Cowden syndrome is a rare autosomal dominant disorder caused by a variant of the PTEN gene,with clinical manifestations mainly of fetal overgrowth and organ tumors.The pregnant woman in this case was 32 years old with gravida 1 and para 0.Prenatal ultrasound in Obstetrics and Gynecology Hospital,Fudan University demonstrated fetal biological parameters abnormally increased(especially in biparietal diameter and circumference of the head)and hepatic tumor.Genetic testing suggested a PTEN gene variant[NM_000314.4:c.193T>G(p.Tyr65Asp)].After termination of pregnancy,autopsy pathology diagnosed fetal organs overgrowth and hepatic hemangioma.This article focuses on the prenatal ultrasound phenotype and genetic features of Cowden syndrome to increase clinicians'awareness of this rare disease.

Objective To explore the clinical effect of totally laparoscopic total gastrectomy combined with hand-sewn esophagojejunos-tomy for gastric cancer.Methods Ninety cases of gastric cancer patients were seleted,of which 45 cases undergoing Roux-en-Y esophagoje-junostomy for digestive tract reconstruction were set as the control group,while 45 cases undergoing hand-sewn esophagojejunostomy for digestive tract reconstruction were set as the observation group.Patients in the control group underwent laparoscopic-assisted total gastrectomy combined with Roux-en-Y esophagojejunostomy to reconstruct digestive tract,while patients in the observation group underwent totally laparoscopic total gastrectomy combined with hand-sewn esophagojejunostomy to reconstruct digestive tract.The perioperative indicators and complications of patients in the two groups were compared.Results The surgical time,time of esophagojejunostomy,and time to get out of bed after surgery of patients in the observation group were significantly shorter than those in the control group(P<0.05),the pain score 24 hours after surgery was significantly lower than that in the control group(P<0.05).There was no statistically significant difference between the two groups in terms of the incidence of complications or Clavien-Dindo grading(P>0.05).Conclusion Hand-sewn esophagojejunostomy for digestive tract reconstruction has a good clinical effect in gastric cancer during totally laparoscopic total gastrectomy.It can shorten the surgical time and time of esophagojejunostomy,reduce postoperative pain,and accelerate postoperative recovery,whose safety is comparable to Roux-en-Y esophagojejunostomy.

Objective To explore the clinical effect of totally laparoscopic total gastrectomy combined with hand-sewn esophagojejunos-tomy for gastric cancer.Methods Ninety cases of gastric cancer patients were seleted,of which 45 cases undergoing Roux-en-Y esophagoje-junostomy for digestive tract reconstruction were set as the control group,while 45 cases undergoing hand-sewn esophagojejunostomy for digestive tract reconstruction were set as the observation group.Patients in the control group underwent laparoscopic-assisted total gastrectomy combined with Roux-en-Y esophagojejunostomy to reconstruct digestive tract,while patients in the observation group underwent totally laparoscopic total gastrectomy combined with hand-sewn esophagojejunostomy to reconstruct digestive tract.The perioperative indicators and complications of patients in the two groups were compared.Results The surgical time,time of esophagojejunostomy,and time to get out of bed after surgery of patients in the observation group were significantly shorter than those in the control group(P<0.05),the pain score 24 hours after surgery was significantly lower than that in the control group(P<0.05).There was no statistically significant difference between the two groups in terms of the incidence of complications or Clavien-Dindo grading(P>0.05).Conclusion Hand-sewn esophagojejunostomy for digestive tract reconstruction has a good clinical effect in gastric cancer during totally laparoscopic total gastrectomy.It can shorten the surgical time and time of esophagojejunostomy,reduce postoperative pain,and accelerate postoperative recovery,whose safety is comparable to Roux-en-Y esophagojejunostomy.

The pregnant woman was 30 years old,G2P0.This singleton pregnancy at 22 weeks of gestation was screened for second-trimester ultrasound malformations,suggesting fetal aortic valve atresia,aortic stenosis with reverse blood flow,mitral valve atresia,and markedly enlarged left ventricle,which was considered for the diagnosis of hypoplastic left heart syndrome(HLHS).The pregnancy was terminated at our hospital and subsequently underwent genetic testing with results of heterozygous variants in the NOTCH1 gene,which can cause aortic valve disease type 1.The findings of the fetal autopsy were aortic valve atresia,mitral valve widening and thickening,and left ventricular enlargement with myocardial infarction.This report focuses on the ultrasound characteristics of HLHS with left ventricular enlargement and its hemodynamic changes in order to improve clinicians'understanding of the progressive changes in the disease phenotype of HLHS.

The differences in chemical quality characteristics between Xinjiang Rehmannia glutinosa and R. glutinosa were analyzed to provide a theoretical basis for the introduction and quality control of R. glutinosa. In this study, the high performance liquid chromatography(HPLC) fingerprints of 6 batches of Xinjiang R. glutinosa and 10 batches of R. glutinosa samples were established. The content of iridoid glycosides, phenylethanoid glycosides, monosaccharides, oligosaccharides, and polysaccharides in Xinjiang R. glutinosa and R. glutinosa was determined by high performance liquid chromatography-diode array detection(HPLC-DAD), high performance liquid chromatography-evaporative light scattering detection(HPLC-ELSD), and ultraviolet-visible spectroscopy(UV-Vis). The determination results were analyzed with by chemical pattern recognition and entropy weight TOPSIS method. The results showed that there were 19 common peaks in the HPLC fingerprints of the 16 batches of R. glutinosa, and catalpol, aucubin, rehmannioside D, rehmannioside A, hydroxytyrosol, leonuride, salidroside, cistanoside A, and verbascoside were identified. Hierarchical cluster analysis(HCA) and principal component analysis(PCA) showed that Qinyang R. glutinosa, Mengzhou R. glutinosa, and Xinjiang R. glutinosa were grouped into three different categories, and eight common components causing the chemical quality difference between Xinjiang R. glutinosa and R. glutinosa in Mengzhou and Qinyang of Henan province were screened out by orthogonal partial least squares discriminant analysis(OPLS-DA). The results of content determination showed that there were glucose, sucrose, raffinose, stachyose, polysaccharides, and nine glycosides in Xinjiang R. glutinosa and R. glutinosa samples, and the content of catalpol, rehmannioside A, leonuride, cistanoside A, verbascoside, sucrose, and glucose was significantly different between Xinjiang R. glutinosa and R. glutinosa. The analysis with entropy weight TOPSIS method showed that the comprehensive quality of R. glutinosa in Mengzhou and Qinyang of Henan province was better than that of Xinjiang R. glutinosa. In conclusion, the types of main chemical components of R. glutinosa and Xinjiang R. glutinosa were the same, but their content was different. The chemical quality of R. glutinosa was better than Xinjiang R. glutinosa, and other components in R. glutinosa from two producing areas and their effects need further study.
Rehmannia/classification* ; Drugs, Chinese Herbal/chemistry* ; Chromatography, High Pressure Liquid/methods* ; Quality Control

The pregnant woman was 30 years old,G2P0.This singleton pregnancy at 22 weeks of gestation was screened for second-trimester ultrasound malformations,suggesting fetal aortic valve atresia,aortic stenosis with reverse blood flow,mitral valve atresia,and markedly enlarged left ventricle,which was considered for the diagnosis of hypoplastic left heart syndrome(HLHS).The pregnancy was terminated at our hospital and subsequently underwent genetic testing with results of heterozygous variants in the NOTCH1 gene,which can cause aortic valve disease type 1.The findings of the fetal autopsy were aortic valve atresia,mitral valve widening and thickening,and left ventricular enlargement with myocardial infarction.This report focuses on the ultrasound characteristics of HLHS with left ventricular enlargement and its hemodynamic changes in order to improve clinicians'understanding of the progressive changes in the disease phenotype of HLHS.

Cowden syndrome is a rare autosomal dominant disorder caused by a variant of the PTEN gene,with clinical manifestations mainly of fetal overgrowth and organ tumors.The pregnant woman in this case was 32 years old with gravida 1 and para 0.Prenatal ultrasound in Obstetrics and Gynecology Hospital,Fudan University demonstrated fetal biological parameters abnormally increased(especially in biparietal diameter and circumference of the head)and hepatic tumor.Genetic testing suggested a PTEN gene variant[NM_000314.4:c.193T>G(p.Tyr65Asp)].After termination of pregnancy,autopsy pathology diagnosed fetal organs overgrowth and hepatic hemangioma.This article focuses on the prenatal ultrasound phenotype and genetic features of Cowden syndrome to increase clinicians'awareness of this rare disease.

Objective To investigate the current status and influencing factors of nurses'missed nursing care in infection prevention and control,and provide reference for establishing targeted programs to improve nursing care situation in clinical infection prevention and control.Methods From October to November 2023,369 nurses from two tertiary first-class hospitals in Zhejiang Province were selected as surveyed subjects by convenience sampling methods.General information questionnaire,missed nursing care in infection prevention and control survey,hospi-tal ethical climate survey,and safety attitudes questionnaire were used for questionnaire survey.Univariate analy-sis,Pearson correlation analysis,and multiple linear regression analysis were adopted to analyze the influencing fac-tors.Results A total of 364 valid questionnaires were collected,with a respond rate of 98.64％.The scores of 364 nurses'missed nursing care in infection prevention and control survey B and C were(48.94±15.06)and(47.88±14.54)points,respectively.The score of hospital ethical climate was(103.00±16.01)points,and the score of safety attitude was(128.50±17.00)points.Multiple linear regression analysis showed that the influencing factors for missed nursing care in infection control and prevention were temporary employment modes,work at pre-hospital emergency departments,and low scores in hospital ethical climate(all P＜0.05).Conclusion Nurses'missed nursing care in infection prevention and control is at a lower-middle level,there is still room for improvement.Nur-sing managers should reduce missed nursing care in infection prevention and control by improving the hospital ethical climate and taking appropriate intervention measures for nurses in different departments and employment styles.

Objective:To investigate the proliferation kinetics of T cells in patients with B-cell hematologic malignancies who received CAR19 T cell therapy.Methods:Observational study. Flow cytometry was used to monitor the levels of CAR19+and CAR19-T cell expansion and the dynamic changes of T lymphocyte subsets before and after CAR19 T cell therapy. The 52 patients with B-cell hematologic malignancies (including 12 B-ALL and 40 NHL) who received CAR19 T cell therapy in the First Affiliated Hospital of Soochow University from November 2021 to December 2023 were recruited in this study. Patients were divided into complete response group and incomplete response group according to the efficacy evaluation criteria in the treatment guidelines for B-cell hematologic malignancies. T test or non-parametric rank sum test were used to compare the differences of CAR19+and CAR19-T cell subsets between the two groups.Results:At the peak of CAR19+T cell expansion, there was no statistic difference of CAR19+T cell subsets between the complete response group and the incomplete response group. After 6 months, the percentage of CD4+T cells (CD3+CD4+CD8-) in CAR19-T cells in patients was lower than the pre-treatment level(48.0+27.2,63.1+19.7,<0.01), and the percentages of CD197+CD45RA+and CD197-CD45RA-subsets recovered to the pre-treatment level, while the percentage of CD197-CD45RA+subset(4.2+3.0,21.1+15.6,<0.01) was lower than the pre-treatment level. The percentage of CD8+T cells (CD3+CD4-CD8+) returned to pre-treatment level after 6 months, CD197-CD45RA-subset in CD8+T cells returned to pre-treatment level, while CD197+CD45RA+subset(16.6+8.7,35.1+30.1,<0.01),CD197+CD45RA-subset(18.7+9.1,25.8+19.1,<0.01) were still lower than pre-treatment level.Conclusion:After CAR19 T cell treatment, there was no significant differences in the proportions of CAR19+T cell subsets in patients with different therapeutic effects. After treatment, the proportion of CAR19-CD3+CD4-CD8+cells recovered earlier than CD3+CD4+CD8-cells, and the dynamic changes of each subgroup were different. This therapeutic regimen has a great impact on the subpopulation of CAR19-T cells in vivo, and the reconstruction of such T cells takes a long time.

Objective To investigate the impact of propofol(Pro)on high glucose(HG)-induced myocardial cell injury through autophagy mediated by forkhead box O1(Fox O1)/thioredoxininteracting protein(TXNIP)signaling pathway.Methods H9c2 cells were divided into blank group(5.5 mmol·L-1 glucose),high glucose(HG)group(30 mmol·L-1 glucose),HG+Pro group(30 mmol·L-1 glucose+25 μmol·L-1 Pro),HG+Pro+negative control(OE NC)group(first transfected with OE NC,then treated with 30 mmol·L-1 glucose+25 μmol·L-1 Pro),HG+Pro+Fox O1 overexpression plasmid(Fox O1-OE)group(first transfected with Fox O1-OE,then treated with 30 mmol·L-1 glucose+25 μmol·L-1 Pro).Cell counting kit-8(CCK-8)method,TdT-mediated dUTP nick end labeling(TUNEL)method,enzyme-linked immunosorbent assay(ELISA),transmission electron microscope and Western blot were applied to detect the cell survival rate,apoptosis rate,superoxide dismutase(SOD)and malondialdehyde(MDA)levels in the supernatant,and the changes in Autophagosome,Fox O1/TXNIP and autophagy protein expression levels.Results The cell viabilities of blank group,HG group,HG+Pro group,HG+Pro+OE NC group and HG+Pro+Fox O1-OE group were(100.00±0.00)％,(48.15±4.82)％,(79.66±7.98)％,(78.89±7.91)％and(49.22±4.93)％,respectively;the apoptosis rates were(12.04±1.21)％,(42.34±4.25)％,(26.22±2.63)％,(27.02±2.71)％,(38.29±3.86)％,respectively;SOD levels were(62.24±6.25),(28.21±2.85),(55.37±5.58),(55.09±5.53),(30.66±3.08)U·mg-1 pro,respectively;MDA levels were(0.38±0.04),(1.43±0.15),(0.67±0.07),(0.72±0.08)and(1.34±0.14)U·mg-1 pro,respectively;the number of autophagosomes was 6.24±0.63,13.05±1.32,8.31±0.84,8.55±0.86 and 12.22±1.23,respectively;phosphorylated Fox O1(p-Fox O1)/Fox O1 ratios were expressed as 0.34±0.04,0.86±0.09,0.48±0.05,0.43±0.05 and 0.74±0.08;TXNIP were expressed as 0.24±0.03,0.62±0.08,0.38±0.04,0.36±0.04 and 0.58±0.06;Bcelin-1 were expressed as 1.12±0.12,0.53±0.06,1.02±0.11,1.05±0.11 and 0.62±0.07;p62 were expressed as 0.56±0.06,1.56±0.16,0.82±0.09,0.86±0.09 and 1.44±0.15;there were statistical differences in the above indexes between HG group and blank group,HG+Pro group and HG group,HG+Pro+Fox O1-OE group and HG+Pro+OE NC group(all P＜0.05).Conclusion Pro inhibits autophagy by inhibiting Fox O1/TXNIP signaling pathway,and improves HG-induced myocardial cell injury.