Objective:To explore the genotype-phenotype relationship in a child with Opitz G/BBB syndrome (OS) with mild clinical phenotype.Methods:A child with motor developmental delay as the initial symptom admitted to Xi ′an Children′s Hospital on June 10, 2021 was selected for this study. Clinical data were collected, and peripheral blood samples were obtained from the child and his mother. Whole exome sequencing (WES) was performed to identify genetic variant in the child. Candidate variant were verified by Sanger sequencing to assess inheritance patterns and pathogenicity. Real-time fluorescence quantitative PCR (RT-qPCR) and Western blot (WB) analyses were conducted to evaluate the effects of the variant on mRNA and protein expression, respectively, using recombinant expression plasmids generated in vitro. This study was approved by the Medical Ethics Committee of Xi′an Children′s Hospital (Ethics No. 20240045).Results:① The child, a 9-month-and-7-day-old boy, presented with a low nasal bridge, hypertelorism, and difficulty sitting independently. Echocardiography revealed an atrial septal defect. ② WES identified a homozygous variant in the MIDI gene, c. 1483C>T (p.R495X), which was confirmed by Sanger sequencing and found to be inherited from the mother.③ Recombinant expression plasmids were successfully constructed. RT-qPCR analysis showed that the variant significantly reduced MIDI gene mRNA expression, while WB results indicated that the variant led to the production of a truncated protein. Conclusion:The mild clinical phenotype of OS in this child may be attributed to the mRNA degradation escape mechanism induced by the nonsense variant c. 1483C>T(p.R495X) in the MIDI gene. These findings provide valuable diagnostic insights for this pedigree and contribute to the understanding of the genotype-phenotype correlation in OS.

Radiation induced lung injury is a common complication of radiation therapy, typically characterized by the involvement of lung parenchyma.The radiation sensitivity of the trachea and bronchi is lower than that of the lung parenchyma, and the damage to the airways is usually not apparent for most patients using the standard radiation dose. The escalation of radiotherapy dose and the utilization of stereotactic body radiotherapy (SBRT) have been shown to enhance local tumor control. However, there is a growing concern regarding the development of radiation-induced airway disease (RIAD), which encompasses central airway stenosis, atelectasis, obstructive pneumonia, airway-wall necrosis, severe airway toxicity, and potentially life-threatening complications. This article presents the latest research advancements regarding the incidence, pathophysiological alterations, injury classification, preventive strategies, and treatment approaches of RIAD.

OBJECTIVE: To explore the genotype-phenotype relationship in a child with Opitz G/BBB syndrome (OS) with mild clinical phenotype. METHODS: A child with motor developmental delay as the initial symptom admitted to Xi'an Children's Hospital on June 10, 2021 was selected for this study. Clinical data were collected, and peripheral blood samples were obtained from the child and his mother. Whole exome sequencing (WES) was performed to identify genetic variant in the child. Candidate variant were verified by Sanger sequencing to assess inheritance patterns and pathogenicity. Real-time fluorescence quantitative PCR (RT-qPCR) and Western blot (WB) analyses were conducted to evaluate the effects of the variant on mRNA and protein expression, respectively, using recombinant expression plasmids generated in vitro. This study was approved by the Medical Ethics Committee of Xi'an Children's Hospital (Ethics No. 20240045). RESULTS: The child, a 9-month-and-7-day-old boy, presented with a low nasal bridge, hypertelorism, and difficulty sitting independently. Echocardiography revealed an atrial septal defect. WES identified a homozygous variant in the MIDI gene, c.1483C>T (p.R495X), which was confirmed by Sanger sequencing and found to be inherited from the mother.Recombinant expression plasmids were successfully constructed. RT-qPCR analysis showed that the variant significantly reduced MIDI gene mRNA expression, while WB results indicated that the variant led to the production of a truncated protein. CONCLUSION The mild clinical phenotype of OS in this child may be attributed to the mRNA degradation escape mechanism induced by the nonsense variant c.1483C>T (p.R495X) in the MIDI gene. These findings provide valuable diagnostic insights for this pedigree and contribute to the understanding of the genotype-phenotype correlation in OS.
Humans ; Male ; Infant ; Transcription Factors/metabolism* ; Microtubule Proteins/genetics* ; Craniosynostoses/genetics* ; Hypospadias/genetics* ; Codon, Nonsense/genetics* ; RNA, Messenger/metabolism* ; Female ; RNA Stability/genetics* ; Phenotype ; Nuclear Proteins/genetics* ; Ubiquitin-Protein Ligases ; Esophagus/abnormalities* ; Hypertelorism

Objective:To propose a processing method of medical image segmentation based on U-Net network with residual connection under single source domain environment,so as to improve the limited diversity of data samples of medical image in the single-source domain environment.Methods:The medical image data under the single-source domain environment were amplified through image transformation,contrast adjustment,and noise addition.The U-Net network was used as the basic structure,and multiple residual connection modules were introduced to achieve reuse of feature.And then,the features at shallow layer were directly transmitted to deep layer,and features at different levels were utilized for segmentation.The input features were added to the features that were processed by partial network layers,thus better learned the features in the data,and constructed medical image segmentation model based on the U-Net network with residual connection.The segmentation model was trained by using the gradient descent method,and the combination of that and the Generalized Dice Loss(GDL)function.Results:The processing method of medical image segmentation based on the U-Net network can effectively achieve segmentation of medical image.Even under low signal-to-noise ratio conditions and facing to different types of segmentation tasks of medical image,the DSC value was greater than 0.90.Conclusion:The processing method of medical image segmentation based on the U-Net network in this study can effectively enhance recognition ability for the features of complex lesions,and increase the segmentation precise of medical images,and improve the accuracy of clinical diagnosis and the effectiveness of treatment.

Objective:To propose a processing method of medical image segmentation based on U-Net network with residual connection under single source domain environment,so as to improve the limited diversity of data samples of medical image in the single-source domain environment.Methods:The medical image data under the single-source domain environment were amplified through image transformation,contrast adjustment,and noise addition.The U-Net network was used as the basic structure,and multiple residual connection modules were introduced to achieve reuse of feature.And then,the features at shallow layer were directly transmitted to deep layer,and features at different levels were utilized for segmentation.The input features were added to the features that were processed by partial network layers,thus better learned the features in the data,and constructed medical image segmentation model based on the U-Net network with residual connection.The segmentation model was trained by using the gradient descent method,and the combination of that and the Generalized Dice Loss(GDL)function.Results:The processing method of medical image segmentation based on the U-Net network can effectively achieve segmentation of medical image.Even under low signal-to-noise ratio conditions and facing to different types of segmentation tasks of medical image,the DSC value was greater than 0.90.Conclusion:The processing method of medical image segmentation based on the U-Net network in this study can effectively enhance recognition ability for the features of complex lesions,and increase the segmentation precise of medical images,and improve the accuracy of clinical diagnosis and the effectiveness of treatment.

Objective:To explore the genotype-phenotype relationship in a child with Opitz G/BBB syndrome (OS) with mild clinical phenotype.Methods:A child with motor developmental delay as the initial symptom admitted to Xi ′an Children′s Hospital on June 10, 2021 was selected for this study. Clinical data were collected, and peripheral blood samples were obtained from the child and his mother. Whole exome sequencing (WES) was performed to identify genetic variant in the child. Candidate variant were verified by Sanger sequencing to assess inheritance patterns and pathogenicity. Real-time fluorescence quantitative PCR (RT-qPCR) and Western blot (WB) analyses were conducted to evaluate the effects of the variant on mRNA and protein expression, respectively, using recombinant expression plasmids generated in vitro. This study was approved by the Medical Ethics Committee of Xi′an Children′s Hospital (Ethics No. 20240045).Results:① The child, a 9-month-and-7-day-old boy, presented with a low nasal bridge, hypertelorism, and difficulty sitting independently. Echocardiography revealed an atrial septal defect. ② WES identified a homozygous variant in the MIDI gene, c. 1483C>T (p.R495X), which was confirmed by Sanger sequencing and found to be inherited from the mother.③ Recombinant expression plasmids were successfully constructed. RT-qPCR analysis showed that the variant significantly reduced MIDI gene mRNA expression, while WB results indicated that the variant led to the production of a truncated protein. Conclusion:The mild clinical phenotype of OS in this child may be attributed to the mRNA degradation escape mechanism induced by the nonsense variant c. 1483C>T(p.R495X) in the MIDI gene. These findings provide valuable diagnostic insights for this pedigree and contribute to the understanding of the genotype-phenotype correlation in OS.

Radiation induced lung injury is a common complication of radiation therapy, typically characterized by the involvement of lung parenchyma.The radiation sensitivity of the trachea and bronchi is lower than that of the lung parenchyma, and the damage to the airways is usually not apparent for most patients using the standard radiation dose. The escalation of radiotherapy dose and the utilization of stereotactic body radiotherapy (SBRT) have been shown to enhance local tumor control. However, there is a growing concern regarding the development of radiation-induced airway disease (RIAD), which encompasses central airway stenosis, atelectasis, obstructive pneumonia, airway-wall necrosis, severe airway toxicity, and potentially life-threatening complications. This article presents the latest research advancements regarding the incidence, pathophysiological alterations, injury classification, preventive strategies, and treatment approaches of RIAD.

Objective To investigate the expression of PIK3CA,phosphorylated protein kinase B(p-AKT)and phosphatase and tensin homologue deleted on chromosome 10(PTEN)in sinonasal squamous cell carcinoma(SNSCC).Methods The expressions of PIK3CA and PTEN in head and neck squamous cell carci-noma(HNSCC)were analyzed through the data set of HNSCC in the cancer genome map of UCSC Xena data-base.The immunohistochemical SP method was used to measure the expression of PIK3CA,p-AKT and PTEN in 43 cases of SNSCC tissues,20 cases of normal inferior concha tissues.The relationship between the expressions of PIK3CA,p-AKT and PTEN protein with the clinicopathological features and prognosis of the patients with SNSCC was analyzed.Results The results of bioinformatic analysis showed that PIK3CA mR-NA expression in HNSCC tissues was higher than that in paracancerous tissues(P＜0.01),while the PTEN mRNA expression was lower than that in paracancerous tissues(P＜0.05).The immunohistochemical detec-tion results showed that the positive expressions rates of PIK3CA and p-AKT proteins in normal nasal mucosa tissues were significantly lower than those in SNSCC tissues,while the positive expression rate of PTEN pro-tein in SNSCC tissues was significantly higher than that in normal inferior nasal concha mucosa tissues,and the differences were statistically significant(P＜0.01).The expressions of PIK3CA and p-AKT protein were related to the clinical stage,differentiation degree and primary site(P＜0.05),but were not related to age,gender,smoking and drinking(P＞0.05);the PTEN protein expression was not related with the clinical stage,differentiation degree,primary site,age,smoking and drinking(P＞0.05).The Spearman analysis showed that the expression of PIK3CA in SNSCC tissues was positively correlated with p-AKT protein ex-pression(r=0.664,P＜0.01),and PIK3CA was negatively correlated with PTEN protein(r=-0.414,P＜0.01).The expression of p-AKT was negatively correlated with PTEN protein(r=-0.453,P＜0.01).The Kaplan-Meier analysis showed that the median survival time of the patients with PIK3CA and p-AKT protein positive expression was shorter than that of the patients with negative expression(P＜0.01).There was no statistically significant difference in median survival between the patients with PTEN protein positive expres-sion and those with negative expression.Conclusion The overexpressions of PIK3CA and p-AKT accompa-nied by the loss of PTEN expression participate in the development and progression of SNSCC,moreover the PIK3CA and p-AKT expressions are related to the poor prognosis of the patients.

Objective To observe the relationship between functional connectivity(FC)of frontoparietal network(FPN)and cognitive function in patients with cerebral small vessel disease(CSVD)using resting-state functional MRI(rs-fMRI).Methods rs-fMRI of 50 CSVD patients with cognitive impairment(CI group),65 CSVD patients with normal cognition(NC group)and 60 healthy controls(HC group),as well as outcomes of neuropsychological tests were retrospectively analyzed.Brain regions with different FC of FPN were compared among 3 groups and between each 2 groups.Partial correlation analysis was used to evaluate the correlations of FC of brain regions value being statistically different between CI and NC groups and cognitive scores.Results Significant differences of FC in bilateral cingulate gyrus,left middle frontal gyrus,right supramarginal gyrus,right inferior parietal lobule and right medial superior frontal gyrus were found among groups(FWE correction,all P＜0.05).Compared with NC group,FC of left cingulate gyrus decreased,of right inferior frontal gyrus and right medial superior frontal gyrus increased in CI group(FWE correction,all P＜0.05).The decreased FC value of left cingulate gyrus was negatively correlated with clock drawing test score in CSVD patients(r=-0.159,P=0.049).Conclusion CSVD patients with or without CI had extensive abnormal FC of FPN,and the left cingulate gyrus was associated with patient's cognitive function.

Objective:To explore clinical application value of immediate breast reconstruction with silicone prosthesis after nipple areolar sparing mastectomy for breast cancer.Methods:The clinical data of 30 breast cancer patients underwent immediate breast reconstruction with the silicone prosthesis after nipple areolar sparing mastectomy from January 2016 to January 2018 were collected. In the observation group, 15 patients underwent immediate breast reconstruction with the silicone prosthesis after nipple areolar sparing mastectomy. In the control group, 15 patients underwent conventional modified radical mastectomy only. The differences of operation indicator and postoperative complications between the two groups were compared, and the postoperative cosmetic effects were evaluated.Results:The patients successfully completed prosthetic breast reconstruction in the observation group. The surgical time and indwelling time of the drainage tube in the observation group were both increased compared with the control group, and the difference was statistically significant ( t=118.8 and t=23.9, P<0.05). There were no statistically significant differences between the two groups in the complications of postoperative flap necrosis, subcutaneous hematoma, intraoperative infection and incision dehiscence ( P>0.05). The total complications rate of the observation group was 40%, compared with the control group (20%), there were not statistically significant differences ( P>0.05). The postoperative aesthetic effect evaluation showed that the reconstructed breast was full in shape and basically symmetrical to the contralateral side, with an excellent and good rate of 83.3%. The patients were satisfied with the appearance of the breast. All patients were followed up for 12 to 36 months with the average time of 24 months, and local recurrence and distant metastasis were not observed. Conclusions:In the modified radical mastectomy for breast cancer with preserved nipple and areola, the immediate application of silicone prosthesis for breast reconstruction has the advantages of less trauma, faster postoperative recovery and better cosmetic effect, which is worthy of clinical application.