Objective: To analyze the characteristics of pediatric pesticide poisoning cases admitted to a children s hospital in Jiangxi Province, so as to provide references for the prevention and treatment of pediatric pesticide poisoning. Methods: Medical records of 349 pesticide poisoning hospitalized cases from 2009 to 2023 in a children s hospital in Jiangxi Province were retrospectively reviewed to summarized clinical features, categories of pesticides involved, therapeutic interventions, and prognostic outcomes. Results: Among the cases of pesticide poisoning in children, there were 217 boys and 132 girls with an average age of 4 years and 8 months; 35.82% of cases occurred during April-June, followed by 27.22% during July-September, during October-December accounting for 22.35%, with 14.61% during January-March. There were 75 (21.49%), 148 (42.41%), 126 cases ( 36.10% ) during 2009-2013, 2014-2018, 2019-2023. In terms of pesticide type, insecticides ranked first (166 cases, 47.56% ), followed by herbicides (116 cases, 33.24%) and rodenticides (58 cases, 16.62%). The average hospitalization time was 4 days, and a total of 73 cases (20.92%) required admission to the intensive care unit among pesticide poisoning cases. There were 11 deaths, including 6 cases who were associated with paraguat esposure of paraquat. Self poisoning accounted for 34 cases, with an average age of 12 years and 2 months; 50.00% (17 cases) were concentrated in 2022-2023, accounting for 64.71% (22 cases) in girls; 8 cases of self poisoning resulted in death, accounting for 72.73% of the total number of deaths. Conclusions The period of April to June repesents the peak time for pediatric pesticide poisoning cases, and the proportion of accidental ingestion is relatively high. It is necessary to strictly prevent child poisoning.

OBJECTIVE To investigate the clinical characteristics of euglycemic diabetic ketoacidosis （euDKA） induced by empagliflozin， and provide references for safe medication. METHODS Case reports of euDKA induced by empagliflozin were retrieved and analyzed from PubMed， Web of Science， CNKI， and Wanfang Data. The Naranjo’s scale was adopted to assess the causal relationship between empagliflozin and euDKA. RESULTS A total of 29 patients were enrolled， including 16 males and 13 females，with a median age of 58 years. All patients were diagnosed with type 2 diabetes mellitus； 22 patients had at least one comorbidity. The median time to euDKA onset was 60 days after administration， and 7 cases occurred within 2 weeks of treatment. Perioperative periods，fasting，and low-carbohydrate or ketogenic diets were the main predisposing factors. Common presentations included nausea，vomiting， fatigue， tachypnea，and tachycardia. The causal relationship between empagliflozin and euDKA was assessed as “probable” in all cases. According to adverse reaction severity grading， 13 cases were grade 3 （severe） and 16 cases were grade 4 （life-threatening）. All patients discontinued empagliflozin and recovered after corresponding treatment. CONCLUSIONS euDKA is a serious adverse reaction to empagliflozin， which mostly occurs early in treatment. Perioperative periods， fasting， and ketogenic diets are prone to induce euDKA. Elderly patients and those with comorbidities are at higher risk. Risk assessment should be conducted before clinical administration； blood ketones and acid-base monitoring should be strengthened in the early medication period； withhold the drug before elective surgery， avoid prolonged fasting；upon diagnosis， discontinue empagliflozin and initiate intravenous insulin， provide fluid resuscitation promptly， and use other treatments to improve patient prognosis.

Debates persist regarding the efficacy and safety of azvudine, particularly its real-world outcomes. This study involved patients aged ≥60 years who were admitted to 25 hospitals in mainland China with confirmed SARS-CoV-2 infection between December 1, 2022, and February 28, 2023. Efficacy outcomes were all-cause mortality during hospitalization, the proportion of patients discharged with recovery, time to nucleic acid-negative conversion (T _NANC), time to symptom improvement (T _SI), and time of hospital stay (T _HS). Safety was also assessed. Among the 5884 participants identified, 1999 received azvudine, and 1999 matched controls were included after exclusion and propensity score matching. Azvudine recipients exhibited lower all-cause mortality compared with controls in the overall population (13.3% vs. 17.1%, RR, 0.78; 95% CI, 0.67-0.90; P = 0.001) and in the severe subgroup (25.7% vs. 33.7%; RR, 0.76; 95% CI, 0.66-0.88; P < 0.001). A higher proportion of patients discharged with recovery, and a shorter T _NANC were associated with azvudine recipients, especially in the severe subgroup. The incidence of adverse events in azvudine recipients was comparable to that in the control group (2.3% vs. 1.7%, P = 0.170). In conclusion, azvudine showed efficacy and safety in older patients hospitalized with COVID-19 during the SARS-CoV-2 omicron wave in China.

Objective To explore the advantages of high-frequency ultrasound-guided"cross-shaped"positioning method in accurate positioning and surgical effect in open reduction and internal fixation of rib fractures.Methods Retrospective analysis of 97 cases of multiple rib fractures treated surgically in our department from october 2019 to october 2024.Patients were divided into three groups based on different localization methods.The control group designed the surgical incision according to the results of chest three-dimensional reconstruction,the ultrasound group determined the incision based on the control group combined with high-frequency ultrasound,and Based on the method used in the ultrasound group,the"cross-localization"technique was combined to determine the incision in the cross-shaped group.The comparison of surgical-related data included fracture positioning accuracy,incision length of per singer rib,postoperative drainage volume,duration of drainage tube retention,postoperative pain score,operative time,intraoperative blood loss,length of hospital stay and incision infection rate.Additionally,commonly used inflammatory markers(white blood cell count,neutrophil percentage,CRP,IL-6,NF-κB)and pain-related biomarkers(PGE2,5-HT)were also included in the comparative analysis.Results In the control group,ultrasound group,and crossover group,aside from wound infections,the respective accuracies of fracture localization were 68.97％vs 87.50％vs 97.22％,the length of single rib incision was(3.50±1.23)cm vs(2.70±0.62)cm vs(2.45±0.58)cm,the volume of drainage on the day of surgery was(170.55±27.85)ml vs(150.69±24.67)ml vs(120.34±18.45)ml,the duration of drainage tube retention was(4.17±1.12)days vs(3.67±0.95)days vs(3.12±0.65)days,the postoperative pain scores were(6.86±2.15)vs(5.54±1.15)vs(4.89±1.53),the operation times were(75.84±15.62)minutes vs(67.74±11.85)minutes vs(57.35±9.36)minutes,the intraoperative blood loss was(85.78±11.78)ml vs(72.65±8.92)ml vs(62.23±9.63)ml,and the length of hospital stay was(8.42±1.47)days vs(7.12±1.14)days vs(6.56±1.32)days.The crossover group showed superior results in all metrics compared to the other two groups,with statistically significant differences(P＜0.05).The inflammatory and pain stress indicators for the control,ultrasound,and crossover groups were as follows:white blood cell counts[(16.39±4.15)× 109/Lvs(13.25±2.45)× 109/L vs(12.02±2.77)× 109/L],neutrophil percentages[(80.14±12.21)vs(72.36±10.34)vs(65.73±8.83)],CRP[(31.86±6.87)mg/L vs(27.72±5.65)mg/L vs(24.69±4.11)mg/L],IL-6[(46.35±11.42)pg/L vs(41.42±8.75)pg/L vs(35.53±9.51)pg/L],NF-B[(22.55±4.98)pg/L vs(17.34±3.62)pg/L vs(15.91±3.84)pg/L],PGE2[(240.37±21.65)ng/L vs(209.45±23.24)ng/L vs(180.21±18.72)ng/L],and 5-HT[(290.62±34.37)ng/L vs(270.85±26.98)ng/L vs(210.62±19.64)ng/L].The crossover group demonstrated statistically significant differences compared to both the control and ultrasound groups(P＜0.05).There was no statistically significant difference in incision infection among the three groups(P＞0.05).Conclusion The ultrasound-guided"cross"positioning method for rib fracture open reduction and internal fixation can more accurately locate the incision,shorten the incision length and hospitalization time,reduce postoperative inflammatory response and patient pain,and facilitate rapid recovery after surgery.

Objective To explore the therapeutic effect of precise disconnection of pargastric varices guided by endoscopic ultrasound in the treatment of esophagogastric variceal bleeding.Method A retrospective analysis was conducted on 20 patients with cirrhosis esophagogastric variceal bleeding treated with endoscopic ultrasound-guided precise disconnection of pargastric varices from January 1,2024 to December 31,2024.The efficacy was analyzed.Result All 20 patients successfully completed the precise disconnection of pargastric varices under the guidance of endoscopic ultrasound.The injection of tissue gel combined with the placement of spring coils(14 cases)and the injection of tissue gel alone(4 cases)successfully blocked the pargastric varices.All patients did not experience perforation,esophageal and cardia stenosis,massive bleeding,septicemia,or ectopic embolization.One patient who received tissue gel alone had slight bleeding from the pargastric varices after surgery and improved after 3 days of treatment to reduce portal vein pressure.Another one patient who received tissue gel alone had a low-grade fever and normal body temperature after 3 days of anti-infection treatment.Conclusion Precise disconnection of pargastric varices under the guidance of endoscopic ultrasound has a good therapeutic effect on esophagogastric variceal bleeding,with fewer complications such as ectopic embolization,massive bleeding,infection,and perforation.However,close follow-up observation is still needed to address the issue of pargastric varices.

Objective:To explore the impact of female body mass index (BMI) on pregnancy outcomes in artificial insemination with donor sperm (AID).Methods:A retrospective cohort study was conducted on 4 484 couples with 9 852 AID treatment cycles treated at Reproductive Center of Guangdong Institute of Reproductive Science from January 2011 to September 2024. Participants were divided into four groups based on BMI: low BMI group (BMI<18.5 kg/m 2), normal BMI group (18.5 kg/m 2≤BMI<24.0 kg/m 2), overweight group (24.0 kg/m 2≤BMI<28.0 kg/m 2), and obese group (BMI≥28.0 kg/m 2). General characteristics and pregnancy outcomes were compared across groups. Kaplan-Meier survival analysis was used to calculate cumulative pregnancy rates from one to six cycles. Generalized estimating equations (GEE), univariate and multivariate logistic and Cox regression analysis were performed, adjusting for age, basal follicle-stimulating hormone, basal luteinizing hormone, endometrial thickness, clinical diagnosis, and treatment protocol, to explore correlations between female BMI and clinical pregnancy rate, spontaneous abortion rate, and cumulative pregnancy rate. Results:1) There were no statistically significant differences in clinical pregnancy rate and spontaneous abortion rate among the low BMI group, the normal BMI group, the overweight group, and the obesity group (all P>0.05). 2) Cumulative pregnancy rates for AID cycles 1-6 were 17.60%, 31.60%, 43.08%, 54.37%, 61.83% and 73.68%, respectively. 3) Multivariate GEE analysis revealed that female age ( OR=0.962, 95% CI: 0.950-0.974, P<0.001), endometrial thickness ( OR=1.040, 95% CI:1.011-1.069, P=0.006), and natural cycles ( OR=1.171, 95% CI: 1.060-1.294, P=0.002) influenced clinical pregnancy rates. Compared with the normal BMI group, there were no statistically significant differences in clinical pregnancy rates of low BMI group, overweight group, and obese group (all P>0.05). Multivariate logistic analysis showed that female age ( OR=1.051, 95% CI: 1.012-1.091, P=0.010), endometrial thickness ( OR=0.920 , 95% CI: 0.847-1.000, P=0.049) and polycystic ovary syndrome ( OR=1.927, 95% CI: 1.044-3.556, P=0.036) influenced spontaneous abortion rates. Compared with the normal BMI group, there were no statistically significant differences in spontaneous abortion rates of low BMI group, overweight group and obese group (all P>0.05). 4) Cox regression analysis indicated that female age ( HR=0.939, 95% CI: 0.928-0.950, P<0.001), endometrial thickness ( HR=1.039, 95% CI: 1.013-1.066, P=0.003) and natural cycles ( HR=1.957, 95% CI: 1.785-2.146, P<0.001) influenced cumulative pregnancy rates. Compared with the normal BMI group, there were no statistically significant differences in cumulative pregnancy rates of low BMI group, overweight group and obese group (all P>0.05). Conclusion:Female BMI does not significantly affect clinical pregnancy rates, spontaneous abortion rates and cumulative pregnancy rates in AID.

In the past decade, real-world data (RWD) research has undergone significant transformations due to data aggregation and processing technologies. However, there is still a lack of consensus regarding the scope of RWD applications and the value of real-world evidence (RWE). This study briefly outlined the origins of the concept of RWD study and its early research scope to promote further development in this area. We also reviewed the understanding of RWD applications and research models from the five perspectives of healthcare professionals, medical institutions, decision-making departments, cross-regional cooperation model, and the practice of the One-Health model. Finally, we systematically summarized the renewed understanding of the value of RWE while looking ahead to the challenges and future developments in this field.

Objective:To explore the impact of female body mass index (BMI) on pregnancy outcomes in artificial insemination with donor sperm (AID).Methods:A retrospective cohort study was conducted on 4 484 couples with 9 852 AID treatment cycles treated at Reproductive Center of Guangdong Institute of Reproductive Science from January 2011 to September 2024. Participants were divided into four groups based on BMI: low BMI group (BMI<18.5 kg/m 2), normal BMI group (18.5 kg/m 2≤BMI<24.0 kg/m 2), overweight group (24.0 kg/m 2≤BMI<28.0 kg/m 2), and obese group (BMI≥28.0 kg/m 2). General characteristics and pregnancy outcomes were compared across groups. Kaplan-Meier survival analysis was used to calculate cumulative pregnancy rates from one to six cycles. Generalized estimating equations (GEE), univariate and multivariate logistic and Cox regression analysis were performed, adjusting for age, basal follicle-stimulating hormone, basal luteinizing hormone, endometrial thickness, clinical diagnosis, and treatment protocol, to explore correlations between female BMI and clinical pregnancy rate, spontaneous abortion rate, and cumulative pregnancy rate. Results:1) There were no statistically significant differences in clinical pregnancy rate and spontaneous abortion rate among the low BMI group, the normal BMI group, the overweight group, and the obesity group (all P>0.05). 2) Cumulative pregnancy rates for AID cycles 1-6 were 17.60%, 31.60%, 43.08%, 54.37%, 61.83% and 73.68%, respectively. 3) Multivariate GEE analysis revealed that female age ( OR=0.962, 95% CI: 0.950-0.974, P<0.001), endometrial thickness ( OR=1.040, 95% CI:1.011-1.069, P=0.006), and natural cycles ( OR=1.171, 95% CI: 1.060-1.294, P=0.002) influenced clinical pregnancy rates. Compared with the normal BMI group, there were no statistically significant differences in clinical pregnancy rates of low BMI group, overweight group, and obese group (all P>0.05). Multivariate logistic analysis showed that female age ( OR=1.051, 95% CI: 1.012-1.091, P=0.010), endometrial thickness ( OR=0.920 , 95% CI: 0.847-1.000, P=0.049) and polycystic ovary syndrome ( OR=1.927, 95% CI: 1.044-3.556, P=0.036) influenced spontaneous abortion rates. Compared with the normal BMI group, there were no statistically significant differences in spontaneous abortion rates of low BMI group, overweight group and obese group (all P>0.05). 4) Cox regression analysis indicated that female age ( HR=0.939, 95% CI: 0.928-0.950, P<0.001), endometrial thickness ( HR=1.039, 95% CI: 1.013-1.066, P=0.003) and natural cycles ( HR=1.957, 95% CI: 1.785-2.146, P<0.001) influenced cumulative pregnancy rates. Compared with the normal BMI group, there were no statistically significant differences in cumulative pregnancy rates of low BMI group, overweight group and obese group (all P>0.05). Conclusion:Female BMI does not significantly affect clinical pregnancy rates, spontaneous abortion rates and cumulative pregnancy rates in AID.

In the past decade, real-world data (RWD) research has undergone significant transformations due to data aggregation and processing technologies. However, there is still a lack of consensus regarding the scope of RWD applications and the value of real-world evidence (RWE). This study briefly outlined the origins of the concept of RWD study and its early research scope to promote further development in this area. We also reviewed the understanding of RWD applications and research models from the five perspectives of healthcare professionals, medical institutions, decision-making departments, cross-regional cooperation model, and the practice of the One-Health model. Finally, we systematically summarized the renewed understanding of the value of RWE while looking ahead to the challenges and future developments in this field.

Objective:To analyze the effects of parental adverse childhood experiences on their offspring's prosocial behaviors,as well as to examine the moderating role of parental positive childhood experiences.Methods:A total of 3 090 parents of preschool children were selected to participate in this study.The Adverse Childhood Ex-periences International Questionnaire(ACE-IQ)and Benevolent Childhood Experiences Scale(BCEs)were used to examine parental adverse childhood experiences(i.e.,abuse,neglect,and dysfunctional households,etc)and posi-tive childhood experiences(i.e.,internal and external perceived safety,support,and positive personality traits,etc),Children Strength and Difficulties Question(SDQ)were performed to test offspring prosocial behaviors.Results:Parents'ACE-IQ scores were negatively correlated with offspring SDQ scores(r=-0.15)and parents'BCEs scores moderated(β=0.19)the relationship between parental ACE-IQ scores and offspring SDQ scores(β=-0.12).Conclusion:The study suggests that parental adverse childhood experiences are negatively associated with offspring pro-social behavior.Additionally,it indicates that an increase in positive childhood experiences can en-hance the relationships of parents'adverse childhood experiences.