Objective:To investigate the clinical value of fetal ultrasonography in the screening of congenital heart malformations in twins at 11-13 + 6 weeks of gestation. Methods:A retrospective cohort study method was used.Cases were collected from Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital (January 2012 to December 2016) and the Fourth Hospital of Shijiazhuang City (January 2014 to December 2018). The twins with singleton or twins with cardiac malformation were screened out as the cardiac malformation group, and the twins with normal delivery during the same period were selected as the control group. Ultrasound data such as the nuchal translucency (NT), crown-rump-length (CRL), chorionicity, conception method, NT discordance, CRL discordance, NT discordance ≥20% incidence rate between twins, and the CRL discordance ≥10% incidence rate between twins in the two groups at 11-13 + 6 weeks were compared and analyzed. Results:①There were 30 cases in the cardiac malformation group (including 27 twins with singleton cardiac malformation and 3 twins with twin cardiac malformation) and 1 906 cases in the control group. ②The incidence rates of NT value ≥95th percentile and NT value ≥99th percentile in one or two pregnancies were significantly higher in the cardiac malformation group than in the control group (20.00% vs 2.20%, P<0.001; 10.00% vs 0.63%, P=0.002), the area under the ROC curve (AUC) for cardiac malformation screening was 0.589 and 0.549, respectively; CRL discordance in cardiac malformation group was higher than that in control group ( P=0.018), the incidence of CRL discordance ≥10% in the cardiac malformation group was higher than that in the control group (26.67% vs 12.70%, P=0.024), the AUC of cardiac malformation screening was 0.570; there were no significant differences in the incidence of NT discordance, the incidence of NT discordance ≥20%, pregnancy pattern and chorionicity between the two groups (all P>0.05). ③Multivariate Logistic regression analysis was performed using the incidence rates of NT value ≥95% and NT value ≥99%, CRL discordance ≥10%, and NT discordance ≥20%. The incidences of fetal NT value ≥95% and NT value ≥99% were risk factors for cardiac malformation in twins ( OR=11.095, 105.778; 95% CI=4.311-28.558, 16.984-658.796). Conclusions:Ultrasound at 11-13 + 6 weeks of gestation showing thickened value of one or two fetuses, and the CRL discordance≥10%, indicates an increased risk of cardiac malformation in the twins; NT value ≥95% and NT value ≥99% is a risk factor for heart defects in twins.

Objective:To explore the mediating effect of perceived professional benefits between the humanistic literacy and spiritual care competence among oncology nurses.Methods:From September to October 2022, convenience sampling was used to select 354 oncology nurses from 11 ClassⅢ Grade A hospitals in Sichuan Province, Guangdong Province, and Hubei Province as the research subject. A survey was conducted on oncology nurses using the General Information Questionnaire, Nurses' Perceived Professional Benefit Questionnaire, Nurses' Humanistic Literacy Scale, and the Chinese version of the Spiritual Care Competence Scale (SCCS) . Pearson correlation was used to analyze the relationship between nurses' humanistic literacy, perceived professional benefits, and spiritual care competence. AMOS 26.0 software was used to analyze mediating effects. A total of 354 questionnaires were distributed, and after excluding 7 unqualified questionnaires, 347 valid questionnaires were collected, with a valid response rate of 98.02%.Results:Among 347 oncology nurses, the score of the Chinese version of SCCS was (77.60±19.04) . The total score of the SCCS was positively correlated with the total scores of the Nurses' Humanistic Literacy Scale, the Nurses' Perceived Professional Benefit Questionnaire, and scores of all dimensions, with statistically significant differences ( P<0.01) . Bootstrap test showed that the mediating effect of perceived professional benefits among oncology nurses between humanistic literacy and spiritual care competence was 0.284 [95% CI (0.408, 0.860) ] , accounting for 50.90% of the total effect. Conclusions:The perceived professional benefits of oncology nurses play a partial mediating role between humanistic literacy and spiritual care competence. We should strengthen training on the humanistic literacy of oncology nurses, enhance their perceived professional benefits, form a virtuous cycle of employment, and thereby improve their spiritual care competence.

Tic disorders(TD)are a group of childhood-onset neuropsychiatric conditions.Due to sudden, aimless, rapid muscle contraction, patients with TD often have different forms of tic such as blinking, frown, shoulder shaking and voice clearing, which seriously affect their quality of life.However, the etiology of TD has not yet been clear, hence the aim of patients management is targeted to symptom relief until now.In fact, many studies have found that the pathogenesis of TD could be a combined effect of multiple factors, including genetic, immunological, psychological and environmental variables.Here, we reviews the results of recent studies on the etiology of TD, hoping to provide new ideas and directions for the etiological research on TD.

Background::Hypertension and non-alcoholic fatty liver disease (NAFLD) share several pathophysiologic risk factors, and the exact relationship between the two remains unclear. Our study aims to provide evidence concerning the relationship between hypertension and NAFLD by analyzing data from the National Health and Nutrition Examination Survey (NHANES) 2017-2018 and Mendelian randomization (MR) analyses.Methods::Weighted multivariable-adjusted logistic regression was applied to assess the relationship between hypertension and NAFLD risk by using data from the NHANES 2017-2018. Subsequently, a two-sample MR study was performed using the genome-wide association study (GWAS) summary statistics to identify the causal association between hypertension, systolic blood pressure (SBP), diastolic blood pressure (DBP), and NAFLD. The primary inverse variance weighted (IVW) and other supplementary MR approaches were conducted to verify the causal association between hypertension and NAFLD. Sensitivity analyses were adopted to confirm the robustness of the results.Results::A total of 3144 participants were enrolled for our observational study in NHANES. Weighted multivariable-adjusted logistic regression analysis suggested that hypertension was positively related to NAFLD risk (odds ratio [OR] = 1.677; 95% confidence interval [CI], 1.159-2.423). SBP ≥130 mmHg and DBP ≥80 mmHg were also significantly positively correlated with NAFLD. Moreover, hypertension was independently connected with liver steatosis ( β = 7.836 [95% CI, 2.334-13.338]). The results of MR analysis also supported a causal association between hypertension (OR = 7.203 [95% CI, 2.297-22.587]) and NAFLD. Similar results were observed for the causal exploration between SBP (OR = 1.024 [95% CI, 1.003-1.046]), DBP (OR = 1.047 [95% CI, 1.005-1.090]), and NAFLD. The sensitive analysis further confirmed the robustness and reliability of these findings (all P >0.05). Conclusion::Hypertension was associated with an increased risk of NAFLD.

Objective:To investigate the status of postoperative sore throat and hoarseness in patients undergoing general anesthesia with double-lumen endotracheal intubation and analyze its influencing factors.Methods:Using the convenient sampling method, a total of 129 patients with double-lumen endotracheal intubation who underwent elective surgery in a Class Ⅲ Grade A general hospital in Wuhan in Hubei Province from July to December 2020 were selected as the research objects. The general information questionnaire, Visual Analogue Scale (VAS), Labial and Tongue Mucosa Scale and Hoarse Voice Scale were used to investigate the patients.Results:The incidence of sore throat in 129 patients with double-lumen endotracheal intubation at 1, 6, 24, 48 and 72 hours after surgery were 68.22%, 44.96%, 76.74%, 64.34% and 48.84%, respectively. Among them, the incidences of sore throat in resting state were respectively 10.9%, 6.2%, 1.6%, 0 and 1.6%, incidences of sore throat in swallowing state were respectively 18.6%, 8.5%, 3.1%, 0 and 0, and the incidences of hoarseness were respectively 66.67%, 45.74%, 78.29%, 65.89% and 48.84%. There were statistically significant differences in the occurrence of hoarseness in patients of different ages and preoperative fasting time 1 hour after extubation ( t=2.499, 2.106; P<0.05). The VAS scores of patients with hoarseness in resting state and swallowing state were higher than those in patients without hoarseness, and the differences were statistically significant ( t=3.688, 2.818; P<0.01). Correlation analysis showed that hoarseness was negatively correlated with the condition of lip and tongue mucosa ( r=-0.309, P<0.01) . Conclusions:The incidence of postoperative throat pain in patients undergoing general anesthesia with double-lumen endotracheal intubation is high. With the extension of time, pain can be gradually relieved. The self-healing effect of hoarseness over time is not ideal. Advanced age, prolonged water fasting before operation and dry lip and tongue mucosa are the influencing factors of postoperative sore throat. Early identification and effective measures should be given in nursing evaluation to reduce the occurrence of postoperative sore throat.

Bluetongue virus is an arbovirus that seriously harms ruminants such as sheep,this study aims to investigate the molecular mechanism of bluetongue virus infection and host cell interferon antiviral immune response.The study was conducted to characterize the mRNA expression of inter-feron pathway genes by real-time fluorescence quantitative PCR,as well as Western blot analysis of MDA5,TRAF3,RIG-Ⅰ,and TBK1 protein expression in BHK-21 cells induced by BTV with a multiplicity of infections(MOI)of 1 for 18,24,and 36 h.The results showed that the most pro-nounced changes in the expression of interferon signaling pathway genes were observed at 24 h of induction,the gene mRNA expression levels of the IFN-α,IFN-β,RIG-Ⅰ,TBK1,MDA5,VISA,and TRAF3 genes were upregulated.However,the mRNA expression levels of IKKε and TRAF6 genes were downregulated.At the protein level,MDA5 and TBK1 proteins were upregulated while RIG-1 and TRAF3 proteins were downregulated,which showed that BTV infection induces a typeⅠ interferon immune response in BHK-21 cells.This study lays the foundation for further exploring the antiviral immunity mechanism of IFN-Ⅰ signaling pathway regulatory genes in host cells infected with BTV infection.

Objective:To explore the clinical characteristics and genetic variants in three children with late-onset Multiple acyl-Coenzyme A dehydrogenase deficiency (MADD type Ⅲ).Methods:Clinical data of three children diagnosed with late-onset MADD at the Children′s Hospital Affiliated to Zhengzhou University between March 2020 and March 2022 were retrospectively analyzed. All children were subjected to whole exome sequencing (WES), and candidate variants were verified by Sanger sequencing. All children had received improved metabolic therapy and followed up for 1 ~ 3 years.Results:The children had included 2 males and 1 female, and aged from 2 months to 11 years and 7 months. Child 1 had intermittent vomiting, child 2 had weakness in lower limbs, while child 3 had no symptom except abnormal neonatal screening. Tandem mass spectrometry of the three children showed elevation of multiple acylcarnitines with short, medium and long chains. Children 1 and 2 showed increased glutaric acid and multiple dicarboxylic acids by urine Gas chromatography-mass spectrometry (GC-MS) analysis. All children were found to harbor compound heterozygous variants of the ETFDH gene, including a paternal c. 1211T>C (p.M404T) and a maternal c. 488-22T>G variant in child 1, a paternal c. 1717C>T (p.Q573X) and a maternal c. 250G>A (p.A84T) variant in child 2, and a paternal c. 1285+ 1G>A and maternal c. 629A>G (p.S210N) variant in child 3. As for the treatment, high-dose vitamin B2, levocarnitine and coenzyme Q 10 were given to improve the metabolism, in addition with a low fat, hypoproteinic and high carbohydrate diet. All children showed a stable condition with normal growth and development during the follow-up. Conclusion:The compound heterozygous variants of the ETFDH gene probably underlay the muscle weakness, remittent vomiting, elevated short, medium, and long chain acylcarnitine, as well as elevated glutaric acid and various dicarboxylic acids in the three children with type Ⅲ MADD.

【Objective】 To investigate the current situation of social anxiety in children with attention deficit hyperactivity disorder (ADHD), and to analyze the factors influencing social anxiety in ADHD children, in order to provide reference for improving the clinical management of ADHD children. 【Methods】 A total of 206 school-age children with ADHD were selected from the Children′s Psychology Clinic of Mianyang Central Hospital from January 2020 to January 2023. The relevant clinical data of the children were collected through the general data questionnaire. Children′s Social Anxiety Scale (SASC) was used to assess social anxiety, and the Social Response Scale (SRS) was used to assess social ability. The Chinese version of Swanson,Nolan and Pelham Rating Scale Ⅳ (SNAP-Ⅳ) was used to assess core symptoms. Multivariate Logistic regression analysis was used to determine influencing factors of social anxiety in children with ADHD. 【Results】 There were 128(62.14%) cases detected with social anxiety among 206 children with ADHD. The score of SASC was 14.02±4.06. The proportions of girls (χ²=6.057), comorbid autism spectrum disorder(ASD) (χ²=4.929), and main caregivers with junior high school education or below (χ²=13.345), the total score of SRS(t=5.842) and SNAP-Ⅳ(t=7.848) and the scores of all dimensions were significantly higher than those in the non-anxious group (P<0.05). Multivariate Logistic regression analysis showed that higher SRS total score(OR=5.217, 95%CI: 2.309 - 11.791), higher SNAP-Ⅳ total score(OR=4.150, 95%CI: 1.974 - 8.722), girls(OR=2.268, 95%CI: 1.423 - 3.616), primary caregivers with junior high school education or below (OR=1.527, 95%CI: 1.162 - 2.005), and comorbid ASD (OR=1.551, 95%CI: 1.209 - 1.990) were risk factors for social anxiety in ADHD children (P<0.05). 【Conclusions】 Children with ADHD have a higher prevalence rate of social anxiety. Cognitive behavioral therapy and psychological intervention should be strengthened for high-risk children to improve social ability and reduce the risk of social anxiety.

Objective:To explore the protective effect of methyl eugenol (Me) on islet ischemia/reperfusion (I/R) injury and elucidate its underlying mechanism.Methods:The islets were isolated and purified from 6-8 week male BALB/c mice and divided into four groups of normal control (normal culture without any treatment), hypoxia/reoxygenation (H/R treatment), H/R+ dimethyl sulfoxide (DMSO dosing plus H/R treatment) and H/R+ Me (Me dosing plus H/R). Viability of islet cells in each group was detected by acridine orange (AO)/propidium iodide (PI) double stain.Function of islet cells (insulin secretion) was measured by enzyme-linked immunosorbent assay (ELISA). Murine islet β Min6 cells were selected for detecting the effect of Me on the proliferative activity of normal cultured and H/R treated islet cells under different concentration gradients by CCK8.Then Min6 cells were divided into four groups of normal, H/R, H/R+ DMSO and H/R+ Me.The definition of group was the same as that of primary murine islets.Flow cytometry and Hoechst 33342 nuclear stain were utilized for detecting cell apoptotic rate in each group.The protein expressions of p-JNK, p-p38, JNK, p38, Bcl-2 and Bax were detected by Western blot.And the data were processed by one-way ANOVA or t test.Results:The proportion of dead islet cells in H/R group was (29.47±2.65)% and it was significantly lower than that in normal group (7.63±1.53)%.And the inter-group differences were statistically significant ( P<0.001). The proportion of dead islet cells was (20.63±3.07)% in H/R+ Me group.It was higher than that in H/R group (29.47±2.65)% and in H/R+ DMSO group (30.13±1.50)% and inter-group difference was statistically significant ( P<0.05 & P<0.01). Under the stimulation of high glucose, the insulin secretion level of islet in H/R+ Me group was (1.76+ 0.08) mg/L, which was higher than that in H/R group and H/R+ DMSD group(1.24±0.14)mg/L and(1.27±0.05)mg/L, and the difference was statistically significant[(1.76±0.08) vs. (1.24±0.14) mg/L; (1.76±0.08) vs.(1.27±0.05) mg/L, P<0.01]. There was no significant effect on cell viability after Me dosing within a certain concentration range (0-40 μmol/L). After Me dosing (5 μmol/L), cell viability of H/R-treated Min6 cells was significantly higher than that without Me.And the difference was statistically significant[(1.19±0.03) vs.(1.00±0), P<0.01]. As compared with H/R and H/R+ DMSO groups, overall apoptotic rate declined in H/R+ Me group (Hoechst 33342 stain: 14.50%±1.05% vs. 23.30%±1.18%, 14.50%±1.05% vs. 22.77%±1.75%, P<0.001; Flow cytometry: 4.36%±0.54% vs. 21.44%±1.02%, 4.36%±0.54% vs. 21.68%±3.06%, P<0.01). The expressions of p-JNK and p-p38 were down-regulated (p-JNK: 0.77±0.06 vs. 1.03±0.05, 0.77±0.06 vs.0.93±0.04, P<0.001; p-p38: 0.80±0.05 vs. 1.01±0.08; 0.80±0.05 vs. 1.00±0.05, P<0.05) while Bcl-2/Bax ratio rose (1.62±0.13 vs. 0.72±0.10, 1.62±0.13 vs. 0.74±0.13, P<0.01). Conclusions:Me can improve the viability and function of islets and suppress the apoptosis of Min6 cells after H/R.The mechanism is correlated with JNK and p38 MAPK signaling pathways.

OBJECTIVE To explore the influence of Zingiber officinale and processed Z. officinale on pharmacodynamic indexes and intestinal flora on gastric ulcer rats with spleen -stomach deficiency and cold type before and after processing with sand . METHODS The SD rats were randomly divided into normal group ，model group ，positive control group （Compound tianqi weitong capsule 0.45 g/kg），Z. officinale high-dose（15.0 g/kg）and low -dose（7.5 g/kg）groups，processed Z. officinale high- dose（15.0 g/kg）and low -dose（7.5 g/kg）groups，with 10 rats in each group . The rat model of gastric ulcer with spleen -stomach deficiency and cold type was established by intragastric administration of vinegar （day 1-10）and absolute ethanol （day 11）. Administration groups were given relevant liquid intragastrically ，and normal group and model group were given water intragastrically（day 5-10）. One hour after intragastric administration of absolute ethanol ，blood was taken from the femoral artery of rats ，the serum contents of motilin （MTL），gastrin（GAS），epidermal growth factor （EGF）as well as 4 items of blood coagulation [activated partial thromboplastin time （APTT），prothrombin time （PT），thrombin time （TT），fibrinogen（FIB）] were detect. The ulcer index and inhibition rate of ulcer in gastric tissue were calculated . The pathological changes of gastric tissue were observed，and the number and area of erosions were recorded . The diversity of gut microbiota in fecal samples of rats was detected . RESULTS Compared with model group ，the contents of MTL （except for processed Z. officinale low-dose group ），GAS（except for processed Z. officinale low-dose group ），EGF（except forofficinale groups） and FIB （except for Z. officinale groups），inhibitory rate of ulcer （only positive control group ）were all increased significantly （P＜0.05）. APTT（except for Z. officinale groups），PT（only processed Z. officinale high- dose group ），TT（except for Z. officinale groups），ulcer index （except for Z. officinale groups），the number （except for Z. officinale groups）and area of erosions （except for Z. officinale groups）were shortened and decreased significantly （P＜0.05）； improvement effects of processed Z. officinale were better than those of the same dose of Z. officinale on EGF ，4 items of blood coagulation（except for PT ，TT，FIB of processed Z. officinale low-dose group ），ulcer index （except for processed Z. officinale low-dose group ）and inhibitory rate of ulcer （P＜0.05）. Compared with model group ，α diversity indexes as ACE ，Shannon and Simpson of intestinal microorganisms in rats were increased significantly in processed Z. officinale group；the relative abundance of Proteobacteria was decreased significantly in processed Z. officinale group，while that of Bacteroidetes was increased significantly （P＜0.05）； the relative abundance of Limosilactobacillus was decreased significantly in Z. officinale group （P＜0.05）. CONCLUSIONS Z. officinale and processed Z. officinale can improve the symptoms of spleen -stomach deficiency and cold ，and enhance gastrointestinal function by increasing the content of GAS and MTL . Processed Z. officinale can significantly inhibit gastric ulcer of spleen -stomach deficiency and cold type ，which is related to the promotion of mucosal protection and repair ，improvement of coagulation functionand adjustment of gut microbiotadisorder .