Objective To construct a nurse-driven multidisciplinary collaborative pain manage-ment protocol for patients after thyroid or parathyroid surgery and to explore its application effect.Methods A total of 116 patients who underwent thyroid or parathyroid surgery were randomly divided into control group and observation group,with 58 patients in each group.The control group received routine pain nursing management,while the observation group received a nurse-driven multidisciplinar-y collaborative perioperative pain management.Postoperative pain scores,blood pressure,the impact of pain on activities,quality of life,psychological state,and patients' satisfaction were compared be-tween the two groups.Results Postoperative pain scores,blood pressure,and scores in each dimen-sion of psychological status in the observation group were all lower than those in the control group,with statistically significant differences(P＜0.05).Except for walking ability,the impact of postoperative pain on activities in other dimensions in the observation group was lower than that in the control group,and scores in each dimension of quality of life and patients' satisfaction in the observation group were higher than those in the control group(P＜0.05).Conclusion The implementation of a nurse-driv-en multidisciplinary collaborative perioperative pain management protocol for patients undergoing thy-roid or parathyroid surgery has effectively retieved patients' pain,enhanced their quality of life,re-lieved their psychological status,and increased patients' satisfaction.

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 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 explore the effect of body fat percent (BFP) on assisted reproductive outcomes in infertile women undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) and fresh embryo transfer. Methods:We analyzed clinical data on infertile women in a retrospective cohort study, who underwent IVF/ICSI and embryo transfer at the Reproductive Health Hospital of the Third Affiliated Hospital of Zhengzhou University from March 2022 to October 2023. The study subjects were divided into non-obese group (BFP<35%, 800 cases) and obese group (BFP≥35%, 742 cases) according to BFP. The baseline data, ovulation induction outcomes and clinical pregnancy outcomes were compared between the two groups.Results:1) The body mass index [BMI, 25.85 (24.22, 28.04) kg/m 2], basal testosterone [0.80 (0.45, 1.12) nmol/L], triglyceride [1.29 (1.03, 1.59) mmol/L], serum total cholesterol [4.55 (4.29, 4.81) mmol/L], low-density lipoprotein cholesterol [3.17 (2.90, 3.40) mmol/L], fasting glucose [5.40 (5.10, 5.75) mmol/L], fasting insulin [12.99 (9.01, 18.31) mU/L], homeostasis model assessment-insulin resistance [3.09 (2.14, 4.50)], antral follicle count [16.00 (11.00, 22.00)], the patients combined with polycystic ovary syndrome [9.4% (70/742)] in obese group were significantly higher than those in non-obese group [21.94 (20.32, 23.51) kg/m 2, P<0.001; 0.69 (0.43, 0.98) nmol/L, P<0.001; 1.00 (0.79, 1.21) mmol/L, P<0.001; 4.42 (4.19, 4.66) mmol/L, P<0.001; 2.91 (2.67, 3.15) mmol/L, P<0.001; 5.22 (5.00, 5.45) mmol/L, P<0.001; 11.30 (8.33, 14.82) mU/L, P<0.001; 2.61 (1.86, 3.48), P<0.001; 14.00 (10.00, 20.00) mmol/L, P<0.001; 4.8% (38/800), P<0.001]. Basal follicle-stimulating hormone [6.58 (5.64, 7.73) U/L], basal estradiol [133.01 (102.35, 171.56) pmol/L], basal luteinizing hormone [4.80 (3.62, 6.53) U/L] and high-density lipoprotein cholesterol [1.29 (1.17, 1.39) mmol/L] in obese group were significantly lower than those in non-obese group [6.91 (5.86, 8.33) U/L, P<0.001; 145.52 (105.23, 187.95) pmol/L, P=0.001; 5.16 (3.82, 6.94) U/L, P=0.022; 1.45 (1.36, 1.55) mmol/L, P<0.001]. 2) The initiated dosage of gonadotropin (Gn) used [187.50 (150.00, 225.00) U] and the total dosage of Gn used [2 481.25 (1 856.25, 3 225.00) U] in obese group were significantly higher than those in non-obese group [225.00 (175.00, 250.00) U, P<0.001; 2 925.00 (2 250.00, 3 675.00) U, P<0.001]. Serum estradiol level on the day of human chorionic gonadotropin (hCG) injection [8 984.00 (6 087.75, 11 978.25) pmol/L], luteinizing hormone level on the day of hCG injection [1.23 (0.87, 1.79) U/L], the rate of blastocyst formation [55.56% (33.33%, 75.00%)] in obese group were significantly lower than those in non-obese group [9 378.50 (6 528.50, 12 624.50) pmol/L, P=0.016; 1.37 (0.94, 2.01) U/L, P=0.001; 60.00% (37.86%, 80.00%), P=0.014]. 3) Sustained pregnancy rate in obese group [41.5% (308/742)] was lower than that in non-obese group [47.6% (381/800), P=0.016]. The number of embryo transfer, embryo transfer type, implantation rate, clinical pregnancy rate, abortion rate and live birth rate were not statistically significant between the two groups (all P>0.05). 4) BFP was not an independent factor of clinical pregnancy rate and live birth rate (all P>0.05). 5) The area under the curve (AUC) of BMI and BFP to predict clinical pregnancy was 0.509 and 0.518, and there was no significant difference between them (AUC difference=0.009, 95% CI: -0.010-0.028, P=0.376). The AUC of BMI and BFP for predicting live birth was 0.501 and 0.513, with no statistically significant difference (AUC difference=0.012, 95% CI: -0.007-0.030, P=0.221). Conclusion:High BFP can increase total dosage of Gn used, decrease blastocyst formation rate and continuous pregnancy rate.

Objective:To investigate the factors influencing patients' willingness to have a second child after obtaining their first singleton live birth by in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). Methods:The data of patients who achieved their first single live birth via IVF/ICSI at the Reproductive Health Hospital of the Third Affiliated Hospital of Zhengzhou University were collected between July 2016 and July 2021 in a retrospective cohort study. Until July 2023, the patients were divided into the returning group ( n=1 809) and the non-returning group ( n=5 824) according to whether they returned again to receive assisted reproduction treatment for the birth of a second child. The clinical data of the two groups were compared, and the factors affecting patients' willingness to have a second child were analyzed. Results:The characteristics of the two groups of patients were compared. Variables that were statistically significant after being included in the univariate analysis were employed to construct a multivariate logistic regression equation. The results indicated that the age of the female ( OR=0.93, 95% CI: 0.91-0.94, P<0.001), the duration of infertility ( OR=0.96, 95% CI: 0.93-0.98, P=0.002), male+female factors of infertility factor ( OR=0.82, 95% CI: 0.70-0.97, P=0.023) the previous reproductive history ( OR=0.33, 95% CI: 0.27-0.42, P<0.001), the method of assisted pregnancy ( OR=1.31, 95% CI: 1.11-1.55, P=0.001), the transplantation plan ( OR=0.83, 95% CI: 0.74-0.93, P=0.002), the mode of delivery ( OR=0.63, 95% CI: 0.55-0.71, P<0.001), pregnancy complications ( OR=0.70, 95% CI: 0.60-0.82, P<0.001), the presence or absence of remaining embryos ( OR=2.67, 95% CI: 2.24-3.19, P<0.001), the gender of the first live birth ( OR=0.40, 95% CI: 0.36-0.45, P<0.001), the degree of education ( OR=0.74, 95% CI: 0.64-0.85, P<0.001), and the type of household registration ( OR=0.74, 95% CI: 0.65-0.84, P<0.001) were the influencing factors of the second-child fertility intention of patients after obtaining the first singleton live birth through IVF/ICSI. Conclusion:The age of the female, the duration of infertility, the factors of infertility, the previous reproductive history, frozen-thawed embryo transfer, cesarean section, having pregnancy complications, the gender of the first live birth being a boy, having a high school education or above, and urban household registration are negatively correlated with the patients' return visits. ICSI-assisted pregnancy and having remaining embryos are positively correlated with the patients' return visits.

Objective:To explore the effect of body fat percent (BFP) on assisted reproductive outcomes in infertile women undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) and fresh embryo transfer. Methods:We analyzed clinical data on infertile women in a retrospective cohort study, who underwent IVF/ICSI and embryo transfer at the Reproductive Health Hospital of the Third Affiliated Hospital of Zhengzhou University from March 2022 to October 2023. The study subjects were divided into non-obese group (BFP<35%, 800 cases) and obese group (BFP≥35%, 742 cases) according to BFP. The baseline data, ovulation induction outcomes and clinical pregnancy outcomes were compared between the two groups.Results:1) The body mass index [BMI, 25.85 (24.22, 28.04) kg/m 2], basal testosterone [0.80 (0.45, 1.12) nmol/L], triglyceride [1.29 (1.03, 1.59) mmol/L], serum total cholesterol [4.55 (4.29, 4.81) mmol/L], low-density lipoprotein cholesterol [3.17 (2.90, 3.40) mmol/L], fasting glucose [5.40 (5.10, 5.75) mmol/L], fasting insulin [12.99 (9.01, 18.31) mU/L], homeostasis model assessment-insulin resistance [3.09 (2.14, 4.50)], antral follicle count [16.00 (11.00, 22.00)], the patients combined with polycystic ovary syndrome [9.4% (70/742)] in obese group were significantly higher than those in non-obese group [21.94 (20.32, 23.51) kg/m 2, P<0.001; 0.69 (0.43, 0.98) nmol/L, P<0.001; 1.00 (0.79, 1.21) mmol/L, P<0.001; 4.42 (4.19, 4.66) mmol/L, P<0.001; 2.91 (2.67, 3.15) mmol/L, P<0.001; 5.22 (5.00, 5.45) mmol/L, P<0.001; 11.30 (8.33, 14.82) mU/L, P<0.001; 2.61 (1.86, 3.48), P<0.001; 14.00 (10.00, 20.00) mmol/L, P<0.001; 4.8% (38/800), P<0.001]. Basal follicle-stimulating hormone [6.58 (5.64, 7.73) U/L], basal estradiol [133.01 (102.35, 171.56) pmol/L], basal luteinizing hormone [4.80 (3.62, 6.53) U/L] and high-density lipoprotein cholesterol [1.29 (1.17, 1.39) mmol/L] in obese group were significantly lower than those in non-obese group [6.91 (5.86, 8.33) U/L, P<0.001; 145.52 (105.23, 187.95) pmol/L, P=0.001; 5.16 (3.82, 6.94) U/L, P=0.022; 1.45 (1.36, 1.55) mmol/L, P<0.001]. 2) The initiated dosage of gonadotropin (Gn) used [187.50 (150.00, 225.00) U] and the total dosage of Gn used [2 481.25 (1 856.25, 3 225.00) U] in obese group were significantly higher than those in non-obese group [225.00 (175.00, 250.00) U, P<0.001; 2 925.00 (2 250.00, 3 675.00) U, P<0.001]. Serum estradiol level on the day of human chorionic gonadotropin (hCG) injection [8 984.00 (6 087.75, 11 978.25) pmol/L], luteinizing hormone level on the day of hCG injection [1.23 (0.87, 1.79) U/L], the rate of blastocyst formation [55.56% (33.33%, 75.00%)] in obese group were significantly lower than those in non-obese group [9 378.50 (6 528.50, 12 624.50) pmol/L, P=0.016; 1.37 (0.94, 2.01) U/L, P=0.001; 60.00% (37.86%, 80.00%), P=0.014]. 3) Sustained pregnancy rate in obese group [41.5% (308/742)] was lower than that in non-obese group [47.6% (381/800), P=0.016]. The number of embryo transfer, embryo transfer type, implantation rate, clinical pregnancy rate, abortion rate and live birth rate were not statistically significant between the two groups (all P>0.05). 4) BFP was not an independent factor of clinical pregnancy rate and live birth rate (all P>0.05). 5) The area under the curve (AUC) of BMI and BFP to predict clinical pregnancy was 0.509 and 0.518, and there was no significant difference between them (AUC difference=0.009, 95% CI: -0.010-0.028, P=0.376). The AUC of BMI and BFP for predicting live birth was 0.501 and 0.513, with no statistically significant difference (AUC difference=0.012, 95% CI: -0.007-0.030, P=0.221). Conclusion:High BFP can increase total dosage of Gn used, decrease blastocyst formation rate and continuous pregnancy rate.

Objective:To investigate the factors influencing patients' willingness to have a second child after obtaining their first singleton live birth by in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). Methods:The data of patients who achieved their first single live birth via IVF/ICSI at the Reproductive Health Hospital of the Third Affiliated Hospital of Zhengzhou University were collected between July 2016 and July 2021 in a retrospective cohort study. Until July 2023, the patients were divided into the returning group ( n=1 809) and the non-returning group ( n=5 824) according to whether they returned again to receive assisted reproduction treatment for the birth of a second child. The clinical data of the two groups were compared, and the factors affecting patients' willingness to have a second child were analyzed. Results:The characteristics of the two groups of patients were compared. Variables that were statistically significant after being included in the univariate analysis were employed to construct a multivariate logistic regression equation. The results indicated that the age of the female ( OR=0.93, 95% CI: 0.91-0.94, P<0.001), the duration of infertility ( OR=0.96, 95% CI: 0.93-0.98, P=0.002), male+female factors of infertility factor ( OR=0.82, 95% CI: 0.70-0.97, P=0.023) the previous reproductive history ( OR=0.33, 95% CI: 0.27-0.42, P<0.001), the method of assisted pregnancy ( OR=1.31, 95% CI: 1.11-1.55, P=0.001), the transplantation plan ( OR=0.83, 95% CI: 0.74-0.93, P=0.002), the mode of delivery ( OR=0.63, 95% CI: 0.55-0.71, P<0.001), pregnancy complications ( OR=0.70, 95% CI: 0.60-0.82, P<0.001), the presence or absence of remaining embryos ( OR=2.67, 95% CI: 2.24-3.19, P<0.001), the gender of the first live birth ( OR=0.40, 95% CI: 0.36-0.45, P<0.001), the degree of education ( OR=0.74, 95% CI: 0.64-0.85, P<0.001), and the type of household registration ( OR=0.74, 95% CI: 0.65-0.84, P<0.001) were the influencing factors of the second-child fertility intention of patients after obtaining the first singleton live birth through IVF/ICSI. Conclusion:The age of the female, the duration of infertility, the factors of infertility, the previous reproductive history, frozen-thawed embryo transfer, cesarean section, having pregnancy complications, the gender of the first live birth being a boy, having a high school education or above, and urban household registration are negatively correlated with the patients' return visits. ICSI-assisted pregnancy and having remaining embryos are positively correlated with the patients' return visits.

Objective:To investigate the performance of W2 plastic scintillator in megavolt photon and electron beams.Methods:The photon and electron beam energy provided by linear accelerator was used to collect data of the W2 scintillator. The parameters include the electrometer reading stability, W2 dose and dose rate linearity, and angular response. And the dose uncertainty of the W2 correction factors was also investigated.Results:The standard deviation of the electrometer reading stability was between 0.03 and 0.47. The linear regression factors of W2 dose were all 1.0; the maximum deviation of the dose rates was 0.61%. The Cerenkov light radiation correction factor(CLR) for 6 and 10 MV were 0.741 and 0.746, respectively, and the CLR for 6, 9, 12 and 15 MeV were 0.750, 0.753, 0.757 and 0.757, respectively. The maximum deviation of dose uncertainty for 15 MeV was 3.15%.Conclusions:The signal obtained by the blue and green channel was no angular dependence, the same as the high-energy electron beam, which verified that the Cerenkov radiation correction factor has good linearity. W2 plastic scintillator can be applied to non-coplanar radiotherapy dosimetry.

Objective:To explore the efficacy of fluorescent retroperitoneal lymph node dissection in the comprehensive treatment of lymph node recurrence after radical prostatectomy (RP).Methods:From January 2017 to December 2020, 25 patients with lymph node recurrence diagnosed by 68Ga-PSMA PET/CT after RP in our hospital were enrolled in this study. The patients were 67 (59-77) years old. The median PSA was 7.7 (0.5-12.6) ng/ml at lymph node recurrence, and was treated with androgen deprivation therapy (ADT), suggesting hormone-sensitive prostate cancer. Before recurrence, 4 cases were in T 2 stage, 17 cases in T 3, 4 cases in T 4, 10 cases in N 0, and 15 cases in N 1stage, 25 cases in M 0stage. 2 cases diagnosed as ISUP grade group <3, 9 cases in group 4, and 14 cases in group 5. The median time from radical resection to recurrence was 43 (27-56) months. All 25 cases were diagnosed as lymph node recurrence by 68Ga-PSMA PET/CT examination. Fluorescence retroperitoneal lymph node dissection was performed. Pelvic lymph nodes were detected in the dark field under the fluorescence mode, and positive lymph nodes were found. The white light mode was switched, and the lymph nodes were cleaned, and recorded. For metastatic lymph nodes indicated by preoperative PSMA PET/CT, routine dissection was performed regardless of whether the lymph nodes were fluorescently positive or not. The only routine examination was performed if there were no lymph nodes with fluorescently positive staining in other sites. Perioperative data, biochemical recurrence (BCR) rate, radiological recurrence (RAR) rate, and follow-up data were collected and analyzed. Results:25 patients were pathologically diagnosed with lymph node metastasis. The median lymph node dissection time was 21(15-28) min, estimated blood loss was 30(20-50) ml, hospital days was 4(3-5)d without any severe complications (

Objective:To investigate the etiology,clinical features and prognosis of pediatric liver retransplantation.Methods:The data of 1 024 cases of pediatric liver transplantation (<18 years old) from January 2014 to December 2019 operated at Tianjin First Central Hospital were collected,retrospectively. Retransplantation was performed in 26 cases,among which 25 cases received secondary liver transplantation and 1 case received a third liver transplantation. There were 13 male and 12 female patients among the 25 patients. The median age was 12.9(20.5) months(range: 5.8 to 134.8 months), the body weight was 8.0(5.6) kg(range: 5.0 to 30.0 kg) at the time of retransplantation. The pediatric end-stage liver disease(PELD) score was 17.0(21.3) (range: 0 to 45) before retransplantation. The etiology of retransplantation was biliary complications in 7 cases,primary nonfunction of liver graft in 5 cases,antibody-mediated rejection in 4 cases,hepatic artery thrombosis in 3 cases,portal vein thrombosis in 3 cases,concomitant hepatic artery and portal vein thrombosis in 2 cases,thrombogenesis of inferior Vena Cava in 1 case and sinusoidal obstruction syndrome in 1 case. The patients were divided into two groups according to the time interval(30 days) between two liver transplantations,8 patients were classified into early-retransplantation(≤30 days) group and 18 patients were classified into late-retransplantation (>30 days) group. The etiology of liver retransplantation,pre-transplant score,time interval between two transplantations,surgical aspects,major complications and survival rates were compared between the two groups. Continuous variables with normal distribution were compared with t test,while Mann-Whitney U test was applied to compare variables without normal distribution. Categorical variables were compared with chi-square test. The survival curves were created by Kaplan-Meier method and compared by Log Rank test. Results:The median follow-up time was 26.8(30.2) months(range: 1 day to 85.7 months), and the incidence of retransplantation was 1.9%. In the early-retransplantation group,the duration of surgery was (439.8±151.0)minutes,the graft-to-recipient weight ratio was 5.0(1.8)%(range:3.6% to 6.1%),the main cause for retransplantation were primary nonfunction and vascular complications. In the late-retransplantation group,the duration of surgery was (604.4±158.0)minutes,the graft-to-recipient weight ratio was 3.4(2.1)%(range:1.4% to 5.3%),the main cause for retransplantation were biliary complications,antibody mediated rejection and vascular complications.The 3-month,1-year and 2-year recipient survival rates in the early-retransplantation group were all 62.3%,while the recipient survival rates in the late-retransplantation group were 100%,93.8% and 93.8%,respectively. The difference of recipient survival rates was significant between the early-retransplantation group and the late-retransplantation group( P=0.019). The overall 3-month,1-year and 3-year recipient survival rates after the primary liver transplantation were 97.1%,95.4%,94.1%,respectively. Conclusions:The vascular complications,biliary complications,primary nonfunction and antibody-mediated rejection are the main causes of liver retransplantation.The PELD score is higher in patients receiving early retransplantation,while the surgery is relatively more complex in patients receiving late retransplantation,which is reflected by longer duration of surgeries. Patients in the late-retransplantation group showed similar recipient survival rates with primary liver transplantation recipients,and the survival rates are superior to those of patients in the early-retransplantation group. Infection and multiple organ failure are the most common fatal causes after retransplantation.