Right atrial diverticulum is a rare congenital cardiac malformation with a very low incidence and few reports in the literature. It is a sac-like structure originating from the free wall of the right atrium or the right auricle，and the wall of the diverticulum is mostly composed of normal myocardial tissue. Patients with diverticulumare asymptomatic in the early stage of the disease，and it is mostly detected by imaging examinations. The patient was a 96-year-old male admitted to the Second Hospital of Hebei Medical University with intermittent chest tightness，shortness of breath，and dizziness for more than half a month. Echocardiography and contrast echocardiography were performed 1 d after the patient was admitted to the hospital，suggesting the diagnasis of right atrial diverticulum with thrombosis，and coronary CT angiography was performed 4 d after the patient was admitted to the hospital，which considered right atrial diverticulum，with an internal filling defect，and suspected thrombus formation. The patient was older and did not receive further diagnosis and treatment，and cardiac ultrasound was repeated 1 month later，with no significant change in the size and morphology of the mass within the right atrial diverticulum. By analyzing in detail a case with right atrial diverticulum initially misdiagnosed as pericardial effusion，this article aimed to raise cardiac sonographers' awareness of the diagnosis of right atrial diverticulum and to explore the key role of cardiac acoustic contrast technology in cardiac ultrasound diagnosis.

Right atrial diverticulum is a rare congenital cardiac malformation with a very low incidence and few reports in the literature. It is a sac-like structure originating from the free wall of the right atrium or the right auricle，and the wall of the diverticulum is mostly composed of normal myocardial tissue. Patients with diverticulumare asymptomatic in the early stage of the disease，and it is mostly detected by imaging examinations. The patient was a 96-year-old male admitted to the Second Hospital of Hebei Medical University with intermittent chest tightness，shortness of breath，and dizziness for more than half a month. Echocardiography and contrast echocardiography were performed 1 d after the patient was admitted to the hospital，suggesting the diagnasis of right atrial diverticulum with thrombosis，and coronary CT angiography was performed 4 d after the patient was admitted to the hospital，which considered right atrial diverticulum，with an internal filling defect，and suspected thrombus formation. The patient was older and did not receive further diagnosis and treatment，and cardiac ultrasound was repeated 1 month later，with no significant change in the size and morphology of the mass within the right atrial diverticulum. By analyzing in detail a case with right atrial diverticulum initially misdiagnosed as pericardial effusion，this article aimed to raise cardiac sonographers' awareness of the diagnosis of right atrial diverticulum and to explore the key role of cardiac acoustic contrast technology in cardiac ultrasound diagnosis.

Objective:To explore the intention of exclusive breastfeeding and its influencing factors within six months after delivery of pregnant women in the third trimester of pregnancy in Xi'an.Methods:From January to February 2019, convenience sampling was used to select 2 671 pregnant women in the third trimester of pregnancy who underwent regular obstetric examinations in Obstetrics Clinic of five hospitals in Xi'an for a cross-sectional survey. Pregnant women were surveyed by means of a field survey using a self-designed Exclusive Breastfeeding Intention of Pregnant Women in the Third Trimester Questionnaire. Multivariate Logistic regression was used to analyze the influencing factors of the intention of exclusive breastfeeding among pregnant women in the third trimester. A total of 2 671 questionnaires were distributed, 2 479 valid questionnaires were recovered, and the valid recovery rate was 92.8% (2 479/2 671) .Results:A total of 60.8% (1 507/2 479) of pregnant women planned to exclusively breastfeed within 6 months of delivery. Pregnant women in the third trimester of pregnancy whose husbands ( OR=2.950, 95% CI: 2.097-4.066) and family members ( OR=2.171, 95% CI: 1.571-3.000) supported exclusive breastfeeding had high intention to exclusively breastfeed, and those who participated in breastfeeding courses had a high intention to exclusively breastfeed ( OR=1.436, 95% CI: 1.199-1.719) . Conclusions:More than half of third-trimester women plan to exclusively breastfeed within six months postpartum. Husband and family support and enrolment in breastfeeding classes increase the intention of pregnant women to exclusively breastfeed. Prenatal breastfeeding courses should be carried out to raise the awareness of pregnant women and family members about exclusive breastfeeding, and focus on the support of husbands and family members for exclusive breastfeeding, so as to increase the exclusive breastfeeding rate within six months after delivery.

Idiopathic pulmonary fibrosis (IPF) is a progressive disease with unknown etiology and limited therapeutic options. Activation of fibroblasts is a prominent feature of pulmonary fibrosis. Here we report that lncRNA DACH1 (dachshund homolog 1) is downregulated in the lungs of IPF patients and in an experimental mouse model of lung fibrosis. LncDACH1 knockout mice develop spontaneous pulmonary fibrosis, whereas overexpression of LncDACH1 attenuated TGF-β1-induced aberrant activation, collagen deposition and differentiation of mouse lung fibroblasts. Similarly, forced expression of LncDACH1 not only prevented bleomycin (BLM)-induced lung fibrosis, but also reversed established lung fibrosis in a BLM model. Mechanistically, LncDACH1 binding to the serine/arginine-rich splicing factor 1 (SRSF1) protein decreases its activity and inhibits the accumulation of Ctnnb1. Enhanced expression of SRSF1 blocked the anti-fibrotic effect of LncDACH1 in lung fibroblasts. Furthermore, loss of LncDACH1 promoted proliferation, differentiation, and extracellular matrix (ECM) deposition in mouse lung fibroblasts, whereas such effects were abolished by silencing of Ctnnb1. In addition, a conserved fragment of LncDACH1 alleviated hyperproliferation, ECM deposition and differentiation of MRC-5 cells driven by TGF-β1. Collectively, LncDACH1 inhibits lung fibrosis by interacting with SRSF1 to suppress CTNNB1 accumulation, suggesting that LncDACH1 might be a potential therapeutic target for pulmonary fibrosis.

Objective:To investigate the maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) during pregnancy at advanced maternal age for their second child at advanced maternal age, and to explore the relationship with neonatal outcomes.Methods:This study involved 1 965 women of advanced maternal age who delivered the second child in the Northwest Women's and Children's Hospital from July 1 to December 31, 2017. Clinical data of these women and their newborns were collected through the electronic medical record information system. According to pre-pregnancy BMI, all subjects were divided into four groups: underweight group (<18.5 kg/m 2, n=139), normal weight group (18.5-23.9 kg/m 2, n=1 342), overweight group (24.0-27.9 kg/m 2, n=404) and obese group (≥28.0 kg/m 2, n=80). According to the GWG standard recommended by the American Institute of Medicine (IOM) in 2009, they were also divided into three groups: inadequate GWG group ( n=478), normal GWG group ( n=884) and excessive GWG group ( n=603). Mann-Whitey U test, Chi-square test or Fisher's exact test were used as statistical methods. Effects of pre-pregnancy BMI and GWG on gestational age and birth weight of the newborns were analyzed by binary and multi-class logistic regression models. Results:The median pre-pregnancy BMI of the 1 965 women was 22.1 (20.3-23.9) kg/m 2 and patients with abnormal pre-pregnancy BMI accounted for 31.7% (623/1 965). Their median GWG was 13.0 (10.0-16.0) kg and 55.0% (1 081/1 965) of them were abnormal. Compared with normal pre-pregnant weight women, overweight and obesity subjects were associated with increased risks of preterm birth ( OR=2.100, 95% CI: 1.398-3.156), low birth weight infants (LBWI) ( OR=3.187, 95% CI: 1.892-5.367) and macrosomia ( OR=1.758, 95% CI: 1.182-2.614); pre-pregnancy underweight reduced the incidence of large for gestational age (LGA) infants ( OR=0.476, 95% CI: 0.236-0.960). Compared with the normal GWG group, the inadequate GWG group had increased risks of preterm birth ( OR=2.316, 95% CI: 1.530-3.505) and LBWI ( OR=1.850, 95% CI: 1.103-3.104), while the excessive GWG group showed increased risks of macrosomia ( OR=1.828, 95% CI: 1.225-2.726) and LGA infants ( OR=1.955, 95% CI: 1.448-2.640), but a reduced risk of LBWI ( OR=0.359, 95% CI: 0.193-0.667) and small for gestational age infants ( OR=0.452, 95% CI: 0.240-0.852). Conclusions:Both abnormal pre-pregnancy BMI (underweight, overweight and obese) and GWG (inadequate and excessive) have adverse effects on neonatal outcomes in women of advanced age in pregnancy for their second baby. Weight management should be addressed during the whole pregnancy, including both adjusting the pre-pregnancy BMI to normal range and maintaining reasonable GWG, so as to reduce potential adverse outcomes in newborns.