Objective To evaluate the predictive ability and clinical application value of artificial intelligence (AI) systems in the benign and malignant differentiation and pathological type of pulmonary nodules, and to summarize clinical application experience. Methods A retrospective analysis was conducted on the clinical data of patients with pulmonary nodules admitted to the Department of Thoracic Surgery, Second Hospital of Lanzhou University, from February 2016 to February 2025. Firstly, pulmonary nodules were divided into benign and non-benign groups, and the discriminative abilities of AI systems and clinicians were compared. Subsequently, lung nodules reported as precursor glandular lesions (PGL), microinvasive adenocarcinoma (MIA), and invasive adenocarcinoma (IAC) in postoperative pathological results were analyzed, comparing the efficacy of AI systems and clinicians in predicting the pathological type of pulmonary nodules. Results In the analysis of benign/non-benign pulmonary nodules, clinical data from a total of 638 patients with pulmonary nodules were included, of which there were 257 males (10 patients and 1 patient of double and triple primary lesions, respectively) and 381 females (18 patients and 1 patient of double and triple primary lesions, respectively), with a median age of 55.0 (47.0, 61.0) years. Different lesions in the same patient were analyzed as independent samples. Univariate analysis of the two groups of variables showed that, except for nodule location, the differences in the remaining variables were statistically significant (P<0.05). Multivariate logistic regression analysis showed that age, nodule type (subsolid pulmonary nodule), average density, spicule sign, and vascular convergence sign were independent influencing factors for non-benign pulmonary nodules, among which age, nodule type (subsolid pulmonary nodule), spicule sign, and vascular convergence sign were positively correlated with non-benign pulmonary nodules, while average density was negatively correlated with the occurrence of non-benign pulmonary nodules. The area under the receiver operating characteristic curve (AUC) of the malignancy risk value given by the AI system in predicting non-benign pulmonary nodules was 0.811, slightly lower than the 0.898 predicted by clinicians. In the PGL/MIA/IAC analysis, clinical data from a total of 411 patients with pulmonary nodules were included, of which there were 149 males (8 patients of double primary lesions) and 262 females (17 patients of double primary lesions), with a median age of 56.0 (50.0, 61.0) years. Different lesions in the same patient were analyzed as independent samples. Univariate analysis results showed that, except for gender, nodule location, and vascular convergence sign, the differences in the remaining variables among the three groups of PGL, MIA, and IAC patients were statistically significant (P<0.05). Multinomial multivariate logistic regression analysis showed that the differences between the parameters in the PGL group and the MIA group were not statistically significant (P>0.05), and the maximum diameter and average density of the nodules were statistically different between the PGL and IAC groups (P<0.05), and were positively correlated with the occurrence of IAC as independent risk factors. The average AUC value, accuracy, recall rate, and F1 score of the AI system in predicting lung nodule pathological type were 0.807, 74.3%, 73.2%, and 68.5%, respectively, all better than the clinical physicians’ prediction of lung nodule pathological type indicators (0.782, 70.9%, 66.2%, and 63.7% respectively). The AUC value of the AI system in predicting IAC was 0.853, and the sensitivity, specificity, and optimal cutoff value were 0.643, 0.943, and 50.0%, respectively. Conclusion This AI system has demonstrated high clinical value in predicting the benign and malignant nature and pathological type of lung nodules, especially in predicting lung nodule pathological type, its ability has surpassed that of clinical physicians. With the optimization of algorithms and the adequate integration of multimodal data, it can better assist clinical physicians in formulating individualized diagnostic and treatment plans for patients with lung nodules.

Objective:To investigate the surgical decision-making types and its influencing factors for obesity patients participating in bariatric metabolic surgery.Methods:The survey targets were patients who were scheduled to bariatric metabolic surgery in The First Affiliated Hospital of Nanjing Medical University, and the survey period was from January 1 to May 30, 2024. The survey was conducted using the general demographic questionnaire, control preference scale, and shared-decision requirements questionnaire for bariatric metabolic surgery. Count data were expressed as absolute numbers and percentages, and comparison between groups was performed using the chi-square test. Comparison of ordinal data was performed using the non parametric test. Univariate analysis was performed using the corresponding statistical methods based on data types. Multivariate analysis was conducted using the willingness of patients to participate in bariatric metabolic surgery decision-making (passive decision-making=1, shared decision-making=2, active decision-making=3) as the dependent variable, and the statistically significant variables in univariate analysis were included as independent variables for disordered multi-class Logistic regression analysis.Results:(1) Results of survey. A total of 568 questionnaires were distributed and collected. After removing 48 unqualified questionnaires, 520 valid questionnaires were collected. Of the 520 patients who completed the questionnaire survey, there were 231 cases participating as the passive decision-making type, 140 cases as shared decision-making type, and 149 as active decision-making type in bariatric metabolic surgery decision-making. (2) Influencing factors for decision-making type of obesity patients participating in bariatric metabolic surgery. Results of multivariate analysis showed that taking the shared decision-making type as a reference, the number of complication (0 compared to ≥4, 1?3 compared to ≥4), medical payment method (medical insurance compared to self-payment), degree of disease understanding (not very understanding compared to general understanding, not understanding compared to general understanding), and the interval between knowing and accep-ting surgery (1-3 months compared to >6 months) were independent factors influencing the willingness of passive decision-making patients to participate in bariatric metabolic surgery deci-sions ( odds ratios=3.520, 2.457, 2.255, 3.147, 1.920, 1.854, 95% confidence interval as 1.552-7.984, 1.215-4.968, 1.335-3.809, 1.865-5.311, 1.025-3.596, 1.065-3.230, P<0.05). Body mass index (BMI) (28.0-31.9 kg/cm 2 compared to ≥37.0 kg/cm 2, 32.0-36.9 kg/cm 2 compared to ≥37.0 kg/cm 2), number of complication (0 compared to ≥4, 1?3 compared to ≥4), family and social support status (poor compared to good), and the interval between knowing and accepting surgery (1?3 months compared to >6 months) were independent factors influencing the willingness of passive decision-making patients to participate in bariatric metabolic surgery decisions ( odds ratios=2.391, 2.478, 6.918, 3.335, 2.974, 2.139, 95% confidence intervals as 1.207-4.735, 1.345-4.563, 2.498-19.159, 1.350-8.242, 1.755-5.039, 1.156-3.957, P<0.05). Taking the passive decision-making type as a reference, BMI (28.0-31.9 kg/cm 2 compared to ≥37.0 kg/cm 2, 32.0-36.9 kg/cm 2 compared to ≥37.0 kg/cm 2) and family social support status (poor compared to good) were independent factors influencing the willingness of passive decision-making patients to participate in bariatric metabolic surgery decisions ( odds ratios=0.404, 0.554, 0.336, 95% confidence interval as 0.221-0.740, 0.327-0.938, 0.212-0.534, P<0.05). (3) Analysis of decision support needs for bariatric metabolic surgery. Results of shared-decision requirements questionnaire showed that the information needs of obesity patients from high to low were surgical indications, postoperative physical changes and dietary habits adjust-ments, surgical costs, surgical complications and risks, and surgical outcomes. The demand for content preference from high to low were in the form of sharing patient experience after bariatric metabolic surgery, comparing before and after bariatric metabolic surgery, popularizing science after bariatric metabolic surgery, introducing surgical methods, live streaming of medical staff, and introducing the hospital environment. In terms of recognition of networked support pathways, 94.04%(489/520) of patients believed that implementing shared decision support based on networked pathways was reliable. Conclusions:Obesity patients are more willing to participate in bariatric metabolic surgery decision-making. But the proportion of patients selecting passive decision-making is relatively high. BMI, number of complication, medical payment method, degree of disease under-standing, family and social support status and the interval between knowing and accepting surgery are independent factors influencing the willingness of obesity patients to paticipate in bariatric metabolic surgery decisions.

The rapid development of bariatric and metabolic surgery in China in the past 20 years is due to the economic development and needs of lifestyle changes, as well as the unremit-ting exploration of surgeons. Although bariatric and metabolic surgery is facing good development opportunities, its specialized development is far from enough, non-standard surgery still exists in clinical work, specialist training and standardization are in the initial stage, and follow-up is also a serious challenge for bariatric and metabolic surgery. The authors believe that on the basis of solid progress in normalization and standardization, bariatric and metabolic surgery will welcome a bright future.

Objective:To investigate the influencing factors of reflux esophagitis after sleeve gastrectomy and its plus procedures.Methods:The retrospective case-control study was conducted. The clinical data of 130 patients who underwent sleeve gastrectomy and its plus procedures (jejunal bypass, duodenal-jejunal bypass) for the treatment of metabolic diseases in the First Affiliated Hospital of Nanjing Medical University from May 2010 to August 2021 were collected. There were 34 males and 96 females, aged (32±8)years, with the body mass index (BMI) as (38±7)kg/m 2. Observation indicators: (1) incidence of reflux esophagitis before and after surgery; (2) clinical manifestations of reflux esophagitis and treatment; (3) influencing factors of reflux esopha-gitis after surgery; (4) follow-up. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. In univariate analysis, the median value of clinical variable was used for grouping and the chi-square test was used for subsequent analysis. Multivariate analysis was conducted using Logistic stepwise regression model. Results:(1) Incidence of reflux esophagitis before and after surgery. Of 130 patients, there were 5 cases with Los Angeles classification grade A reflux esopha-gitis before the surgery, and there were 35 cases with reflux esophagitis after surgery, including 26 cases as Los Angeles classification grade A esophagitis, 8 cases as Los Angeles classification grade B esophagitis and 1 case as Los Angeles classification grade C esophagitis. There was a significant difference in the incidence of reflux esophagitis for patients before and after surgery ( P<0.05). (2) Clinical manifestations of reflux esophagitis and treatment. The 5 patients with preoperative reflux esophagitis described with no obvious heartburn and acid regurgitation and did not receive treat-ment. For the 35 patients with postoperative reflux esophagitis, 22 cases described with heartburn and acid regurgitation, and 13 cases described without any symptoms. Of the 35 patients, 10 were treated with continuous oral proton pump inhibitors, 2 were treated with intermittent oral proton pump inhibitors, 10 were relieved by dietary adjustment, and 13 were not treated. For the 95 patients without postoperative reflux esophagitis, 5 cases described with heartburn and acid regurgitation, requiring continuous oral proton pump inhibitor treatment. The remaining 90 cases described no heartburn and acid regurgitation and did not receive treatment. (3) Influencing factors of reflux esophagitis after surgery. Results of multivariate analysis showed that the preoperative reflux diagnostic questionnaire scoring >0 and the occurrence of postoperative heartburn and acid regurgi-tation were independent risk factors of postoperative reflux esophagitis ( odds ratio=7.84, 47.16, 95% confidence interval as 2.04?30.20, 11.58?192.11, P<0.05). (4) Follow-up. All 130 patients were followed up for 17(range, 12?60)month after surgery. The BMI, percentage of total weight loss, diabetes remission rate, fasting blood glucose and glycosylated hemoglobin of the 130 patients at postoperative 12 month were (25±4)kg/m 2, 31%±8%, 84.6%(22/26), (5.6±1.2)mmol/L and 5.9%±1.3%. Conclusions:The sleeve gastrectomy and its plus procedures increase the risk of postoperative reflux esophagitis. Preoperative reflux diagnostic questionnaire scoring>0 and the occurrence of postoperative heartburn and acid regurgitation are independent risk factors of postoperative reflux esophagitis. Dietary adjustment and proton pump inhibitor therapy can alleviate symptoms of reflux esophagitis, but cannot cure reflux esophagitis.

Objective:To compare the 1-year effects of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy with Roux-en-Y duodenal bypass (SG+RYDJB) on weight loss, remission of diabetes, and postoperative complications in patients with obesity and type 2 diabetes.Methods:A single-center retrospective cohort study was conducted at the First Affiliated Hospital of Nanjing Medical University from January 2020 to December 2020. Sixty-four patients with type 2 diabetes and body mass index (BMI) of 27.5-40.0 kg/m 2 were included in this study and divided into the RYGB group ( n=34) and the SG+RYDJB group ( n=30). In both procedures, the biliopancreatic branch was measured 100 cm distal to the Treitz ligament, and the food branch was measured 100 cm distal to the gastric or duodenojejunal anastomosis. Patients were followed up by telephone or WeChat, a free messaging and calling app at 1, 3, 6, and 12 months postoperatively to determine their weight loss and remission of diabetes. The primary outcomes were the weight loss and reduction in blood glucose concentrations at 1 year after surgery and postoperative complications. Other postoperative changes, including body weight, BMI, percentage of total weight loss (%TWL), percentage of excess weight loss (%EWL), glycated hemoglobin A1c (HbA1c), and fasting blood glucose at 1 year after surgery were also assessed. Results:There were no significant differences in baseline data between the two groups (all P>0.05). No conversion to open surgery or death occurred in either group. Operation time was longer in the SG+RYDJB than the RYGB group (137.8±22.1 minutes vs. 80.0±24.9 minutes, t=9.779, P<0.001) and the incidence of perioperative complications was higher in the SG+RYDJB than the RYGB group (20% [6/30] vs. 2.9% [1/34], χ 2=4.761, P=0.029). However, the postoperative hospital stay was similar between the two groups [3.0 (3.0, 4.3) days vs. 3.0 (4.0, 6.0) days, U=641.500, P=0.071]. Perioperative complications comprised small gastric pouch anastomotic leakage in one patient in the RYGB group and leakage (three patients) and bleeding (two patients with gastrointestinal bleeding and one with trocar site bleeding) in the SG+RYDJB group. Long-term complications were as follows. The incidence of anemia was significantly higher in the RYGB than the SG+RYDJB group (26.5% [9/34] vs. 3.3% [1/30], χ 2=6.472, P=0.011). However, there were no significant differences in incidences of postoperative reflux, dumping syndrome, alopecia, diarrhea, constipation or foul-smelling flatus between the two groups (all P>0.05). Compared with 1 year before surgery, the body weights and fasting plasma glucose concentrations of patients in the SG+RYDJB and RYGB group (72.4±10.6 kg vs. 98.5±14.2 kg, respectively; 68.2±10.0 kg vs. 91.9±14.8 kg, respectively), BMI (25.2±2.9 kg/m 2 vs. 34.3±4.2 kg/m 2, respectively; 24.3±2.4 kg/m 2 vs. 32.7±3.7 kg/m 2, respectively) (5.5±1.6 vs. 10.6±3.3, respectively; 5.8±2.1 vs. 9.0±3.4, respectively); HbA1c (5.7±0.8 vs. 9.7±1.2, respectively; 9.1±1.9 vs. 5.9±0.9, respectively) were significantly lower at 1 year after surgery (all P<0.05). However, the % TWL (26.5%±6.0% vs. 25.6%±4.4%, t=0.663, P=0.510) and % EWL (109.1%±38.2% vs. 109.4%±40.3%, t=-0.026, P=0.026), rate of complete remission of diabetes at 1 year (80.0% [24/30] vs. 82.4% [28/34], χ 2=0.058, P=0.810] did not differ significantly between the two groups (all P>0.05). Conclusions:Although SG+RYDJB surgery compared with RYGB is more difficult to perform, it can achieve similar weight loss and remission of diabetes and is associated with a lower incidence of anemia because of the preservation of the pylorus.

Objective:To compare the 1-year effects of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy with Roux-en-Y duodenal bypass (SG+RYDJB) on weight loss, remission of diabetes, and postoperative complications in patients with obesity and type 2 diabetes.Methods:A single-center retrospective cohort study was conducted at the First Affiliated Hospital of Nanjing Medical University from January 2020 to December 2020. Sixty-four patients with type 2 diabetes and body mass index (BMI) of 27.5-40.0 kg/m 2 were included in this study and divided into the RYGB group ( n=34) and the SG+RYDJB group ( n=30). In both procedures, the biliopancreatic branch was measured 100 cm distal to the Treitz ligament, and the food branch was measured 100 cm distal to the gastric or duodenojejunal anastomosis. Patients were followed up by telephone or WeChat, a free messaging and calling app at 1, 3, 6, and 12 months postoperatively to determine their weight loss and remission of diabetes. The primary outcomes were the weight loss and reduction in blood glucose concentrations at 1 year after surgery and postoperative complications. Other postoperative changes, including body weight, BMI, percentage of total weight loss (%TWL), percentage of excess weight loss (%EWL), glycated hemoglobin A1c (HbA1c), and fasting blood glucose at 1 year after surgery were also assessed. Results:There were no significant differences in baseline data between the two groups (all P>0.05). No conversion to open surgery or death occurred in either group. Operation time was longer in the SG+RYDJB than the RYGB group (137.8±22.1 minutes vs. 80.0±24.9 minutes, t=9.779, P<0.001) and the incidence of perioperative complications was higher in the SG+RYDJB than the RYGB group (20% [6/30] vs. 2.9% [1/34], χ 2=4.761, P=0.029). However, the postoperative hospital stay was similar between the two groups [3.0 (3.0, 4.3) days vs. 3.0 (4.0, 6.0) days, U=641.500, P=0.071]. Perioperative complications comprised small gastric pouch anastomotic leakage in one patient in the RYGB group and leakage (three patients) and bleeding (two patients with gastrointestinal bleeding and one with trocar site bleeding) in the SG+RYDJB group. Long-term complications were as follows. The incidence of anemia was significantly higher in the RYGB than the SG+RYDJB group (26.5% [9/34] vs. 3.3% [1/30], χ 2=6.472, P=0.011). However, there were no significant differences in incidences of postoperative reflux, dumping syndrome, alopecia, diarrhea, constipation or foul-smelling flatus between the two groups (all P>0.05). Compared with 1 year before surgery, the body weights and fasting plasma glucose concentrations of patients in the SG+RYDJB and RYGB group (72.4±10.6 kg vs. 98.5±14.2 kg, respectively; 68.2±10.0 kg vs. 91.9±14.8 kg, respectively), BMI (25.2±2.9 kg/m 2 vs. 34.3±4.2 kg/m 2, respectively; 24.3±2.4 kg/m 2 vs. 32.7±3.7 kg/m 2, respectively) (5.5±1.6 vs. 10.6±3.3, respectively; 5.8±2.1 vs. 9.0±3.4, respectively); HbA1c (5.7±0.8 vs. 9.7±1.2, respectively; 9.1±1.9 vs. 5.9±0.9, respectively) were significantly lower at 1 year after surgery (all P<0.05). However, the % TWL (26.5%±6.0% vs. 25.6%±4.4%, t=0.663, P=0.510) and % EWL (109.1%±38.2% vs. 109.4%±40.3%, t=-0.026, P=0.026), rate of complete remission of diabetes at 1 year (80.0% [24/30] vs. 82.4% [28/34], χ 2=0.058, P=0.810] did not differ significantly between the two groups (all P>0.05). Conclusions:Although SG+RYDJB surgery compared with RYGB is more difficult to perform, it can achieve similar weight loss and remission of diabetes and is associated with a lower incidence of anemia because of the preservation of the pylorus.

The wind, phlegm, and blood stasis are important pathogenic factors of cough variant asthma in children, and they are also the pathological products in the occurrence and development of this disease. They have typical pathogenic characteristics. The main pathogenesis characteristics of cough caused by wind, phlegm and blood stasis are as follows that external wind attacks the lungs and induces internal wind, phlegm and dampness accumulates in the lungs, and the lungs fail to declare and descend, and blood stasis obstructs the collaterals and stagnation of Qi. The wind, phlegm, and blood stasis have their own pathogenic characteristics, and their cough-causing also have their own pathogenic characteristics and clinical characteristics. Based on the characteristics of wind, phlegm, and blood stasis, the application of medicine based on the differentiation of symptoms and signs can effectively prevent and treat this disease, and provide theoretical basis and treatment ideas for the treatment of cough variant asthma in children with Chinese medicine.

Objective: To analyze the characteristics of perioperative mortality (POM) in oral maxillofacial head and neck cancer patients. Methods: A retrospective study was adapted for head and neck cancer patients who were treated and had POM in the department of oral maxillofacial & head and neck oncology in Shanghai Ninth People′s Hospital from Jan 1999 to Dec 2019. Demographic information, disease characteristic and clinical records were collected. The factors of POM were classified into surgical complication, medical complication, mixed complication (surgical and medical) and personal complication. SPSS 17.0 software was used to analyze the cause composition for POM under different condition. Results : 55 patients were included: 39 were male, and 16 were female. A total of 12 patients had a smoking history. Furthermore, 28 patients had general comorbidities. 20 underwent preoperative radiotherapy and 9 received preoperative chemotherapy. Squamous cell carcinoma was the most frequent pathological diagnosis in 37 patients. A total of 9 patients had tumors in the maxilla and skull base. In addtition, 4 patients had POM preoperatively, 1 patient had POM within the operation, and 50 patients had POM postoperatively. The leading causes of death were as follows: rupture of the carotid artery was the most frequent (8), and the surgical complication of pulmonary infection was the main medical complication (6). Pulmonary infection and hemorrhage were regarded as the main mixed complication (4). Two patients had POM due to personal complications. The higher the American Society of Anesthesiologists (ASA) score, the higher the proportion of medical factors in POM (P=0.039). Conclusion The composition of POM in oral maxillofacial- head and neck cancer (OMHNC) patients was complicated. Carotid artery rupture was the most common and fatal surgical complication, especially for those who underwent preoperative radiotherapy. Pulmonary infection was the most frequent medical complication, and those who had a higher ASA grade tended to have more complication.

Objective To investigate the predictive value of cumulative body mass index (cumBMI) on new-onset cholelithiasis.Methods The retrospective cohort study was conducted.The data of 31 794 subjects who participated health examination at the Kailuan Hospital,Kailuan Linxi Hospital,Kailuan Zhaogezhuang Hospital,Kailuan Tangjiazhuang Hospital,Kailuan Fan'gezhuang Hospital,Kailuan Lyujiatuo Hospital,Kailuan Jinggezhuang Hospital,Kailuan Linnancang Hospital,Kailuan Qianjiaying Hospital,Kailuan Majiagou Hospital and Kailuan Branch Hospital in 2006,2008,2010,2012 and 2014 were collected.All the subjects were allocated into 4 groups according to squartiles of cumBMI:7 949 with cumBMI＜ 140.81 kg/m2 ×year in the Q1 group,7 946 with 140.81 kg/m2×year≤ cumBMI＜ 159.69 kg/m2 ×year in the Q2 group,7 949 with 159.69 kg/m2×year≤cumBMI＜ 180.49 kg/m2 ×year in the Q3 group and 7 950 with cumBMI ≥ 180.49 kg/m2×year in the Q4 group.All the subjects received respectively the five health examinations in 2006,2008,2010,2012 and 2014 at the same place.Epidemiological investigation,anthropometric parameters and biochemical indicators were collected.Observation indicators:(1) incidence of cholelithiasis in the 4 groups;(2) risk factors analysis affecting newonset cholelithiasis:sex,age,cumBMl,BMI,drinking,smoking,physical exercise,hypertension,diabetes,C-reactive protein (CRP),triglyceride (TG) and total cholesterol (TC).Measurement data with normal distribution were represented as-x±s and comparisons among groups were analyzed using the one-way ANOVA.Pairwise comparison and homogeneity of variance were done using the LSD test.Heterogeneity of variance was done using the Dunnett's T3 test.Measurement data with skewed distribution were described as M (Q) and comparisons among groups were analyzed using the nonparametric test.Count data were analyzed by the chi-square test.The incidence of cholelithiasis in the 4 groups were calculated by the Kaplan-Meier method and comparisons of incidence were done by the Log-rank test.The univariate analysis and multivariate analysis were done using the COX regression model.Results (1) Incidence of cholelithiasis in the 4 groups:31 794 subjects were observed for (2.1 ± 0.4) years,and 236 had new-onset cholelithiasis with an incidence of 7.42‰.Incidences of cholelithiasis in the Q1,Q2,Q3 and Q4 groups were respectively 4.03‰,7.17‰,7.93‰ and 10.57‰,with a statistically significant difference among the 4 groups (x2 =72.39,P＜0.05).(2) Risk factors analysis affecting new-onset cholelithiasis:results of univariate analysis showed that sex,age,cumBMI,BMI,hypertension and CRP were independent risk factors affecting new-onset cholelithiasis of subjects [HR =1.61,1.75,1.64,1.36,1.39,1.39,95％ confidence interval (CI):1.23-2.10,1.49-2.05,1.45-1.86,1.21-1.53,1.07-1.79,1.18-1.62,P＜0.05].Results of multivariate analysis showed that female,age between 50 years and 60 years,age≥60 years,140.81 kg/m2×year ≤cumBMI ＜159.69 kg/m2×year,159.69 kg/m2×year≤cumBMI＜ 180.49 kg/m2 ×year,cumBMI ≥ 180.49 kg/m2 × year were independent risk factors affecting new-onset cholelithiasis of subjects (HR=1.59,1.78,2.33,2.04,2.42,3.66,95％CI:1.21-2.09,1.31-2.44,1.63-3.34,1.29-3.24,1.47-3.95,2.15-6.25,P＜0.05).Conclusion Female,advanced age and increasing cumBMI are independent risk factors affecting new-onset cholelithiasis,and the incidence of cholelithiasis rises as cumBMI increases.

Objective To investigate the expression levels of the CD14 mRNA and TLR4 mRNA in peripheral blood mononuclear cells from patients with Parkinson disease and to explore the clinical signicance. Methods For?ty-four patients with Parkinson disease and 37 healthy controls were recruited. We recorded age of onset, duration of ill?ness and sex of all recruited patients. PD patients were evaulated using the Hoehn-Yahr stages, Unified Parkinson Dis?ease Rating Scale (UPDRS) Ⅱand UPDRS Ⅲ,non-motor symptoms scale (NMSS) on“off”time. Reverse transcrip?tion-polymerase chain reaction was performed to determine the expression levels of CD14 mRNA and toll-like receptor 4 (TLR4) mRNA. Results The expression levels of CD14 mRNA(1.459±0.658)2-△△CT and TLR4 mRNA (1.408±0.698)2-△△CT was significantly up-regulated (P<0.05) in Parkinson disease compared with controls((1.162 ± 0.631)2-△△CT、(1.122 ± 0.557)2-△△CT). In addition, there was positive correlation between the expression levels of CD14 mRNA in Parkinson dis?ease patients with the Hoehn-Yahr stages. Meanwhile, there was no significant correlation between the expression levels of CD14 mRNA and TLR4 mRNA with other clinical scores. Conclusions There is positive correlation between the ex?pression levels of CD14 mRNA in Parkinson disease patients with the Hoehn-Yahr stages,indicating that CD14/TLR4 positive monocyte may be involved in the pathogenesis of the Parkinson disease.