Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective To explore the value of deep learning image reconstruction(DLIR)by comparing subjective and objec-tive evaluation of DLIR and adaptive statistical iterative reconstruction(ASIR-V)images in gastric cancer CT.Methods Abdominal CT images in the venous phase of 80 untreated patients with primary gastric cancer were included,and five CT reconstruction meth-ods of 50％ASIR-V,80％ASIR-V,DLIR-low(DLIR-L),DLIR-medium(DLIR-M)and DLIR-high(DLIR-H)were adopted,respec-tively.The objective evaluation included background standard deviation(SD),signal-to-noise ratio(SNR),contrast-to-noise ratio(CNR)values and pericancerous fat density resolution.The subjective evaluation included SD,overall image quality,the display of gastric cancer lesions,and diagnostic confidence in whether the serosal surface of the gastric wall was infiltrated.Results The subjective and objective evalua-tion indicators showed statistically significant differences among the five reconstruction models(P＜0.001).In terms of objective evalua-tion,the SD value of gastric cancer lesions in the DLIR-H was the lowest,while the SNR and CNR values were the highest among the five groups.In terms of subjective evaluation,the DLIR-M had the highest scores in gastric cancer lesions display,overall image quality and diagnostic confidence among the five groups.Conclusion Compared with ASIR-V,DLIR can significantly reduce image noise and improve image quality,and DLIR-M and DLIR-H are respectively the optimal subjective and objective reconstruction models for showing gastric cancer lesions.

Objective To explore the value of deep learning image reconstruction(DLIR)by comparing subjective and objec-tive evaluation of DLIR and adaptive statistical iterative reconstruction(ASIR-V)images in gastric cancer CT.Methods Abdominal CT images in the venous phase of 80 untreated patients with primary gastric cancer were included,and five CT reconstruction meth-ods of 50％ASIR-V,80％ASIR-V,DLIR-low(DLIR-L),DLIR-medium(DLIR-M)and DLIR-high(DLIR-H)were adopted,respec-tively.The objective evaluation included background standard deviation(SD),signal-to-noise ratio(SNR),contrast-to-noise ratio(CNR)values and pericancerous fat density resolution.The subjective evaluation included SD,overall image quality,the display of gastric cancer lesions,and diagnostic confidence in whether the serosal surface of the gastric wall was infiltrated.Results The subjective and objective evalua-tion indicators showed statistically significant differences among the five reconstruction models(P＜0.001).In terms of objective evalua-tion,the SD value of gastric cancer lesions in the DLIR-H was the lowest,while the SNR and CNR values were the highest among the five groups.In terms of subjective evaluation,the DLIR-M had the highest scores in gastric cancer lesions display,overall image quality and diagnostic confidence among the five groups.Conclusion Compared with ASIR-V,DLIR can significantly reduce image noise and improve image quality,and DLIR-M and DLIR-H are respectively the optimal subjective and objective reconstruction models for showing gastric cancer lesions.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

【Objective】 To investigate the expressions of containing CKLF like MARVEL transmembrane domain gene 6 (CMTM6) and ras protein activator like 2 (RASAL2) in prostate cancer tissues, and to analyze the relationships between the above factors and the clinicopathological characteristics and prognosis of prostate cancer patients. 【Methods】 The prostate cancer tissues and adjacent tissues of 80 prostate cancer patients admitted to Zhumadian City Center Hospital during Feb.2018 and Feb.2020 were collected.Expressions of CMTM6 and RASAL2 were detected with immunohistochemical method.The relationship between the expressions of CMTM6 and RASAL2 and the clinical pathological characteristics of prostate cancer were analyzed.The survival curve was plotted with Kaplan-Meier method.The prognostic factors were analyzed with multivariate Cox regression. 【Results】 The positive expression rate of CMTM6 in prostate cancer tissues was 67.50%, which was obviously higher than 38.75% in adjacent tissues (χ²=13.277, P<0.001).The positive expression rate of RASAL2 in prostate cancer tissues was 47.50%, which was obviously lower than 73.75% in adjacent tissues (χ²=11.546, P=0.001).The expressions of CMTM6 and RASAL2 were not related to patients’ age, tumor size and tissue differentiation (P>0.05), but to TNM staging, Gleason score, lymph node metastasis and preoperative PSA level (P<0.05).Survival curve showed that the 3-year survival rate of positive CMTM6 expression patients was 61.11% (33/54), which was obviously lower than that of negative patients, which was 88.46% (23/26) (χ²=5.940, P=0.015).The 3-year survival rate of positive RASAL2 expression patients was 81.85% (31/38), which was obviously higher than that of negative patients, which was 59.52% (25/42) (χ²=4.887, P=0.027).Cox multivariate regression showed that Gleason score, lymph node metastasis, preoperative PSA level, CMTM6, and RASAL2 were independent influencing factors of prognosis (P<0.05). 【Conclusion】 The positive expression rate of CMTM6 in prostate cancer tissues is significantly higher than that in paracancer tissues, while the positive expression rate of RASAL2 in prostate cancer tissues is significantly lower than that in paracancer tissues. Both CMTM6 and RASAL2 are closely related to the clinical pathological characteristics and prognosis of prostate cancer patients, and may provide reference for the prognosis.

OBJECTIVE: To analyze the Z values of true and false positive cases by non-invasive prenatal testing (NIPT) in order to improve its accuracy in clinical practice. METHODS: Results of 24 384 NIPT tests were reviewed. For cases with high risks for trisomies 21, 18 and 13, the range of Z values in true and false positive cases was analyzed and discussed. RESULTS: A total of 335 high-risk cases were identified by NIPT, among which 256 had elected prenatal diagnosis, 153 (59.77%) were verified as true positives, and 103 (40.23%) were false positives, and the area under the curve (AUC) was 0.9994. For NIPT screening, the positive predictive value (PPV) for trisomy 21 was 100% when Z>13, regardless if the pregnant woman was over 35. When 335 and about 41.6% (5/12) for those<35. For trisomy 18, the PPV was 100% when Z>13, and only 14.3% (1/7) when 3CONCLUSION NIPT is a technique similar to prenatal diagnosis and has a high positive predictive value for trisomies 18 and 21. Proper classification and division of the high-risk Z value of NIPT can further improve the positive predictive values for trisomies 21, 18 and 13 in different intervals, and is more helpful to guide clinicians in genetic counseling for high-risk pregnant women. Meanwhile, the compliance of prenatal diagnosis in high risk NIPT pregnant women with Z value between 3~13 was improved.
Female ; Pregnancy ; Humans ; Trisomy 13 Syndrome/genetics* ; Trisomy/genetics* ; Down Syndrome/genetics* ; Chromosome Disorders/genetics* ; Trisomy 18 Syndrome/diagnosis* ; Prenatal Diagnosis/methods*

Objective:To investigate the clinical outcomes and prognosis of children who were prenatally diagnosed with solid space-occupying abdominal lesions by ultrasound.Methods:This study retrospectively enrolled 30 children with solid space-occupying abdominal lesions that were indicated by prenatal ultrasound at Children's Hospital of Fudan University from March 2015 to March 2021. Prenatal ultrasound findings, postnatal treatment, clinical outcomes, and prognosis were analyzed.Results:These subjects included 18 male and 12 female infants, with the median gestational age at the first sonographic diagnosis of 36 weeks (28 to 39 weeks). The intra-abdominal solid masses were postnatally confirmed to be located in liver, retroperitoneum, and gastrointestinal tract, which were hepatic hemangioma ( n=14), hepatoblastoma ( n=2), neuroblastoma ( n=6), abdominal teratoma ( n=4), adrenal hematoma ( n=1), adrenocortical adenoma ( n=1), hyperplasia of renal capillary ( n=1), and gastrointestinal teratoma ( n=1). The accuracy of prenatal ultrasound in detecting the location of masses was 73% (22/30) and which was 13/16 in detecting masses from liver and 9/14 in that outside the liver. Among the 30 cases, 73% (22/30) were benign tumors, and 27% (8/30) were malignant tumors (hepatoblastoma in two cases and neuroblastoma in six cases). Among 15 patients with benign tumors (hepatic hemangioma and adrenal hematoma) who received close follow-up or drug therapy, tumor/lesion regression occurred in 13 cases and the other two were observed with stable hepatic hemangiomas. Fourteen patients, including six with neuroblastoma, two with hepatoblastoma, five with teratoma, one with adrenocortical adenoma, and one with hyperplasia of renal capillary, had good prognosis after primary tumor resection or combined with postoperative chemotherapy. One hepatoblastoma case died after withdrawing treatment. The overall survival rate was 97% (29/30) with a median follow-up time of 24 months (4 to 60 months). Conclusions:Prenatal ultrasound has high accuracy in identifying the anatomic region of fetal solid space-occupying abdominal lesions. With close postnatal follow-up and proper treatment, most of the affected fetuses will have a good outcome and prognosis.

Objective:To study the effect of extract of livistona chinensis on the proliferation and apoptosis of bladder cancer cells and the related mechanism.Methods:T24 cells were cultured in medium with the final concentration of 0, 25, 50 and 100 mg/L livistona chinensis extract, respectively. And then they were divided into control group and low, medium and high dose groups. The cell survival rate was detected by cell counting kit 8 (CCK-8). Colony formation assay was used to detect the number of cell clones. Apoptosis was detected by flow cytometry. Western blot was used to detect the expression of related proteins. The Syk overexpression vector plasmid and its negative control were transfected into T24 cells. After transfection, the cells were treated with 100 mg/L livistona chinensis. The cell survival rate, colony formation number and apoptosis rate were detected by the above method. The bladder cancer model nude mice were treated with different concentrations of livistona chinensis extract. Under the microscope, the expression of protein was detected by immunohistochemical staining of bladder tissue.Results:Compared with the control group, the survival rate of T24 cells in the low, medium and high dose livistona chinensis extract groups were significantly decreased [(88.50±3.65)%, (70.58±2.47)%, (48.90±2.37)% vs. (98. 25±4.26)%], and the number of clone formation decreased significantly [(101. 33±3.40), (84.00±2.94), (60.00±2.16) vs. (121.33±4.64) ], and the apoptosis rate was significantly increased [(11.45± 0.59)%, (17.71±0.64)%, (21.33±0.83)% vs. (7. 86±0.43)%]. The expression level of Ki-67 protein was significantly decreased, while the expression levels of Caspase3 and Syk protein were significantly increased in a concentration dependent manner ( P < 0.05). The cell survival rate of pcDNA3.1-Syk group was significantly lower than that of pcDNA3.1 group [(63.87±2.53)% vs. (98. 45±3.54)%], the number of clone formation decreased significantly [(74. 33±2.87) vs. (121.33±3.68)], and the apoptosis rate was significantly increased [(18.39±0.63)% vs. (7.89± 0.45)%] (all P<0.05). The cell survival rate in the high-dose group of livistona chinensis+ pcDNA3.1-Syk was significantly lower than that in the high-dose group of livistona chinenisi+ pcDNA3.1 group [ (29.80±1.63)% vs.(49.33±2.76)% ], the number of clone formation decreased significantly [(33.00±2.94) vs. (59.67±3.30) ], and the apoptosis rate was significantly increased [(26.93±0.68)% vs. (21.25±0.78)% ]( P<0.05). The experimental results of nude mice of bladder cancer model showed that the tumor volume of transplanted bladder cancer nude mice in the control group and the low, medium, and high dose livistona chinensis extract groups were (1 209.75±64.37), (1 006.31±40.49), (530.58±42.87), (267.58±16.73)mm 3, respectively, the weight of the transplanted tumor were (0.36±0.08), (0.30±0.04), (0.26±0.03), (0.18±0.06)g, and the differences between the two groups were statistically significant ( P <0.05). Immunohistochemical staining results showed that the expression of Sky and Caspase3 was increased and the expression of Ki-67 was decreased in the middle and high dose groups compared with that in the control group. Conclusion:Extract of livistona chinensis can inhibit the proliferation and promote apoptosis of bladder cancer cells by up regulating Syk expression.

Objective:To observe the clinical characteristics of patients with familial vitreous amyloidosis (FVA) and the efficacy of vitrectomy (PPV) and the occurrence of complications.Methods:A retrospective clinical study. From June 2009 to March 2020, 32 eyes of 18 patients from 3 FVA families who were diagnosed and treated by PPV at Department of Ophthalmology of Jiaxing TCM Hospital were included in the study. Among them, there were 12 males with 22 eyes and 6 females with 10 eyes. The average age of onset was 42.28±3.25 years; the average duration of disease was 3.75±3.93 years. All the affected eyes underwent best corrected visual acuity (BCVA) and B-mode ultrasound examination. A logarithmic visual acuity chart was used in the BCVA examination, which was converted to the logarithmic minimum angle of resolution (logMAR) visual acuity when recorded. The average logMAR BCVA of the affected eye was 1.72±0.53; the intraocular pressure was less than 21 mm Hg (1 mm Hg=0.133 kPa). The vitreous body of the affected eye was obviously cloudy. All the affected eyes underwent standard three-channel PPV through the flat part of the ciliary body, and vitreous specimens were collected for pathological examination during the operation. Peripheral venous blood of probands from 3 families was collected, and the whole exome gene sequencing was performed. The follow-up time after surgery was ≥6 months. The patient's clinical characteristics, fundus lesions in PPV, changes in BCVA after surgery, and complications was observed. One-way analysis of variance or t test was performed for measurement data comparison; χ2 test was performed for count data comparison. Results:The vitreous body of the affected eye showed gray-white dense and thick flocculent changes, and the posterior capsule attached to the lens showed "foot disc-like" turbidity; later the lens was mainly cystic opacity. Pathological examination of the vitreous body showed positive staining of Congo red; under a polarized light microscope, it showed apple green dots and sheet-like birefringence. The genetic test results showed that there was a c.307G>C (p.Gly103Arg) missense mutation in the TTR gene of the proband in Family 2. Peripheral retinal hemorrhages in 4 eyes (12.5%, 4/32), retinal tears in 5 eyes (15.6%, 5/32), retinal degeneration in 4 eyes (12.5%, 4/32), retinal detachment were found in PPV 3 eyes (9.4%, 3/32). The vitreous body was filled with C 3F 8 and silicone oil respectively for 2, 1 eye. Six months after the operation, the logMAR BCVA of the affected eye was 0.39±0.32, which was significantly higher than that before the operation, and the difference was statistically significant ( t=15.131, P=0.000). After the operation, high intraocular pressure occurred in 2 eyes (6.3%, 2/32), secondary glaucoma in 1 eye (3.1%, 1/32), retinal detachment in 2 eyes (6.3%, 2/32), neovascular glaucoma (NVG) in 2 eyes (6.3%, 2/32), cataract in 10 eyes (31.3%, 10/32). Conclusion:The vitreous body of FVA eyes are gray-white dense, thick and flocculent, attached to the posterior lens capsule, showing "foot disc-like" turbidity; PPV treatment can effectively improve the BCVA of the FVA eyes; secondary glaucoma, secondary retinal detachment, NVG can occur after surgery.

[摘 要] 目的：探讨肝内胆管癌（intrahepatic cholangiocarcinoma，ICCA）围手术期外周血中性粒细胞与淋巴细胞比率（neutrophil-to-lymphocyte ratio，NLR）和血小板与淋巴细胞比率（platelet-to-lymphocyte ratio，PLR）对患者预后的预测价值。方法：收集2015年1月至2018年1月在上海市松江区中心医院接受肝切除术治疗的ICCA患者97例作为ICCA组，选择同期在本院做健康体检的志愿者100例作为正常对照组。检测两组受试者术前1 d、术后3 d和7 d外周血的NLR、PLR，采用单因素、多因素分析ICCA患者术后随访期死亡的危险因素，采用Kaplan-Meier生存曲线分析术后3 d的NLR和PLR对ICCA患者术后生存时间的影响，采用受试者工作特征曲线（receiver operating characteristic curve，ROC）分析术后3 d的NLR和PLR水平对患者术后随访期死亡的预测价值。结果：ICCA组患者术前1 d、术后3和7 d外周血的NLR、PLR均高于正常对照组（均P<0.05），术前1 d和7 d外周血NLR、PLR差异无统计学意义（P>0.05），术后3 d外周血NLR、PLR水平最高（P<0.05）。多发肿瘤、合并淋巴结转移、TNM分期Ⅲ~Ⅳ、CA199水平增高、术后3 d的NLR和PLR较高分别是ICCA患者随访期死亡的独立危险因素（均P<0.05）。ROC曲线显示，术后3 d的NLR和PLR高低对ICCA患者术后生存时间具有预测价值。Kaplan-Meier生存曲线显示，低NLR[（50.32±3.69） vs （30.12±2.36）个月]和低PLR[（53.6±3.75） vs （37.6±2.96）个月]患者生存时间均长于高NLR和PLR的ICCA患者（均P<0.05）。结论：ICCA术后3 d的NLR和PLR异常增高是患者肝切除术后死亡的独立危险因素，其对患者生存时间具有早期预测价值。