Objective To investigate the relationship between the abnormalities in the area behind the heart in the four-chamber view and fetal defects, the clinical significance of assessment of area behind the heart in fetal screening.Methods 7062 fetuses were scanned.Area behind the heart in the four-chamber view and anatomical survey were detected.Results Fifty-three cases (0.8％, 53/7062) with abnormal sonographic findings in the area behind the heart in the four-chamber view were detected prenatally.Thirtyseven cases were confirmed by autopsy postnatally.Among these cases, 73.0％ (27/37) had heterotaxy syndrome,8.1％(3/37) had situs inversus totalis,18.9％ (7/37) had heart defects.Conclusions There is close relationship between the abnormalities in the area behind the heart and the fetal defects.This can be used as an effective and simple indicator in screening situs inversus and cardiovascular abnomalities.

Objective To investigate the expression of monocyte-macrophage-related factors and interstitial fibrosis in kidney tissues of rats with ureter obstruction and recanalization .Methods Forty-eight male Spragur-Dawley rats were divided randomly into the obstructive group:sham (n=6), unilateral ureteral obstruction(UUO)3 days (n=6), UUO 7 days (n=6), and UUO 14 days (n=6) and recanalization group:bilateral ureteral obstruction(RBUO)0 day (n=6), 3 days after RBUO (n=6), 7 days after RBUO (n=6), and 14 days after RBUO (n=6).The kidneys were excised on day 3, 7, and 14, and the deposition of collagen fibers in kidney was detected with HE and Masson staining . Immunohistochemical analysis was performed to evaluate the protein expressions of monocyte chemoattractant protein -1 (MCP-1), macrophage colony-stimulating factor (M-CSF) and activated-macrophage marker CD68.Real-time PCR was used to detect the mRNA expressions of MCP-1 and M-CSF.TGF-β1 levels were determined by ELISA .Results Fibrosis observed with HE and Masson staining was obviously increased in kidney tissue of UUO rats , and aggravated as time prolonged, but alleviated in rats with recanalization .TGF-β1 levels were increased obviously in the UUO group , but decreased in rats with recanalization compared with those in BUO rats .In UUO rats, mRNA and protein expression levels of MCP-1 and M-CSF were increased .MCP-1 and M-CSF expression was gradually decreased in rats with recanalization compared with those in BUO rats .The dynamic change in expression of MCP-1 and M-CSF in both UUO rats and recanalization rats was consistent with the change in expression of CD 68. Conclusion Dynamic change in expression of MCP-1 and M-CSF in kidney tissues reflects change of activated and accumulated monocyte -macrophages , which may be one of the major mechanisms contributing to fibrosis induced by ureter obstruction .Renal fibrosis is alleviated by down-regulated expression of monocyte-macrophages factors with recanalization operation .

Objective: To investigate the relationship between hypertriglyceridemic waist (HTW) phenotype and abnormal blood pressure in children and adolescents in Yinchuan City, Ningxia, and to provide scientific basis for early identification and prevention of hypertension. Methods: A cluster sampling method was adopted to select 1 566 children and adolescents in Yinchuan. All participants completed questionnaire survey, physical measurement and biochemical examination. Results: In general, after adjusting for age, smoking, drinking, and family history of hypertension, compared with the normal triglyceride normal waist (NWNT) phenotype, the enlarged waist (EW) and HTW phenotypes both increased the risk of abnormal blood pressure ( OR EW =2.62, 95% CI =1.87-3.67; OR HTW =3.97, 95% CI =2.30-6.86); the risk of abnormal blood pressure in boys with EW and HTW phenotypes was that of boys with NTNW phenotype, respectively 3.80 times (95% CI =2.35-6.15) and 3.32 times (95% CI =1.59-6.92) of girls EW and HTW phenotypes. The risk of abnormal blood pressure in girls with EW and HTW phenotypes was that of girls with NTNW phenotype, respectively 1.72 times (95% CI =1.06-2.82) and 4.62 times(95% CI =1.97-10.85). Conclusion The hypertriglyceridemic waist phenotypes among children and adolescents in Yinchuan is significantly correlated with increased risk of abnormal blood pressure. More attention should be paid to triglyceride level and waist circumference among children and adolescents.

Objective: To explore the relationship between the muscle mass index (MMI) and the aggregation of cardiovascular risk factors (CVRFs) in children and adolescents, and to provide a scientific basis for the prevention and treatment of cardiovascular diseases in children and adolescents. Methods: The current situation study design was adopted, and 1 622 children and adolescents aged 12-17 years old in Yinchuan City were selected by a cluster random sampling method. All subjects were subjected to questionnaire survey, physical examination, body composition determination and laboratory index testing. Results: When other variables were not adjusted, MMI was a risk factor for the aggregation of cardiovascular risk factors ( P <0.01). After adjusting for age, gender and BMI, MMI became a protective factor for CVRFs≥1 ( OR =0.74, 95% CI =0.62-0.89), compared with insufficient MMI, the risk of developing CVRFs≥1 with good MMI and sufficient MMI was 0.60(95% CI =0.46-0.79), 0.56(95% CI =0.37- 0.85 ) times. The risk of CVRFs≥2 was 0.54(95% CI =0.37-0.79), 0.51(95% CI =0.30-0.87) times, and similar results were found in boys ( P <0.05). Conclusion Under the same BMI level, muscle mass index is a protective factor for cardiovascular risk factor aggregation in children and adolescents. Physical exercise of children and adolescents should be emphasized to maintain the best muscle mass and weight.

Objective: To analyze the interaction of fat mass (FM) and fat free mass (FFM) on the aggregation of cardiovascular disease risk factors (CVRFs) among children and adolescents in Yinchuan City, China, so as to provide scientific basis for the prevention of CVRFs and cardiovascular disease in children and adolescents. Methods: A total of 1 822 children and adolescents aged 12 to 18 years in Yinchuan City were randomly selected for questionnaire survey, physical examination, body composition assessment and laboratory tests, through a cluster sampling method from 2017 to 2020. Binary Logistic regression was used to analyze the relationship between FM, FFM and the aggregation of CVRFs, and their interaction was analyzed. Results: After adjusting for sex and age, the risk of having CVRFs aggregation ≥1 in high FM and low FFM group and high FM and high FFM group was 2.01(95% CI =1.46-2.77) and 3.64(95% CI =2.66-4.98) times higher than that in low FM and low FFM group, and the risk of having CVRFs aggregation ≥2 was 1.67(95% CI =1.06-2.63) and 4.20 (95% CI =2.76-6.38) times, respectively( P <0.05). There was a multiplicative interaction between FM and FFM, which increased the risk of CVRFs aggregration ≥1 and ≥2. The adjusted OR and 95% CI were 1.58(1.04-2.40) and 1.95(1.12-3.42), respectively( P <0.05). Conclusion The results indicated the additive and multiplicative interactions between high levels of fat mass and fat free mass on the aggregation of cardiovascular risk factors, which increased the risk of aggregation of cardiovascular risk factors.

Botulinum toxin type A (BTX A) has gain widespread use in various neurological conditions, characterized by safe injection and less side-effect. This review will examine the current research of BTX A in the following aspects: mechanism, location, dose and outcome, which manifests the safety and efficacy data of BTX A injection treatment to the symptoms of Parkinson disease, including refractory tremor, focal dystonia, loss of postural reflexes, sialorrhea, gastrointestinal symptoms and depressive disorder.

Objective:To explore the clinical characteristics and genetics of a pedigree with Stargardt disease, and investigate the pathogenicity of ABCA4 (ATP binding cassette subfamily A member 4) gene mutations in Stargardt disease.Methods:The proband was admitted to the Second People′s Hospital of Jinan in May 2021 due to diminution of vision. The proband was diagnosed with Stargardt disease according to the clinical diagnostic criteria of Stargardt disease. Detailed ophthalmological examinations was also performed on family members of the proband. Genomic DNA were extracted from the proband and the family members, and the whole exon sequencing was performed to find pathogenic gene mutations. The hazard of mutations was analyzed by polyphen-2, SIFT and MutationTaster websites. Sanger sequencing was used to verify the mutations. Conserved analysis of homologous species and 3-dimensional (3D) molecular model of the protein were used to analyze the pathogenicity.Results:Ophthalmological examinations showed reduced binocular vision, macular atrophy and "bull′s eye sign" in the proband and there was no abnormal signs and symptoms among the family members. Through whole exon sequencing analysis and Sanger sequencing verification, the compound heterozygous mutations (c.215G>A and c.6563T>C) of ABCA4 gene were co-segregated with this disease in this family. SIFT, Polyphen-2 and MutationTaster predicted that these two mutations were pathogenic. Conservative analysis and 3D molecular model of protein showed that mutations could cause changes in protein structure and affect protein function.Conclusion:The compound heterozygous mutations (C.215G>A and C.6563T>C) of ABCA4 gene are the pathogenic mutations of Stargardt disease in this pedigree.

Objective: To explore school counselors' attitude and decision-making towards dual relationship and confidentiality. Methods: Totally 123 school counselors (27 males and 96 females, aged 20 to 60 years old, 41 primary and secondary counselors, 82 college counselors) filled up of self-designed Questionnaire for School Psychological Consultants on Dual Relationship and Confidentiality Rules, and the related factors which could influence the school counselors' attitude and their decision-making in dual relationship and confidentiality in the counseling work. Results:Totally 71.5％ (n =88) school counselors chose not to accept other relationships with students after counseling, 14.6％ (n = 18) school counselors chose to accept other relationships with students after counseling. The school counselors who had not accepted supervisioneasier to answer as "accept other relationship may raise clients self-esteem or feelings" than those had got supervision (P <0.05). The school counselor believed that the confidentiality agreement should be breached of the top 3(suicide attention, drug use and bad gangs). Counselors easier to breach confidentiality agreements on situation of students had suicide plans than situation of students had plans to run away from home(P <0.001). Conclusion:This study shows that two factors, including supervision and differential clients "issue may have effect on school counselors" attitudes and decision-making towards dual relationship and confidentiality situation in their counseling practice.

Objective To investigate the prevalence and associated risk factors for pterygium among people aged 50 years and above in Funing County,Jiangsu Province.Methods A cluster random sampling method was performed,the subjects aged 50 years or above were randomly selected from 30 survey sites in Funing County,Jiangsu Province.Questionnaires,visual acuity tests,the examinations of eye surface,anterior segment,fundus examinations were conducted.Pterygium was diagnosed and graded clinically by slit lamp examination.The risk factors were acquired from questionnaires and analyzed by the multivariate logistic regression analysis.This study protocol was approved by Ethic Committee of Affiliated Hospital of Nantong University (NO.2010-05).Written informed consent was obtained from each subject prior to entering study cohort.Results A total of 6 145 persons aged 50 years and above were enumerated,and actually 5 947 (96.8％) participants were examined.Among them,1 950 cases were diagnosed as pterygium in either eye and 1 228 cases were diagnosed as pterygium in binoculus,which was equivalent to the 32.79％ [95％ confidence interval(CI):31.60％-33.98％] of pterygium in either eye and 20.65％ (95％ CI:19.62％-21.68％) in bilateral pterygium.Among 2467 male subjects,838 were diagnosed as pterygium (33.97％,95％ CI:32.10％-35.84％).Among 3480 female subjects,1 112 were diagnosed as pterygium (31.95％,95％ CI:30.40％-33.51％).There was no significant difference in the prevalence of pterygium between genders (P =0.135).Multivariate Logistic analysis showed that,older age (50 ～ ＜60 years:odds ratio [OR] =1.00;60 ～ ＜70 years:OR=1.54,P＜0.001;70 ～ ＜80 years,OR=1.83,P＜0.001;≥80 years:OR=1.99,P＜0.001),low educational level (no education:OR =1.00;＜primary:OR =0.87,P =0.031;primary education:OR =0.72,P =0.002;≥ secondary education:OR =0.63,P =0.002),farmer occupations (OR =1.34,P =0.020),and long outdoor work time (OR =1.13,P =0.026) were independent risk factors for pterygium.Gender,marriage,income,hypertension,diabetes,smoking and alcohol use history were not associated with pterygium (all at P＞0.05).Conclusions The prevalence of pterygium in Funing County is 32.79％ in people aged 50 years and above.The high prevalence of pterygium may be associated with older age,low education level and long outdoor work time.

Objective In the recovery process of stroke patients, the ability of maintaining standing and sitting position might have a great effect on the improvement of activity of daily living. There are few the methods which evaluate quantitatively and effectively the ability of position control ability in clinical practice. The aim of the study is to quantitatively evaluate the reliability of posturographic parameters based on the center of pelvis in different standing positions and walking activity.Methods From May to June, 2018, Seventy-nine healthy participants were enrolled. They were evaluated with iReGo, a walking assisstant robot, in three conditions: normal standing position, left/right standing position and walking 10 meters at an appropriate speed. The computer calculated the posturographic parameters automatically. The participants completed their second test one day after the first one.Results During normal standing position, the intra-class correlation coefficients (ICC) of average sway in coronal plane, average sway in sagittal plane, path length, and covered area were more than 0.70. During left standing position, ICC of all the above parameters were more than 0.70. During right standing position, ICC of all the above parameters were more than 0.49. When walking 10 meters at an appropriate speed, ICC of path length and covered area were more than 0.75. Comparing different standing positions, the normal standing position was more stable than the left/right standing position, and there was no difference between the left and the right standing positions.Conclusion Posturographic parameters based on the center of pelvis might be a reliable way to assess the position control ability in different standing positions and walking process.