ObjectiveTo investigate the mechanism of action of modified Chaihu Shugan Powder in the treatment of abnormal gallbladder relaxation in gallbladder cholesterol stone （CS） with liver depression syndrome， and to provide a basis for clinical medication. MethodsMice were given a high-fat lithogenic diet combined with chronic unpredictable mild stress （CUMS） to establish a model of CS. A total of 45 male C57BL/6 mice were randomly divided into blank group （6 mice fed a normal diet） and CS group （39 mice fed a high-fat lithogenic diet）. After CS modeling， the CS group was further randomly divided into four subgroups of CS group， CS liver depression group， traditional Chinese medicine group （treated with modified Chaihu Shugan Powder）， and Western medicine group （treated with ursodeoxycholic acid）， with 9 mice in each group. All subgroups were fed with the high-fat lithogenic diet， and all mice except those in the CS group were given 21 days of CUMS for modeling. Samples were collected after intervention. The serum levels of cholecystokinin （CCK）， liver function parameters， and blood lipid profiles were measured； HE staining was performed for liver and gallbladder tissue； qPCR and Western blot were used to measure the mRNA and protein expression levels of G protein-coupled bile acid receptor 1 （TGR5） and glucagon-likepeptide-1/2 （GLP-1/2） in the intestine and TGR5 and glucagon-like peptide-2 receptor （GLP-2R） in gallbladder； metabolomics methods were used to determine bile acid composition in intestinal contents. The independent-samples t-test was used for comparison of continuous data between two groups； a one-way analysis of variance was used for comparison between multiple groups， and the least significant difference t-test or the Games-Howell method was used for further comparison between two groups. ResultsCompared with the blank group， the CS group showed significant gallstone formation， bile turbidity， hepatic steatosis， abnormal gallbladder wall structure， and significant increases in anxiety- and depression-like behaviors based on behavioral tests； significant increases in the level of total cholesterol in bile and the serum levels of alanine aminotransferase， aspartate aminotransferase， and low-density lipoprotein and significant reductions in the level of total bile acid （TBA） in bile and the serum levels of CCK and high-density lipoprotein （HDL） （all P<0.05）； significant increases in the mRNA expression levels of GLP-1/2 and TGR5 in the intestine and the protein expression levels of GLP-2R and TGR5 in the gallbladder and significant reductions in the mRNA expression levels of GLP-2R and TGR5 in the gallbladder （all P<0.05）； significant changes in multiple bile acid components in intestinal contents （all P<0.05）. Compared with the CS group， the CS liver depression group had further aggravation of pathological and behavioral manifestations， changes in bile acid composition， significant increases in the protein and mRNA expression levels of TGR5 and GLP-1/2 in the intestine， and significant increases in the protein and mRNA expression levels of TGR5 and GLP-2R in the gallbladder （all P<0.01）. Compared with the CS liver depression group， both treatment groups had an improvement in gallbladder morphology， alleviation of stones and liver injury， and recovery of liver function and blood lipid levels， as well as significant reductions in the protein and mRNA expression levels of TGR5 and GLP-1/2 in the intestine and TGR5 and GLP-2R in the gallbladder （all P<0.05）； the traditional Chinese medicine group showed significant increases in glycodeoxycholic acid （GDCA）， tauro-α-muricholic acid （T-α-MCA）， and taurochenodeoxycholic acid （TCDCA） （all P<0.05）， while the Western medicine group showed significant increases in taurohyodeoxycholic acid， T-α-MCA， TCDCA， GDCA， and glycoursodeoxycholic acid （all P<0.05）. Compared with the Western medicine group， the traditional Chinese medicine group had significantly greater behavioral improvements， significantly higher levels of TBA in bile and serum HDL （both P<0.01）， significant reductions in the protein expression levels of TGR5 and GLP-1/2 in the intestine and TGR5 and GLP-2R in the gallbladder， and a significant reduction in the mRNA expression level of TGR5 in the intestine （all P<0.01）， as well as a significant increase in tauroursodeoxycholic acid and significant reductions in glycoursodeoxycholic acid， taurohyodeoxycholic acid， TCDCA， and taurolithocholic acid （all P<0.05）. ConclusionModified Chaihu Shugan Powder can improve liver function and abnormal gallbladder relaxation in CS with liver depression syndrome by regulating the bile acid-TGR5 axis， thereby exerting the therapeutic effect of soothing the liver， resolving depression， moving Qi， and promoting bile flow.

Objective To mine and analyze adverse drug events(ADEs)signals in minors using recombinant human growth hormone(rhGH),and to provide reference for clinically safe use of drugs.Methods Based on the the U.S.Food and Drug Administration Adverse Event Reporting System(FAERS)database,the data of ADE reports related to rhGH from the third quarter of 2014 to the second quarter of 2024 were retrieved.The ADE reports were standardized and categorized using the Medical Dictionary for Regulatory Activities(MedDRA).The reporting odds ratio(ROR)method and Bayesian confidence propagation neural network(BCPNN)method were employed to mine and analyze ADE signals between rhGH and individuals under 18 years of age.Results A total of 33,642 ADE reports related to the use of rhGH in minors were retrieved.After excluding signals unrelated to ADEs(product issues,social issues,etc.),358 ADE signals were ultimately identified,involving 21 system organ lasses(SOCs).The most frequently reported ADEs were general disorders and administration site reactions(3,621 cases),as well as various laboratory test abnormalities(3,259 cases).Notably,ADE signals related to cardiovascular system tests,psychiatric disorders,and reproductive system and breast disorders,such as decreased serum creatinine,elevated alkaline phosphatase,reduced red blood cell distribution width,crying,aggression,and hypogonadism,were not documented in the drug package insert.Conclusion When administering rhGH to minors,in addition to monitoring common ADEs such as changes in blood glucose levels and scoliosis,attention should also be given to potential ADEs,including alterations in hematological parameters,psychiatric issues,and reproductive system and breast disorders,to ensure medication safety.

Objective To exploring the effect of inflammatory indicators on the outcome of assisted conception of in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)in patients with ovarian endometriosis(OEM).Methods The study subjects were selected as the patients with OEM who received IVF/ICSI treatment at the Third Affiliated Hospital of Zhengzhou University from January 2019 to February 2024.Based on whether previous surgery for uterine endometriosis cyst removal had been performed,they were divided into non-surgery group(n=73)and surgery group(n=112).To explore the differences in inflammatory markers between two groups and to determine whether they have an impact on the outcome of assisted reproduction.Results The lymphocytes(L)and blastocyst formation rates of patients in surgery group were significantly higher than those in non-surgery group,platelet to lymphocyte ratio(PLR)and carbohydrate antigen 125(CA125)were significantly lower than those in non-surgery group(P＜0.05).There were no statistically significant differences in the clinical pregnancy rate and live birth rate between two groups of patients(P＞0.05).After adjusting for confounding factors,the results of multivariate Logistic regression analysis showed that L,PLR,and CA125 had no statistically significant impact on the clinical pregnancy rate and live birth rate(P＞0.05).Both maternal age and the number of embryos transferred exerted a certain influence on clinical pregnancy rates and live birth rates(P＜0.05),furthermore,the type of embryo transferred had a significant effect on clinical pregnancy rates(P＜0.05).Conclusion Compared with non-surgery group,surgery group had higher L level and lower PRL and CA125 levels,but these changes did not significantly affect clinical pregnancy or live birth outcomes in OEM patients undergoing IVF/ICSI assisted reproduction.

Objective:To explore the clinical efficacy of super-selective ophthalmic artery thrombolysis in the treatment of central retinal artery occlusion (CRAO).Methods:This is a retrospective case series study,based on the analysis of clinical data of 50 non-arteritic CRAO patients. The patients were advised to be treated with super-selective intra-ocular arterial thrombolysis at the Neurosurgery Department, Shenyang No. 4 People′s Hospital from May to December 2024, and treated with intra-arterial thrombolysis and postoperative management guidance by the Department of Neurosurgery, General Hospital of the Northern Theater Command. There were 36 males and 14 females, aged (59.5±10.2)years (range: 41 to 75 years). There were 5 cases of complete obstruction of the central retinal artery and 45 cases of subtotal obstruction.Before the operation, all patients underwent optical coherence tomography angiography (OCTA)+ocular vascular ultrasonography, and their visual acuity was measured using a standard visual acuity logarithmic scale, visual field was measured using the contrast visual field examination method;One week after the operation, all patients were rechecked for OCTA, visual acuity and visual field. The patients′ preoperative and postoperative visual field recovery status were compared. Significant effect was defined as an improvement of more than 3 lines of visual acuity or a complete improvement of visual field defects after treatment compared with pretreatment visual acuity; effectiveness was defined as an improvement of 1 to 2 lines of visual acuity or an improvement of visual field defects after treatment compared with pretreatment visual acuity.Results:The overall effective rate of 50 patients with CRAO treated with super-selective ophthalmic artery urokinase thrombolysis was 94.0% (47/50), with 29 very effective, 18 effective and 3 ineffective. The time from onset to surgery was 0 to 6 hours in 5 patients, with an effective rate of 5/5; >6 to 24 hours in 11 patients, with an effective rate of 10/11; >1 to 7 days in 21 patients, with an effective rate of 90.5%(19/21); >7 to 14 days in 9 patients, with an effective rate of 9/9; and >14 to 21 days in 4 patients, with an effective rate of 4/4, and the difference in effective rate between the different time windows of thrombolytic therapy was not statistically significant ( P=0.961). There were 3 cases of intraoperative and postoperative complications, including 1 case of ophthalmic artery entrapment, 1 case of femoral artery pseudoaneurysm and 1 case of fundus hemorrhage, but all of them were cured after symptomatic treatment. Conclusions:Intra-arterial thrombolysis for CRAO patients has a high effective rate and a low complication rate. The surgical time window can be extended to 21 days after the onset, which is of positive significance for the recovery and improvement of the patient′s final visual acuity.

Objective:To investigate the influencing factors and perinatal outcomes associated with monozygotic twins (MZT) following elective single embryo transfer (eSET) via in vitro fertilization or intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET). Methods:A retrospective cohort study was conducted on 12 079 patients who achieved pregnancy after undergoing IVF/ICSI-eSET at Reproductive Health Hospital of the Third Affiliated Hospital of Zhengzhou University between January 2015 and September 2023. Patients were stratified into two groups based on ultrasound findings 30 d post-transfer: singleton pregnancy group and MZT pregnancy group. Finally, 300 MZT and 1 500 single pregnancies, which were randomly matched according to 1∶5 were included by study period. General patients' characteristics, embryo-related factors, and perinatal outcomes were compared between the two groups. A multivariate logistic regression model was employed to identify risk factors for MZT after single embryo transfer, adjusting for potential confounding variables.Results:The incidence of twin pregnancy following single embryo transfer was 2.48% (300/12 079), which was higher than that of naturally conceived monozygotic twin pregnancy. No significant difference was found in baseline characteristics between the two groups (all P>0.05). The blastocyst transfer rate was higher in the MZT pregnancy group [93.3% (280/300)] than in the singleton pregnancy group [88.8% (1 332/1 500), P=0.022]. Multivariate logistic regression analysis also showed that blastocyst transfer was associated with an increased risk of MZT ( OR=0.552, P=0.016, 95% CI: 0.341-0.894). Analysis of blastocyst cycles showed that the risk of MZT was higher when transferring high-quality blastocysts [79.6% (223/280) vs. 67.8% (903/1 332), P<0.001], where as a trophectoderm (TE) grading of C [20.4% (57/280) vs. 32.2% (429/1 332), P<0.001] had a lower risk of MZT. After adjusting for confounding factors, the risk of MZT was found to increase with the transfer of blastocysts with a B-grade inner cell mass (ICM) ( OR=0.601, P=0.001, 95% CI: 0.442-0.819) and A/B grade TE (grade A: OR=2.951, P<0.001, 95% CI: 1.980-4.399; grade B: OR=1.840, P<0.001, 95% CI: 1.315-2.576). The risk of complications during pregnancy [47.7% (143/300) vs. 19.3% (289/1 500), P<0.001], preterm labor [55.1% (140/254) vs. 7.4% (101/1 368), P<0.001], and the risk of stillbirth [3.7% (11/300) vs. 1.5% (22/1 500), P=0.016] were significantly higher in the MZT pregnancy group than in the singleton pregnancy group. Conclusion:Assisted reproductive technology may contribute to the risk of MZT. Transfer of blastocysts, particularly those with loose ICM arrangement and dense TE arrangement, appears to increase the risk of MZT in patients undergoing eSET.

Objective:To investigate whether malignant tumors affect the laboratory outcomes of patients in their first controlled ovarian hyperstimulation (COH) cycle.Methods:This study was a retrospective case-control study that analyzed the clinical and laboratory data of patients who underwent fertility preservation before chemotherapy and radiotherapy due to malignant tumors, as well as patients with infertility caused by tubal factors who first underwent in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) at the Reproductive Health Hospital of the Third Affiliated Hospital of Zhengzhou University from January 2020 to May 2024. Patients who underwent fertility preservation were designated as the research group, while patients who underwent assisted reproduction due to tubal factors during the same period were designated as control group. After 1∶3 propensity score matching (PSM), 40 patients were included in the research group and 118 patients were included in control group. The ovarian response, oocyte retrieval outcomes, and embryonic development after fertilization in the first COH cycle were compared between the two groups. Results:After PSM, the research group and control group showed statistically significant differences in the gonadotropin (Gn) starting dosage [225.00 (162.50, 300.00) U vs. 193.75 (150.00, 225.00) U, P=0.002], duration of Gn used [10.00 (8.00, 11.00) d vs. 12.00 (10.00, 13.00) d, P<0.001], and average estradiol levels on human chorionic gonadotropin trigger day [2 487.00 (1 461.25, 4 090.25) pmol/L vs. 10 738.50 (8 400.00, 16 507.25) pmol/L, P<0.001]. However, no statistically significant difference was found in the total dosages of Gn used between the two groups ( P>0.05). There were no significant differences between the groups in terms of the number of oocytes retrieved, the number of metaphase Ⅱ oocytes, two pronuclei (2PN) rate, 2PN cleavage rate, available embryo rate, high-quality embryo rate, blastocyst formation rate, and available blastocyst formation rate (all P>0.05). Conclusion:Compared with infertility patients with tubal factors, there is no significant difference in the laboratory outcomes of malignant tumor patients undergoing COH for fertility preservation prior to chemotherapy and radiation.

Objective To compare the clinical outcomes of the clomiphene citrate(CC)dual stimulation protocol and the luteal phase ovarian stimulation protocol after natural cycle oocytes retrieved in POSEIDON patients with low expected prognosis.Methods The clinical data from patients who underwent in vitro fertilization(IVF)or intracytoplasmic sperm injection(ICSI)at the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from May 2016 to December 2023 were analyzed retrospectively.According to the POSEI-DON criteria,including POSEIDON group 3 and group 4,which were treated with the CC dual stimulation protocol(the CC group)and the luteal-phase ovarian stimulation protocol after the natural cycle oocytes retrieval(the natural cycle group).The basic data and clinical outcomes of the two ovulation protocols were analyzed,and the main observations included the number of oocytes retrieved,the cumulative clinical pregnancy rate and the cumulative live birth rate,and explored the impact of ovulation promotion regimens on clinical outcomes through binary logis-tic regression.Results On the whole,there was no significant difference in the total number of oocytes retrieved,cumulative clinical pregnancy rate and live birth rate between the CC group and the natural cycle group(all P>0.05),And in POSEIDON group 4,the numbers of oocytes retrieved in the follicular phase of the CC group were higher than those in the natural cycle group,whereas the number of oocytes retrieved in the luteal phase of natural cycle group were higher,and the difference was statistically significant(P<0.05).After logistic regression analysis,the ovulation stimulation protocols did not affect the cumulative clinical pregnancy rate and live birth rate of POSEI-DON 3 and 4 group(P>0.05).Conclusions For the POSEIDON patients with a low expected prognosis,the clinical effectiveness of the luteal phase ovarian stimulation protocol after natural cycle oocytes retrieved is not inferior to that of the CC dual stimulation protocol.In POSEIDON group 4,on the premise that the AMH levels of patients in the natural cycle group were lower than those in the CC group,who underwent natural cycle ovulation followed by luteal phase induction achieved similar clinical outcomes to those of the CC dual stimulation protocol group.Therefore,the luteal phase ovarian stimulation protocol after natural cycle oocytes retrieved should be more clinically recommended for POSEIDON group 4 patients.

The paper introduces 5 books written by WANG Mengying, including Suixiju Chongding Huoluan Lun, Guiyan Lu, Wenre Jingwei, Wang Mengying Yi'an and Suixiju Yinshipu; and analyzes the ideas of diagnosis and treatment of cholera and the academic thoughts in treatment with acupuncture-moxibustion therapy. In pathogenesis, cholera is classified into cold and heat types. Cholera of heat type roots on qi and blood. If the pathogenic factors are mild and located shallowly, the sneezing method, followed by scraping method, is adopted to open meridians and collaterals, as well as the qi level, so as to eliminate pathogens. When the pathogens go deeply, the bloodletting technique is used to clean the toxic heat in blood level and reduce the reversed qi. For cholera of cold type, warm ironing moxibustion is delivered to promote qi circulation and disperse cold, and improve qi movement. If spasm and syncope occur in cholera, no matter of cold or heat identification, the emergent measure is operated with the external application of pungent, warm and salty herbal plaster at Yongquan (KI1). When the pathogens are almost eliminated, the herbal medicines are combined to treat the symptoms and remove the causative factors of the disease.
Acupuncture Therapy/history* ; Moxibustion/history* ; Humans ; Cholera/history* ; China ; History, Ancient ; Medicine in Literature ; Books/history*

Objective:To investigate whether hysteroscopic transcervical resection of septum (TCRS) prior to in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) can improve cumulative live birth rates in patients with uterine septum. Methods:A retrospective cohort study was conducted to analyze data from 244 patients with partial uterine septum who underwent IVF/ICSI at the Reproductive Medicine Center of the Third Affiliated Hospital of Zhengzhou University between January 2016 and August 2022. The patients were divided into a surgical group ( n=171) and a non-surgical group ( n=73) based on whether TCRS was performed prior to IVF/ICSI. The clinical outcomes of IVF/ICSI in the two groups were analyzed, with the primary observation indicator being the cumulative live birth rate. Cox regression analysis was employed to identify determinants. Results:The age of patients in the operated group [(31.20±3.80) years] was younger than that in the non-operated group [(32.92±5.34) years, P=0.005], and the basal antral follicle count [17.0 (11.0, 24.0)] was higher than that in the non-operated group [14.0 (8.0, 21.5), P=0.039]. There were no significant differences in other baseline data (all P>0.05). The cumulative pregnancy rate [79.53% (136/171)] and the cumulative live birth rate [60.23% (103/171)] in the operated group during the 24-month follow-up period were significantly higher than those in the non-operated group [65.75% (48/73), P=0.022; 45.21% (33/73), P=0.030]. Compared with the operated group [296.0 (260.0, 430.0) d], the duration from the start of ovarian stimulation to the first live birth was significantly prolonged in the non-operated group [379.0 (329.5, 471.5) d, P<0.001]. Adjusted Cox-regression analysis showed that whether or not surgery was performed ( HR=1.683, 95% CI: 1.116-2.539, P=0.013) and the basal antral follicle count ( HR=1.032, 95% CI: 1.000-1.065, P=0.048) were independent factors affecting cumulative live birth rate. Conclusion:Performing TCRS before IVF/ICSI can improve cumulative live birth rates of patients with uterine septum.

Objective:To investigate the effects of male body mass index (BMI) on semen parameters and perinatal outcomes following artificial insemination by husband (AIH) treatment.Methods:A retrospective cohort study was conducted to analyze the clinical data of 5 053 patients underwent AIH treatment at the Reproductive Health Hospital of the Third Affiliated Hospital of Zhengzhou University, from January 2017 to February 2024. The study focused on factors such as male semen parameter abnormalities, male sexual dysfunction, female cervical factors, reproductive tract malformations, and unexplained infertility. Patients were classified into three groups based on male BMI: normal weight group (18.5-23.9 kg/m2, n=1 673), overweight group (24.0-27.9 kg/m2, n=2 078), and obese group (BMI≥28.0 kg/m2, n=1 302). The primary objective was to assess the differences in semen parameters and perinatal outcomes among the three groups. Multivariable logistic regression and linear regression analyses were applied to adjust for potential confounders that could influence semen parameters and perinatal outcomes. Results:Semen volume in the normal weight group and overweight group [4.00 (3.00, 5.50) mL, 4.00 (3.00, 5.50) mL] was higher than that in the obese group [4.00 (3.00, 5.00) mL], with a significant difference among the three groups ( P<0.001, a P<0.001). The total sperm count in the normal group and overweight group [207.60 (121.90, 341.75)×10 6, 211.80 (119.88, 334.83)×10 6] was higher than that in the obese group [188.40 (110.96, 323.41)×10 6], with a significant difference among the three groups ( P=0.007, a P<0.001). The total progressive sperm motility count in the normal group [88.18 (43.63, 163.80)×10 6] was higher than that in the obese group [75.30 (40.29, 147.86)×10 6], with a significant difference among the three groups ( P=0.001, a P<0.001). The percentage of forward motile sperm in the normal group [(45.37±17.16)%] was higher than that in the overweight group [(44.03±17.36)%] and the obese group [(43.80±17.21)%], with a significant difference compared among the three groups ( P=0.020, a P=0.016]. In terms of perinatal outcomes, after multivariate logistic regression analysis, only the overweight and obese groups had higher newborn birth weights [(3 389.53±472.65) g, (3 408.57±507.90) g] compared with the normal group [(3 271.32±532.02) g], with a significant difference among the three groups ( P=0.010, a P=0.009). Conclusion:Higher male BMI is associated with decreased semen quality and may increase newborn birth weight following AIH treatment.