Objective To investigate the impact of body mass index (BMI) on the outcome of intrauterine insemination (IUI) for infertility patients. Methods A total of 1 393 infertility patients undergoing their first cycle of IUI were selected as study subjects, and were divided into normal BMI group (n=824), overweight group (n=394) and obese group (n=175) based on BMI. Age, duration of infertility, type of infertility, sex hormones, fasting blood glucose, fasting insulin, thyroid function, timing of insemination, number of progressively motile spermatozoa, biochemical pregnancy rate, clinical pregnancy rate and miscarriage rate were compared among the three groups. Multiple linear regression analysis was used to analyze the influencing factors of BMI; the effects of age, BMI, fasting blood glucose and fasting insulin on IUI outcome were analyzed by binary Logistic regression. Receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of BMI for biochemical pregnancy and clinical pregnancy, and the cut-off value was calculated. Results There were no significant differences in age, time of insemination, number of progressively motile spermatozoa, clinical pregnancy rate and miscarriage rate among the three groups (P>0.05). The duration of infertility, fasting blood glucose and fasting insulin levels in the obese and overweight groups were significantly longer or higher than those in the normal BMI group (P < 0.05). The follicle-stimulating hormone (FSH) level in the obese group was significantly lower, while the free thyroxine (FT4) level in the obese group was significantly higher than that in the overweight group and normal BMI group (P < 0.05). The biochemical pregnancy rate in the obese group was significantly higher than that in the normal BMI group (P < 0.05). Multiple linear regression analysis showed that BMI was negatively correlated with FSH and estradiol (E2) (P < 0.01) and positively correlated with fasting blood glucose and fasting insulin (P < 0.01). Multivariate binary logistic regression analysis showed that age and BMI were influencing factors for clinical pregnancy (P < 0.05), while age, BMI, and fasting insulin were influencing factors for biochemical pregnancy (P < 0.05). The ROC curve showed that the area under the curve (AUC) for BMI predicting biochemical pregnancy and clinical pregnancy was 0.608 and 0.610, respectively, with a cut-off value of 23.05 kg/m² for both. Conclusion BMI affects the endocrine and glycolipid metabolism of infertility patients. BMI can be used as an independent factor to predict biochemical pregnancy and clinical pregnancy in IUI.

Objective:To evaluate the clinical efficacy of Bushen Huoxue Shujin Decoction combined with thunder fire moxibustion in the treatment of lumbar intervertebral disc herniation with kidney deficiency and blood stasis syndrome.Methods:Randomized controlled trial. A total of 200 lumbar intervertebral disc herniation patients from Dongzhimen Hospital of Beijing University of Chinese Medicine from January to December 2021 were selected as observation objects and the computer random method was used to divide 66 patients into combination group, 67 in the control group 1, and 67 in the control group 2. The Control group 1 was given conventional western medicine and thunder fire moxibustion, the control group 2 was given conventional western medicine and Bushen Huoxue Shujin Decoction, and the combined group was given conventional western medicine and Bushen Huoxue Shujin Decoction and thunder fire moxibustion. All the groups were treated with 14 days as a course of treatment, a total of 3 courses. TCM syndrome scores were performed before and after treatment, and lumbar joint activity was measured by using a muscle state testing analyzer; the levels of NF-κB, prostaglandin E2 (PGE2) and hypoxia-inducible factor-2α (HIF-2α) were determined by ELISA; adverse reactions during treatment were recorded and clinical efficacy was evaluated.Results:The total effective rate of the combination group was 92.42%(61/66), the control group 1 was 71.64% (48/67), and the control group 2 was 74.63% (50/67), with a statistically significant difference among the three groups ( χ2=10.28, P=0.006). After treatment, the scores of waist and leg pain, lumbar stiffness, lower limb numbness, and tongue dullness in the combination group were significantly lower than those in the control group 1 and control group 2 ( F values were 15.25, 12.21, 11.77, 14.49, respectively, P<0.01); the range of motion of lumbar joint forward flexion, backward extension, lateral flexion, and lateral rotation in the combination group were significantly greater than those in the control group 1 and control group 2 ( F values were 19.66, 29.50, 33.33, and 24.54, respectively, P<0.01); the levels of serum NF-κB [(41.29±5.91)ng/L vs. (49.97±5.98)ng/L, (50.92±6.02)ng/L, F=47.00], PGE2 [(67.09±8.08)ng/L vs. (80.22±9.92)ng/L, (78.17±9.09)ng/L, F=40.27], HIF-2α[(16.95±3.46) ng/L vs. (20.83±3.98)ng/L, (19.67±3.89)ng/L, F=18.38] in combination group were significantly lower than those in the control group 1 and control group 2 ( P<0.01). During the treatment period, the incidence of adverse reactions in the combination group was 15.15% (10/66), control group 1 was 8.96% (6/67), and control group 2 was 10.45% (7/67), there was no statistically significant difference between the three groups ( χ2=1.36, P=0.506). Conclusion:The combination of Bushen Huoxue Shujin Decoction and thunder fire moxibustion can improve the TCM syndrome and range of motion of patients with kidney deficiency and blood stasis syndrome of lumbar intervertebral disc herniation, inhibit the expression of inflammatory factors, improve clinical efficacy, and have good safety.

Objective To evaluate the clinical value of Fluorine-18-fluorodeoxyglucose (18F-FDG) positron-emission temography-computed tomography (PET-CT) examination in intrahepatic cholangiocarcinoma (ICC) staging.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 190 patients with ICC who were admitted to the Eastern Hepatobiliary Surgery Hospital Affiliated to Naval Military Medical University from September 2013 to June 2016 were collected.There were 107 males and 83 females,aged from 37 to 79 years,with an average age of 57 years.There were 90 cases without distant metastasis undergoing surgery treatment and 100 with distant metastasis undergoing non-surgical treatment.Patients underwent preoperative CT,magnetic resonance imaging (MRI),and PET-CT examination,and then received surgery or non-surgery according to preference of patients and their family members.Observation indicators:(1) imaging features on preoperative CT,MRI,PET-CT examination;(2) treatment;(3) evaluation of tumor diameter,multiple tumors,macrovascular invasion,and bile duct invasion by three examinations in ICC staging of patients undergoing operation;(4) evaluation of regional lymph node metastasis by three tests in ICC staging of patients undergoing operation;(5) evaluation of distant metastasis in ICC staging by three tests.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed by single factor ANOVA and paired comparison was analyzed by SNK method.Measurement data with skewed distribution were described as M (range).Count data were described as absolute number or percentage,and comparison between groups was analyzed using the chi square test.Results (1) Imaging features on preoperative CT,MRI,PET-CT examination:all the 190 patients received routine upper abdominal CT,MRI,and systemic PET-CT examination before treatment.CT imaging of ICC showed inhomogeneous low density on plain scan,peripheral enhancement in arterial phase,persistent enhancement of tumor margin in portal phase,and sometimes mild to moderate centripetal enhancement.MRI imaging showed heterogeneous low signal on T1-weighted imaging,uneven high,and slightly high signal on T2-weighted imaging.Reinforcement on MRI is the same as CT.Transverse images,fusion transverse images and maximum intensity projection images of PET-CT imaging showed abnormal high FDG uptake around the tumor.(2) Treatment:81 out of the 90 ICC patients with surgery treatment underwent hepatectomy and lymphadenectomy,and 9 underwent only tumor tissue biopsy and lymph node biopsy due to intraoperative finding of abdominal metastasis.Of the 100 non-operated patients,30 received systemic chemotherapy,23 received local radiotherapy,and 47 gave up treatment.(3) Evaluation of tumor diameter,multiple tumors,macrovascular invasion,and bile duct invasion by three examinations in ICC staging of patients undergoing operation:the tumor diameters of ICC on CT,MRI and PET-CT were (6.8±2.8)cm,(6.9±2.9)cm,(7.2±2.8)cm,respectively.There was no significant difference among the three methods (F=0.085,P＞0.05).CT,MRI,PET-CT had similar accuracy of 80.0％ (72/90),78.9％ (71/90),72.2％ (65/90) on diagnosing multiple tumors,87.8％(79/90),92.2％ (83/90),94.4％ (85/90) for macrovascular invasion,and 93.3％ (84/90),95.6％ (86/90),96.7％ (87/90) for vascular and bile duct invasion,respectively,there was no significant difference in the above indicators between the three groups (x2 =1.801,2.662,1.131,P＞0.05).(4) Evaluation of regional lymph node metastasis by three examinations in ICC staging of patients undergoing operation:the accuracy of CT,MRI and PET-CT examination for lymph node metastasis was 62.2％ (56/90),68.9％(62/90),86.7％ (78/90) and sensitivity was 40.0％ (16/40),47.5％ (19/40),80.0％ (32/40),respectively,showing significant differences between the three groups (x2 =14.446,14.666,P＜0.05),showing a significant difference between CT and PET-CT examination (x2=14.134,13.333,P＜0.05),showing a significant difference between MRI and PET-CT examination (x2=8.229,9.141,P＜0.05).The sensitivity of CT,MRI and PET-CT examination for lymph node metastasis was 80.0％ (40/50),86.0％ (43/50),92.0％ (46/50),showing no significant difference between the three groups (x2=2.990,P＞0.05).(5) Evaluation of distant metastasis in ICC staging by three tests:there were 27,34 and 100 cases with distant metastasis evaluated by CT,MRI and PET-CT examination,including 40 with supraclavicular lymph node metastasis,32 with bone metastasis,30 with mediastinal lymph node metastasis,20 with hilar lymph node metastasis,17 with pulmonary metastasis;77 patients had more than 2 sites of metastasis.The accuracy of CT,MRI and PET-CT examination for distal metastasis in 190 ICC patients was 61.58％ (117/190),65.26％ (124/190),98.42％ (187/190),respectively,with a significant difference between the three groups (x2=83.639,P＜0.05),with a significant difference between CT and PET-CT examination (x2=80.592,P＜0.05),between MRI and PET-CT examination (x2=70.284,P＜ 0.05).Conclusion PET-CT examination makes up for the deficiency of CT and MRI in judging regional lymph node metastasis and distant metastasis,and contributes to the clinical staging of ICC.

Due to prolonged life expectancy, people's requirements for quality of life are also increasing. As a protein anabolic hormone, testosterone not only improves muscle and bone health, but also improves energy and sexual function. It is widely used in middle-aged and elderly people, especially in patients with delayed-onset hypogonadism( LOH). However, as several clinical studies have found that testosterone supplementation increases cardiovascular risk, the use of testosterone decreased sharply, and some patients who require testosterone therapy thus do not receive treatment timely. This article summarizes the current clinical research results and analyzes the dilemma of testosterone supplementation therapy.

Objective To investigate serum lipid profiles in newly diagnosed patients with polycystic ovary syndrome (PCOS) using lipidomics and correlate these features with hyperinsulinemia and hyperandrogenism associated with PCOS and obesity. Methods 32 newly-diagnosed PCOS women and 34 controls were enrolled and divided into obese and lean subgroups according to the body mass index (BMI). Anthropometric, biochemical, and hormonal parameters were collected. Serum lipid profiles including phospholipids, free fatty acids (FFAs), and bioactive lipids were analyzed using GC-MS and LC-MS. Results PCOS patients, in particular, the obese ones with fatty liver, have abnormal phosphatidylcholine (PC)/lysophospholipid (LPC) metabolism. PC was increased (16∶0, 18∶0, 18∶1, 18∶2, and 20∶4), while LPC was decreased (16∶0, 18∶0, and 18∶1; all P<0.05). Serum polyunsaturated fatty acids (PUFAs), were decreased significantly, and the long chain saturated fatty acid was increased. We also found that insulin stimulated the metabolism of PUFAs, but the androgen inhibits the metabolism of PUFAs by measuring their metabolites. Conclusion PCOS patients have metabolic disorders of phospholipids and PUFAs. Insulin stimulated while androgen inhibited PUFAs metabolism.

Polycystic ovary syndrome ( PCOS) is a complex syndrome with clinical manifestations of both endocrine and metabolic disorders. The etiology and pathogenesis are complex. PCOS seriously affects reproductive function, and also significantly increases the risk of metabolic and cardiovascular diseases, which often requires long-term intervention, with uncertain efficacy. Proteomics and lipidomics/metabolomics are efficient methods to determine the metabolic disorders using liquid/gas chromatography-tandem mass spectrometry ( LC/GC-MS/MS ) . A deeper understanding of the metabolic characteristics presented in different subtypes of PCOS may, in future, be able to find new biomarkers and to guide some novel precise interventions.

Objective To determine whether the single nucleotide polymorphisms (SNPs) rs231775 and rs3087243 of the cytotoxic T lymphocyte antigen 4 (CTLA-4) gene are associated with susceptibility to Graves' disease (GD) in Chinese Han population.Methods Patients were enrolled from outpatient department and wards.Blood samples from each subject were collected to extract DNA,and the genotypes were determined by TagMan-MGB probe.Results The frequencies of allele G (OR =1.244,95％ CI 1.124-1.377,P＜0.01) and genotype GG (55.3 ％ vs 49.1％,OR =1.279,95 ％ CI 1.126-1.454,P＜0.01) of rs231775 in GD group were higher than those in control group.The frequencies of allele G (OR =1.303,95％ CI 1.166-1.457,P＜0.01) and genotype GG (76.8％ vs 71.8％,OR=1.302,95％ CI 1.143-1.484,P＜0.01) of rs3087243 in GD group were also higher.Conclusion GG genotypes in rs231775 and rs3087243 of CTLA-4 gene are related to the high risk of GD.

Objective To explore the prevalence of polycystic ovary syndrome (PCOS) in nurse of reproductive age and compare the characteristics of four phenotypic subgroups.Methods A cross-sectional survey was carried out in nurses aged 18-45 years in Renji Hospital in 2011.Questionnaire and anthropometric and biochemical assessments were made.Pelvic ultrasound evaluations were made and blood androgen levels were determined.Diagnosis of PCOS was based on Rotterdam 2003 criteria,consisting of anovulation/oligo-ovulation (ANOVU),clinical and/or biochemical hyperandrogenism (HA) and polycystic ovaries (PCO).Results There were 520 participants and finally 486 individuals finished questionnaire and androgen level determination.283 subjects were totally normal,48 suffered from PCO,129 HA,and 89 ANOVU.54 out of 486 women were diagnosed as PCOS,a prevalence of 11.1％.A significant difference exited only in age among four phenotypic subgroups (P＜0.05).There was no statistic difference in other parameters.Conclusion Establishing an explicit definition of each condition in PCOS criteria has important investigational implications and increase the comparability of published researches.Application of Rotterdam criteria is feasible for earlier diagnosis and timely intervention in order to prevent serious complications.

Objective To investigate the relationship between serum uric acid level and body fat depots as well as the possible influencing factors of the relationship in type 2 diabetic patients.Methods Five hundred and thirty two patients hospitalized for type 2 diabetes were recruited in this study.According to serum uric acid,the subjects were classified into normal uric acid group (group NUA,n =426) and high uric acid group ( group HUA,n =106 ).Anthropometry ( BMI,waist circumference,hip circumference and WHR),serum uric acid level,blood glucose,renal function and lipid levels were compared between the two groups.Results Serum uric acid level was closely related to body fat distribution:(1) in group HUA,WHR,BMI,BUN,SCr and TG were significantly higher than that of group NUA ( [ 0.94 ± 0.07 ] vs.[ 0.91 ± 0.07 ],[ 26.91 ± 3.90 ]kg/m2 vs.[23.84 ±3.80] kg/m2,[8.66 ±5.94] mmol/L vs.[6.29 ±3.64] mmol/L,[93.9 ± 67.6 ] μmol/Lvs.[63.9 ± 20.6 ] μmol/L,[ 2.65 ± 1.92 ] mmol/L vs.[ 1.86 ± 1.46 ] mmol/L,respectively; all P ＜ 0.05 ] ;while HDL-C was lower in Group HUA than in group NUA ( [ 1.09 ± 0.32 ] mmol/L vs.[ 1.24 ± 0.45 ] mmol/L,P ＜0.05).(2) Multiple regression analysis revealed that the serum uric acid levels were positively correlated with BMI,SCr,and TG ( b =0.201,0.500,0.153,respectively,P ＜ 0.05 ),but negatively correlated with HbA(1)c and HDL-C ( b =- 0.168 and - 0.121,P ＜ 0.05 ).Conclusion In patients with type 2 diabetes,serum uric acid levels are closely related with the BMI and Glucose/lipid metabolism,which suggests that body weight control is as important as the uric acid lowering treatment in patients with type 2 diabetes to cut the risks of cardiac and vascular diseases.

Diabetic rat model was induced by high fat diet combined with streptozotocin (STZ). After the model was established, blood samples were taken from jugular veins to examine plasma adrenocorticotropic hormone (ACTH) and corticosterone, and hypothalamus and pituitary were removed for real-time PCR. There were no significant differences in basal plasma ACTH and corticosterone level among control, obese, and obese diabetic rats (P=0.07). The corticosterone rhythm in obese and obese diabetic rats was impaired. Hypothalamus glucocorticoid receptors (GR) mRNA expressions yielded similar results in the groups, but 11β-HSD1 mRNA expression in obese diabetic rats was up-regulated ( vs control rats, P<0.05 ). The expressions of GR and 11β-HSD1 in pituitary of obese diabetic and obese rats were significantly down-regulated (both P<0.05). In the obese diabetic rats, the impaired glucocorticoid negative feedback was partly due to down-regulation of 11 β-HSD1 and GR expressions in pituitary.