Purpose To investigate the sex differences of white matter damage in Alzheimer's disease(AD)and their association with cognitive impairment.Materials and Methods This retrospective study included 88 AD patients(48 females),71 amnestic mild cognitive impairment(aMCI)patients(39 females),and 95 healthy controls(63 females)recruited from the Memory Disorder Clinic at the First Affiliated Hospital of Anhui Medical University from September 2017 to July 2024.High-resolution three-dimensional T1 structure images and diffusion tensor imaging images were all obtained from each participant.The mean diffusivity(MD)and fractional anisotropy(FA)values of each white matter region were obtained,and the two-way ANOVA analysis was conducted to investigate brain regions with interaction effects between groups and sexes,those brain regions were then chosen as regions of interest for further correlation analysis with a series of cognitive scale scores.Results In terms of FA values,the right posterior corona radiata,right anterior limb of the internal capsule and left corticospinal tract showed interaction between sexes and cognitive groups(F=4.764,3.812,5.937,all P<0.05).The FA value of AD group was significantly lower than that of healthy control and aMCI group(all P<0.05),but there was no significant difference between healthy control and aMCI group(except the right anterior limb of the internal capsule,P=0.018).In AD group,FA values were significantly higher in women than in men in the previously described brain regions(all P<0.05),while there was no significant difference in FA values between male and female in healthy control and aMCI groups(except the left corticospinal tract,P<0.001).In terms of MD values,the right anterior limb of the internal capsule,right superior corona radiata and left external capsule showed interaction effect between sexes and cognitive groups(F=8.581,3.680,7.218,all P<0.05).The MD value of AD group was significantly higher than that of aMCI group(P<0.001),and aMCI group was higher than that of healthy control group(all P<0.05).In AD group,the MD values in the above brain regions were significantly higher in males than those in females(all P<0.01),while no significant difference was found between males and females in healthy control and aMCI groups(except for the left external capsule,P<0.05).For correlation analysis,the AD group was dimidiated into two groups by sex,the scores of the Montreal cognitive assessment,the Mini Mental state examination and the verbal fluency test of the female patient group were positively correlated with the FA values of the right posterior corona radiate(r=0.372,P=0.009;r=0.345,P=0.016;r=0.383,P=0.007),while the Mini Mental state examination and the verbal fluency test scores of female AD patient group were negatively correlated with the MD values of the right superior corona radiata(r=-0.360,P=0.012;r=-0.360,P=0.003).Conclusion Compared to the healthy control and MCI groups,white matter damage in AD patients shows sex differences and is associated with general cognitive and language functions impairment in female AD patients.

Purpose To investigate the sex differences of white matter damage in Alzheimer's disease(AD)and their association with cognitive impairment.Materials and Methods This retrospective study included 88 AD patients(48 females),71 amnestic mild cognitive impairment(aMCI)patients(39 females),and 95 healthy controls(63 females)recruited from the Memory Disorder Clinic at the First Affiliated Hospital of Anhui Medical University from September 2017 to July 2024.High-resolution three-dimensional T1 structure images and diffusion tensor imaging images were all obtained from each participant.The mean diffusivity(MD)and fractional anisotropy(FA)values of each white matter region were obtained,and the two-way ANOVA analysis was conducted to investigate brain regions with interaction effects between groups and sexes,those brain regions were then chosen as regions of interest for further correlation analysis with a series of cognitive scale scores.Results In terms of FA values,the right posterior corona radiata,right anterior limb of the internal capsule and left corticospinal tract showed interaction between sexes and cognitive groups(F=4.764,3.812,5.937,all P<0.05).The FA value of AD group was significantly lower than that of healthy control and aMCI group(all P<0.05),but there was no significant difference between healthy control and aMCI group(except the right anterior limb of the internal capsule,P=0.018).In AD group,FA values were significantly higher in women than in men in the previously described brain regions(all P<0.05),while there was no significant difference in FA values between male and female in healthy control and aMCI groups(except the left corticospinal tract,P<0.001).In terms of MD values,the right anterior limb of the internal capsule,right superior corona radiata and left external capsule showed interaction effect between sexes and cognitive groups(F=8.581,3.680,7.218,all P<0.05).The MD value of AD group was significantly higher than that of aMCI group(P<0.001),and aMCI group was higher than that of healthy control group(all P<0.05).In AD group,the MD values in the above brain regions were significantly higher in males than those in females(all P<0.01),while no significant difference was found between males and females in healthy control and aMCI groups(except for the left external capsule,P<0.05).For correlation analysis,the AD group was dimidiated into two groups by sex,the scores of the Montreal cognitive assessment,the Mini Mental state examination and the verbal fluency test of the female patient group were positively correlated with the FA values of the right posterior corona radiate(r=0.372,P=0.009;r=0.345,P=0.016;r=0.383,P=0.007),while the Mini Mental state examination and the verbal fluency test scores of female AD patient group were negatively correlated with the MD values of the right superior corona radiata(r=-0.360,P=0.012;r=-0.360,P=0.003).Conclusion Compared to the healthy control and MCI groups,white matter damage in AD patients shows sex differences and is associated with general cognitive and language functions impairment in female AD patients.

ObjectiveTo explore the influence of excessive weight gain during pregnancy in pre-pregnancy overweight and obese women on pregnancy outcomes and neonatal conditions， and to provide scientific evidence for formulating weight management strategies before and during pregnancy and prevent adverse pregnancy outcomes. MethodsClinical data of 2 172 parturients collected from a community in Huangpu District from 2017 to 2021 were retrospectively analyzed， and they were divided into pre-pregnancy overweight and obesity group （n=530）， normal pre-pregnancy weight group（n=937）， and underweight pre-pregnancy group（n=705） according to maternal precursor body mass index （BMI）. Based on their weight gain during pregnancy，the parturient were divided into moderate gestational weight gain （MGWG） group and excessive gestational weight gain （EGWG） group. Meanwhile， the pregnancy and neonatal outcomes such as postpartum hemorrhage， puerperal infection， placental abruption， premature rupture of membranes， mode of delivery， premature birth， stillbirth， fetal distress， admission to the intensive care unit （ICU）， macrosomia， and Apgar score， were recorded. Then the differences in pregnancy and neonatal outcomes between groups were compared. The effects of pre-pregnancy BMI and gestational weight gain on pregnancy outcomes and neonatal conditions was retrospectively analyzed. ResultsThe pre-pregnancy overweight and obese group had higher proportions of placental abruption， premature rupture of membranes， cesarean section， premature birth， fetal distress， and macrosomia compared to the normal pre-pregnancy weight group and the underweight pre-pregnancy group， with Apgar scores lower than the normal pre-pregnancy weight group and the underweight pre-pregnancy group （all P<0.05）. The EGWG group had higher proportions of postpartum hemorrhage， placental abruption， premature rupture of membranes， cesarean section， premature birth， fetal distress， admission to the ICU， and macrosomia than the MGWG group （all P<0.05）. In the pre-pregnancy overweight and obese group， the EGWG group had higher proportions of placental abruption， premature rupture of membranes， premature birth， fetal distress， admission to the ICU， and macrosomia than the MGWG group， with lower Apgar scores than the MGWG group （all P<0.05）. In the normal pre-pregnancy weight group， the EGWG group had higher proportions of placental abruption， premature rupture of membranes， premature birth， fetal distress， admission to the ICU， and macrosomia than the MGWG group （all P<0.05）. In the pre-pregnancy overweight and obese group， the EGWG group had higher proportions of premature rupture of membranes， cesarean section， premature birth， fetal distress， and macrosomia than the EGWG group in the normal pre-pregnancy weight group（all P<0.05）. Logistic regression analysis showed that EGWG in pre-pregnancy overweight and obese women was a risk factor for placental abruption （OR=2.971， 95%CI： 1.098‒8.042）， premature rupture of membranes （OR=4.662， 95%CI： 2.798‒7.770）， cesarean delivery （OR=1.375，95%CI： 1.260‒2.541）， premature birth （OR=4.249， 95%CI： 2.384‒7.573）， fetal distress （OR=3.238， 95%CI： 1.589‒6.598）， admission to the ICU （OR=3.010， 95%CI： 1.265‒7.164）， and macrosomia （OR=5.437， 95%CI： 3.392‒8.716） （all P<0.05）. ConclusionExcessive gestational weight gain in pre-pregnancy overweight and obese women is a risk factors for placental abruption， premature rupture of membranes， cesarean section， premature birth， fetal distress， admission to the ICU， and macrosomia.

ObjectiveTo investigate the relationship between serum 25(OH)D and gestational diabetes mellitus in the second trimester (GDM), to analyze the interaction effect of key risk factors, so as to provide a basis for clinical personalized vitamin D supplementation. MethodsA total of 266 pregnant women who registered and took regular obstetric check-ups in Shanghai Pudong New Area Health Care Hospital for Women and Children from June to December 2022, were selected as the research subjects. According to the results of oral glucose tolerance test (OGTT), the subjects were divided into the GDM group (131) and control group (135). The level of serum 25(OH)D at the time of OGTT were detected and other clinical indicators were followed up. ResultsThe age, systolic blood pressure in early pregnancy, pre-pregnancy BMI, FPG, OGTT 1-hour and 2-hour glucose, GHb, HOMA-IR, TG, AST, Cr, D-D, FDP and SF at 35 weeks’ gestation of the pregnant women were higher in the GDM group than that of the pregnant women in the normal group, while gestational weight gain and serum 25(OH)D level were significantly lower than that of the pregnant women in the normal group. Serum 25(OH)D was negatively correlated with HOMA-IR and WBS’s, but positively correlated with TG and ALT. Serum 25(OH)D was non-linearly correlated with the risk of GDM in an inverted J-shape, and there was an interaction effect of advanced age, pre-pregnancy obesity and vitamin D deficiency on the risk of GDM. ConclusionVitamin D is non-linearly associated with the risk of GDM. The risk of GDM is significantly reduced when serum 25(OH)D level ≥30 ng∙mL^-1.

Objective::Data comparing the outcomes of MiStent (Micell Technologies, Durham, North Carolina, USA) microcrystalline biodegradable polymer (BP) drug-eluting stent (DES) and those of another post-marketing BP-DES, TIVOLI (EssenTech, Beijing, China) are rare. This study sought to compare the angiographic efficacy and clinical outcomes of the microcrystalline BP sirolimus-eluting stent (SES) system MiStent and those of TIVOLI BP-SES.Methods::The DESSOLVE-C trial was a prospective, single-blinded, multicenter, randomized trial (NCT02448524), which randomly assigned patients with de novo coronary lesions to receive MiStent or TIVOLI BP-SES by a 1:1 ratio. The primary endpoint was a non-inferiority comparison of in-stent late lumen loss (LLL) by quantitative coronary angiography at 9 months. The secondary endpoint was device-related clinical cardiovascular composite events (target lesion failure (TLF), composite of cardiac death, target vessel myocardial infarction (MI), and clinically driven target lesion revascularization) and 1-year outcomes. Results::A total of 428 patients (216 patients in the MiStent group and 212 patients in the TIVOLI group) were enrolled and included in an intention-to-treat analysis. MiStent was not only non-inferior but superior to TIVOLI for in-stent LLL at 9 months ((0.23 ± 0.37) mm vs. (0.34 ± 0.48) mm, P for non-inferiority <0.001, P for superiority = 0.02). Although without significant difference, the rate of TLF in MiStent was quantitatively lower than that in TIVOLI (3.70% vs. 6.60%; P = 0.17). Conclusion::Compared with TIVOLI BP-SES, the MiStent system was superior in in-stent LLL at 9 months and had a comparable clinical benefit at 1 year in de novo coronary lesions.

Objective::Data comparing the outcomes of MiStent (Micell Technologies, Durham, North Carolina, USA) microcrystalline biodegradable polymer (BP) drug-eluting stent (DES) and those of another post-marketing BP-DES, TIVOLI (EssenTech, Beijing, China) are rare. This study sought to compare the angiographic efficacy and clinical outcomes of the microcrystalline BP sirolimus-eluting stent (SES) system MiStent and those of TIVOLI BP-SES.Methods::The DESSOLVE-C trial was a prospective, single-blinded, multicenter, randomized trial (NCT02448524), which randomly assigned patients with de novo coronary lesions to receive MiStent or TIVOLI BP-SES by a 1:1 ratio. The primary endpoint was a non-inferiority comparison of in-stent late lumen loss (LLL) by quantitative coronary angiography at 9 months. The secondary endpoint was device-related clinical cardiovascular composite events (target lesion failure (TLF), composite of cardiac death, target vessel myocardial infarction (MI), and clinically driven target lesion revascularization) and 1-year outcomes. Results::A total of 428 patients (216 patients in the MiStent group and 212 patients in the TIVOLI group) were enrolled and included in an intention-to-treat analysis. MiStent was not only non-inferior but superior to TIVOLI for in-stent LLL at 9 months ((0.23 ± 0.37) mm vs. (0.34 ± 0.48) mm, P for non-inferiority <0.001, P for superiority = 0.02). Although without significant difference, the rate of TLF in MiStent was quantitatively lower than that in TIVOLI (3.70% vs. 6.60%; P = 0.17). Conclusion::Compared with TIVOLI BP-SES, the MiStent system was superior in in-stent LLL at 9 months and had a comparable clinical benefit at 1 year in de novo coronary lesions.

Medical ethics has a long history and rich connotations.It has developed from the simple "medical morality" of ancient times to the modem medical ethics.The basic principles of medical ethics include autonomy,non-maleficence,beneficence,justice,and so on.Researchers often conduct clinical researches in the balance between achievements and ethical norms.Clinical researchers of surgery should have a deep understanding of medical ethical principles and strictly abide by medical ethics.Ethics committee should strictly perform their duties and play the role of inspection and supervision.Modem medical knowledges should be popularized throughout the society to make clinical research correctly understood.Adhering principles of ethics first,people orientation and cooperation practice,with patients' benefit as evaluation criteria,balance of surgical "Dao" and "Shu" can be achieved.

Objectives To evaluate the relationship between body mass index (BMI) and the incidence risk of papillary thyroid microcarcinoma (PTMC).Methods This retrospective study included 1210 PTMC patients who underwent surgery between November 2013 and October 2014 in Peking Union Medical College Hospital,China Academy of Medical Science.A population-based 1∶1 matched case-control study was conducted,and each PTMC patients was matched with one who received thyroid function and ultrasonic to confirm that there was no disease in the thyroid.The clinical profiles of these patients were collected.According to Guidelines for Prevention and Control of Overweight and Obesity in Chinese Adults,all subjects were divided into three groups:underweight (BMI ≤ 18.5 kg/m2),normal(18.5 kg/m2 ＜ BMI ≤ 23.9 kg/m2),overweight (24.0 kg/m2 ＜ BMI ＜ 27.9 kg/m2) and obese group(BMI≥28.0 kg/m2).The relationship between BMI and PTMC incidence risk was analyzed by casecontrol study.Univariate and multivariate logistic regression analysis was applied to analyze the relationship between BMI and PTMC severity.Results The BMI of PTMC patients was significant higher than in normal control [(24.30 ±3.33) kg/m2 vs (23.31 ± 3.50) kg/m2,P ＜ 0.0001].Compared with BMI normal group,the incidence risk of PTMC in underweight group was significantly lower (OR =0.449,95 ％ CI:0.270-0.747),which is higher in overweight and obese group (OR =1.559,95％ CI:1.261-1.928;OR =2.059,95％ CI:1.501-2.823).Histopathological review of 1210 PTMC patients with surgical resection revealed.The proportions of underweight,normal,overweight and obese group of the patients with extrathyroid extension (3.1％,48.0％,36.7％,12.2％) have significant differences with those in the patients whose tumor are limited to the thyroid (0.7％,45.2％,36.0％,18.1％) (P =0.0090).The proportions of 4 group of the patients with multiple lesions (3.2％,49.0％,35.6％,12.2％) were significantly differences to those in the patients with single lesion (0.8％,43.3％,38.7％,17.2％) (P =0.0050).Multivariate analysis showed that underweight is a protective factor of extrathyroidal extension (OR =0.219,95 ％ CI:0.051-0.932;OR =0.279,95 ％ CI:0.085-0.935) and mulifocality,and obese is an independent risk factors(OR =1.556,95％CI:1.047-2.312;OR =1.764,95％CI:1.204-2.584).Conclusions This study identified that the incidence risk of PTMC is positive related with BMI.In PTMC patients,obesity increases the risk of mulifocality and extrathyroidal extension.Attention should be paid to the effect of obesity on the incidence risk of PTMC and the diagnosis and treatment in clinical practice.

Objective To investigate the correlation between serum sFas and sLOX-1 with occurrence and development of acute coronary syndrome (ACS).Methods A total of 52 patients definitely diagnosed ACS (ACS group) by coronary artery angiography (CAG) were enrolled,including 23 cases of unstable angina (UA group) and 29 cases of acute myocardial infarction (AMI group),and contemporaneous 58 cases of non-coronary arterial stenosis confirmed by CAG were selected as the control group (NC group).The serum levels of sFas and sLOX-1 were measured by enzyme linked immunosorbent assay.Results Compared with the NC group,the serum levels of sFas and sLOX-1 in the ACS group were increased,the serum levels of sFas and sLOX-1 in the AMI group and UA group were higher than those in the NC group,moreover which in the AMI group were higher than those in the UA group (P＜0.01).The serum sFas level in the ACS group was positively correlated with the sLOX-1 level (r=0.825,P=0.001),but both had no obvious correlation with the serum levels of CK-MB and cTnⅠ (P＞0.05).Conclusion High levels of serum sFas and sLOX-1 may be the risk factors of ACS.

ObjectiveTo investigate its dynamic characteristics and pathological mechanism on magnatic resonance diffusion weighted imaging (DWI) after chemoembolization in rabbit liver VX-2 tumor model.MethodsForty New Zealand rabbits were included in the study and forty-seven rabbit VX-2 tumor models were raised by implanting directly and intrahepatically after abdominal cavity was opened.Forty VX-2 tumor models from them were divided into four groups.DWI was performed periodically and respectively for each group after chemoembolization.All VX-2 tumor samples of each group were studied by pathology.The distinction of VX-2 tumors on DWI was assessed by their apparent diffusion coefficient (ADC) values.The statistical significance between different time groups,different area groups,or different b-value groups was calculated using SPSS 12.0 software.ResultsWhen b-value was 100 s/mm2,ADC values in the area of VX-2 tumor periphery,VX-2 tumor central,or normal liver parenchyma around tumor became gradually low in sixteen hours after chemoembolization,and were the lowest at sixteenth hour,and then they increased gradually from sixteenth hour to fourty-eighth hour after chemoembolization.The distinction of ADC between different time groups was significant,respectively ( F =7.325,P ＜ 0.01 ; F =2.496,P ＜ 0.05 ; F =6.856,P ＜0.01 ).Cellular edema in the area of VX-2 tumor periphery or normal liver parenchyma around tumor increased quickly in sixteen hours after chemoembolization; however,from sixteenth hour to forty-eighth hour,cellular edema in the area of normal liver parenchyma around tumor decreased gradually and that in the area of VX-2 tumor periphery decreased lightly at first and then increased continually.Cellular necrosis in the area of VX-2 tumor periphery after chemoembolization was more significant than that before chemoembolization.The areas of dead cells in VX-2 tumors manifested low signal and high ADC value while the areas of viable cells manifested high signal and low ADC value.ConclusionsDWI is able to detect and discriminate tumor necrotic areas from viable cellular areas before and after chemoembolization.ADC of normal liver parenchyma and VX-2 tumor are influenced by intracellular edema,tissue cellular death,and microcirculation disturbance after chemoembolization.