目的 探讨精子DNA碎片指数（DFI）对体外受精-胚胎移植（IVF-ET）胚胎发育及妊娠结局的影响，为优化男性生育力评估及辅助生殖治疗策略提供依据。方法 回顾性分析2023年1月—2024年1月于徐州市妇幼保健院接受IVF-ET治疗的126对不孕夫妇，根据男方DFI检测结果分为低碎片组（DFI≤15%，n=42）、临界组（15%＜DFI＜30%，n=45）和高碎片组（DFI≥30%，n=39）。比较三组患者受精相关指标、胚胎发育指标及妊娠结局指标的差异，并分析DFI与各指标的相关性。结果 低碎片组双原核率（2PN）率、优质胚胎率及囊胚形成率均高于临界组和高碎片组（P＜0.001），低碎片组1PN率、多PN率均低于临界组和高碎片组（P＜0.001）；三组种植率、临床妊娠率、早期流产率比较差异无统计学意义（P＞0.05），但高碎片组活产率低于低碎片组（P＜0.05）。相关性分析结果表明，DFI与优质胚胎率（r=-0.412，P＜0.001）、囊胚形成率（r=-0.387，P＜0.001）、活产率（r=-0.287，P=0.012）呈负相关，与早期流产率（r=0.206，P=0.059）、种植率（r=-0.215，P=0.058）、临床妊娠率（r=-0.203，P=0.072）无显著相关性。结论 精子DNA碎片指数是影响IVF-ET胚胎发育及妊娠结局的重要因素，高DFI主要通过降低胚胎发育潜能及增加流产风险导致活产率下降，临床需对高DFI患者进行干预以改善治疗结局。
Objective To investigate the impact of sperm DNA fragmentation index（DFI）on embryo development and pregnancy outcomes of in vitro fertilization-embryo transfer（IVF-ET），and to provide a basis for optimizing male fertility assessment and assisted reproductive treatment strategies．Methods A retrospective analysis was performed on 126 infertile couples undergoing IVF-ET treatment at the Reproductive Medicine Center of Xuzhou Maternal and Child Health Hospital from January 2023 to January 2024．According to the male DFI test results，they were divided into three groups：low fragmentation group（DFI≤15%，n=42），critical group（15% ＜ DFI ＜ 30%，n=45），and high fragmentation group（DFI≥30%，n=39）．Differences in fertilization-related indicators，embryo development indicators，and pregnancy outcome indicators were compared among the three groups，and the correlation between DFI and each indicator was analyzed．Results The 2 pronuclei rate（PN）rate，high-quality embryo rate，and blastocyst formation rate in the low fragmentation group were significantly higher than those in the critical and high fragmentation groups（P＜0.001）．The 1PN rate and multi-PN rate in the low fragmentation group were significantly lower than those in the critical and high fragmentation groups（P＜0.001）．There was no significant difference in the three groups of implantation rate，clinical pregnancy rate and early abortion rate（P＞0.05），but the live birth rate of high fragment group was significantly lower than that of low fragment group（P＜0.05）．The results of correlation analysis showed that DFI was significantly negatively correlated with the rate of high quality embryos（r=-0.412，P＜0.001），blastocyst formation rate（r=-0.387，P＜0.001）and live birth rate（r=-0.287，P=0.012），but not with the rate of early abortion（r=0.206，P=0.059），implantation rate（r=-0.215，P=0.058）and clinical pregnancy rate（r=-0.203，P=0.072）．Conclusions Sperm DFI is an important factor affecting embryo development and pregnancy maintenance in IVF-ET．High DFI leads to a decrease in live birth rate mainly by reducing embryo developmental potential and increasing the risk of early abortion．Clinically，early intervention is needed for patients with high DFI to improve treatment outcomes．
目的 基于结构方程模型（SEM）验证早产儿母亲育儿胜任感的多路径作用机制。方法 采用便利抽样法选取2024年6月—2025年6月在莆田学院附属医院分娩的早产儿母亲250例作为研究对象。采用一般资料调查表、中文版育儿胜任感量表（C-PSOC）、婴儿母亲育儿支持问卷（PSM）、角色适应问卷、简式亲职压力量表收集数据。通过单因素分析及多元线性回归分析母亲育儿胜任感的影响因素，使用AMOS软件构建结构方程模型，分析早产儿分娩后母亲育儿胜任感的作用路径。结果 250例早产儿母亲的C-PSOC得分为（61.93±6.02）分，多元线性回归分析结果显示，早产儿母亲育儿胜任感的影响因素包括产次、育儿支持、角色适应、亲职压力（均P＜0.05）。结构方程模型拟合良好（χ 2 /df=1.026，GFI=0.987，AGFI=0.978，NFI=0.987，CFI=1.000，RMSEA=0.010），其中角色适应正向预测育儿胜任感（β=0.344），育儿支持（β=-0.477）与亲职压力（β=-0.283）负向预测（均P＜0.05），并且角色适应通过育儿支持、亲职压力间接提升育儿胜任感（效应值0.467）；产次经角色适应间接降低压力源影响（效应值0.529）。结论 早产儿母亲育儿胜任感受多路径机制调控，临床需针对角色适应、育儿支持及亲职压力设计级联干预策略。
Objective To verify the multi-pathway mechanism of parenting competence of premature infant mothers based on structural equation modeling（SEM）．Methods A convenience sampling method was used to select 250 mothers of preterm infants who delivered in Affiliated Hospital of Putian University between June 2024 and June 2025 as the study subjects．Data was collected using a general information survey，the Chinese version of the Parenting Sence of Competence Scale（C-PSOC），the Parenting Support Questionnaire for Infant Mothers（PSM），the Role Adaptation Questionnaire，and the Simplified Parenting Stress Scale．By conducting single factor analysis and multiple linear regression analysis on the influencing factors of maternal parenting competence，a structural equation model was constructed using AMOS software to analyze the pathway of maternal parenting competence after premature birth．Results The C-PSOC score of 250 mothers of premature infants was（61.93±6.02）．Multiple linear regression analysis showed that the influencing factors of parenting competence among mothers of premature infants included parity，parenting support，role adaptation，and parental pressure（all P＜0.05）．The structural equation model fits well（2/df=1.026，GFI=0.987，AGFI=0.978，NFI=0.987，CFI=1.000，RMSEA=0.010），which role adaptation positively predicted parenting competence（β=0.344），parenting support（β=-0.477）and parenting stress（β=-0.283）negatively predicted（all P＜0.05），and role adaptation indirectly enhanced parenting competence through parenting support and parenting stress（effect value 0.467）．The adaptation of roles during childbirth indirectly reduced the impact of stressors（effect value 0.529）．Conclusions The multi-pathway mechanism of parental competence perception regulation in premature infant mothers requires the design of cascading intervention strategies targeting role adaptation，parenting support，and parental stress in clinical practice．
目的 压疮是指由于组织受压时间过长引起的严重并发症，2025年的数据显示，压疮在活动受限患者中发生率高。机体代谢紊乱可能会引起压疮，但是否与血清代谢物有因果影响，暂不明确。方法 本文运用孟德尔随机化（MR）方法评价血清代谢物与压疮间风险因素，基于MR方法评价血清代谢物和压疮的因果联系，分别纳入由欧洲人群全基因组关联研究（GWAS）。压疮：FinnGen R10，3 167例；血清代谢物：EMBL-EBI数据库16种代谢物数据作为研究样本；筛选条件：工具变量筛选条件［P＜5×10-8，连锁不平衡聚类r 2 ＜0.001，kb=10 000，F统计量＞10（公式：F=R2 ×N-2/1-R2 ）］；主要分析方法：使用（IVW）法，辅助采用加权中位数法（WM）、MR-Egger回归法校验；用Benjamini-Hochberg法进行多重检验校正（FDR＜0.05为有统计学意义）。结果 共鉴定出10种代谢物与压疮存在关联（P＜0.01），经FDR校正后4种：代谢物18：2/20：4n6的水平升高（P＜0.000 2）2-Oxopeptide的作用相反，降低压疮的风险（OR=0.73，95%CI：0.59~0.92，P=0.011）；琥珀酸可增加压疮的风险（OR=1.13，95%CI：1.03~1.24，P=0.018）；甘氨酸/丙氨酸比值降低压疮风险（OR=0.849，95%CI：0.76~0.93，P=0.022）。稳定性分析证明上述发现是可信的、稳健的（heterogeneity：P＞0.05，pleoitropy：P＞0.05）。结论 血清代谢物通过调控炎症反应、影响微循环障碍以及干预能量代谢途径，参与压疮的发生发展，可作为构建压疮风险的模型以及制定相关干预策略为压疮评估、治疗、预防提供因果层面的理论依据。
Objective Pressure ulcer（PU）is a serious complication caused by prolonged tissue compression．Data of 2025 shows that PUs have a high incidence among patients requiring long-term bed rest．Metabolic disorders may contribute to PU development，but whether serum metabolites causally affect PU risk remains unclear．Methods this study employed the Mendelian randomization（MR）method to evaluate whether serum metabolites are risk factors for PU．To assess the causal relationship between serum metabolites and PU，data from Genome-Wide Association Studies（GWAS）of European populations were included：PU data from FinnGen R10（3 167 cases）and data on 16 serum metabolites from the EMBL-EBI database．Instrumental variable screening criteria were as follows：P＜5×10-8，linkage disequilibrium clustering（r 2 ＜0.001，kb=10，000），and F-statistic ＞10（Formula：F=［R2 ×N-2］/［1-R2 ］）．The inverse variance weighting（IVW）method was used as the primary analytical approach，supplemented by the weighted median（WM）method and MR-Egger regression for verification．The Benjamini-Hochberg method was applied for multiple test correction（FDR＜0.05 was considered statistically significant）．Results A total of 10 metabolites were identified to be associated with PU（P＜0.01），and 4 remained significant after FDR correction：elevated levels of metabolite 18：2/20：4n6（P＜0.0002）；2-Oxopeptide exerted an opposite effect，reducing PU risk（OR=0.73，95%CI：0.59-0.92，P=0.011）；succinic acid increased PU risk（OR=1.13，95%CI：1.03-1.24，P=0.018）；and the glycine/alanine ratio reduced PU risk（OR=0.849，95%CI：0.76-0.93，P=0.022）．Stability analysis（PH-TauNE［novel pleiotropy test］） confirmed that the above findings were credible and robust（heterogeneity：P＞0.05，pleiotropy：P＞0.05）．Conclusions Serum metabolites are involved in the occurrence and development of PU by regulating inflammatory responses，affecting microcirculatory disorders，and interfering with energy metabolism pathways．They can provide causal theoretical basis for constructing PU risk prediction models，formulating relevant intervention strategies，and guiding PU treatment，prevention，and assessment．
目的 分析对肺癌化学治疗（化疗）患者采取个性化营养干预联合分级步行运动方案的应用价值。方法 将郑州大学附属郑州中心医院2023年7月—2024年7月符合标准的198例肺癌化疗患者作为研究对象，通过随机数字表法分为观察组和对照组各99例。对照组仅采用个性化营养干预方案，观察组则联合分级步行运动方案，两组患者均在同一时间内入组并接受持续干预3个月。对两组干预前后癌因性疲乏［Piper疲乏修订量表（PFS-R）］、营养状况、睡眠质量［匹茨堡睡眠质量指数（PSQI）］、生活质量［生活质量评估量表（SF-36）］水平予以比较。结果 相较于对照组，干预后观察组PFS-R、PSQI评分较低，白蛋白、前白蛋白、血红蛋白、铁转蛋白水平和SF-36评分较高（P＜0.05）。结论 对肺癌化疗患者采取个性化营养干预联合分级步行运动方案，有利于促进其癌因性疲乏的减轻和营养状态、睡眠质量及生活质量水平的提高。
Objective To analyze the effects of personalized nutritional intervention combined with graded walking exercise treatment on cancer-related fatigue and quality of life in lung cancer patients during chemotherapy．Methods A total of 198 lung cancer patients undergoing chemotherapy who met the criteria in our hospital from July 2023 to July 2024 were selected as the research subjects．They were divided into an observation group and a control group，with 99 cases in each group，by the random number table method．The control group only received individualized nutritional intervention，while the observation group received graded walking exercise additionally．Both groups of patients were enrolled at the same time and received continuous intervention for three months．Cancer-related fatigue（Piper’s Fatigue Scale-Revised［PFS-R］），nutritional status，sleep quality（Pittsburgh Sleep Quality Index［PSQI］），and quality of life（Quality of Life Scale［SF-36］） before and after the intervention were compared between the two groups．Results Compared with the control group，the observation group had lower PFS-R and PSQI scores and higher albumin，prealbumin，hemoglobin，transferrin levels and SF-36 scores after the intervention（P＜0.05）．Conclusions Adopting personalized nutritional intervention combined with graded walking exercise for lung cancer patients during chemotherapy is beneficial to promote the reduction of cancer-caused fatigue and the improvement of their nutritional status，sleep quality and quality of life．
目的 探讨TAP水平与乳腺癌分子亚型及临床病理参数之间的相关性。方法 以2021年3月—2025年1月期间收治的150例乳腺癌病例为样本，采用静脉采血方式测定TAP凝聚物表面积指标，通过免疫组织化学EnVision双步染色技术，对雌激素受体（ER）、雄激素受体（AR）、孕激素受体（PR）、Ki-67及p53等表达水平进行分析，采用荧光原位杂交（FISH）对人表皮生长因子受体2（HER2）基因扩增状态进行检测。结果 150例患者中，TAP强阳性131例，TAP弱阳性15例，TAP阴性4例，TAP阳性率97.33%。免疫表型：ER阴性43例，ER阳性107例；AR阳性133例，AR阴性17例；PR阴性60例，PR阳性90例；p53阳性73例，p53阴性77例；HER2强阳性41例，HER2弱阳性89例，HER2阴性20例；Ki-67增殖指数≥20% 116例，Ki-67增殖指数＜20% 34例。FISH对65例免疫组织化学检测结果为HER2（2+ ）的乳腺癌病例进行基因扩增状态分析，其中阳性7例，阴性58例。Ki-67高增殖组TAP表达水平显著高于低增殖组（P＜0.05）；不同临床分期患者TAP表达水平存在差异（P＜0.05）；三阴型、HER2阳性型、Luminal A型和Luminal B型的患者之间的TAP表达水平存在差异（P＜0.05），各分子分型（HER2阳性型、三阴型、Luminal A型和Luminal B型）与其对应非分型组的TAP表达均无统计学差异（均P＞0.05）。结论 TAP在乳腺癌中广泛表达，且与Ki-67增殖指数、临床分期呈正相关。虽然不同分子分型间TAP表达存在总体差异，但具体亚型对比未显示显著性，后期需扩大样本量验证。
Objective To explore the relationship between tumor abnormal protein（TAP）level and molecular typing and clinicopathological features of breast cancer．Methods A total of 150 breast cancer cases admitted from March 2021 to January 2025 were enrolled in this study．The surface area of TAP condensates was measured using venous blood samples．The expression levels of estrogen receptor（ER），androgen receptor（AR），progesterone receptor（PR），Ki-67，and P53 were analyzed via immunohistochemistry（IHC）using the EnVision two-step staining technique．The amplification status of the human epidermal growth factor receptor 2（HER2+）gene was determined using fluorescence in situ hybridization（FISH）．Results Among 150 patients，131 cases were strongly positive，15 cases were weakly positive and 4 cases were negative，with a positive rate of 97.33%．Immunophenotype：ER positive in 107 cases and ER negative in 43 cases，133 cases were positive for AR and 17 cases were negative，PR was positive in 90 cases and negative in 60 cases，73 cases were positive for p53 and 77 cases were negative．HER2 is strongly positive in 41 cases，weakly positive in 89 cases and negative in 20 cases．There were 116 cases with Ki-67 proliferation index ≥ 20% and 34 cases with Ki-67 proliferation index ＜ 20%．Sixty-five cases of breast cancer HER2（2 ）were detected in the later stage．by FISH，of which 7 cases were positive and 58 cases were negative．The expression level of TAP in patients with high Ki-67 proliferation index was higher than that in patients with low Ki-67 proliferation index（P＜0.05）．The expression level of TAP in patients with different clinical stages was different（P＜0.05）．There were differences in TAP expression levels among patients with triple negative type，HER2 positive type，Luminal A type and Luminal B type（P＜0.05）．There was no statistical difference in TAP expression between each molecular type（triple negative type，HER2 positive type，Luminal A type and Luminal B type）and its corresponding non-typing group（all P＞0.05）．Conclusions TAP is widely expressed in breast cancer，and it is positively correlated with Ki-67 proliferation index and clinical stage．Although there is a general difference in TAP expression among different molecular typing，the comparison of specific subtypes shows no significance，and it needs to be verified by expanding the sample size
目的 分析改良经脊柱内椎间孔镜系统技术（TESSYS）对腰椎间盘突出症患者疼痛及功能的影响，以期分析该术式优劣，丰富该研究领域。方法 回顾性选取2022年10月—2024年10月医院治疗的80例腰椎间盘突出症患者作为研究对象，根据治疗方式的不同划分为观察组（TESSYS技术治疗）和对照组（经皮椎间孔镜髓核摘除术治疗），每组各40例。观察两组患者疗效、手术时间、术中出血量、住院时间、透视次数、切口长度等情况。比较两组患者术前、术后6 h、术后1天、术后1周、术后1个月VAS评分情况，比较两组患者术前及术后1个月腰椎功能情况，包括Oswestry功能障碍指数（ODI）、腰椎曲度、腰背肌后伸活动度。比较两组患者术前及术后24 h的血清超敏C-反应蛋白（hs-CRP）、白细胞介素-6（IL-6）水平。结果 观察组患者疗效优于对照组（Z=-3.737，P＜0.001）。交互效应下，两组疼痛因不同术式而随着时间增加而有所不同（P＜0.05）；时点效应下，观察组、对照组各组均随着时点增加疼痛随之减少（P＜0.05）；组间效应下，干预前、干预后1个月两组差异不明显，但是观察组疼痛干预后6 h（Z=-2.831，P=0.005）、干预后1天（Z=-3.253，P=0.001）低于对照组。术后1个月，观察组患者的ODI（Z=-4.804，P＜0.001）低于对照组，而腰椎曲度（Z=-6.218，P＜0.001）、腰背肌后伸活动度（Z=-7.014，P=0.001）高于对照组。术后24 h后，观察组患者的hs-CRP（Z=-5.671，P＜0.001）、IL-6（Z=-3.262，P＜0.001）低于对照组。结论 TESSYS相较于经皮椎间孔镜髓核摘除术在治疗腰椎间盘突出症时具有显著优势，可提高疗效，减少出血量，减轻疼痛，减少炎症反应，加快腰椎功能康复，缩短住院时间。
Objective The effect of modified transforaminal endoscopic spine system（TESSYS） on pain and function in patients with lumbar disc herniation was analyzed，so as to analyze the advantages and disadvantages of this procedure and enrich the research field．Methods Retrospectively，80 patients with lumbar disc herniation treated in the hospital from October 2022 to October 2024 were selected as the study subjects．These patients were divided into two groups based on their treatment methods：the observation group（treated with TESSYS technology）and the control group（treated with percutaneous endoscopic discectomy）．Each group consisted of 40 patients．The study evaluated the treatment efficacy，surgical duration，intraoperative bleeding volume，hospital stay fluoroscopy frequency，and incision length for both groups．Additionally，we compared the VAS scores of both groups before surgery，six hours post-surgery，one day post-surgery，one week post-surgery，and one month post-surgery．We also compared the lumbar function of both groups before surgery and 1 month post-surgery，including the Oswestry Functional Index（ODI），lumbar lordosis，and lumbar back muscle extension activity．Furthermore，we compared the serum levels of high-sensitivity C-reactive protein（hs-CRP）and interleukin-6（IL-6）in both groups before and 24 hours after surgery．Results The therapeutic effect of the observation group was better than that of the control group（Z=-3.737，P＜0.001）．Under the interaction effect，the pain of the two groups varied with time due to different surgical procedures（P＜0.05）．Under the time effect，both the observation group and the control group showed a decrease trend in pain as the time to treatment increased（P＜0.05）．Under the inter group effect，there was no significant difference between the two groups before and 1 month after intervention，but the pain in the observation group was less than that in the control group at 6 hours after intervention（Z=-2.831，P=0.005）and 1 day after intervention（Z=-3.253，P=0.001）．One month after surgery，the ODI（Z=-4.804，P＜0.001）of the observation group patients was lower than that of the control group，while the lumbar curvature（Z=-6.218，P＜0.001）and lumbar back muscle extension activity（Z=-7.014，P=0.001）were higher than those of the control group．Twenty-four hours after surgery，the hs-CRP（Z=-5.671，P＜0.001）and IL-6（Z=-3.262，P＜0.001）levels in the observation group were lower than those in the control group．Conclusions The improved percutaneous transforaminal endoscopic technique has significant advantages over percutaneous transforaminal discectomy in the treatment of lumbar disc herniation．It can improve efficacy，reduce bleeding，alleviate pain，reduce inflammatory reactions，accelerate lumbar functional recovery，and shorten hospitalization time．
目的 探讨多组分运动训练对老年慢性阻塞性肺疾病（COPD）稳定期病人骨骼肌功能的影响。方法 前瞻性选择2022年10月—2024年10月90例COPD稳定期患者，采用抽签法随机分为观察组与对照组，对照组45例采取常规运动干预，观察组45例在对照组基础上增加多组分运动训练。干预前、干预后3个月比较两组患者四肢骨骼肌含量，四肢肌群力量，运动耐力与肺功能，生活质量。结果 干预后，两组上肢、下肢骨骼肌含量均略增加，观察组高于对照组（P＜0.05）；干预后，两组膝伸肌、膝屈肌、肘伸肌、肘屈肌肌群力量均增加，观察组高于对照组（P＜0.05）；干预后，两组6 min步行试验、用力肺活量及第一秒用力呼气量均升高，观察组高于对照组（P＜0.05）；干预后，两组圣乔治呼吸问卷各维度分数及总分均降低，观察组低于对照组（P＜0.05）。结论 针对老年COPD稳定期患者采取多组分运动训练可提升患者四肢骨骼肌含量与四肢肌群力量，改善患者运动耐力与肺功能，减轻COPD及骨骼肌功能障碍对患者生活质量造成的负面影响。
Objective To explore the effect of multi-component exercise training on skeletal muscle function in elderly patients with stable chronic obstructive pulmonary disease（COPD）．Methods From October 2022 to October 2024，90 stable COPD patients were prospectively selected and randomly divided into an observation group and a control group using a lottery method．The control group consisted of 45 patients who received routine exercise care，while the observation group consisted of 45 patients who received multi-component exercise training in addition to the routine care．Skeletal muscle content，muscle group strength，exercise endurance，lung function，and quality of life between two groups of patients were compared before and three months after intervention．Results After intervention，the skeletal muscle content of both upper and lower extremities slightly increased in both groups，with the observation group being higher than the control group（P＜0.05）．After intervention，the strength of the knee extensor，knee flexor，elbow extensor，and elbow flexor muscle groups increased in both groups，with the observation group had better results than the control group（P＜0.05）．After intervention，both groups showed an increase in six-minute walking test，forced vital capacity，and forced expiratory volume in first second，with the observation group had better results than the control group（P＜0.05）．After intervention，the scores of each dimension and total score of the SGRQ in both groups decreased，and the observation group had lower scores than the control group（P＜0.05）．Conclusions Multi-component exercise training for stable elderly COPD patients can improve the skeletal muscle content and muscle strength of the extremities，enhance exercise endurance and lung function，and alleviate the negative impact of COPD and skeletal muscle dysfunction on patients’quality of life．
