Objective:To analyze the consecutive pregnancy outcomes in women with different times of tubal pregnancy (TP) history.Methods:The data of 415 patients with a history of TP≥1 times admitted in Gynecology Department of Obstetrics & Gynecology Hospital of Fudan University from January 2019 to April 2023 were retrospectively analyzed. They were divided into two groups: the first TP group ( n=359) and the second TP group ( n=56). Clinical data and consecutive pregnancy outcomes were collected and the differences of TP rate between patients treated by retaining fallopian tubes and those treated by salpingectomy were analyzed. Patients with a second TP were divided into two subgroups: ipsilateral recurrence subgroup and contralateral recurrence subgroup, and difference of TP rate between the two subgroups was assessed. Risk factors for recurrent TP were assayed by binary logistic analysis. Results:Intrauterine pregnancy rate in the first TP group was higher than that in the second TP group [66.0% (237/359) vs. 48.2% (27/56), P=0.008]. Salpingectomy resulted in significantly lower rate of intrauterine pregnancy [35.7% (35/98)] compared with treatment with methotrexate or salpingotomy or extrusion of fallopian tubes in the first TP group, 77.0% (97/126), 78.2% (93/119), 90.0% (9/10), respectively; all P<0.001]. There was no difference of intrauterine pregnancy rate among patients treated by expectant management or methotrexate or salpingectomy or salpingotomy in the second TP group (all P>0.05). There were 24 cases in the ipsilateral recurrent subgroup and 32 cases in the contralateral recurrent subgroup. The rates of recurrent intrauterine pregnancy, ipsilateral ectopic pregnancy and contralateral ectopic pregnancy were not different between the two subgroups (all P>0.05). Logistic regression analysis suggested time interval from prior TP to next pregnancy ≥36 months were positively correlated with occurrence of the second TP ( OR=5.012, 95% CI: 2.525-9.949, P<0.001). Patients concept by in vitro fertilization and embryo transfer (IVF-ET) after the first TP had higher rate of intrauterine pregnancy compared with natural conception [91.4% (53/58) vs. 61.1% (184/301), P<0.001] and IVF-ET significantly decreased the occurrence of the second TP ( OR=9.666, 95% CI: 3.303-28.287, P<0.001). Patients concepted by IVF-ET after the second TP had higher rate of intrauterine pregnancy compared with natural conception [76.5% (13/17) vs. 35.9% (14/39), P<0.001] and IVF-ET significantly decreased the occurrence of the third TP ( OR=5.987, 95% CI: 1.529-23.447, P=0.010). Conclusion:For patients who experience first-time TP, preserving the fallopian tube can help them gain the opportunity for intrauterine pregnancy. For patients with recurrent ipsilateral fallopian TP, there is currently insufficient evidence to support the benefit of removing the affected fallopian tube. Whether it is the first or the second TP, IVF-ET can help patients achieve a higher intrauterine pregnancy rate.

Objective:To investigate the inhibitory effect of ferulic acid on the retina of diabetic mice and high glucose-induced human retinal pigment epithelium (RPE) cell injury and the mechanism.Methods:Thirty 8-week-old SPF male type 2 diabetic db/db mice were selected and divided into a model group and a ferulic acid group by the random number table method, with 15 mice in each group.Another 15 db/m mice of the same age were selected as a control group.The model and control groups received normal saline (5 ml/kg) by gavage daily, and the ferulic acid group received ferulic acid solution (0.05 g/kg) by gavage daily.After two months of treatment, the mice were sacrificed and the eyeballs were removed.The morphological changes of mouse retinal tissues were observed by hematoxylin-eosin staining.The fluorescence intensity and expression levels of mitochondrial calcium uniporter (MCU), p38 mitogen-activated protein kinase (p38 MAPK) and phosphorylated p38 MAPK (p-p38 MAPK) in mouse retinal tissues were detected by immunofluorescence staining and Western blot.Human RPE cells were divided into control group, dimethyl sulfoxide (DMSO) group, high glucose group and high glucose+ ferulic acid group.The control group received no treatment, and the other cell groups were cultured with the corresponding reagents for 24 hours.The reactive oxygen (ROS) level of RPE cells in each group was detected with the ROS detection kit.The mitochondrial membrane potential level of RPE cells was detected with the a mitochondrial membrane potential detection kit (JC-1).The MCU and microfilament fluorescence intensity of RPE cells were detected with the a microfilament green fluorescent probe.To explore the regulatory relationship between MCU, p38 MAPK and p-p38 MAPK, the MCU protein level was silenced and overexpressed by lentivirus transfection technology.The fluorescence intensity and expression levels of MCU, p38 MAPK and p-p38 MAPK proteins in RPE cells were detected by immunofluorescence staining and Western blot.The use and feeding of experimental animals followed the 3R principle and the Statement of the Association for Research in Vision and Ophthalmology on the Use of Animals in Ophthalmology and Vision Research.This study protocol was approved by the Ethics Committee of Ningxia Eye Hospital, People's Hospital of Ningxia Hui Autonomous Region (No.2019085).Results:The intercellular space of the outer nuclear layer, inner nuclear layer and ganglion cell layer of the retinal tissue in the model group was increased and the cell arrangement was disordered compared with the control group, and the retinal tissue in the ferulic acid group was significantly improved.Compared with the control group, the fluorescence intensity of MCU, p-p38 MAPK and MCU+ p-p38 MAPK protein of mouse retinal tissue in model group and ferulic acid group was significantly increased (all at P<0.05).Compared with the model group, the fluorescence intensity of MCU, p-p38 MAPK and MCU+ p-p38 MAPK protein of mice retinal tissue in ferulic acid group was significantly decreased (all at P<0.05).Compared with the control group, the relative expression levels of MCU, p38 MAPK and p-p38 MAPK proteins of mouse retinal tissue in model group were significantly increased (all at P<0.05).Compared with the model group, the relative expression levels of MCU, p38 MAPK and p-p38 MAPK proteins of mice retinal tissue in ferulic acid group were significantly decreased (all at P<0.05).The ROS fluorescence intensities in the control group, DMSO group, high glucose group and high glucose+ ferulic acid group were 0.22±0.02, 0.22±0.03, 0.30±0.02 and 0.24±0.02, respectively, and the overall difference was statistically significant ( F=7.845, P<0.01).The ROS fluorescence intensity was significantly higher in the high glucose group than in the control and DMSO groups, and it was significantly lower in the high glucose+ ferulic acid group than in the high glucose group (all at P<0.05).The mitochondrial membrane potential was significantly lower in high glucose group and high glucose+ ferulic acid group than in control and DMSO groups, and significantly higher in high glucose+ ferulic acid group than in high glucose group (all at P<0.05).Compared with the control group and DMSO group, the fluorescence intensity of MCU was higher in the high glucose group, accompanied by the decrease and thinning of cell microfilaments, and the fluorescence intensity of MCU protein was significantly decreased in high glucose+ ferulic acid group, with the number of microfilaments increased significantly.Compared with the control group and DMSO group, the fluorescence intensity and relative expressions of MCU, p38 MAPK and p-p38 MAPK proteins were significantly increased in the high glucose group (all at P<0.05).Compared with the high glucose group, the fluorescence intensity and relative expressions of MCU, p38 MAPK and p-p38 MAPK proteins were significantly decreased in the high glucose+ ferulic acid group (all at P<0.05).Compared with the control group and the empty vector group, the relative expressions of MCU, p38 MAPK and p-p38 MAPK proteins were significantly increased in the MCU overexpression group and significantly decreased in the MCU shRNA group and the MCU overexpression+ ferulic acid group (all at P<0.05).Compared with MCU overexpression group, the relative expressions of MCU, p38 MAPK and p-p38 MAPK proteins were significantly decreased in MCU shRNA group and MCU overexpression+ ferulic acid group, and the differences were statistically significant (all at P<0.05). Conclusions:Ferulic acid can regulate oxidative stress and mitochondrial dysfunction, thereby ameliorating retinal damage and high glucose-induced RPE cell injury in diabetic mice, which may play a protective role through MCU and p38MAPK signaling pathways.

Objective:To evaluate the influencing factors and predictive value of renal function recovery in elderly patients with heart failure(HF)and acute renal injury(AKI)after intermittent veno-venous hemofiltration(IVVH)using critical care ultrasound.Methods:The clinical data of elderly patients with heart failure(NYHF grade Ⅲ~Ⅳ)complicated with acute kidney injury(stage 2~stage 3)who underwent intravenous veno-venous hemofiltration(IVVH)in the critical care unit(CCU)of our hospital were retrospectively analyzed.The demographic information of the patients and the changes in clinical biochemical and critical care ultrasound monitoring parameters before and after 7 days of IVVH were recorded.Based on the recovery of renal function, the patients were divided into two groups: a renal function recovery group and a renal function non-recovery group.Logistic regression and Receiver Operating Characteristic Curve(ROC)curve analysis were performed to determine the predictive value of various influencing factors on the recovery of renal function in patients.Results:A total of 178 patients were enrolled in this study.After starting IVVH treatment, renal function recovered in 143 cases at 30 days, and in 138 cases at 90 days.However, renal function did not recover in 35 cases at 30 days, and in 40 cases at 90 days.The proportion of NYHF Ⅲ patients、the proportion of diabetic patients、the decrease of Beta 2-microglobulin(β2-MC)、the decrease of Cystain C(CysC)、the increase of venous transit time index(VTI)、the increase of Cardiac Output(CO)and the decrease in renal blood flow resistance index(RI)in the recovery groups at both 30 days and 90 days was significantly higher than that in the non-recovery group(all P<0.05).The total treatment time of IVVH in the recovery group was significantly shorter than that in the non-recovery group, with 30 days and 90 days( P<0.05).Logistic analysis revealed that the total treatment time of IVVH( OR=1.067, P<0.001), VTI( OR=0.652, P=0.024), CO( OR=0.037, P<0.001), and RI(OR<0.001, P=0.010)of the interlobar artery were identified as independent factors influencing the recovery of renal function in AKI patients at 30 days and 90 days after IVVH treatment.The ROC curve demonstrated the predictive value of various independent influencing factors for 30-day renal function recovery.The area under the curve(AUC)for VTI was 0.610(95% CI: 0.513-0.707), for CO it was 0.760(95% CI: 0.656-0.864), and for RI it was 0.694(95% CI: 0.589-0.799).Similarly, the ROC curve showed the predictive value of these factors for renal function recovery at 90 days.The AUC for VTI was 0.654(95% CI: 0.564-0.744), for CO it was 0.697(95% CI: 0.605-0.789), and for interlobar artery RI it was 0.605(95% CI: 0.495-0.715). Conclusions:The venous transit time index(VTI), cardiac output(CO), and renal interlobar artery RI, monitored by critical care ultrasound, are independent factors that can be used to evaluate the recovery of renal function in elderly patients with HF and AKI after IVVH treatment.Additionally, the changes in these parameters within 7 days after IVVH treatment have a high predictive value for the improvement of renal function in elderly patients after 30 days and 90 days.

Objective:To analyze the consecutive pregnancy outcomes in women with different times of tubal pregnancy (TP) history.Methods:The data of 415 patients with a history of TP≥1 times admitted in Gynecology Department of Obstetrics & Gynecology Hospital of Fudan University from January 2019 to April 2023 were retrospectively analyzed. They were divided into two groups: the first TP group ( n=359) and the second TP group ( n=56). Clinical data and consecutive pregnancy outcomes were collected and the differences of TP rate between patients treated by retaining fallopian tubes and those treated by salpingectomy were analyzed. Patients with a second TP were divided into two subgroups: ipsilateral recurrence subgroup and contralateral recurrence subgroup, and difference of TP rate between the two subgroups was assessed. Risk factors for recurrent TP were assayed by binary logistic analysis. Results:Intrauterine pregnancy rate in the first TP group was higher than that in the second TP group [66.0% (237/359) vs. 48.2% (27/56), P=0.008]. Salpingectomy resulted in significantly lower rate of intrauterine pregnancy [35.7% (35/98)] compared with treatment with methotrexate or salpingotomy or extrusion of fallopian tubes in the first TP group, 77.0% (97/126), 78.2% (93/119), 90.0% (9/10), respectively; all P<0.001]. There was no difference of intrauterine pregnancy rate among patients treated by expectant management or methotrexate or salpingectomy or salpingotomy in the second TP group (all P>0.05). There were 24 cases in the ipsilateral recurrent subgroup and 32 cases in the contralateral recurrent subgroup. The rates of recurrent intrauterine pregnancy, ipsilateral ectopic pregnancy and contralateral ectopic pregnancy were not different between the two subgroups (all P>0.05). Logistic regression analysis suggested time interval from prior TP to next pregnancy ≥36 months were positively correlated with occurrence of the second TP ( OR=5.012, 95% CI: 2.525-9.949, P<0.001). Patients concept by in vitro fertilization and embryo transfer (IVF-ET) after the first TP had higher rate of intrauterine pregnancy compared with natural conception [91.4% (53/58) vs. 61.1% (184/301), P<0.001] and IVF-ET significantly decreased the occurrence of the second TP ( OR=9.666, 95% CI: 3.303-28.287, P<0.001). Patients concepted by IVF-ET after the second TP had higher rate of intrauterine pregnancy compared with natural conception [76.5% (13/17) vs. 35.9% (14/39), P<0.001] and IVF-ET significantly decreased the occurrence of the third TP ( OR=5.987, 95% CI: 1.529-23.447, P=0.010). Conclusion:For patients who experience first-time TP, preserving the fallopian tube can help them gain the opportunity for intrauterine pregnancy. For patients with recurrent ipsilateral fallopian TP, there is currently insufficient evidence to support the benefit of removing the affected fallopian tube. Whether it is the first or the second TP, IVF-ET can help patients achieve a higher intrauterine pregnancy rate.

Objective:To investigate the volume management of intermittent veno-venous hemofiltration (IVVH) guided by critical care ultrasound in the treatment of acute kidney injury (AKI) in patients with heart failure (HF).Methods:A total of 216 patients with HF and AKI treated with IVVH in the coronary care unit (CCU) of the Third Central Hospital of Tianjin from April 2019 to June 2022 were selected as the study subjects, the patients were randomly divided into conventional guidance group (107 cases) and ultrasound guidance group (109 cases). According to the recovery of renal function, IVVH was performed 12 hours every day or 12 hours every other day. The conventional guidance group selected the conventional method to formulate IVVH prescription, and the ultrasound guidance group used critical care ultrasound to adjust the treatment parameters of IVVH on the basis of the conventional guidance group. Respiratory variation index (RVI) of inferior vena cava (IVC), right left ventricular end-diastolic transverse area ratio, early diastolic peak mitral flow velocity/mitral annulus velocity peak (E/E'), aortic flow velocity time integral (VTI), cardiac output (CO), bilateral lung ultrasound B-line range, bilateral renal interlobar arteries resistance index (RI) were recorded before and 3, 6, 9 hours after each treatment. The net dehydration rate was adjusted in real time according to the comprehensive results. Urine volume, serum creatinine (SCr), estimated glomerular filtration rate (eGFR), blood B-type brain natriuretic peptide (BNP), β 2-microglobulin (β 2-MG) and cystatin C (Cys C) levels of patients in both groups were monitored before and 3, 7 and 10 days after initial treatment, and renal function recovery and clinical prognostic indexes of patients in both groups were recorded. Results:The dehydration rate of the ultrasound guidance group was slow at the beginning of IVVH, and gradually increased after 6 hours, and the overall dehydration rate was significantly slower than that of the conventional guidance group. In the ultrasound guidance group using critical care ultrasound, the RVI gradually increased, the right left ventricular end-diastolic area ratio gradually decreased, the E/E' ratio gradually decreased, and the range of B-line of bilateral lungs gradually decreased, RI of bilateral renal interlobar arteries decreased. At 3, 7 and 10 days after the first IVVH, renal function related indexes in both groups were significantly improved compared with before treatment, and the decline rate of β 2-MG and Cys C in the ultrasound guidance group was faster than that in the conventional guidance group at early (3 days) [β 2-MG (mg/L): 3.69±1.31 vs. 3.99±1.45, Cys C (mg/L): 2.91±0.95 vs. 3.14±0.96, both P < 0.05], urine volume, SCr and eGFR at 7 days were also significantly improved compared with the conventional guidance group [24-hour urine volume (mL): 1 128.23±153.92 vs. 1 015.01±114.18, SCr (μmol/L): 145.86±32.25 vs. 155.64±28.42, eGFR (mL/min): 50.26±11.24 vs. 46.51±10.61, all P < 0.05]. The time of SCr recovery, the time of reaching polyuria, the total time of IVVH treatment, the time of non-invasive mechanical ventilation and the time of living in CCU in the ultrasound guidance group were shorter than those in the conventional guidance group. The incidences of hypotension, long-term RRT, incidence of major cardiovascular adverse event (MACE) and at 28-day mortality were all lower than those in the conventional guidance group. Kaplan-Meier survival curve showed that the 28-day cumulative survival rate in the ultrasound guidance group was significantly lower than that in the conventional guidance group (Log-Rank test: χ 2 = 3.903, P = 0.048). Conclusion:The strategy of IVVH guided by critical care ultrasound in the treatment of HF with AKI has unique advantages.

Objective:To identify the risk factors for functional delayed gastric emptying(FDGE)after retroperitoneal tumor resection.Meth-ods:Sixty-seven patients with postoperative FDGE after retroperitoneal tumor resection from September 2017 to December 2022 admited in Peking University International Hospital were included in the observation group,and 836 normal patients who underwent ret-roperitoneal tumor resection during the same period were included in the control group.Medical histories and clinical treatment data were obtained for each group and compared to identify the risk factors for FDGE after retroperitoneal tumor resection.Results:The overall incid-ence of postoperative FDGE was 7.42%.Factors that were significantly elevated(P<0.05)in the observation group relative to the control group included adverse mental factors(37.31%),preoperative digestive tract obstruction(41.79%),postoperative abdominal cavity complic-ations(79.10%),diabetes(29.86%),average age of(61.85±6.11)years,and blood loss(1 011.94±507.30)mL.Pre-and post-surgery albumin levels[(38.22±3.75)g/L and(30.22±3.36)g/L,respectively]were significantly reduced(P<0.05)in the observation group compared to the control group.Risk factor analyses revealed that advanced age,diabetes,preoperative digestive tract obstruction,intraoperative blood loss,perioperative albumin level,postoperative abdominal cavity complications,and adverse mental factors were correlated with postoperative FDGE.Conclusions:Diverse factors could impact the risk of FDGE after retroperitoneal tumor resection.Patients should be accurately evalu-ated;reasonable and detailed prevention and treatment plans should be developed.

Objective In order to establish a basis for exploring diagnostic biomarkers of type 2 diabetes mellitus (T2DM), our research screened differentially expressed circRNAs in high glucose treated human umbilical vein endothelial cells ( HUVECs) and validated these circRNAs in both cell models and peripheral blood samples of T 2DM patients.Methods The research used HUVECs as experimental model . The control group (n=3) and high glucose group (n=3) were set up and treated under normal condition (5.5 mmol/L) and high glucose condition (30.0 mmol/L), respectively.The research utilized high-throughput sequencing technology to preliminarily screen differentially expressed circRNAs .Differentially expressed circular RNAs were validated in the endothelial cell model by PCR and real -time quantitative PCR ( q-PCR) techniques.Subsequently , in the peripheral blood samples of T 2DM patients ( n=32) and control individuals ( n=28 ), the differentially expressed circRNAs were further validated . Finally, t-Test, correlation analysis and ROC curve were used to analyze the experimental results .Results Total 1087 differentially expressed circular RNAs were screened by high-throughput sequencing;and of these , 554 were up-regulated, 533 were down-regulated.Six increased circRNAs were selected and validated in HUVEC model;and their PCR and q-PCR results matched with sequencing results .Further validation was conducted in peripheral blood samples for three most up-regulated circRNAs.This study found that the differential expression of hsa_circ_0031739 in peripheral blood samples was statistically significant ( 0.015 ±0.0025 vs.0.006 ±0.0013,P=0.0059 <0.05).The area under the ROC curve (AUC) was 0.730 and the expression level of hsa_circ_0031739 was positively correlated with blood glucose ( GLU ) and glycated hemoglobin ( GHb ) ( r=0.317, P=0.0137 <0.05;r=0.348, P=0.0064 <0.05 ) .Conclusion HUVECs were commonly utilized as cell models in the study of T 2DM, and differentially expressed circular RNA profiles existed afterhigh glucose treatment .The differential expression of hsa_circ_0031739 was significant in both high glucose treated HUVECs and peripheral blood samples of T 2DM patients, and the expression level of hsa_circ_0031739 was correlated with GLU and GHb , which has certain diagnostic significance.Therefore, hsa_circ_0031739 may become a new diagnostic biomarker for T2DM and be helpful for the comprehensive diagnosis and mechanism research of T 2DM.

The disrupted caregiver infant relationships are not unpopular (infant abuse and non-traumatic caregiver-infant relationship).Animal and human studies have demonstrated this disruptive relationship exerts the fundamental and enduring impacts on stress system, limbic system and relevant cortex.Individual carrying such biological susceptibility might develop psychopathology under stresses at later life.The assessment needs to get involved the measures with more objectivity,real time and moment-to-moment components.The study on caregiverinfant relationship also should focus on the historical and cultural aspects of China.

Flumazenil ,a benzodiazepine antagonist ,specifically binds the benzodiazepine receptors in central nervous system and reduces the release of gamma-aminobutyric acid .It is used for the reversal of sedative effects of benzodiazepine and benzodiazepine-induced anesthesia .In this article ,the clinical applications of flumazenil and the developments of different dos-age forms were reviewed .

Objective To analyze the current problems on tumor‐targeting nanoparticle drug delivery system .Methods Recent researches of tumor‐targeting nanoparticle drug delivery system were collected ,read and summarized .Results Three research fields on tumor‐targeting nanoparticle drug delivery system were reviewed in this article .Conclusion Not only a deeper understanding of the human physiology and tumor biology ,but changes in strategies and experimental methods are needed to make new achievements on nanoparticle drug delivery system .