Objective To investigate the echocardiographic features and clinical significance of prenatal diagnosis of fetal double aortic arch (DAA). Methods Totally 21 596 fetuses underwent fetal echocardiography in Nanjing Medical University Afifliated Suzhou Hospital and ifve cases were diagnosed as DAA by echocardiography. Echocardiographic characteristics, types and outcomes of these ifve cases were summarized retrospectively. Results Five fetal cases were diagnosed as DAA by fetal echocardiography. 1. Prenatal echocardiographic features:In three-vessel and trachea view, the normal“V”-shaped conlfuence formed by the aortic arch and ductal arch was absent. However, the ascending aorta bifurcated into the left and right aortic arch and these two arches encircled the trachea. Annular lfow signal around trachea was seen on color Doppler imaging. 2. Types:Among these ifve fetuses, three cases were called right arch predominant type, whose diameters of right arches were larger than those of left arches. The other two were balanced type, whose diameters of right arches were almost equal to those of left arches. 3. Accompanied malformations:Case 2 was accompanied with membranous ventricular septal defect and permanent left superior vena cava. Case 4 was associated by hemivertebrae. The other three cases had no other abnormalities. 4. Follow-up:These five cases were all arranged for MRI subsequently and all were confirmed by follow-up till to the induction of labor or three months after birth. Conclusions Double aortic arch is a kind of severe congenital heart disease. Echocardiography is the ifrst choice to diagnose DAA prenatally and three-vessel and trachea view are the effective cross sections in the diagnosis of double aortic arch.

Objective To explore the clinical value of prenatal ultrasonography in the differentiation among the etiologies of fetal megacystis.Methods Twenty seven fetuses,diagnosed as fetal megacystis by prenatal ultrasonography,were retrospectively analyzed.The etiologies of fetal megacystis were presumed by such characteristics as keyhole sign,thickness of the bladder wall,amniotic fluid index,fetal sex and other combined signs.All fetuses were followed up until to the induction of labor or birth.Results Twenty seven singleton fetuses (19 males and 8 females) were diagnosed as megacystis.According to the characteristics and other combined signs,8 cases of posterior urethral valves (PUV),1 of prune belly syndrome(PBS),1 of megacystis-microcolon intestinal hypoperistalsis syndrome(MMIHS),1 of urethral atresia and 5 of chromosomal abnormality were presumed by prenatal ultrasound.Multiple malformations were found in 5 fetuses and there were also 6 fetuses with unknown reason originally.Among the 27 fetuses,21 were induced labor and 6 continued pregnancy to birth.Except for the 6 cases of unknown reason,etiologies of 17 fetuses with megacystis were confirmed by autopsy,genetic tests,surgery or further examination after birth.The accuracy rate of prenatal ultrasonography in the differentiation among the etiologies of fetal megacystis was 80.95％ (17/21).Conclusions On the basis of detailed prenatal ultrasonography and typical characteristics,it is reliable to differentiate the etiologies of fetal megacystis.Sometimes fetal megacystis may be one part of multiple malformations or complex syndrome,such as VACTERL syndrome.However,it is difficult for ultrasonography to diagnose vesicoureteral reflux(VUR)prenatally.

Objective To investigate the fetal ultrasonographic features in pregnancies with Toxoplasma (TOX), rubella virus (RV), cytomegalovirus (CMV) and herpes simplex virus (HSV) infection. Methods From January 2011 to March 2013, prenatal ultrasound examination was performed in 545 fetuses with mothers of speciifc positive IgM of TOX, RV, CMV and HSV, detected by enzyme-linked immune sorbent assay (ELISA) in Nanjing Medical University Affiliated Suzhou Hospital. Ultrasonographic features were summarized and pregnancy outcome was followed up in fetuses with abnormal ifndings. Results Among the 545 fetuses, 56 cases with abnormal sonographic ifndings:6 cases with central nervous systerm abnormalities (2 intracranial calcifications, 4 hydrocephaly);9 cases with digestive system abnormalities (1 intrahepatic calcifications, 8 echogenic bowel);2 cases with heart abnormalities (1 interventricular septal defect, 1 right heart enlargement);17 cases with abnormal amniotic fluid volume (16 polyhydramnios, 1 oligohydramnios);3 cases with placental abnormality (1 thick placenta, 2 placenta abnormal calciifcation);13 cases with urinary systerm abmormality appearing as renal sinus separation;and 6 cases with other systerm abnormalities (1 neck lymphatic hygroma, 1 single umbilical artery, 1 sacrococygeal teratoma and 3 intrauterine growth restriction);2 cases of complicated abnormalities. Conclusions Prenatal ultrasonography is signiifcant in detecting serious fetal malformations, such as hydrocephaly, heart abnormalities and characteristic ultrasound features such as intracranial calciifcations, echogenic bowel, placenta abnormal calciifcation complicated with TOX, RV, CMV and HSV infection, providing valuable information for further clinical treatment, such as induced labour.

Fluoroquinolones are widely used in clinical practice, but their clinical application in juvenile patients has been controversial.The purpose of this study was to investigate the pharmacokinetic characteristics, indications and adverse reactions of Ciprofloxacin and Levofloxacin in minors.It is shown that the two drugs are effective for infectious diseases and no serious or persistent joint or skeletal muscle injury occurs in minors using the drugs.Hence, in the absence of alternatives, the benefits of Ciprofloxacin or Levofloxacin treatment for minors may outweigh the risks.

The emerging and re-emerging arthropod-borne infectious diseases pose a serious threat to global public health security. Field and laboratory studies of arthropods of medical importance are essential and critical for the prevention and control of arthropod-borne infectious diseases. Various institutions or universities in China have been conducting research in the field or laboratory study of arthropods of medical importance, but up to 2023, it is still lacking detailed biosafety guidelines or recommendations that can guide the related work for arthropods of medical importance. In order to proactively address potential biosafety issues in the field or laboratory activities related to arthropods of medical importance, improve the standardization of arthropod biosafety classification, operations, and protection, and ensure the safety of practitioners, an expert consensus on the biosafety recommendation of arthropods of medical importance in field and laboratory has been developed, aiming to guide the future work of arthropods and ensure the national biosafety and biosecurity of China.

Objective:To investigate the association between serum levels of thyroglobulin (Tg), thyroid stimulating hormone (TSH) and antibodies and lymph node metastasis (LNM) in papillary thyroid cancer (PTC) .Methods:A total of 1 502 patients with PTC who were admitted to the Department of Breast and Thyroid Surgery of the First Affiliated Hospital of Chongqing Medical University from Jan. 2019 to Jan. 2022 were retrospectively enrolled, including males ( n=431), females ( n=1 071), aged < 55 years ( n=1 271), and ≥ 55 years old ( n=231). All patients were pathologically confirmed to have PTC after surgery. Univariate analysis was performed on the general data of patients and the indexes in the postoperative pathology report and the LNM group, and the data of P<0.05 in the analysis were included in the regression analysis to determine the independent risk factors of cervical LNM in PTC patients. Patients were divided into 8 subgroups according to the different statuses of the three thyroid antibodies (TGAb, TPOAb, TRAb) : [ (+) indicates positive; (-) indicates negative]. According to the order of TGAb, TPOAb, and TRAb, there are the following 8 states, 1 (+++) ; 2 (---) ; 3 (++-) ; 4 (+--) ; 5 (+-+) ; 6 (-+-) ; 7 (-++) ; 8 (--+). The differences in general clinical information, Tg and TSH between the two groups were compared, and the receiver operating characteristic curve (ROC) curve of Tg in the diagnosis of PTC lymph node metastasis was constructed, and regression analysis was used to explore the diagnostic value of serological indicators in the diagnosis of cervical LNM in PTC. Results:In this study, compared with the non-metastasis group, there were 308 males (33.2%) and 225 patients (24.3%) with bilateral PTC in metastasis group. The mean serum Tg value was (25.5±2.1) ng/mL and the TSH level was significantly increased ( P<0.05), and the results of binary logistic regression analysis showed that males ( OR=1.57, P<0.001), bilateral PTC ( OR=1.448, P<0.001), non-papillary carcinoma (>10 mm) ( OR=1.745, P<0.001) and increased Tg level ( OR=1.007, P=0.002) were independent risk factors for cervical lymph node metastasis in PTC patients, and the area under the ROC curve of Tg in the evaluation of cervical lymph node metastasis was 0.634 [95% CI (0.636, 0.691), P<0.05], while the TSH status was 0.56-1.39 ( OR=0.375, P=0.013). 1.40-2.29 ( OR=0.422, P=0.003) ; 2.30-5.91 ( OR=0.466, P=0.004) ; ≥5.91 ( OR=0.41, P=0.001) was not a risk factor. Conclusion:Male sex, bilateral thyroid cancer, non-papillary carcinoma (>10 mm), and preoperative serum Tg>29.8 ng/mL are the influencing factors of LNM in PTC patients.

The 8th Japan-China Hepato-Pancreato-Biliary Symposium was held in Tokyo,Japan from 22nd to 23rd November 2018.The meeting was convened coincidently with the 80th Annual Congress of Japanese Surgical Association,which attracted the participation of Chinese and Japanese hepatobiliary and pancreatic surgeons.The symposium aimed to explore the latest achievements and clinical issues of diagnosis and treatment for hepato-pancreato-biliary diseases.In this article,authors reviewed the up-to-date research information in order to share the experience,achievements and new information in the field of hepatobiliary and pancreatic diseases with colleagues.

Objective:To explore the clinical value of prenatal ultrasound in diagnosis of fetal cleft lip and palate during first-trimester (11-13 + 6 gestational weeks). Methods:Ultrasonographic images were retrospectively selected from those fetuses who underwent first trimester scanning during July 2017 to June 2020 in the Affiliated Suzhou Hospital of Nanjing Medical University. Fetal facial mid-sagittal section and the retronasal triangle (RNT) section were combined together to evaluate whether the fetuses had cleft lip and palate (CLP) or not. All fetuses were followed up to birth or induced abortion.Results:A total of 5 520 fetuses were enrolled, with crown-rump length (CRL) between 45-84 mm. Seven cases of different types of CLP were detected by the 2 combined sections, including 4 cases with unilateral CLP, 1 case with median CLP, and 2 cases with bilateral CLP, which were confirmed by follow-up. In addition, 2 cases of isolated cleft lip (CL) were missed.Conclusions:Combination of fetal facial mid-sagittal section and RNT section is useful for the early diagnosis of fetal cleft lip and palate during first-trimester scanning.

Objective To discuss the clinical application of getting the images related to the partogram content using the intrapartum ultrasound. Methods One hundred twenty-three pregnant women who tried vaginal delivery in Huai'an Maternity and Children Hospital were included in this study. Intrapartum ultrasound was performed during the progression of labor every two hours. To obtain the images related to the fetal position by transabdominal or transperineal ultrasound in transverse view, determining the fetal head position; to obtain the images related to the fetal head station by transperineal ultrasound in mid-sagittal and transverse views , measuring the angle of progression (AOP) and the fetal head-perineum distance (HPD); to obtain the images related to the cervical dilatation by transperineal ultrasound in transverse view, measuring the anteroposterior diameter of the cervical dilatation. Results This study included 123 pregnant women, 123 images were obtained related to the fetal position; 122 images of AOP related to the fetal head station were measured; and 123 images of HPD related to the fetal head station were measured; 121 images related to the cervical dilatation, all the images can clearly displayed various ultrasonic markers, which can be used to determine the fetal position, the fetal head station and the cervical dilation. Conclusion Intrapartum ultrasound could get the images related to the partogram content, it could be studied to use in labor.

Objective:To explore the relationship between soft markers found in the first trimester (11-13 + 6 gestational weeks) ultrasound screening and fetal adverse pregnancy outcomes. Methods:Single pregnancy fetuses were selected from the Multicenter Clinical Study of First Trimester Screening in China during August 2017 to August 2020. The types and detection rate of soft markers during the first trimester were compared. The correlation between positive soft markers and adverse pregnancy outcomes was analyzed by binary Logistics regression.Results:A total of 16 625 fetuses with complete follow-up outcomes were included in the group. Six hundred and seven ultrasonic soft markers were detected in 556 fetuses with positive soft markers during the first trimester, and the first four most frequently occurred were increased nuchal translucency (NT) (2.08%, 345/16 625), echogenic intracardiac focus (EIF) (0.94%, 156/16 625), hypoplasia of fetal nasal bone (0.20%, 34/16 625), single umbilical artery (SUA) (0.19%, 31/16 625). Among 556 fetuses, the incidence of adverse pregnancy outcome in fetuses with two or more positive soft markers was 32.50% (13/40), which was significantly higher than fetuses with single positive soft marker (11.05%, 57/516), and the difference was statistically significant (χ 2=5.055, P<0.001). The incidence of adverse pregnancy outcome in positive soft markers fetus associated with structural abnormalities was 80.77% (21/26), which was significantly higher than fetuses with isolated positive soft marker (12.08%, 64/530), and the difference was statistically significant (χ 2=90.310, P<0.001). Binary logistic regression analysis showed choroid plexus cyst (CPC), SUA, echogenic bowel (EB), absent/reversed a-wave of ductus venosus, hypoplasia of fetal nasal bone, increased NT, and EIF were closely related to the adverse pregnancy outcomes (all P<0.05). However, there were no significant correlations between tricuspid regurgitation (TR), pyelectasis (PYE) and fetal adverse pregnancy outcomes (all P>0.05). Conclusions:The ultrasonic soft markers during the first trimester are of great significance in predicting fetal adverse pregnancy outcomes. For multiple positive soft markers or positive soft markers combined with structural abnormalities, more attention should be paid to them and comprehensive evaluation is required to be carried out.