Objective:To explore the relationship between body composition and the risk of gestational diabe-tes mellitus(GDM)in pregnant women.Methods:90 pregnant women with spontaneous pregnancy of singleton who underwent routine prenatal examination in our hospital were selected as GDM group,and 219 pregnant women with normal singleton in the same period as control group(NGT).The body composition was determined by bioimpedance method at 24-28 weeks of gestation.The relationship between body mass index(BMI),per-centage of body fat(FMP),percentage of fat-free body weight(FFMP),extracellular/intracellular fluid(ECW/ICW),body fat index(FMI)and GDM were analyzed.The levels of circulating adiponectin,fatty acid binding pro-tein 4(FABP4),leptin and fasting insulin(FINS)were measured by enzyme linked immunosorbent assay(ELISA)method,and their relationship with various indicators of human body composition was analyzed.Results:①Adi-ponectin in GDM group was lower than that in NGT group,while leptin was higher than that in control group(P＜0.05).②The FMP,ECW/ICW and FMI in GDM group were significantly higher than those in control group(P＜0.05).Univariate regression analysis showed that BMI,FMP,FMI and ECW/ICW before pregnancy were the risk factorsof GDM(OR＞1,P＜0.05),FFMP,MP,PP and M/F was the protective factor of GDM(OR＜1,P＜0.05).Multivariate analysis showed that only FMP was significantly correlated with the risk of GDM,which was an independent risk factor(OR＞1,P＜0.05).③In GDM group,HOMA-IR was positively correlated with FMI(r＞1,P＜0.05)and negatively correlated with PP(r＜1,P＜0.05).④The ROC curve showed that the diagnostic value of pre-pregnancy BMI、FMP、ECW/ICW and FMI in GDM was similar.There was no significant difference in pre-pregnancy BMI,FMP and FMI(P＞0.05),but they were slightly better than ECW/ICW(P＜0.001).Conclu-sions:Body composition during pregnancy is related to the risk of gestational diabetes.The increase in FMP is associated with an increased risk of developing GDM.The higher the FMP,the higher the risk of GDM.The diag nostic efficacy of BMI,FMP and FMI in GDM is Similar.

ObjectiveTo investigate the effects of Guizhi Fulingwan on oxidative stress and renal fibrosis in diabetic mice based on the nuclear factor E₂-associated factor 2/antioxidant response element （Nrf2/ARE） pathway， and to explore its mechanism of action. MethodA diabetic mouse model was established by feeding high-fat diet combined with intraperitoneal injection of streptozotocin. The diabetic mice were divided into a model group， a metformin group （250 mg·kg^-1）， and Guizhi Fulingwan low， medium， and high dose groups （400.4， 800.8， 1 601.6 mg·kg^-1）， with 10 mice in each group. Another 10 mice were included in a normal group. The treatment was conducted continuously for 8 weeks. Body mass and blood glucose were recorded， and the renal index was calculated. Triglyceride （TG）， total cholesterol （TC）， urea nitrogen （BUN）， serum creatinine （SCr）， superoxide dismutase （SOD）， and malondialdehyde （MDA） levels were measured. Pathological changes in renal tissues were observed using Hematoxylin-eosin， periodate-Schiff， and Masson staining. The protein levels of α-smooth muscle actin （α-SMA）， fibronectin （FN）， and transforming growth factor-β₁ （TGF-β₁） were detected by immunohistochemistry. The protein levels of Nrf2， Kelch-like ECH-associated protein 1 （Keap1）， SOD1， NAD（P）H single-nucleotide oxidase 1 （NQO1）， and heme oxygenase-1 （HO-1） were detected by Western blot. ResultCompared with the normal group， the model group showed elevated glucose， renal index， TG， TC， BUN， and SCr levels， thickened glomerular basement membrane， increased collagen fibers in renal tissues， decreased SOD activity， elevated MDA content， increased protein levels of FN， TGF-β₁， α-SMA， and Keap1， and decreased protein levels of Nrf2， SOD1， NQO1， and HO-1 （P<0.01）. Compared with the model group， the Guizhi Fulingwan and metformin groups showed reduced blood glucose， renal index， TG， TC， BUN， and SCr levels， improved renal histopathological injury， significantly increased SOD activity， significantly reduced MDA content， reduced protein levels of FN， TGF-β₁， α-SMA， and Keap1， and increased protein levels of Nrf2， SOD1， NQO1， and HO-1 （P<0.05， P<0.01）. ConclusionGuizhi Fulingwan can improve oxidative stress and inhibit renal fibrosis， and its mechanism may be related to the activation of the Nrf2/ARE signaling pathway.

Objective:To analyze the clinical manifestations,imaging characteristics,treatment measures,and efficacy of mitral valve aneurysm(MVA),and to enhance the clinicians'understandings of MVA.Methods:The clinical data of one patient with aortic valve bicuspid malformation leading to mitral valve anterior leaflet aneurysm were collected.The clinical diagnosis was confirmed based on the clinical characteristics and imaging features,the treatment methods were selected,and the efficacy was analyzed.The relevant literatures were reviewed.Results:The patient,a 68-year-old female,was admitted due to palpitations and shortness of breath for 13 years,and the symptoms worsened one month ago.Thirteen years ago,the patient experienced palpitations and shortness of breath without any inducement and was diagnosed with"heart valve disease"in the local hospital.The symptoms worsened one month ago,leading to hospitalization.The transthoracic two-dimensional echocardiography(TTE)results showed the left ventricular hypertrophy,bicuspid aortic valve with thickened and echogenic leaflets,the forward flow velocity was increased,and the aortic valve orifice area was 2.0 cm2;the mitral valve anterior leaflet margin was slightly thickened and echogenic,presenting a cystic"honeycomb-like"structure closely related to the aortic valve regurgitation jet,which appeared to enter the"sac".The preoperative transesophageal echocardiography(TEE)results showed the bicuspid aortic valve malformation with the anterior leaflet prolapsing into the left ventricular outflow tract during diastole;a"sac-like"structure was detected on the atrial surface of the mitral valve anterior leaflet,changing shape with the cardiac cycle and communicating with left ventricular blood flow.The ultrasound diagnosis was bicuspid aortic valve malformation with transverse fissure,severe regurgitation with mild stenosis,and mitral valve anterior leaflet aneurysm.Intraoperatively,the aortic valve annulus was enlarged with the significant leaflet regurgitation.The leaflets were excised,and a 23 mm bioprosthetic valve was implanted in the aortic position.Upon exploration through the aortic valve orifice,a"sac-like"structure was found on the mitral valve anterior leaflet,which was not specially treated.The postoperative TEE results showed good echo and activity of the aortic bioprosthetic valve,and the"sac-like"structure on the mitral valve remained unchanged.The follow-up results at 10 d and 4 months after operation showed good echo and activity of the aortic bioprosthetic valve,and compared with before operation,there was no significant change in the nature and size of the mitral valve cystic lesion.Conclusion:MVA is clinically rare.TTE is currently the most valuable imaging diagnostic method for MVA,especially when combined with TEE,which is the best diagnostic method and can assist in the treatment and efficacy evaluation.

Objectives:This study aimed to compare the clinical characteristics between light-chain cardiac amyloidosis(AL-CA)and transthyretin cardiac amyloidosis(ATTR-CA). Methods:A retrospective analysis was conducted in patients diagnosed with AL-CA and ATTR-CA at Peking University Third Hospital from January 2011 to October 2023.There were 35 patients diagnosed with AL-CA(AL-CA group)and 21 patients diagnosed with ATTR-CA(ATTR-CA group).Clinical manifestations,ECG,echocardiography and cardiac magnetic resonance(CMR)results were compared between patients with AL-CA and ATTR-CA. Results:Compared to the AL-CA group,the ATTR-CA group has a higher proportion of males(54.3%vs.90.5%,P=0.005),the proportion of patients with hypertension was lower(42.9%vs.9.5%,P=0.009).In terms of clinical manifestations,edema,proteinuria,renal insufficiency and serous effusion were more common in the AL-CA group,while the incidence of limb numbness was higher in the ATTR-CA group(all P＜0.05).There were significant differences in the incidence of limb lead low voltage(57.1%vs.28.6%,P=0.038)and conduction block(14.3%vs.61.9%,P=0.001)between the AL-CA group and ATTR-CA group on ECG.Although the AL-CA group had a shorter time interval from initial symptoms to diagnosis(6.0[2.0,15.0]months vs.35.0[14.0,56.5]months,P=0.002)and less pronounced left ventricular thickening on echocardiography(interventricular septum thickness:[13.3±2.0]mm vs.[15.7±2.2]mm,P=0.001;left ventricular mass:[198.4±67.8]g vs.[246.6±53.5]g,P=0.009)and CMR(interventricular septum thickness:[16.0±2.1]mm vs.[18.9±3.8]mm,P=0.033;left ventricular mass:[132.9±45.3]g vs.[194.7±50.8]g,P=0.011),the proportion of patients with NYHA grades Ⅲ-Ⅳ(48.6%vs.19.0%,P=0.027)was higher,the levels N-terminal B-type natriuretic peptide precursor and cardiac troponin T levels were higher(both P＜0.05),and the 1-year survival rate was lower in the AL-CA group than in the ATTR-CA group(65.7%vs.100%,P=0.001). Conclusions:AL-CA and ATTR-CA had differences in clinical and ECG manifestations.While the severity of left ventricular hypertrophy was less pronounced in AL-CA compared to ATTR-CA,cardiac function and prognosis were worse in AL-CA than in ATTR-CA.

Objective To observe the effects of electroacupuncture on the motor function and expressions of Irisin,Decorin and Myostatin in skeletal muscle of SAMP8 mice;To explore the mechanism of electroacupuncture in the treatment of the motor dysfunction of Alzheimer disease(AD).Methods Totally 247-month-old male SAMP8 mice were randomly divided into model group and electroacupuncture group,with 12 mice in each group,and the 12 male SAMR1 mice with the same age were set as the control group."Baihui","Dazhui"and"Shenshu"were selected in the electroacupuncture group,once a day,8 days as one course of treatment,with an interval of 2 days,for a total of 3 courses.The control group and the model group were not intervened.The motor function of mice was tested by grip strength test,pole climbing test and open field test,the mRNA expressions of Irisin,Decorin and Myostatin in quadriceps muscle were detected by RT-qPCR,and the protein expressions of Irisin,Decorin and Myostatin in quadriceps muscle were detected by immunohistochemistry and Western blot.Results Compared with the control group,the grip peak and duration of the mice in the model group decreased,head turning time and pole climbing time were prolonged(P<0.01),the mRNA and protein expressions of Irisin and Decorin decreased(P<0.05,P<0.01),and the expressions of Myostatin mRNA and protein increased(P<0.05).Compared with the model group,the grip peak and duration of the mice in the electroacupuncture group increased,head turning time and pole climbing time were decreased(P<0.05),the mRNA and protein expressions of Irisin and Decorin increased(P<0.05),and the expressions of Myostatin mRNA and protein decreased(P<0.05).Conclusion Electroacupuncture can improve the motor dysfunction of SAMP8 mice,and its mechanism may be related to regulating the expressions of Irisin,Decorin and Myostatin in skeletal muscle.

Objective To investigate the clinical and dose-volume factors for damages to organs at risk(OARs)during preoperative chemoradiotherapy for gastric cancer, and to provide a reference for optimization of radiotherapy plans to avoid or reduce damages to OARs.Methods A total of 58 patients with locally advanced gastric adenocarcinoma undergoing neoadjuvant treatment were enrolled as subjects.In those patients,30 received preoperative chemoradiotherapy combined with surgery and adjuvant chemotherapy, while others received preoperative chemotherapy combined with surgery and adjuvant chemotherapy. The preoperative chemotherapy group received 2-3 cycles of xeloxregimen(capecitabine+oxaliplatin)before surgery and 3-4 cycles of xeloxregimen after surgery(a total of 6 cycles). The preoperative chemoradiotherapy group received preoperative radiotherapy(45 Gy in 25 fractions)combined with 2 cycles of concurrent xeloxchemotherapy at 14-21 days after the first cycle of xeloxregimen, as well as 3 cycles of xeloxchemotherapy after surgery. The analyses of clinical and dose-volume factors for damages to OARs were performed based on laboratory indices and clinical symptoms during the treatment. Results In all the patients,the incidence rates of liver injury(LI), renal injury(RI), and duodenum injury(DI)before surgery were 22%,48%,and 33%,respectively;the incidence rates of LI and RI after treatment were 35%and 49%, respectively. After appropriate treatment, neither LI nor DI affected the treatment of gastric cancer. RI healed without any special treatment. Compared with preoperative chemotherapy, preoperative chemoradiotherapy caused higher incidence of LI(P=0.00,0.03).RI was only associated with glomerular filtration rate before radiotherapy(P=0.08,0.13). A V3.5of ≤98.96% for the liver reduced LI, while a D2ccof ≤48 Gy for the duodenum reduced DI. Conclusions Preoperative chemoradiotherapy is safe for treating gastric cancer. Compared with preoperative chemotherapy, preoperative chemoradiotherapy does not increase the risk of RI. However,preoperative chemoradiotherapy tends to increase LI.Further studies are needed to improve the treatment method.

Objective In this prospective study,the performance between high-resolution diffusion-weighted imaging ( DWI) and diffusion kurtosis imaging ( DKI) for prediction of radiotherapy response in patients with nasopharyngeal carcinoma was compared. Methods Forty-one patients pathologically diagnosed with NPC received IMRT. All patients underwent conventional MRI,high-resolution DWI and DKI before and after radiotherapy (1-2 d after the plan dose was administered).All patients received conventional MRI during follow-up at 3,6,9 and 12 months after radiotherapy. According to the RECIST 1. 1( response evaluation criteria in solid tumors),all patients were divided into the response group (RG;n＝36) and non-response group (NRG;n＝5). The mean kurtosis coefficient (Kmean) and the mean diffusion coefficient (Dmean) of DKI and apparent diffusion coefficient ( ADC) of DWI were analyzed before and after radiotherapy. Results Among 41 patients,36 cases were assigned into the RG group and 5 in the NRG group. Before and after radiotherapy, all parameters significantly differed between two groups ( P＝0. 000-0. 013) except for the Dmeanand ADC prior to radiotherapy. At the end of radiotherapy,the sensitivity of Kmeanwas calculated as 87. 5% and the specificity was 91. 3% for predicting local control (optimal threshold＝0. 30, AUC: 0. 924; 95%CI: 0. 83-1. 00 ). Conclusion Kmeanvalue after radiotherapy is a potential biomarker for the early evaluation of clinical efficacy of radiotherapy in NPC patients.

Objective To investigate the relationship between different topographic locations and neurological deteriorations (ND) in patients with acute new isolated pontine infarction.Methods One hundred sixty-eight patients with acute new isolated pontine infarction during arch 2012 to March 2016 were identified by diffusion weighted imaging (DWI) for retrospective review.Patients were divided into two groups according to their clinical symptoms:patients with ND and patients without ND.According to neuroimaging of DWI,the topographic location of pontine infarction was divided into three types:The upper,middle,and lower ones,and the correlations of ND with risk factors,laboratory examination results,clinical manifestations and different topographic locations were explored by statistical tests.Results Of 168 patients,26.8％ (45/168) were diagnosed with ND,and 73.2％ (123/168) were diagnosed without ND.Univariate analysis showed that there were differences in female ratio [62.2％ (28/45) vs 41.5％ (51/ 123)],smoking ratio [13.3％ (6/45) vs 26.0％ (32/123)],mean length of hospital stay [(22.83 ± 7.12)d vs (19.31 ± 7.65)d],ratio of worse short-term clinical outcomes [77.8％ (35/45) vs 33.3％ (41/123)],and ratio of lower pontine infarction [55.6％ (25/45) vs 26.0％ (32/123)] between two groups (P ＜ 0.05).Logistic regression analysis showed that lower pontine infarction was the independent risk factor of ND (OR =1.953,95％ CI:1.092-3.535,P =0.029).Conclusions Topographic location of lower pons lesions may be reliable predictor of ND in acute new isolated pontine infarction.

Objective To analyze the correlation between clinical features and renal dysfunction in patients of acute lacunar infarction with progressive cerebral microbleeds (CMBs). Methods Two hundred and sixty-five patients with first-episode acute lacunar infarction were selected. The serum creatinine was measured within 24 h of admission and the estimated glomerular filtration rate (eGFR) was calculated. The brain MRI (including gradient-echo images) was examined within 2 d of admission and after 1 years of follow-up, respectively. The progressive CMBs was assessed with microbleeds anatomical rating scale (MARS), and the patients were divided into progressive CMBs group (progressive group, 42 cases) and non progressive CMBs group (non progressive group, 223 cases). The clinical features of 2 groups were compared and the correlation between progressive CMBs and renal dysfunction was analyzed. Results The age, 24 h pulse pressure, incidences of renal dysfunction and CMBs in progressive group were significantly higher than those in non progressive group: (69.8 ± 5.8) years vs. (61.5 ± 4.9) years, (63.3 ± 3.1) mmHg (1 mmHg=0.133 kPa) vs. (51.8 ± 4.2) mmHg, 69.0％(29/42) vs. 39.9％(89/223) and 57.1％(24/42) vs. 25.1％(56/223), and the platelet was significantly lower than that in non-progression group:(168 ± 35) ×109/L vs. (189 ± 40) ×109/L, and there were statistical differences (P<0.05 or<0.01). The Logistic regression analysis result showed that renal dysfunction and CMBs were Independent risk factors of progressive CMBs (OR = 1.571 and 1.054, 95％ CI 1.042 - 2.493 and 1.010 - 1.142, P<0.05). Conclusions The rate of renal dysfunction is higher in patients of acute lacunar infarction with progressive CMBs, and progressive CMBs are associated with renal dysfunction.

Objective To establish a Loop-mediated Isothermal Amplification (LAMP) for Pseudomonas aeruginosa rapid detection. Method 152 P. aeruginosa strains isolated from nasal swabs and 30 reference strains were applied. P. aeruginosa ATCC15442 was used to develop LAMP amplification and evaluate sensitivity and specificity. Results Sensitivity of LAMP was 103 times higher than PCR, with DNA amount as 132 fg. When LAMP was applied to 30 reference strains and 152 P. aeruginosa strains , the specification was 100% while iden-tification rate reached 94.7%. Conclusion The establishment LAMP showed a promising prospect in P. aerugi-nosa rapid detection.