Objective To investigate the correlation between ipsilateral prominent posterior cerebral artery laterality (PCAL) and white matter hyperintensities (WMHs) in patients with severe internal carotid artery (ICA) stenosis. Methods From April 2016 to December 2017, patients with unilateral ICA stenosis≥70% (including occlusion) and contralateral ICA stenosis <50% or no stenosis admitted to the Department of Neurology, Liaoning Provincial People's Hospital were enrolled. According to the presence or absence of PCAL on the ipsilateral side of ICA stenosis, they were divided into positive group and negative group, and the severity of WMHs was compared between the 2 groups. The patients were grouped according to the severity of overall WMHs and deep WMHs (DWMHs) and periventricular WMHs (PWMHs) on the ipsilateral side of ICA stenosis. Multivariate logistic regression analysis was used to determine the independently relevant factors of WMHs. Results A total of 131 patients were enrolled, 65 of them (49.62% ) had ipsilateral PCAL positive. The proportion of severe DWMHs in this group was significantly lower than that in the ipsilateral PCAL negative group (38.46% vs. 59.09% ; χ2 =5.578, P=0.018 ). Multivariate logistic regression analysis showed that advanced age (odds ratio [ OR] 2.196, 95% confidence interval [ CI] 1.278-3.773; P=0.004), hypertension (OR 3.279, 95% CI 1.107-9.709; P=0.032), and high systolic blood pressure (OR 1.027, 95% CI 1.002-1.053; P=0.031) were independently associated with severe overall WMHs; advanced age (OR 1.957, 95% CI 1.141-3.358; P=0.015) and hypertension (OR 4.739, 95% CI 1.570-14.286; P=0.006) were independently correlated with ipsilateral severe DWMHs, ipsilateral PCAL (OR 0.340, 95% CI 0.135-0.856; P=0.022 ) was independently correlated with ipsilateral mild DWMHs; advanced age (OR 1.805, 95% CI 1.175-2.775; P=0.007) and high systolic blood pressure (OR 1.030, 95% CI 1.007-1.053; P=0.010) were independently correlated with ipsilateral severe PWMHs. Conclusion Ipsilateral PCAL is an independent protective factor for ipsilateral DWMHs in patients with severe ICA stenosis.

Objective To explore the influence of Rosenthal effect on the psychological status of pregnant women at risk of miscarriage in early pregnancy. Methods From January 2014 to June 2015 151 cases of early pregnancy abortion risk women were set as the control group, and was given conventional psychological intervention.From July 2015 to December 2016 135 cases of early pregnancy abortion risk women were named as the observation group by convenient sampling selection, which was given interventionbased on Rosenthal effect on the basis of routine psychological intervention. The Self-rating Depression Scale (SDS) and the Self-rating Anxiety Scale (SAS) score, the introversion and extroversion scores and the satisfaction degree with intervention were compared between the two groups before and after the intervention. Results There was no significant difference in SDS and SAS scores, inotropic challenge and extroversion challenge between the two groups before treatment (P >0.05). The scores of SDS and SAS, the inotropic challenge and extroversion challenge scores were 41.45 ± 4.26, 40.34 ± 5.82,4.76 ± 1.03,5.55 ± 1.26 in the observation group after intervention,and 47.22 ± 3.93,47.18 ± 7.04,5.39 ± 1.12, 6.43 ± 1.86 respectively in the control group. There were significant difference in scores of SDS and SAS, the inotropic challenge and extroversion challenge (t=2.215-2.573, P <0.05). The satisfaction rates of the observation group and the control group were 93.32%(126/135)and 74.17% (112/151) respectively, the difference was statistically significant (χ2=5.921, P<0.05). Conclusions The intervention based on Rosenthal effect on the basis of conventional psychological intervention for early pregnancy abortion risk women can relieve negative emotions such as anxiety and depression, besides it can also improve satisfaction degree of inpatients with intervention.

Objective To study the association between leptomeningeal anastomosis (LMA) collateral circulation and cerebral infarction in patients with middle cerebral artery (MCA) M1-segment stenosis by observing the compensatory characteristics of LMA collateral circulation.Methods One hundred and fourteen MCA M1-segment stenosis patients were divided into cerebral infarction group (n=68) and cerebral infarction-free group (n=46).The hemilateral phenomenon of homolateral anterior cerebral artery (ACA) stenosis and posterior cerebral artery stenosis was assessed and its effect on the incidence of cerebral infarction was studied according to its magnetic resonance angiography.Results The ACA score and MCA stenosis severity were significantly different between cerebral infarction group and cerebral infarction-free group (P＜0.05).Multivariate logistic regression analysis showed that low ACA score and MCA M1-segment stenosis were two independent risk factors for cerebral infarction (OR =0.390,95％ CI:0.154-0.987;OR =2.421,95％CI:1.324-4.428,P＜0.01).Conclusion The incidence of cerebral infarction is low in MCA M1-segment stenosis patients with good ACA collateral circulation.

Objective:To investigate the effects of gestational weight gain (GWG) at different stages on pregnancy complications such as preeclampsia, gestational hypertension, gestational diabetes mellitus(GDM), small for gestational age (SGA), and large for gestational age (LGA).Methods:This was a prospective longitudinal cohort study. Singleton pregnancies at 11-13 +6 weeks of gestation in the Affiliated Drum Tower Hospital, Medical School of Nanjing University from January 2017 to November 2019 were recruited. The maternal height, weight, blood pressure, and fetal ultrasonic parameters were measured at 19-23 +6, 29-34 +6, and 35-40 +6 weeks of gestation by face-to-face interview and the pregnancy outcomes were followed up. All participants were grouped by body mass index (BMI) in the first trimester, with <18.50 kg/m 2 as underweight group, 18.50-23.99 kg/m 2 as normal group, ≥24.00 kg/m 2 as overweight/obesity group. Chi-square test and rank-sum test were adopted for comparison among groups. Weekly weight gain was converted into Z scores, and insufficient, appropriate, and excessive weight gain were respectively defined when Z<-1, -1≤ Z≤1, and Z>1. The effect of weekly weight gain at different gestational trimesters on pregnancy complications was analyzed by binary logistic regression. Results:Totally, 4 143 pregnant women entered the cohort. After excluding 327 cases, 3 816 were finally included in the analysis, with 394 in underweight group, 2 668 in normal group, and 754 in overweight/obesity group. Excessive weekly weight gain in the early second trimester was a risk factor for LGA( aOR=1.78, 95% CI:1.31-2.42, P<0.001), and in the later second trimester it was associated with preterm preeclampsia ( aOR=3.00, 95% CI: 1.26-7.10, P=0.013), gestational hypertension ( aOR=2.38, 95% CI: 1.44-3.94, P=0.001), and LGA ( aOR=1.59, 95% CI: 1.15-2.22, P=0.005). In the third trimester, excessive weekly weight gain was associated with higher risks of term preeclampsia ( aOR=2.70, 95% CI: 1.61-4.54, P<0.001) and gestational hypertension ( aOR=1.84, 95% CI: 1.05-3.21, P=0.033); while insufficient weekly weight gain was a risk factor for SGA ( aOR=1.58, 95% CI: 1.01-2.48, P=0.045), but a protective factor for term preeclampsia ( aOR=0.37, 95% CI: 0.14-0.97, P=0.041). Insufficient and excessive weekly weight gain in the early second trimester were not related to GDM (both P>0.05). Conclusions:GWG at different stages has different effects on pregnancy complications. A more relaxed control of GWG in the early second trimester combined with strict control in both the later second trimester and the third trimester may be a reasonable strategy to reduce the risk of preeclampsia without increasing the risk of SGA.

Objective:To construct the gestational‐age‐specific blood pressure curve and percentile blood pressure values of pregnant women in Jiangsu Province, and to explore the clinic significance of the blood pressure changes in women whose blood pressure was less than 140/90 mmHg (1 mmHg=0.133 kPa) in each trimester and eventually developed pregnancy induced hypertension (PIH) or pre-eclampsia (PE).Methods:A prospective longitudinal cohort during pregnancy was built. Singleton pregnant women in the first trimester (11-13 +6 weeks) were recruited from July 2017 to September 2020 in Nanjing Drum Tower Hospital, and were followed up in the second trimester (19-23 +6 weeks), the third trimester (30-33 +6 weeks) and approaching the expected date of delivery (35-38 +6 weeks). The Viewpoint 6.0 software was used to record pregnancy-related information. The blood pressure was measured by standard methods in our clinic. Least mean square (LMS) function was performed to fit the gestational-age-specific blood pressure curve and percentile blood pressure values were calculated at every follow‐up time point. Logistic regression was applied to calculate the OR for the groups with blood pressure ≥95th percentile ( P95). Results:There were 3 728 singleton pregnant women invited in this study, including 3 490 normal pregnant women (93.62%, 3 490/3 728), and 238 pregnant women with PIH or PE (6.38%, 238/3 728). Gestational-age-specific blood pressure curve showed that systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) decreased in the second trimester, compared with those in the first and the third trimester, however the fluctuation of blood pressure was low, but regardless of the gestational age, P95 of SBP, DBP and MAP increased by 14, 11 and 11 mmHg respectively, compared with 50th percentile ( P50). In the first trimester, the risk of developing PIH or PE finally in pregnant women with blood pressure ≥ P95 was 4.36-fold (95% CI: 2.99-6.35) for SBP than women with SBP< P95, 5.22-fold (95% CI: 3.65-7.46) for DBP and 5.14-fold (95% CI: 3.61-7.32) for MAP. When approaching the expected date of delivery, the corresponding risks of the women with blood pressure ≥ P95 were 16.76 times, 27.45 and 27.31 times respectively than those of the women with blood pressure < P95. In the first trimester, every 1 mmHg elevation of SBP the risk developing PIH or PE increased by 24% ( OR=1.24, 95% CI: 1.15-1.33), 44% ( OR=1.44, 95% CI: 1.31-1.59) for DBP and 47% ( OR=1.47, 95% CI: 1.33-1.61) for MAP, respectively. The risk in the second trimester was similar to that in the first trimester, and in the third trimester, the risk was further increased. When approaching the expected date of delivery, DBP or MAP increased by 1 mmHg, the risk developing PIH or PE was double; while SBP increased by 1 mmHg, the risk increased by 58%. The areas under the receiver operator characteristic curves of SBP, DBP and MAP were similar for predicting PIH or PE, and the predictive efficiency were all poor. Conclusions:Construction of percentile blood pressure values for pregnant women is helpful in identification of high-risk women of developing PIH or PE. The risk of PIH or PE in pregnant women with blood pressure ≥ P95 but <140/90 mmHg has significantly increased compared with women with blood pressure < P95.

Objective:To investigate the predictive value of controlling nutritional status (CONUT) score in the prognosis of patients with advanced diffuse large B-cell lymphoma (DLBCL).Methods:A retrospective case series study was performed. The clinical data of 654 patients newly diagnosed with advanced DLBCL diagnosed in 7 medical centers in Huaihai Lymphoma Working Group from October 2009 to January 2022 were retrospectively collected. All the patients received rituximab-based immune chemotherapy regimens. The patients were randomly assigned to the training set (458 cases) and the validation set (196 cases) in a 7:3 ratio. The clinicopathological data of patients were collected, and the CONUT score was calculated based on albumin, lymphocyte count, and total cholesterol. The optimal critical value of CONUT scote was determined by using MaxStat method. Kaplan-Meier method was used to draw survival curves; Cox proportional hazards model was used to make univariate analysis and multivariate analysis on the factors influencing overall survival (OS). The efficacy of CONUT score in combination with the International prognostic index (IPI) and an enhanced IPI (NCCN-IPI) in predicting OS was evaluated by using receiver operating characteristic (ROC) curves.Results:The median follow-up time of 654 patients was 38.1 months (95% CI: 35.3 months- 40.9 months), and the 5-year OS rate was 49.2%. According to the MaxStat method, the optimal critical value for CONUT score was determined to be 6 points. All the patients were classified into the normal nutritional status group (CONUT score ≤ 6 points, 489 cases) and the poor nutritional status group (CONUT score > 6 points, 165 cases). The results of the multivariate analysis showed that CONUT score > 6 points, male, lactate dehydrogenase >240 U/L, high white blood cell count, low hemoglobin level and age > 60 years were independent risk factors for OS of patients with advanced DLBCL (all P < 0.05). Patients in the poor nutritional status group (CONUT score > 6 points) had worse OS compared with that in the normal nutritional status group in the overall cohort of advanced DLBCL. Subgroup analysis revealed that among patients with Eastern Cooperative Oncology Group-performance status (ECOG PS) score < 2 points, IPI low-intermediate risk, IPI intermediate-high risk, NCCN-IPI low-intermediate risk, and NCCN-IPI intermediate-high risk, the patients in the poor nutritional status group (CONUT score > 6 points) had worse OS compared with that in the normal nutritional status group (CONUT score ≤ 6 points) (all P < 0.05). Conclusions:CONUT score has a certain value in the assessment of the prognosis of patients with advanced DLBCL, and its predictive efficacy is further improved when combined with IPI and NCCN-IPI.

Objective:To evaluate the performance of biomarkers in aneuploidy screening in the first trimester-pregnancy associated plasma protein A(PAPP-A) combined with Fetal Medicine Foundation (FMF)'s competing risk model in screening preeclampsia among our population.Methods:This study was based on a prospective cohort of singleton pregnant women who underwent aneuploidy screening in the first trimester in Nanjing Drum Tower Hospital from January 2017 to September 2020. Mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), and PAPP-A were converted into multiples of median (MoM) using the algorithm disclosed on the website of the FMF (fetalmedicine.org). The predictive outcomes of maternal factors alone or in combination with MAP, UtA-PI, and PAPP-A (alone or in combination) were calculated. Chi-square test, Fisher's exact test or rank sum test were used for comparison among groups and Bonferroni method for pairwise comparisons. Receiver operating characteristic (ROC) curve was used to evaluate the screening efficiency and to calculate the sensitivities of predicting preeclampsia, term and preterm preeclampsia at false-positive rates of 5% and 10%. The predictive performance of this model was further compared to the screening strategy that was recommended in Diagnosis and treatment of hypertension and pre-eclampsia in pregnancy: a clinical practice guideline in China (2020). Results:Among the 5 144 singleton pregnancy women who were recruited in the cohort, 4 919 cases were included and analyzed in this study. A total of 223 cases were diagnosed as preeclampsia (4.5%), including 55 preterm (1.1%) and 168 term preeclampsia (3.4%). The median of MoM values of MAP, UtA-PI, and PAPP-A in the non-preeclampsia group were around 1.0±0.1. Statistical significance was observed in the difference of MAP, UtA-PI, and PAPP-A Mom between women with preterm preeclampsia and those without preeclampsia [1.061 (0.999-1.150) vs 0.985 (0.935-4.043), 1.115 (0.873-1.432) vs 1.039 (0.864-1.236), 0.820 (0.493-1.066) vs 1.078 (0.756-1.508)], which was also seen in the difference of MAP and PAPP-A Mom between women with term preeclampsia and those without preeclampsia [1.065 (1.002-1.133) vs 0.985 (0.935-4.043), 1.007 (0.624-1.393) vs 1.078 (0.756-1.508)] (all P<0.025). The combination screening with maternal factors+MAP+UtA-PI+PAPP-A was noted for the best efficiency. In predicting preeclampsia preterm and term preeclampsia at the false-positive rate of 10%, the sensitivity of the model was 53.0%, 76.4% and 44.6% respectively. Using the screening method recommended in Diagnosis and treatment of hypertension and pre-eclampsia in pregnancy: a clinical practice guideline in China(2020), the proportion of people at high risk of preeclampsia was 5.9% (290/4 919), and the sensitivity for predicting preterm preeclampsia was 25.5% (14/55), which was significantly lower than the combination screening with maternal factors+MAP+UtA-PI+PAPP-A [65.5% (36/55)] when using the same proportion of high-risk population. Conclusion:The preeclampsia screening model based on aneuploidy screening biomarkers in the first trimester--PAPP-A in combination with materral factors, MAP, UtA-PI, can effectively screen preterm preeclampsia in the local population without increasing the laboratory costs.

Objective:To investigate the effects of early-life (intrauterine and breastfeeding period) exposure to angiotensin Ⅱ type 1 receptor autoantibody (AT 1-AA) on lipid metabolism in offspring rats. Methods:Thirty-two AT 1-AA negative healthy nonpregnant specific pathogen free female Sprague Dawley rats weighing 150-170 g were randomly divided into two groups. Those in the immune group ( n=16) were subcutaneously injected with the mixture of an equal volume of Freund's adjuvant and the second extracellular loop of human-derived angiotensin Ⅱ receptor type 1 (AT1R-ECⅡ) repeatedly to establish the AT 1-AA-positive rat model by active immunization and those in the control group ( n=16) with normal saline solution. Before each immunization, blood samples were collected from the tail of rats to detect serum AT 1-AA levels of those rats in both groups, and the AT 1-AA-positive rat model was successfully established when the serum AT 1-AA was positive and its level reached a plateau. After eight weeks of immunization, the female rats in the two groups were mated with healthy AT 1-AA-negative male rats to conceive. Serum samples were collected from the maternal and offspring rats at the gestation of 18 days (G18), postnatal 21 days (P21), and from the normally fed offspring rats from the time of weaning to 12 weeks old (W12). Active immunization was not performed on the offspring throughout the experiment. The serum AT 1-AA levels of maternal and offspring rats were determined by enzyme-linked immunosorbent assay, and serum AT1-AA was positive when the ratio of AT1-AA level of the immune group over the control group ≥2.1. The blood lipid levels of maternal and offspring rats were measured by an automatic biochemical analyzer. Serum AT 1-AA levels, total cholesterol (TC), high-density lipoprotein-cholesterol [instead of high-density lipoprotein (HDL)], low-density lipoprotein-cholesterol, and free fatty acid levels of the offspring and maternal rats were determined for correlation analysis. Two independent sample t-test, linear regression analysis, and analysis of variance were adopted for statistical analysis. Results:(1) The serum levels of AT 1-AA in maternal rats at G18 and P21 in the immune group were significantly higher than those in the control group (G18: 1.170±0.190 vs 0.114±0.016, t=14.64; P21: 0.988±0.283 vs 0.084±0.006, t=9.57; both P<0.001). (2) The serum levels of AT 1-AA in the offspring at G18 and P21 in the immune group were significantly higher than those in the control group (offspring at G18: 0.948±0.220 vs 0.105±0.010, t=10.10; male offspring at P21: 0.758±0.273 vs 0.080±0.002, t=7.46; female offspring at P21: 0.774±0.274 vs 0.084±0.005, t=7.55; all P<0.001), which showed a positive correlation with those in maternal rats at the same period (offspring at G18: R=0.78; male offspring at P21: R=0.82; female offspring at P21: R=0.82; all P<0.05). However, there was no significant difference in the serum AT 1-AA level in offspring at W12 between the immune and control group ( P>0.05). (3) The serum levels of TC at G18 and P21, and HDL at P21 in maternal rats in the immune group were all higher than those in the control group [TC at G18: (2.36±0.32) vs (1.95±0.24) mmol/L, t=2.70; P21: (2.82±0.50) vs (2.18±0.26) mmol/L, t=3.41; HDL at P21: (1.94±0.33) vs (1.57±0.23) mmol/L, t=2.80; all P<0.05]. (4) Compared with the offspring in the control group, there was no significant change in lipid metabolism at G18 and W12 in the offspring in the immune group (both P>0.05). The serum levels of TC and HDL in male and female offspring at P21 in the immune group were higher than their counterparts in the control[TC in male offspring: (2.38±0.52) vs (1.83±0.30) mmol/L, t=2.73; HDL in male offspring: (1.44±0.32) vs (1.07±0.18) mmol/L, t=2.98; TC in female offspring: (2.50±0.72) vs (1.70±0.26) mmol/L, t=3.16; HDL in female offspring: (1.41±0.33) vs (1.00±0.14) mmol/L, t=3.41; all P<0.05]. (5) The serum levels of TC and HDL in male and female offspring at P21 in the immune group showed no correlation with those in maternal rats at P21 (all R<0.5, all P>0.05). The serum levels of HDL in male and female offspring at P21 in the immune group had a positive correlation with their own serum TC levels (male offspring: R=0.98; female offspring: R=0.97; both P<0.001) and also with their own serum AT 1-AA levels (male offspring: R=0.74, P=0.023; female offspring: R=0.91, P=0.001). The serum levels of TC in male and female offspring at P21 in the immune group had a positive correlation with their serum AT 1-AA levels (male offspring: R=0.72, P=0.030; female offspring: R=0.90, P=0.001). Conclusion:The early-life exposure to AT 1-AA may cause abnormal expression of TC and HDL in offspring rats.