Objective To understand the status of perinatal folic acid intake by childbearing-aged women in Shaanxi Province and analyze the influencing factors so as to provide data support for current policy adjustment.Methods We sampled in 10 cities of Shaanxi and Yangling Demonstration area,and chose women who had been pregnant in the past 3 years or were pregnant at the time of the survey to answer questionnaires.The unconditional logistic regression model was used to analyze the influencing factors.Results At the whole provincial level,the intake rate of folic acid was 84.1％.The intake rate of folic acid varied significantly among different regions,being 88.9％ in southern Shaanxi,85.7％ in Guanzhong area,and 88.9％ in northern Shaanxi (x2=24.011,P＜0.001).It also significantly differed between urban and rural areas (89.5％ vs.80.6％,x2=19.974,P ＜ 0.001).The intake rate of folic acid was different significantly among different age groups,too,being lower in the old-age group than in the young-age group (x2 =13.637,P=0.003).The rate of free access to folic acid and duration of folic acid intake also significantly differed among urban and rural areas,different regions and different age groups (P ＜ 0.05).By using logistic regression model we found that the childbearing-aged women's knowlage of folic acid was the most important influencing factors besides urban/rural area,region,age and education level.Among these factors the odds ratio of awareness intake of folic acid during perinatal period was 14.13 (95％ CI:6.16-32.44),the odds ratio of knowing that folic acid can prevent neural-tube defects was 2.71 (95％ CI:1.43-5.14) and odds ratio of knowing the policy of free distribution of folic acid supplements was 2.88 (95％ CI:1.52-5.47).Conclusion The rate of folic acid intake among childbearing-aged women in Shaanxi Province is relatively high,but the duration of folic acid intake is still short.The understanding about folic acid is an important factor which affects the use of folic acid.Improving the cognitive level of folic acid among childbearing-aged women is the most useful way to enhance the effective prevention of neural tube defects.

Objective To construct a clinical prediction model for the risk of Alzheimer's disease based on ApoE,combined with risk factors and common clinical indicators.Methods There were 61 cases of Alzheimer's disease patients and 111 cases of fuzzy matching healthy physical examination from Nanjing Hospital of Chinese Medicine data platform from January 2019 to January 2021.Using LASSO regression screening of risk factors,constructing logistic regression forecasting model,10 fold cross verifies the degree of differentiation,validation the calibration of the bootstrap method.The clinical guidance of the prediction model was evaluated by the clinical decision curve,and finally,the clinical prediction model was visualized by nomogram.Results 12 variables were screened out and four risk factors were included,which are age,free triiodothyroxine(FT3),gender and ApoE.The AUC of ROC of the whole sample was 0.879,and the average AUC of ROC after 10 folded and 9 crossed training sets verification was 0.864.Bootstrap method and Hosmer-Lemeshow were used to test the calibration degree.Results χ2 =6.496,P=0.592>0.05.The threshold probability of clinical decision curve ranged from 1%to 88.6%.Conclusion Individualized evaluation of patients using clinical prediction models constructed by age,FT3,gender and ApoE can provide early warning of Alzheimer's disease,carry out early prevention intervention and slow down the development of the disease.

Objective:To investigate the optimal gestational weight gain (GWG) in dichorionic twin pregnancies.Methods:We conducted a retrospective analysis on 755 uncomplicated dichorionic twin pregnancies delivered at Peking University Third Hospital from August 2011 to December 2019. All participants were classified into three groups according to their pre-pregnancy body mass index (BMI), including underweight (BMI<18.5 kg/m 2, n=40), normal weight (BMI=18.5-24 kg/m 2, n=509), and overweight/obese (BMI≥24 kg/m 2, n=206) groups. Gestational BMI, rate of assisted reproduction, and the velocity of GWG were compared between the three groups using analysis of variance, Chi-square test and Kruskal-Wallis test. Regression model of GWG with the increase of gestational weeks was established using random effects model combined with restricted cubic spline to evaluate the percentiles of maternal weight gain during 4-39 gestational weeks. Results:The median of total GWG in the underweight, normal weight, and overweight/obese groups were noted for 17.0 (15.0-20.5) kg, 17.0 (14.0-21.0) kg, and 15.0 (12.0-20.0) kg, respectively, which decreased with the increase of pre-pregnancy BMI ( χ 2=11.974, P=0.002). The regression model fit well with the weight gain during different gestational weeks, which revealed that the weight gain was slow before 13 weeks of gestation, and kept at a steady speed thereafter, regardless of the pre-pregnancy BMI. The median and quartile ( P25- P75) of weight gain were 17.6 (15.2-20.3) kg, 17.3 (14.7-20.2) kg, and 15.7 (12.9-18.8) kg at 37 weeks in the underweight, normal weight, and overweight/obese groups, respectively. Conclusions:GWG of twin pregnancy changes slowly in the first trimester, and increases at a constant rate after the second trimester regardless of pre-pregnant BMI. Overweight/obese pregnancies have lower GWG.

Objective:To investigate the short- and long-term outcomes of fetuses with selective fetal growth restriction (sFGR).Methods:A retrospective study was conducted on monochorionic diamniotic (MCDA) twins with sFGR admitted to the Neonatal Intensive Care Unit of Peking University Third Hospital from September 2017 to December 2019. MCDA neonates delivered during the same period without significant complications were selected as the control group. MCDA twins with sFGR were divided into type Ⅰ, Ⅱ, and Ⅲ groups and then further divided into the larger and the smaller fetus subgroups according to the birth weight. These children were followed up by telephone at 2-3 years old. Height-for-age and weight-for-age Z-scores were calculated. Ages and Stages Questionnaire-Third Edition (ASQ-3) was used to determine comprehensive development. Independent sample t-test, one-way analysis of variance, non-parameter test, and Chi-square test (or rank-sum test) were used for statistical analysis. Results:(1) A total of 116 pregnant women with sFGR (232 neonates) were enrolled in this study. There were 43, 40, and 33 mothers and 86, 80, and 66 newborns in type Ⅰ, Ⅱ, and Ⅲ groups, respectively. The control group included 31 pregnant women and 62 neonates. The gestational age at onset of sFGR was younger in the type Ⅱ and Ⅲ groups than in type Ⅰ group [(23.8±4.8) and (24.1±3.1) vs (27.0±6.1) weeks, F=5.19, P<0.05; all P<0.017 during pairwise comparisons]. (2) The incidence of sepsis and treatment abandonment/death in neonates in type Ⅱ and Ⅲ groups were higher than those in type Ⅰ and control groups [neonatal sepsis: 11.3% (9/80) and 6.1% (4/66) vs 2.3% (2/86) and 0.0% (0/62), χ2=6.30, P=0.001; death or treatment abandonment rate:13.8% (11/80) and 10.6% (7/66) vs 3.5% (3/86) and 0.0% (0/62), χ2=4.68, P=0.003; all P<0.017 during pairwise comparisons]. In cases with type Ⅱ or type Ⅲ sFGR, the risk of digestive system diseases was significantly higher in the smaller fetus group than in the larger fetus group [type Ⅱ: 46.2% (37/80) vs 38.7% (31/80), χ2=16.72; type Ⅲ: 47.0% (31/66) vs 34.8% (23/66), χ2=39.69; both P<0.001], while the rate of respiratory system diseases was lower in the smaller fetus group [type Ⅱ: 35.0% (28/80) vs 45.0% (36/80), χ2=36.85; type Ⅲ: 37.9% (25/66) vs 45.4% (30/66), χ2=12.55; both P<0.001]. The incidence of neonatal sepsis in smaller fetuses was higher than that in larger ones in type Ⅱ sFGR [7.5% (6/80) vs 3.7% (3/80), χ2=4.68, P=0.034]. The incidence of neurological complications in larger fetuses was higher than that in smaller ones in type Ⅲ sFGR [15.1% (10/66) vs 4.5% (3/66), χ2=5.72, P<0.001]. (3) In type Ⅱ group, seven neonates died (one case of cerebral hemorrhage, two cases of gastrointestinal perforation, two cases of septic shock, and two cases of necrotizing enterocolitis), and four cases withdrew the treatment. In type Ⅲ group, four neonates died (two cases of necrotizing enterocolitis, one case of gastrointestinal perforation, and one case of cerebral hemorrhage), and three cases withdrew from the treatment. (4) Totally, 71 children in type Ⅰ, 61 in type Ⅱ, and 58 in type Ⅲ group were followed up at the age of 2-3. Children with type Ⅱ or type Ⅲ sFGR lagged behind those in type Ⅰ group and control group in physical growth [ M ( P25- P75), Z-scores:－0.46 (－0.87-0.42),－0.35 (－0.62-0.71), 0.05 (－0.61-0.51), and 0.14 (－0.57-0.75); H=6.20, P=0.001]. In type Ⅱ and Ⅲ groups, the smaller fetuses lagged the larger fetuses in physical growth at 2-3 years of age. ASQ-3 scores in communication, gross motor, fine motor, problem-solving and personal-social areas were all lower in type Ⅱ and Ⅲ groups than in type Ⅰ and control groups. ASQ-3 scores in the five dimensions of the smaller fetuses in the type Ⅱ group were lower than those of the larger fetuses. In the type Ⅲ group, the smaller fetuses had lower ASQ-3 scores in communication and gross motor than the larger ones [communication ability: (42.6±18.8) vs (56.4±9.4) scores, t=19.63, P<0.001; gross motor: (45.5±19.7) vs (54.5±9.7) scores, t=12.64, P=0.003]. Conclusion:The neonatal morbidity is significantly increased in type Ⅱ and Ⅲ sFGR, and babies lagged others in height, weight, and ASQ-3 score at 2-3, which is worthy of early attention.

Objective:To explore the differences in bacterial community structure between proximal colon cancer (PC), distal colon cancer (DC), and rectal cancer (RC), and the values of featured microbiota in differentiating PC with tumor markers.Methods:This case-control study enrolled 85 newly diagnosed colorectal cancer patients, including 22 PC, 15 DC and 48 RC patients, and 8 colorectal adenoma patients from May 2019 to July 2022 at the Department of General Surgery, Anyang Oncology Hospital. The blood and fecal samples were collected before surgery and then subjected to biochemical tests for tumor markers and 16S rDNA tests, respectively. SPSS (27.0.1) was applied to perform the t-test, one-way ANOVA, Mann-Whitney U test, Kruskal-Wallis H test, and Chi-Squared Test. Also, the receiver operating characteristic curve (ROC) was plotted on tumor markers and/or f_Bacteroidaceae with SPSS software .Results:All groups had significant differences in the CA125 ( F=3.543, P<0.05), CA72-4 ( F=3.596, P<0.05), and serum tumor-associated materials (TAM) levels ( F=5.787, P<0.01). In PC group, the levels of CA125 [PC vs RC, (36.84±6.30) kU/L vs (12.73±4.21) kU/L, P<0.01] and CA72-4 [PC vs RC, (45.56±10.86) kU/L vs (3.30±7.63) kU/L, P<0.01] were significantly higher than that of the RC group, while the level of TAM was remarkably elevated in PC group than in RC group [PC vs RC, (124.84±5.19) U/ml vs (102.44±3.63) U/ml, P<0.001] and CRA group [PC vs CRA, (124.84±5.19) U/ml vs (95.39±8.42) U/ml, P<0.01]. The LEfSe analysis showed that the featured microbiota in the PC group included f_Bacteroidaceae, f_Neisseriaceae, f_Clostridiaceae_1, f_Spirochaetaceae, and so on. The largest area under the ROC belonged to the combination of TAM and f_Bacteroidaceae, which reached 0.845 (95% CI 0.747-0.944), with sensitivity being 0.857 and specificity being 0.815. Conclusions:There is heterogeneity in gut microbiota composition among PC, DC, RC, and CRA. The combination of gut microbiota and tumor biomarkers demonstrated good differentiating effects in proximal colon cancers.