ObjectiveTo analyze the effects of the progestin-primed ovarian stimulation （PPOS） protocol on embryo euploidy rate and clinical pregnancy outcomes in infertile patients. MethodsWomen who underwent Preimplantation genetic testing for aneuploidy （PGT-A） cycles were selected as study participants （a total of 656 cycles and 3 081 blastocysts）. Participants were divided into two age groups （≤35 years and >35 years） and further stratified by ovarian stimulation protocol： the Progestin-Primed Ovarian Stimulation （PPOS） group （n=48 and 60， respectively）， the Luteal Phase Long Protocol （LP） group （n=160 and 57， respectively）， and the Gonadotropin-Releasing Hormone Antagonist Protocol （AP） group （n=220 and 111， respectively）. Baseline characteristics， ovarian stimulation outcomes， and embryo development parameters were compared among the three protocols within each age group. Additionally， clinical pregnancy outcomes of the first frozen embryo transfer （FET） cycle were compared. The primary outcome measure was the embryo euploidy rate. Results① In the ≤35 years age group， baseline follicle-stimulating hormone （bFSH） levels were significantly higher in the PPOS group compared to the LP and AP groups， and the bFSH/bLH ratio was significantly higher in the PPOS group than in the AP group （P < 0.05）. In the >35 years age group， bFSH levels in both the PPOS and AP groups were significantly higher than in the LP group （P < 0.05）.② In the ≤35 years group， there were no significant differences in the rates of metaphase II （MII） oocytes， 2-pronuclei （2 PN） zygotes， cleavage， 2 PN cleavage， blastocyst formation， high-quality embryos， or embryo euploidy between the PPOS group and either the LP or AP groups. However， the PPOS group showed significantly lower values for the following parameters compared to the other two groups： total oocytes retrieved， number of MII oocytes， number of 2 PN zygotes， number of cleaved embryos， number of 2 PN cleaved embryos， number of blastocysts formed， number of high-quality embryos， number of high-grade blastocysts， number of transferable embryos， number of cryopreserved embryos， number of biopsied blastocysts， number of euploid embryos， and the rate of obtaining at least one euploid embryo. In the >35 years group， no significant differences were observed among the PPOS， LP， and AP groups in the rates of MII oocytes， 2 PN cleavage， blastocyst formation， or in the number of euploid embryos， euploidy rate， and the rate of obtaining at least one euploid embryo. However， the PPOS group had significantly lower numbers of total oocytes retrieved， MII oocytes， 2 PN zygotes， cleaved embryos， 2 PN cleaved embryos， blastocysts formed， transferable embryos， and cryopreserved embryos compared to the LP group （P<0.05）. The high-quality embryo rate was significantly lower in the PPOS group than in the AP group （P<0.05）. The numbers of high-quality embryos， high-grade blastocysts， and biopsied blastocysts were significantly lower in the PPOS group than in both the LP and AP groups （P<0.05）. Notably， the 2 PN fertilization rate was significantly higher in the PPOS group than in the AP group， and the cleavage rate was significantly higher in the PPOS group than in both the LP and AP groups （P<0.05）.③ No significant differences were found among the three groups in the biochemical pregnancy rate， clinical pregnancy rate， live birth rate， early miscarriage rate， and late miscarriage rate following the first FET cycle. ConclusionCompared to the other two protocols， the PPOS protocol does not significantly affect embryo euploidy or clinical pregnancy rates. However， in freeze-all cycles with PGT-A， the PPOS protocol does not reduce the rate of chromosomally normal embryos but may decrease the total number of available embryos. It may not be the optimal choice for younger women， but it can be considered as a viable option for women of advanced maternal age.

Objective To observe the value of T2 mapping for quantitatively evaluating the changes of junctional zone and outer myometrium caused by endometrial fibrosis.Methods A total of 73 infertility patients with endometrial fibrosis confirmed by hysteroscopy(disease group)and 33 healthy women of childbearing age(control group)were prospectively enrolled,and MR examinations were performed at the late proliferative phase of endometrium.The thickness and T2 value of junctional zone,T2 value of outer myometrium on anterior,posterior and fundus wall of midsagittal corpus uteri were measured,and the mean value of the above measurements on the three walls were calculated.Receiver operating characteristic curves were constructed,the areas under the curves(AUC)were calculated to explore the efficacy of those with significant difference among the mean thickness and the mean T2 value of junctional zone,the mean T2 value of outer myometrium and their combination for evaluating endometrial fibrosis.Results The thickness and T2 value of anterior wall,posterior wall,fundus wall and the mean junctional zone in disease group were all significantly higher than those in control group(all P＜0.001).No significant difference of T2 value of anterior wall,posterior wall,fundus wall nor the mean outer myometrium was found between groups(all P＞0.05).The mean thickness and the mean T2 value of junctional zone and their combination could be used to effectively evaluate endometrial fibrosis,with AUC of 0.839,0.822 and 0.922,respectively,and their combination had the best performance(both P＜0.01).Conclusion T2 mapping could be used to quantitatively evaluate the injury of junctional zone caused by endometrial fibrosis.

The nervous system not only affects the core processes of tumors such as proliferation, metastasis and angiogenesis, but is also closely related to symptoms such as tumor-related pain and cachexia. Meanwhile, tumor cells can invade adjacent tissues through nerve pathways to induce perineural invasion, which promotes tumor development. This article reviews the research progress in role of the nervous system in tumor occurrence and development from perspectives of tumor perineural invasion, neurotrophic factors, autonomic and sensory nerves, and influence of the neuroimmune system in tumors, in order to provide new perspective and method for tumor treatment.

Objective To observe the value of T2 mapping for quantitatively evaluating the changes of junctional zone and outer myometrium caused by endometrial fibrosis.Methods A total of 73 infertility patients with endometrial fibrosis confirmed by hysteroscopy(disease group)and 33 healthy women of childbearing age(control group)were prospectively enrolled,and MR examinations were performed at the late proliferative phase of endometrium.The thickness and T2 value of junctional zone,T2 value of outer myometrium on anterior,posterior and fundus wall of midsagittal corpus uteri were measured,and the mean value of the above measurements on the three walls were calculated.Receiver operating characteristic curves were constructed,the areas under the curves(AUC)were calculated to explore the efficacy of those with significant difference among the mean thickness and the mean T2 value of junctional zone,the mean T2 value of outer myometrium and their combination for evaluating endometrial fibrosis.Results The thickness and T2 value of anterior wall,posterior wall,fundus wall and the mean junctional zone in disease group were all significantly higher than those in control group(all P＜0.001).No significant difference of T2 value of anterior wall,posterior wall,fundus wall nor the mean outer myometrium was found between groups(all P＞0.05).The mean thickness and the mean T2 value of junctional zone and their combination could be used to effectively evaluate endometrial fibrosis,with AUC of 0.839,0.822 and 0.922,respectively,and their combination had the best performance(both P＜0.01).Conclusion T2 mapping could be used to quantitatively evaluate the injury of junctional zone caused by endometrial fibrosis.

The nervous system not only affects the core processes of tumors such as proliferation, metastasis and angiogenesis, but is also closely related to symptoms such as tumor-related pain and cachexia. Meanwhile, tumor cells can invade adjacent tissues through nerve pathways to induce perineural invasion, which promotes tumor development. This article reviews the research progress in role of the nervous system in tumor occurrence and development from perspectives of tumor perineural invasion, neurotrophic factors, autonomic and sensory nerves, and influence of the neuroimmune system in tumors, in order to provide new perspective and method for tumor treatment.

Objective:To investigate the clinicopathological characteristics and prognostic factors of different histological subtypes of intrahepatic cholangiocarcinoma (ICC).Methods:The retrospective cohort study was conducted. The clincopathological data of 171 patients with ICC who underwent initial curative resection in Peking University People′s Hospital from January 2015 to December 2023 were collected. There were 94 males and 77 females, aged 60(range, 53-68)years. Measurement data with normal distribution were expressed as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were expressed as M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi‐square test or Fisher exact probability. The Kaplan‐Meier method was used to draw survival curve and calculate survival rates, and the Log-rank test was used for survival analysis. The COX stepwise regression model was used for univariate and multivariate analyses. Results:(1) Comparison of clinicopathological characteristics of different histological subtypes of ICC. Results of postoperative histopathological examination showed that of the 171 ICC patients, there were 76 cases of large duct type ICC and 95 cases of small duct type ICC. There was a significant difference in cases with concomitant intrahepatic biliary stone between patients with different histological subtypes of ICC ( P<0.05), and there were significant differences in cases with concomitant viral hepatitis, cases with CA19-9 >39 U/mL versus CA19-9 ≤39 U/mL, cases with CA19-9 >1 000 U/mL versus CA19-9 >39-1 000 U/mL, tumor gross morphology, and tumor peri-neural invasion between patients with different histological subtypes of ICC ( χ2=8.906, 18.208, 5.689, 43.886, 6.178, P<0.05). (2) Prognostic analysis of different histological subtypes of ICC. Of the 171 patients, 130 cases were followed up for 22(range, 16-43)months, including 63 cases of large duct type ICC and 67 cases of small duct type ICC. The 5-year overall survival rates of the 63 cases of large duct type ICC and 67 cases of small duct type ICC were 12.60% and 43.70%, respectively, showing a significant difference between them ( χ2=5.799, P<0.05). (3) Analysis of prognostic factors for patients undergoing radical resection of ICC. Results of multivariate analysis showed that tumor perineural invasion and lymph node metastasis were independent risk factors affecting overall survival rates of patients undergoing radical resection of ICC ( hazard ratio=0.447, 0.383, 95% confidence interval as 0.259-0.771, 0.225-0.651, P<0.05). Conclusions:There are differences in both clinicopatholo-gical characteristics and prognosis between patients with large duct type ICC and small duct type ICC. Tumor perineural invasion and lymph node metastasis are independent risk factors affecting overall survival rates of patients undergoing radical resection of ICC.

Objective:To investigate the clinicopathological characteristics and prognostic factors of different histological subtypes of intrahepatic cholangiocarcinoma (ICC).Methods:The retrospective cohort study was conducted. The clincopathological data of 171 patients with ICC who underwent initial curative resection in Peking University People′s Hospital from January 2015 to December 2023 were collected. There were 94 males and 77 females, aged 60(range, 53-68)years. Measurement data with normal distribution were expressed as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were expressed as M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi‐square test or Fisher exact probability. The Kaplan‐Meier method was used to draw survival curve and calculate survival rates, and the Log-rank test was used for survival analysis. The COX stepwise regression model was used for univariate and multivariate analyses. Results:(1) Comparison of clinicopathological characteristics of different histological subtypes of ICC. Results of postoperative histopathological examination showed that of the 171 ICC patients, there were 76 cases of large duct type ICC and 95 cases of small duct type ICC. There was a significant difference in cases with concomitant intrahepatic biliary stone between patients with different histological subtypes of ICC ( P<0.05), and there were significant differences in cases with concomitant viral hepatitis, cases with CA19-9 >39 U/mL versus CA19-9 ≤39 U/mL, cases with CA19-9 >1 000 U/mL versus CA19-9 >39-1 000 U/mL, tumor gross morphology, and tumor peri-neural invasion between patients with different histological subtypes of ICC ( χ2=8.906, 18.208, 5.689, 43.886, 6.178, P<0.05). (2) Prognostic analysis of different histological subtypes of ICC. Of the 171 patients, 130 cases were followed up for 22(range, 16-43)months, including 63 cases of large duct type ICC and 67 cases of small duct type ICC. The 5-year overall survival rates of the 63 cases of large duct type ICC and 67 cases of small duct type ICC were 12.60% and 43.70%, respectively, showing a significant difference between them ( χ2=5.799, P<0.05). (3) Analysis of prognostic factors for patients undergoing radical resection of ICC. Results of multivariate analysis showed that tumor perineural invasion and lymph node metastasis were independent risk factors affecting overall survival rates of patients undergoing radical resection of ICC ( hazard ratio=0.447, 0.383, 95% confidence interval as 0.259-0.771, 0.225-0.651, P<0.05). Conclusions:There are differences in both clinicopatholo-gical characteristics and prognosis between patients with large duct type ICC and small duct type ICC. Tumor perineural invasion and lymph node metastasis are independent risk factors affecting overall survival rates of patients undergoing radical resection of ICC.

BACKGROUND:Gut microbiota is closely related to host energy balance and metabolism.The metabolites of intestinal flora can regulate the occurrence and development of obesity and can be a new target for the prevention and treatment of obesity. OBJECTIVE:To summarize the interaction between the intestinal flora and obesity,as well as the specific mechanism underlying regulation of obesity by metabolites of intestinal flora,thereby providing a new reference and basis for the prevention and treatment of obesity. METHODS:"Intestinal microbiota,intestinal bacteria,intestinal microbiota metabolites,short-chain fatty acids,bile acids,ipopolysaccharide,trimethylamine N-oxide,medium-chain fatty acids,tryptophan derivatives,obesity"were used as search terms in Chinese and English.Literature related to obesity from 1990 to 2022 was retrieved in PubMed and CNKI databases.According to inclusion and exclusion criteria,88 articles were finally selected. RESULTS AND CONCLUSION:Intestinal flora is closely related to the occurrence and development of obesity.For example,changes in the Firmicutes to Bacteroidetes ratio can be used as a biomarker for the diagnosis of obesity,and the occurrence of obesity can be delayed by the colonization of probiotics such as Bifidobacterium breve,Lactobacillus and Akkermansia.Intestinal flora is mainly mediated by the metabolites of intestinal flora to participate in the regulation of obesity.For example,short-chain fatty acid can regulate adipogenesis by regulating signaling pathways such as G protein-coupled receptors 41,43 and peroxisome proliferator-activated receptor γ,thus delaying the occurrence and development of obesity.Bile acids can increase insulin sensitivity and body energy expenditure by promoting the activation of G protein-coupled receptor 5 and farnesol X receptor.In addition,lipopolysaccharide,trimethylamine oxide,medium-chain fatty acids and tryptophan derivatives are also widely involved in the occurrence and development of obesity through various signaling pathways.Further studies have found that metabolites of the same bacterial community exert heterogeneous effects in the specific process of regulating obesity via different signaling pathways.For example,under the influence of high-fat diet,acetic acids can activate the parasympathetic nervous system,leading to hyperphagia and liver insulin resistance and thus accelerating the physiological course of obesity.

BACKGROUND:Intestinal flora and its metabolites can participate in the pathological process of osteoporosis and play an important role in the diagnosis and treatment of osteoporosis.In addition,exercise can regulate the intestinal flora and thus affect the occurrence and development of osteoporosis. OBJECTIVE:To summarize the effects and mechanism of intestinal flora on osteoblasts,osteoclasts,and bone marrow mesenchymal stem cells,and the potential role of exercise-mediated intestinal flora in regulating osteoporosis. METHODS:"Intestinal flora,intestinal bacteria,metabolites of intestinal flora,bone metabolism,osteoporosis,exercise"were selected as keywords.Literatures from 1990 to 2023 were retrieved from PubMed and CNKI databases. RESULTS AND CONCLUSION:Changes in the abundance and diversity of intestinal flora and changes in the levels of intestinal flora metabolites such as trimethylamine oxide and bile acid can be used as biomarkers for the diagnosis of osteoporosis.The imbalance of intestinal flora can lead to intestinal barrier dysfunction and excessive production of lipopolysaccharides and trimethylamine oxide,induce the secretion of tumor necrosis factor-α and other inflammatory cytokines,activate the nuclear factor κB signaling pathway and aggravate oxidative stress,thus promoting osteoclast differentiation,inducing osteoblast apoptosis and affecting bone marrow mesenchymal cell migration.Remodeling intestinal flora homeostasis can inhibit inflammatory response,downregulate oxidative stress,inhibit osteoclast differentiation,promote osteoblast differentiation,and regulate the osteogenic migration of bone marrow mesenchymal cells to prevent and treat osteoporosis.Exercise can regulate intestinal flora homeostasis,improve intestinal barrier function,promote the secretion of short-chain fatty acids and bile acids,down-regulate serum lipopolysaccharide level,reduce oxidative stress,and then inhibit osteocyte apoptosis,inhibit osteoclast differentiation,promote osteoblast differentiation,and regulate osteocyte nutrient metabolism to exert the potential of preventing and treating osteoporosis.

Infrared thermography is an advanced technology that utilizes infrared detectors to sense the infrared thermal radiation emitted from the human body's surface,converting it into electrical signals.These signals are then processed by computers to generate planar temperature color images,providing an intuitive display of the body surface temperature distribution.Rheumatic diseases,as prevalent conditions that significantly impact the quality of life of millions of people worldwide,pose significant challenges in diagnosis and assessment.Traditional diagnostic and evaluation methods,while possessing certain clinical value,exhibit non-negligible limitations.With the advancements and increasing popularity of infrared thermography technology,combined with the progress in medical image recognition and artificial intelli-gence algorithms,this technology has demonstrated increasingly prominent advantages in the field of rheu-matology.By employing this non-invasive and highly efficient technique for analyzing superficial tissue thermal radiation distribution,early and precise diagnosis of rheumatic diseases,as well as dynamic mo-nitoring of disease progression,becomes feasible.This technological advancement enhances the accuracy and efficiency of rheumatic disease diagnosis,thereby alleviating the burden on healthcare systems and optimizing the allocation of medical resources.Furthermore,infrared thermography introduces new vitality into the diagnosis and treatment monitoring of rheumatic diseases.It enables clinicians to detect subtle changes in body surface temperature that may indicate underlying inflammatory or metabolic processes associated with rheumatic conditions.This capability facilitates early intervention and personalized treat-ment strategies,ultimately contributing to improved patient outcomes and satisfaction.The integration of infrared thermography with advanced image processing algorithms and artificial intelligence further ampli-fies its potential,enabling automated analysis and interpretation of thermal images,thus reducing the dependence on manual interpretation and enhancing the reproducibility and reliability of diagnostic results.In conclusion,infrared thermography represents as a promising tool in the management of rheu-matic diseases,offering a non-invasive,cost-effective,and efficient means for early diagnosis,monito-ring,and therapeutic evaluation of diseases.As technology continues to evolve,the application of infra-red thermography is expected to advance further in rheumatic diseases.