Infection is an important trigger for the initiation of pancreatic islet autoimmunity in type 1 diabetes mellitus （T1DM）. From the perspective of latent pathogen and dryness disorder， this study analyzes the core pathogenesis and dynamic evolution of T1DM in the subclinical and clinical stages. Combined with the T1DM "constraint， heat， deficiency， damage" state and target differentiation and treatment theory， the course of infection-induced T1DM is divided into three stages， including latent dryness， dry-heat and collateral damage. The "latent dryness" stage corresponds to the subclinical phase of T1DM， while the "dry-heat" stage corresponds to the clinical phase， and the "collateral damage" stage corresponds to the phase in which chronic complications develop. Treatment principles include supplementing deficiency and dispelling pathogen during the "latent dryness" stage， clearing heat and moistening dryness in the "dry-heat" stage， and dissolving stasis and unblocking collaterals in the "collateral damage" stage. Furthermore， syndrome-targeted and target-directed therapeutic modifications were made according to T1DM-related autoimmune activity， metabolic comorbidities， and vascular comorbidities， providing a reference for clinical management of T1DM.

Decreased endometrial receptivity is a critical factor contributing to the decline in fertility among women of advanced age. With the increase of age, the endometrium exhibits diminished hormonal responsiveness, a phenomenon known as inflammaging, and an imbalance in immune cell populations. These changes impede the processes of endometrial epithelial-mesenchymal transition and decidualization, thereby negatively impacting embryo implantation and reducing overall fertility potential. Furthermore, adverse lifestyle choices, exposure to environmental factors, inflammatory conditions, and repeated interventions within the uterine cavity can result in pathological aging of the endometrium that does not align with its chronological age. This misalignment may be associated with the emergence of various reproductive disorders, even in younger women. This paper seeks to investigate the relationship between pathological aging of the endometrium and reproductive disorders, particularly in the context of embryo implantation, with the aim of providing new insights into the pathogenesis, clinical diagnosis, and treatment of reproductive disorders.

Objective:To evaluate the therapeutic efficacy of the Wenyang Huazhuo Formula on spontaneous pregnancy outcomes in advanced-age infertile patients with spleen-kidney yang deficiency syndrome.Methods:A retrospective cohort study design was employed to gather clinical data from 303 advanced-age infertile patients with spleen-kidney yang deficiency syndrome who sought treatment at the Department of Reproductive Medicine in the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine between June 2019 and June 2023. Patients were categorized into two groups based on their treatment regiments: a basic treatment group (non-exposed group, n=151) and a group receiving basic treatment in conjunction with the Wenyang Huazhuo Formula (exposed group, n=152). The study compared and analyzed pregnancy outcomes, including time to pregnancy (TTP) within one year, ongoing pregnancy rate, and clinical pregnancy rate, between the two groups over a one-year follow-up period. Additionally, stratified analyses were performed based on age and anti-Müllerian hormone (AMH) levels to evaluate the impact of Wenyang Huazhuo Formula on pregnancy outcomes across different patient subgroups. Results:The TTP in the exposed group was significantly reduced compared with the non-exposed group ( HR=1.70, 95% CI: 1.12-2.57, P=0.013), suggesting a significant shortening of their TTP, and the ongoing pregnancy rate [28.29% (43/152)] and the clinical pregnancy rate [33.55% (51/152)] were significantly higher than those in the non-exposed group [13.91% (21/151), P=0.020; 21.85% (33/151), P=0.023], and the early abortion rate [15.69% (8/51)] was significantly reduced compared with the non-exposed group [36.36% (12/33), P=0.031]. Stratified analyses by age revealed that for patients aged 35-37 years, the exposed group exhibited a significantly shorter TTP ( HR=1.67, 95% CI: 1.03-2.70, P=0.038), while no significant difference in TTP was observed in the 38-44-year old patients ( HR=1.78, 95% CI: 0.77-4.10, P=0.174). Regarding the ongoing pregnancy rate, the exposed group showed a significant higher rate [31.31% (31/99)] than the non-exposed group [13.91% (15/112), P=0.022] among patients aged 35-37 years, whereas no significant difference was observed in the 38-44 years old group ( P=0.386). Stratified analysis based on AMH levels showed that both low AMH levels (<1.68 μg/L) and high AMH levels (≥1.68 μg/L) patients in the exposed group experienced a significant reduction in TTP compared with the non-exposed group ( HR=8.07, 95% CI: 1.04-62.52, P=0.046; HR=1.57, 95% CI: 1.01-2.43, P=0.044, respectively), along with a notable improvement in the ongoing pregnancy rate [13.64% (6/44) vs. 0% (0/29), P=0.038; 34.26% (37/108) vs.17.21% (21/122), P=0.028, respectively]. Further stratified analysis indicated that, compared with patients with low AMH levels, both the exposed group and the non-exposed group of patients with high AMH levels exhibited a significantly shorter TTP ( HR=1.91, 95% CI: 1.02-3.69, P=0.043; HR=9.48, 95% CI: 1.30-69.22, P=0.002, respectively), along with a significantly higher ongoing pregnancy rate ( P=0.014; P=0.008). Conclusion:The Wenyang Huazhuo Formula significantly shortens TTP, enhances both the clinical pregnancy rate and the ongoing pregnancy rate and reduces the early abortion rate in advanced-age infertile women diagnosed with spleen-kidney yang deficiency syndrome.

Objective:To explore the dynamic change trajectory and influencing factors of postoperative fatigue (POF) in patients with early digestive tract cancer undergoing endoscopic submucosal dissection (ESD), so as to provide theoretical basis for individualized management of such patients.Methods:Using cross-sectional survey and convenient sampling method, the patients who underwent ESD for early cancer of digestive tract in the endoscopic center of the Second Affiliated Hospital of Zhejiang University School of Medicine from January to June 2024 were selected as the research objects. The questionnaires were conducted at 30 min, 24 h, 3 days, 5 days, 7 days after ESD with Christensen's postoperative fatigue score. Spearman test was used to analyze the correlation between pain, insomnia and POF. The latent variable growth model was used to identify the potential categories of POF trajectory, and the influencing factors were analyzed by Logistic regression.Results:A total of 232 patients were finally induded, with ages of 19-94(59.53 ± 13.29) years, including 120 males and 112 femalss. The POF level of patients with early cancer of digestive tract showed a downward trend one week after operation. Three postoperative fatigue trajectories were fitted, 9.05% in moderate or severe fatigue low-speed smooth descent group (C1 group); 32.76% in moderate fatigue first decreased quickly and then slowly group (C2 group) and 58.19% in mild fatigue continuous decline group (C3 group). The result of Logistic regression analysis showed that, compared with C1 group, people without religious beliefs were morelikely to enter C2 group [ β = 1.572, OR = 4.818(1.033 - 22.465), P<0.05]; compared with C3 group, patients with high pain level and severe insomnia degree were likely to enter C1 [ β = 2.621, 0.663, OR were 13.754(2.692 - 70.283) and 1.942(1.429 - 2.638), both P<0.05] and C2 [ β = 2.010, 0.491, OR were 7.464(1.890 - 29.482) and 1.634(1.348 - 1.982), both P<0.05] group. Conclusions:There were three potential types of POF in patients with early digestive tract cancer ESD. Medical staff should pay attention to patients with severe insomnia, intense pain and religious beliefs, and give staged fatigue assessment and individualized intervention, so as to reduce the level of POF and promote rapid recovery.

Volume overload is one of the major causes of recurrent hospital admissions in patients with heart failure, and proper volume management is critical to patient treatment and prognosis. This paper introduces the concept of mobile health, describes the application forms and effects of mobile health in volume management of heart failure patients, summarizes the shortcomings of existing research and prospects for the future, so as to provide reference for further promoting the application of mobile health in volume management of heart failure patients in China.

Objective To construct a home cardiac rehabilitation program based on mobile healthcare for patients undergoing transcatheter aortic valve replacement(TAVR)and validate its application effectiveness.Methods Based on the best evidence summary,using the Behavior Change Wheel as a framework,15 experts from relevant fields were invited for the Delphi expert consultation to construct a home-based cardiac rehabilitation program and devel-op an intervention system.Using convenience sampling method,72 patients from a tertiary hospital in Zhejiang Province from January to March 2024 were selected as research subjects,and the intervention was implemented from June to August 2024.They were randomly divided into an experimental group and a control group using a random number table method,with 36 cases in each group.The experimental group received a home rehabilitation program based on mobile healthcare on the basis of routine care,while the control group received routine care.The differences in outcome indicators were compared between 2 groups of patients after 12 weeks of intervention.Re-sults The expert authority coefficients for the 2 rounds of Delphi expert inquiry were 0.95,and Kendall's W were 0.591 and 0.414,respectively(P＜0.001).The final draft of the intervention plan includes 6 primary indicators,14 secondary indicators,and 25 tertiary indicators.A total of 70 patients completed the intervention,with 35 in the ex-perimental group and 35 in the control group.Before intervention,there was no statistically significant difference in home cardiac rehabilitation exercise compliance,frailty,and activities of daily living ability between the 2 groups(P＞0.05).After 12 weeks of intervention,the scores of the home-based cardiac rehabilitation exercise adherence scale in the experimental group improved compared to the control group(Z=-7.203,P＜0.001).Conclusion The home reha-bilitation program for TAVR patients based on mobile healthcare is scientific and feasible,and can effectively im-prove patients' exercise compliance with home cardiac rehabilitation.In the future,the rehabilitation program and the system can be continuously optimized in the clinical application to improve patient prognosis.

Objective:To evaluate the therapeutic efficacy of the Wenyang Huazhuo Formula on spontaneous pregnancy outcomes in advanced-age infertile patients with spleen-kidney yang deficiency syndrome.Methods:A retrospective cohort study design was employed to gather clinical data from 303 advanced-age infertile patients with spleen-kidney yang deficiency syndrome who sought treatment at the Department of Reproductive Medicine in the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine between June 2019 and June 2023. Patients were categorized into two groups based on their treatment regiments: a basic treatment group (non-exposed group, n=151) and a group receiving basic treatment in conjunction with the Wenyang Huazhuo Formula (exposed group, n=152). The study compared and analyzed pregnancy outcomes, including time to pregnancy (TTP) within one year, ongoing pregnancy rate, and clinical pregnancy rate, between the two groups over a one-year follow-up period. Additionally, stratified analyses were performed based on age and anti-Müllerian hormone (AMH) levels to evaluate the impact of Wenyang Huazhuo Formula on pregnancy outcomes across different patient subgroups. Results:The TTP in the exposed group was significantly reduced compared with the non-exposed group ( HR=1.70, 95% CI: 1.12-2.57, P=0.013), suggesting a significant shortening of their TTP, and the ongoing pregnancy rate [28.29% (43/152)] and the clinical pregnancy rate [33.55% (51/152)] were significantly higher than those in the non-exposed group [13.91% (21/151), P=0.020; 21.85% (33/151), P=0.023], and the early abortion rate [15.69% (8/51)] was significantly reduced compared with the non-exposed group [36.36% (12/33), P=0.031]. Stratified analyses by age revealed that for patients aged 35-37 years, the exposed group exhibited a significantly shorter TTP ( HR=1.67, 95% CI: 1.03-2.70, P=0.038), while no significant difference in TTP was observed in the 38-44-year old patients ( HR=1.78, 95% CI: 0.77-4.10, P=0.174). Regarding the ongoing pregnancy rate, the exposed group showed a significant higher rate [31.31% (31/99)] than the non-exposed group [13.91% (15/112), P=0.022] among patients aged 35-37 years, whereas no significant difference was observed in the 38-44 years old group ( P=0.386). Stratified analysis based on AMH levels showed that both low AMH levels (<1.68 μg/L) and high AMH levels (≥1.68 μg/L) patients in the exposed group experienced a significant reduction in TTP compared with the non-exposed group ( HR=8.07, 95% CI: 1.04-62.52, P=0.046; HR=1.57, 95% CI: 1.01-2.43, P=0.044, respectively), along with a notable improvement in the ongoing pregnancy rate [13.64% (6/44) vs. 0% (0/29), P=0.038; 34.26% (37/108) vs.17.21% (21/122), P=0.028, respectively]. Further stratified analysis indicated that, compared with patients with low AMH levels, both the exposed group and the non-exposed group of patients with high AMH levels exhibited a significantly shorter TTP ( HR=1.91, 95% CI: 1.02-3.69, P=0.043; HR=9.48, 95% CI: 1.30-69.22, P=0.002, respectively), along with a significantly higher ongoing pregnancy rate ( P=0.014; P=0.008). Conclusion:The Wenyang Huazhuo Formula significantly shortens TTP, enhances both the clinical pregnancy rate and the ongoing pregnancy rate and reduces the early abortion rate in advanced-age infertile women diagnosed with spleen-kidney yang deficiency syndrome.

Objective:To investigate the incidence and influencing factors of optic disc changes in children and adolescents with high myopia.Methods:A clinical cross-sectional study. A total of 162 children and adolescents with high myopia (162 eyes) who visited Department of Ophthalmology, Northern Jiangsu People's Hospital Affiliated to Yangzhou University from January to April 2025 were included in this study. Myopia refractive error ≥6.00 D and/or axial length (AL) ≥26 mm. All participants underwent best-corrected visual acuity, refraction, fundus color photography, swept-source optical coherence tomography (SS-OCT), and AL measurement. Subfoveal choroidal thickness (ChT) was measured within 1 mm using SS-OCT. Optic disc changes assessed included tilt, rotation, peripapillary atrophy (PPA), and peripapillary hyperreflective ovoid mass-like structures (PHOMS). The patients were divided into the children group (4-11 years old) and the adolescents group (12-18 years old) based on age, with 63 (38.9%, 63/162) and 99 (61.1%, 99/162) cases respectively. The incidence of ocular features and optic disc morphology changes in the two groups was compared and observed. According to the myopia diopter, the patients were divided into the high diopter long axial group (myopia diopter ≥6.00 D, AL≥26 mm) and the low diopter long axial group (myopia diopter <6.00 D, AL≥26 mm), with 85 (52.5%, 85/162) and 77 (47.5%, 77/162) eyes respectively. The incidence of optic disc morphological changes in the two groups was compared and observed. The comparison of quantitative data between groups was conducted using the Mann-Whitney U test. Multivariate logistic regression was used to analyze the correlations between PPA, optic disc tilt, PHOMS occurrence and gender, age, diopter, AL, and ChT. Results:Among the 162 patients, 103 were male and 59 were female. Age was 12 (10.5, 13.5) years old. Among the 162 eyes, the optic disc morphology changed in 152 eyes (93.8%, 152/162). Among them, the PPA, optic disc tilt, PHOMS, and optic disc rotation were 148 (91.4%, 148/162), 95 (58.6%, 95/162), 62 (38.3%, 62/162), and 35 (21.6%, 35/162) eyes respectively. Myopic macular degeneration in 137 eyes. There were 56 eyes with peripheral retinopathy. There was no statistically significant difference in myopia diopter, AL and ChT between the children group and the adolescent group ( Z=-1.201, -1.934, ?0.761; P=0.230, 0.053, 0.447). There was no statistically significant difference in the incidences of PPA, optic disc tilt and optic disc rotation ( χ2=0.293, 2.618, 0.398; P>0.05). There was no statistically significant difference in the incidence of optic disc morphological changes between the low diopter long axial group and the high diopter long axial group ( χ2=0.000, P>0.05). The results of multivariate logistic regression analysis showed that the thinner the ChT, the higher the risk of PPA [odds ratio (OR) =0.98, 95% confidence interval ( CI) 0.97-0.99, P<0.001]. Female ( OR=2.3, 95% CI 1.04-5.07, P=0.039), older age ( OR=1.17, 95% CI 1.01-1.37, P=0.043), thinner ChT ( OR=0.99, 95% CI 0.99-1.00, P=0.012), the higher the risk of optic disc tilt. The older the age, the higher the risk of developing PHOMS ( OR=1.22, 95% CI 1.06-1.40, P=0.006). Conclusions:Optic disc morphology changes may be the most common fundus alterations in children and adolescents with high myopia. The influencing factors of optic disc morphological changes (including PPA, optic disc tilt, and PHOMS) are female sex, advanced age, and ChT thinning.

Objective:To compare the clinical efficacy and effects on cognitive function of magnetic seizure therapy (MST) and modified electroconvulsive therapy (MECT) in the treatment of major depressive episode (MDE).Methods:From January 1, 2019 to December 31, 2021, 40 patients who met the MDE diagnostic criteria in the fifth edition of the Diagnostic Statistical Manual of Mental Disorders (DSM-5) were selected in Shanghai Mental Health Center. Participants were randomly assigned to MECT therapy group (20 patients) and MST therapy group (20 patients) using the random number table method. Both groups received MECT or MST while using serotonin reuptake inhibitors (SSRIs), 3 times a week for 4 weeks. The 17-items Hamilton Depression Rating Scale (HAMD 17) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) were performed before and after treatment. HAMD 17 reduction rate and effective rate were the main assessment indicators, while RBANS total score and factor scores were considered as the secondary assessment indicators. T-test was used to compare the reduction rate of HAMD 17 between the two groups, and corrected Chi-square test or Fisher′s exact probability method was used to compare the effective rate of treatment between the two groups. HAMD 17 scores and RBANS scores before and after treatment were compared using two-factor repeated measure ANOVA. Results:There were no significant differences in baseline HAMD 17 scores and RBANS scores between 2 groups( t=0.29, P=0.773; t=0.67, P=0.509). The treatment effective rate in the MECT group was 90% (18/20), and the average reduction rate of HAMD 17 was 67.9%. Meanwhile, the effective rate of MST group was 75% (15/20), and the average reduction rate of HAMD 17 was 60.9%. There was no significant difference in the reduction rate and effective rate of HAMD 17 between the two groups ( t=0.69, P=0.493; χ2=0.16, P=0.693). The total scores and factor scores of RBANS after treatment were lower than those before treatment, with statistical significance(total scores: F=19.29, P<0.001;immediate memory score: F=6.22, P=0.020; language function score: F=9.13, P=0.006;attention score: F=5.23, P=0.031;delayed memory score: F=35.90, P<0.001). There was no significant difference in the total scores and factor scores of RBANS before and after treatment in MST group(total scores: F=0.49, P=0.490;immediate memory score: F=2.25, P=0.147;language function score: F=1.22, P=0.280;attention score: F=0.23, P=0.640;delayed memory score: F=0.02, P=0.887). Conclusions:The efficacy of MST treatment and MECT treatment in treating MDE patients seems to be comparable. MDE patients receiving MST had less impact on cognitive function compared to those treated with MECT.

Polyetheretherketone (PEEK) and its composite materials have garnered widespread attention in the field of dental implantology due to their good biocompatibility, mechanical properties, and corrosion resistance. The low elastic modulus of PEEK, comparable to that of human jawbone, helps to reduce the stress shielding effect around the implant, thereby enhancing the rate of bone integration. This article reviews the latest research progress of PEEK and its composite materials in the field of dental implantation, including the synthesis of materials, surface modification techniques, and applications in implant-abutment-crown complexes and full-arch denture bridges.