ObjectiveTo explore the effect of Buzhong Yiqitang on the immune imbalance of helper T cell 17 （Th17）/regulatory T cell （Treg） and Notch1 signaling pathway in mice with autoimmune thyroiditis （AIT）. MethodA total of 60 8-week-old NOD.H-2^h4 mice were randomly divided into the normal group， model group， western medicine group （selenium yeast tablet， 32.5 mg·kg^-1）， and low-dose （4.78 g·kg^-1·d^-1）， middle-dose （9.56 g·kg^-1·d^-1）， and high-dose （19 g·kg^-1·d^-1） Buzhong Yiqitang groups， with 10 mice in each group. The normal group was fed with distilled water， and the other groups were fed with water containing 0.05% sodium iodide for eight weeks. After the animal model of AIT was formed spontaneously， the mice were killed under anesthesia after intragastric administration for eight weeks. Serum anti-thyroglobulin antibodies （TGAb）， thyroid-stimulating hormone （TSH）， free triiodothyronine （FT3）， and free thyroid hormone （FT4） were detected by enzyme-linked immunosorbent assay （ELISA）， and thyroid tissue changes were observed by hematoxylin-eosin （HE） staining. The mRNA and protein expressions of retinoid-related orphan receptor-γt （RORγt）， interleukin （IL）-17， forkhead box P3 （FoxP3）， IL-10， Notch1， and hair division-related enhancer 1 （Hes1） in thyroid tissue were detected by Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） and Western blot， respectively. ResultCompared with the normal group， the thyroid structure of the model group was severely damaged， and lymphocytes were infiltrated obviously. The levels of serum TGAb， FT3， and FT4 contents were significantly increased， and TSH content was significantly decreased （P<0.01）. The mRNA and protein expression levels of RORγt， IL-17， Notch1， and Hes1 were significantly increased， while those of FoxP3 and IL10 were significantly decreased in the model group （P<0.01）. Compared with the model group， thyroid structural damage and lymphocyte infiltration were improved in the treatment groups， and serum TGAb， FT3， and FT4 contents were significantly decreased. TSH content was increased， and mRNA and protein expression levels of RORγt， IL-17， Notch1， and Hes1 were decreased. mRNA and protein expression levels of FoxP3 and IL-10 were increased to different degrees （P<0.05， P<0.01）， and the middle-dose Buzhong Yiqitang group had the most significant intervention effect. ConclusionBuzhong Yiqitang can alleviate the thyroid structural damage in AIT mice， and its mechanism may be related to improving the abnormal differentiation of Th17/Treg immune cells and inhibiting the activation of the Notch1 signaling pathway.

OBJECTIVE To evaluate the cost-effectiveness of adebrelimab combined with chemotherapy versus chemotherapy alone in the first-line treatment of extensive stage small cell lung cancer from Chinese healthcare system perspective. METHODS Using the data obtained from the CAPSTONE-1 trial(230 cases for adebrelimab group, and 232 cases for chemotherapy group), Markov model was created for simulation of the disease development process of the extensive stage small cell lung cancer. The total costs, quality-adjusted life-years(QALYs) and incremental cost-effectiveness ratio(ICER) in each group were calculated. The sensitivity of key parameters was analyzed. RESULTS Compared with pure chemotherapy(etoposide plus carboplatin chemotherapy), the ICER of adebrelimab combined with chemotherapy was 157128.79 yuan·QALY−1 under the situation of charity assistance, and 351367.27 yuan·QALY −1 in the environment of no charity assistance. Sensitivity analysis showed that the utility and the cost of adebrelimab were the main influence parameter. CONCLUSION Adebrelimab combined with chemotherapy regimen has no cost-effective advantage versus chemotherapy alone in the treatment of extensive stage small cell lung cancer under the current economic level of China; the probability of adebrelimab combined with chemotherapy being cost- effectiveness was 44.5% under the situation of charity assistan.

Objective To investigate the factors influencing the pregnancy outcomes during frozen-thawed embryo transfer(FET)cycles in patients with polycystic ovary syndrome(PCOS).Methods A retrospective analysis was conducted on patients'data from 882 FET cycles.According to the pregnancy outcome,the patients were divided into non-implantation group(Group A),abortion group(Group B1)and live birth group(Group B2).Clinical data and laboratory parameters were compared among the three groups,and ordered Logistic regression analysis was used to study the factors influencing pregnancy outcomes after FET.Patients were also divided into four groups(C1-C4)based on the number of high-quality embryos obtained(0-3,4-6,7-10,≥11),and their clinical data and laboratory parameters were compared.Results The clinical pregnancy rate,live birth rate,and miscar-riage rate in the 882 treatment cycles were 71.09%(627/882),61.68%(544/882),and 13.24%(83/627),respectively.Single-factor analysis showed significant differences in body mass index(BMI),infertility type,hu-man chorionic gonadotropin(hCG)day estradiol(E2)level,number of retrieved oocytes,and number of high-quality embryos among Groups A,B1,and B2(P<0.05).Further multiple Logistic regression analysis revealed that BMI(OR=1.046,95%CI:1.001-1.093,P=0.044)and a history of previous pregnancy(OR=1.417,95%CI:1.030-1.950,P=0.032)were independent risk factors for successful FET in PCOS patients,while an in-creased number of high-quality embryos was an independent protective factor for successful pregnancy.Based on the results of Group B2,compared to Group A,OR=0.920,95%CI:0.880-0.962,P=0.000;compared to Group B1,OR=0.923,95%CI:0.862-0.988,P=0.022.Compared with the other three groups(C1-C3),the total amount of gonadotropin(Gn)in the C4 group was the lowest and the number of oocytes obtained was the high-est(P<0.05).Multiple comparisons showed that Group C4 had lower BMI,follicle-stimulating hormone(FSH),very low-density lipoprotein(vLDL)levels,a higher luteinizing hormone and follicle-stimulating hormone(LH/FSH)ratio compared to Group C1(P<0.05).Group C4 had lower fasting insulin(FINS)and homeostasis model assessment of insulin resistance(HOMA-IR)levels compared to Group C3,and higher high-density lipoprotein-cholesterol(HDL-C)and apolipoprotein A1(Apo A1)levels compared to Groups C2 and C3(P<0.05).Con-clusion BMI,the history of previous pregnancy and the number of high-quality embryos were both independent factors for predicting pregnancy outcomes in PCOS patients undergoing FET cycles.Patients with a higher number of high-quality embryos have a higher clinical pregnancy rate during FET cycles.

Objective To investigate the clinical effect of monosialotetrahexosyl ganglioside(GM1)combined with recombinant human erythropoietin(rhEPO)in treating neonates with hypoxic-ischemic encephalopathy(HIE)and its influence on inflammatory factors and neurological function.Methods A total of 78 neonates with HIE admitted to the Department of Neonatology of Nanyang Central Hospital from June 2017 to June 2020 were selected as the research subjects,and they were divided into the control group(n=39)and the observation group(n=39)by random number table method.All neonates were given routine treatment,including oxygen inhalation,maintenance of water,electrolyte and acid-base balance,control of convulsions and intracranial pressure,and moderate and severe HIE neonates were given mild hypothermia therapy on this basis.Neonates in the control group were given rhEPO 200 IU·kg-1 via subcutaneous injection on the basis of routine treatment,3 times a week.Neonates in the observation group were given GM1 20 mg intravenously once a day on the basis of the treatment of the control group.Seven days were taken as one course of treatment,and four courses of continuous treatment were taken.Moderate and severe HIE neonates were treated for 1-3 courses additionally according to their condition.The total effective rate of the two groups after treatment was compared.The neurological function of neonates in the two groups was evaluated by neonatal behavioral neurological assessment(NBNA)before,14 and 28 days after the treatment.The interleukin-6(IL-6),intercellular adhesion molecule-1(ICAM-1),tumor necrosis factor-α(TNF-α),hypoxia inducible factor-1α(HIF-1α)and neuron specific enolase(NSE)in the serum were measured by enzyme-linked immunosorbent assay before,14 and 28 days after the treatment.Results The total effective rate of treatment in the control group and the observation group was 69.23％(27/39)and 94.87％(37/39),respectively;the total effective rate of the observation group was significantly higher than that in the control group(x2=8.705,P=0.003).The total effective rate of treatment for mild HIE neonates in both groups was 100％.The total effective rate of moderate and severe HIE neonates in the observation group was significantly higher than that in the control group(x2=4.843,3.898,P=0.028,0.048).There was no significant difference in NBNA scores between the two groups before treatment(P＞0.05).The NBNA scores of neonates in the two groups were significantly higher on the 14 and 28 days after treatment(P＜0.05).The NBNA scores of the two groups were significantly higher on the 28 day after treatment than those on the 14 day after treatment(P＜0.05).The NBNA scores of the neonates in the observation group were significantly higher than those in the control group on the 14 and 28 days after treatment(P＜0.05).There was no significant difference in serum ICAM-1,IL-6,TNF-α,HIF-1α and NSE levels between the two groups before treatment(P＞0.05).The serum ICAM-1,IL-6,TNF-α,HIF-1α and NSE levels in the two groups on the 14 and 28 days after treatment were significantly lower than those before treatment(P＜0.05);the levels of serum ICAM-1,IL-6,TNF-α,HIF-1α and NSE in the two groups were significantly lower on the 28 day after treatment than those on the 14 day after treatment(P＜0.05).On the 14 and 28 days after treatment,the serum ICAM-1,IL-6,TNF-α,HIF-1α and NSE levels of the neonates in the observation group were significantly lower than those of the control group(P＜0.05).Conclusion GM 1 combined with rhEPO in the treatment of neonatal HIE can reduce the levels of inflammatory factors,serum HIF-1α and NSE,and promote the recovery of neurological function,with significant effects.

Objective: To estimate the risk for type 2 diabetes mellitus (T2DM) death attributed to insufficient whole grain intake in seven regions of China from 2005 to 2018. Methods: Based on China National Nutrition and Health Surveys and China Adult Chronic Disease and Nutrition Surveillance, ordinary Kriging method and locally weighted regression were used to estimate the level of whole grain intake of Chinese residents from 2005 to 2018. Based on the results of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 and Chronic Diseases Risk Factors Surveillance in China, we calculated the population attributable fraction (PAF), attributable death number and attributable mortality rate of T2DM due to insufficient whole grain intake in people aged ≥20 years in different regions of China, and we used the 2010 Chinese census data to compare the changes in T2DM deaths attributed to insufficient intake of whole grains in seven regions of China. Results: The whole grain intake levels of Chinese people over 20 years old in 2002, 2010 and 2015 were 19.0 g/d, 14.3 g/d and 19.8 g/d, respectively. The estimated overall whole grain intake level was 20.1 g/d in Chinese residents in 2018, and the intake level was 19.4 g/d in men and 20.8 g/d in women. Among the seven regions, the intake level was highest in northern China (47.4 g/d) and lowest in southwestern China (6.0 g/d). In 2018, the PAF was lowest in northern China (12.8%) and highest in southwestern China (19.3%). From 2005 to 2018, the PAF varied in the seven regions, and the PAF in northeastern China fluctuated around 18.5%. Other regions showed downward trends, especially in northern China and northwestern China, decreased by 26.4% and 21.2%, respectively. Over the past 14 years, the number of attributable deaths in the seven regions showed upward trends, with the highest annual average growth rate of 6.7% in southern China and the lowest annual average growth rate of 2.4% in northern China. In 2018, the standardized T2DM mortality rate attributed to insufficient whole grain intake in China was 3.13/100 000, and the attributable mortality was 3.21/100 000 in men and 3.05/100 000 in women. The standardized attributable mortality rate was highest in southwestern China (3.97/100 000) and lowest in northern China (1.78/100 000). From 2005 to 2018, the standardized attributable mortality rate increased by 11.5% in men and decreased by 8.1% in women. The standardized attributable mortality rate in southwestern, southern and central China increased by 23.7%, 21.3% and 4.2%, respectively. The standardized attributable mortality rate in northern, northwestern, eastern and northeastern China decreased by 20.9%, 11.0%, 4.5% and 3.9%, respectively. Conclusion: The whole grain intake level of Chinese residents was low, and the whole grain intake of residents in all seven regions should be increased, especially in the southwest, and men should have more whole grain intake than women to reduce the death risk in patients with T2DM.
Adult ; Male ; Humans ; Female ; Young Adult ; Whole Grains ; Diabetes Mellitus, Type 2/epidemiology* ; Risk Factors ; Chronic Disease ; China/epidemiology*

Objective : To analyze the metabolism of blood glucose，blood lipid and insulin in patients with recur- rent pregnancy loss (RPL) ，and to compare the predictive efficacy of triglyceride glycemic index (TyG) ，triglycer- ide glycemic body mass index (TyG-BMI) and homeostatic model assessment of insulin resistance( HOMA-IR) for RPL． Methods : A total of 573 patients with RPL were selected as the RPL group，and 652 women who received as- sisted reproductive technology for male infertility were selected as the control group．The general data of the two groups were retrospectively analyzed．The levels of body mass index(BMI) ，fasting blood glucose (FPG) ，fasting triglyceride (FTG) ，fasting insulin ( FINS) ，TyG index，TyG-BMI index and HOMA-IR were compared between the two groups．Spearman correlation analysis was used to verify the correlation between TyG index，TyG-BMI in- dex and HOMA-IR. Receiver operating characteristic (ROC) curve was used to evaluate the predictive efficacy of TyG index，TyG-BMI index and HOMA-IR for RPL occurrence，and the optimal predictive cut-off point was calculated. Results : The BMI，FPG，FTG，TyG index，TyG-BMI index and HOMA-IR in the RPL group were significantly higher than those in the control group (P＜0. 05) ．TyG index and TyG-BMI index were positively correlated with HOMA-IR , and the correlation coefficients were 0. 442 and 0. 505，respectively (P＜0. 001) . ROC curve a- nalysis showed that the area under the curve of TyG-BMI index predicting RPL was 0. 579 (95% CI : 0. 551 - 0. 607，P＜0. 001) ，which was greater than that of TyG index of 0. 557 (95% CI : 0. 529－0. 585，P＜0. 001) and HOMA-IR of 0. 535 (95% CI : 0. 507 －0. 563，P ＜0. 05) ，among which the difference between TyG-BMI index and HOMA-IR index area under the curve was statistically significant (P ＜0. 05 ) ．The optimal cut-off points of TyG-BMI index ，TyG index and HOMA-IR for predicting RPL were 172. 3 ( sensitivity 75. 7% ，specificity 37. 06% ) ，8. 32 ( sensitivity 59. 44% ， specificity 51. 61% ) and 3. 58 ( sensitivity 25. 87% ， specificity 81. 62% ) ，respectively． Conclusion The incidence of overweight，abnormal blood glucose，lipid and insulin me- tabolism in RPL patients is higher than that in normal women．TyG index and TyG-BMI index can be used as indi- cators of insulin metabolic status in RPL population besides HOMA-IR , and TyG-BMI index has a higher efficacy in predicting the occurrence of RPL compared to HOMA-IR.

Objective: To investigate the difference of clinical characteristics of recurrent spontaneous abortion (RSA) in patients with losses after spontaneous gestation and after in vitro fertilization and embryo transfer ( IVFET) ． Methods : 237 patients diagnosed with RSA were divided into spontaneous gestation group ( n = 185) and IVF group (n = 52) according to their previous modes of fertilization．The clinical characteristics of the two groups were analyzed. Results: Compared with the spontaneous gestation group，the age of the first pregnancy and the age at the time of RSA in the IVF group were statistically greater than those in the natural pregnancy group ( P < 0. 05 ) ．The number of biochemical pregnancies in IVF group was statistically higher than that in spontaneous gestation group，and the number of spontaneous abortions in IVF group was statistically lower than that in spontaneous gestation group (P＜0. 001) ．The proportion of patients with irregular menstruation in IVF group was statistically higher than that in spontaneous gestation group ( P ＜ 0. 05 ) ． The serum activated partial prothrombin time (APTT) ，R , K，high density lipoprotein cholesterol (HDL-C) ，thyrotropin (TSH) and homocysteine ( HCY) in IVF group were statistically lower than those in spontaneous gestation group，and the Angel，Ma，low density lipoprotein cholesterol (LDL-C) and body mass index (BMI) in IVF group were statistically higher than those in spontaneous gestation group (P＜0. 05) ．In the comparison of etiological composition between the two groups，the proportion of anatomical factors in IVF group was statistically higher than that in spontaneous gestation group (P < 0. 05) ． Conclusion The abortion risk factors in RSA patients after IVF-ET is more serious than that in RSA patients after natural pregnancy．It is suggested to further improve and implement the pre-pregnancy examination and education of infertile patients during IVF-ET treatment，so as to reduce the risk of RSA and obtain a better pregnancy outcome.

Abdomen/diagnostic imaging* ; Artificial Intelligence ; Body Composition ; Magnetic Resonance Imaging ; Practice Guidelines as Topic

Objective:To investigate the fertility needs and outcome of pregnancy in patients with young breast cancer in China.Methods:A retrospective cross-sectional investigation was conducted on 374 young breast cancer women from Cancer Hospital, Chinese Academy of Medical Sciences. Young patients with breast cancer were defined as patients who got initial diagnosis of breast cancer at age no more than 40 years old. We conducted a questionnaire survey and collected clinical data from medical chart. Logistic regression model was used to analyze the possible factors influencing patients′ fertility intention.Results:308 young women with breast cancer completed questionnaires, and the response rate was 82.4%. 81 patients (26.3%) had fertility needs after diagnosis. Of them, 6 cases took active measures to preserve fertility. 72 patients (23.4%) received fertility counseling during treatment. 7 patients were successfully pregnant, including four cases who delivered normally. Multivariate logistic regression analysis showed that patients under 35 years old ( OR=4.81), bachelor degree or above ( OR=3.26), receiving breast-conserving surgery ( OR=2.15) and childless patients ( OR=3.03) were more likely to have fertility needs after diagnosis of breast cancer (all P<0.05). Conclusions:The fertility needs of young breast cancer women in China are gradually increasing. Healthcare providers associated with tumor patients should actively offer corresponding fertility consultation and individualized diagnosis and therapy plans for patients with fertility needs.

Objective:To investigate the fertility needs and outcome of pregnancy in patients with young breast cancer in China.Methods:A retrospective cross-sectional investigation was conducted on 374 young breast cancer women from Cancer Hospital, Chinese Academy of Medical Sciences. Young patients with breast cancer were defined as patients who got initial diagnosis of breast cancer at age no more than 40 years old. We conducted a questionnaire survey and collected clinical data from medical chart. Logistic regression model was used to analyze the possible factors influencing patients′ fertility intention.Results:308 young women with breast cancer completed questionnaires, and the response rate was 82.4%. 81 patients (26.3%) had fertility needs after diagnosis. Of them, 6 cases took active measures to preserve fertility. 72 patients (23.4%) received fertility counseling during treatment. 7 patients were successfully pregnant, including four cases who delivered normally. Multivariate logistic regression analysis showed that patients under 35 years old ( OR=4.81), bachelor degree or above ( OR=3.26), receiving breast-conserving surgery ( OR=2.15) and childless patients ( OR=3.03) were more likely to have fertility needs after diagnosis of breast cancer (all P<0.05). Conclusions:The fertility needs of young breast cancer women in China are gradually increasing. Healthcare providers associated with tumor patients should actively offer corresponding fertility consultation and individualized diagnosis and therapy plans for patients with fertility needs.