2023 were selected as the study subjects.According to the degree of brain injury,the SAE patients were categorized into mild brain injury group[Glasgow Coma Scale(GCS)score 13-14,27 cases],moderate brain injury group(GCS score 9-12,36 cases),and severe brain injury group(GCS score 3-8,45 cases).Based on the 28-day prognosis,they were divided into death group(51 cases)and survival group(57 cases).Serum LncRNA XIST and miR-122-5p expression levels were measured using real-time quantitative PCR.The binding site of LncRNA XIST and miR-122-5p was predicted using the StarBase database,and Pearson correlation analysis was performed to evaluate the relationship be-tween serum LncRNA XIST and miR-122-5p expression in SAE patients.Multivariate unconditional Logistic regression was used to determine the association between serum LncRNA XIST,miR-122-5p expression,and prognosis in SAE patients.Receiver operating characteristic curves were used to assess the predictive efficacy of LncRNA XIST and miR-122-5p expression for SAE prognosis.Results Compared with non-SAE group,se-rum LncRNA XIST expression was increased and miR-122-5p expression was decreased in SAE group,with statistical significance(P＜0.05).There were binding sites between LncRNA XIST and miR-122-5p,and the expression of LncRNA XIST in serum of SAE patients was negatively correlated with that of miR-122-5p(P＜0.05).Serum LncRNA XIST expression in mild brain injury group,middle brain injury group and severe brain injury group was increased successively,while miR-122-5p expression was decreased successively,with statistical significance(P＜0.05).The 28-day mortality rate of SAE patients after admission was 47.22％(51/108).Compared with the survival group,the expression of serum LncRNA XIST was higher in the death group,and the expression of miR-122-5p was lower,with statistical significance(P＜0.05).High sequential organ failure assessment(SOFA)score and high expression of LncRNA XIST were independent risk factors for death in SAE patients,while high GCS scores and high miR-122-5p expression of were independent protec-tive factors(P＜0.05).The combined expression of serum LncRNA XIST and miR-122-5p predicted the death of SAE patients with greater area under the curve than that of serum LncRNA XIST and miR-122-5p a-lone(P＜0.05).Conclusion Elevated serum LncRNA XIST and decreased miR-122-5p expression levels are associated with the severity of brain injury and poor prognosis in SAE patients.The combined detection of Ln-cRNA XIST and miR-122-5p has a high predictive value for SAE prognosis.