Objective To explore the application effect of sacubitril valsartan in patients with chronic heart failure(CHF).Methods A total of 66 CHF patients admitted to Xinyu Yuanhe Hospital from September 2021 to September 2022 were selected and divided into control group and study group according to random number table method,with 33 cases in each group.The control group was treated with benazepril + spironolactone + metoprolol,and the study group was treated with sacubitril valsartan + spironolactone + metoprolol.The clinical efficacy,ventricular remodeling,cardiac function,serum factor levels and adverse reactions were compared between two groups.Results The total effective rate in study group was significantly higher than that in control group(χ2=5.974,P=0.015).After treatment,left ventricular mass index,myocardial wall stress,left ventricular posterior wall thickness,left ventricular ejection fraction,N-terminal pro-brain natriuretic peptide(NT-proBNP),angiotensin Ⅱ and aldosterone in study group were significantly lower than those in control group,and left ventricular remodelling index,stroke volume and left ventricular end-diastolic volume were significantly higher than those in control group(P<0.05).There was no significant difference in adverse reactions between two groups(P>0.05).Conclusion The treatment effect of sacubitril valsartan in CHF patients is significant,which can effectively improve cardiac function indicators,reverse ventricular remodeling,reduce serum NT-proBNP level,and have fewer adverse reactions.

Objective:To investigate the clinical efficacy of humidified high flow nasal cannula oxygen inhalation (HFNC) versus conventional nasal cannula oxygen inhalation on hypoxemia after complex ventral hernia surgery in elderly patients.Methods:The retrospective cohort study was conducted. The clinical data of 80 elderly patients with hypoxemia after complex ventral hernia surgery who were admitted to Huadong Hospital Affiliated to Fudan University from January 2021 to June 2022 were collected. There were 44 males and 36 females, aged (74±7)years. Of the 80 patients, 40 cases undergoing HFNC were allocated into HFNC group, and 40 cases undergoing conventional nasal cannula oxygen inhalation were allocated into conventional group, respectively. Observation indicators: (1) postoperative blood gas analysis; (2) postoperative complications. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the rank sum test. Count data were represented as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Repeated measurement data were analyzed using the repeated ANOVA. Results:(1) Postoperative blood gas analysis. Before surgery and at 12 hours, 24 hours, 3 days after surgery, the partial pressure of blood oxygen was (13.5±2.3)kPa, (13.4±3.2)kPa, (13.8±2.3)kPa, (13.7±2.0)kPa for the HFNC group, and (12.7±2.1)kPa, (12.9±2.4)kPa, (12.3±2.5)kPa, (13.9±2.1) kPa for the conventional group. The partial pressure of carbon dioxide was (5.6±0.7)kPa, (5.0±0.6)kPa, (4.7±0.6)kPa, (4.9±0.6)kPa for the HFNC group, and (5.6±0.6)kPa, (4.4±0.8)kPa, (5.0±4.8)kPa, (5.1±1.1)kPa for the conventional group. The saturation of blood oxygen was 97.8%±2.2%, 98.1%±2.1%, 98.9%±1.8%, 99.2%±2.0% for the HFNC group, and 97.8%±3.1%, 97.8%±2.1%, 99.0%±1.5%, 98.8%±2.0% for the conventional group. The oxygenation index was 259±28, 300±45, 352±46, 353±57 for the HFNC group, and 262±29, 297±54, 304±63, 345±53 for the conventional group, respectively. There was a significant difference in the interven-tion effect of partial pressure of blood oxygen between the two groups ( Fgroup=4.09, P<0.05) and no significant difference in the time effect or interaction effect ( Ftime=2.37, Finteraction=1.71, P>0.05). There were significant differences in the time effect and interaction effect of partial pressure of carbon dioxide between the two groups ( Ftime=7.23, Finteraction=13.21, P<0.05) and no significant difference in the intervention effect ( Fgroup=1.02, P>0.05). There was a significant difference in the time effect of saturation of blood oxygen between the two groups ( Ftime=5.54, P<0.05) and no significant difference in the intervention effect or interaction effect ( Fgroup=1.78, Finteraction=0.46, P>0.05). There were signifi-cant differences in the intervention effect, time effect, interaction effect of oxygenation index between the two groups ( Fgroup=8.21, Ftime=42.07, Finteraction=3.49, P<0.05). (2) Postoperative complications. The time in intensive care unit and cases with pulmonary infection were 3(3,3)days and 3 for the HFNC group, versus 6(5,7)days and 10 for the conventional group, showing significant differences between the two groups ( Z=27.50, χ2=4.50, P<0.05). Cases with atelectasis and endotrachead intubation were 0 and 1 for the HFNC group, versus 4 and 7 for the conventional group, showing no significant difference between the two groups ( P>0.05). There was no death in either group. Conclusion:Humidified high flow oxygen inhalation has certain advantages over conventional nasal cannula oxygen inhalation in improving partial pressure of blood oxygen and oxygenation index after complex ventral hernia surgery in elderly patients.

Objective: Based on observational, longitudinal and intervention study of common diseases among students in Jiangsu Province, this paper presents the current progress of two year follow up of myopia cohort regarding the association between growth parameters with progression of myopia among children and adolescents in areas with rapid economic growth. Methods: This survey adopted the stratified cluster sampling method for school selection. The full automatic computer optometry (TOPCON RM800) was used to track myopia related parameters for all participants from 2019 to 2020 under the condition of mydriasis (compound topicamide eye drops). Relationship between growth parameters of children and adolescents and the incidence and progression of myopia was analyzed by using Cox regression multiple statistical model. Results: The myopia rates of students from grade 1 to grade 3 in 2019 were 5.4%, 21.5% and 37.3% respectively. After one year, the myopia rates of all school stages increased to 25.3%, 43.3% and 58.1% respectively( χ 2=53.59, 49.63, 32.52, P <0.01). The mean diopter of right eye and left eye after mydriasis were ( 0.30± 1.24/0.39±1.26)D in 2019 and (-0.33±1.54/-0.19±1.55)D in 2020, respectively based on Cox multiple regression results, age ( HR =1.21, 95% CI =1.09-1.34), naked eye vision ( HR =0.08, 95% CI =0.07-0.11), height ( HR =0.98, 95% CI =0.97-0.99) showed a strong correlation with the incidence and progression of myopia( P <0.05). Conclusion Myopia is growing rapidly in the central region of Jiangsu Province. It is suggested that diopter, axial length, naked eye vision, age, height and other indicators should be included in the refractive archives of children and adolescents in the region.

Objective:To summarize the ultrasound manifestations of submucosal cleft palate, and explore the diagnostic value of prenatal ultrasound for submucosal cleft palate.Methods:A total of 21 146 pregnant women who underwent fetal ultrasound examination in the second and third trimesters in the Affiliated Hospital of Jining Medical University from January 2013 to May 2018 were collected. They were all singleton pregnancy. The ultrasound image which was the horizontal plate of the palatine bone at the posterior border of the fetal hard palate was routinely obtained. The presence of bone loss at the posterior border of the hard palate was defined as a positive case. Then the palate targeted ultrasound examinations of the positive cases were performed to observe the continuity of the soft palate. The ultrasound images of positive cases were compared with the results of induction or delivery, and their postpartum diagnosis and treatment were tracked.Results:A total of 44 simple cleft palate were detected in 21 146 fetuses, including 23 dominant cleft palate and 21 submucosal cleft palate. Two cases of 21 submucosal cleft palate were induced because of other deformities, the other 19 cases were born. The follow-up of the 19 submucosal cleft palate cases showed that 15 cases visited to stomatology department before 3 years of age, and 2 cases of newborns with dominant cleft palate were misdiagnosed as submucosal cleft palate by prenatal ultrasound, and the other13 of them were clinically diagnosed as submucosal cleft palate. The ultrasound of the submucosal cleft palate showed there was no inverted "V" -shaped bone in the posterior edge of the hard palate which was connected by a membranous connection, and the soft palate was complete, but the center of soft palate was thinner or even present membranous hyperechoic in ultrasound.Conclusions:Submucosal cleft palate has characteristic ultrasound features, and prenatal ultrasound make a diagnosis and provide some basis for obtaining early diagnosis and treatment after birth.

Objective:To investigate the clinical features of encephalocraniocutaneous lipomatosis (ECCL).Methods:The clinical characteristics, imaging manifestations and electroencephalogram changes of five patients with ECCL from Guangdong 999 Brain Hospital between December 2016 and February 2019 were collected and analyzed.Results:All five cases showed ocular, skin and central nervous system anomalies. Corneal anomalies were found in five cases, eyelid coloboma in three cases, calcification of the globe in two cases, and choristoma in one case. All five cases presented with naevus psiloliparis, three cases with small nodular skin tags on eyelids, and three cases with café-au-lait spots on the trunk. Dysplasia of the right cerebral hemisphere was observed in all five cases, four cases with enlargement of the right ventricle, three cases with arachnoid cysts, and one case with dysplasia of the corpus callosum. The onset of the seizures of five cases was found within one year old. Spasms were observed in five cases, partial seizure in three cases, and tonic seizure in one case. Five cases were drug-resistant epilepsy. Seizures decreased significantly after adrenocorticotropic hormone treatment in one case and seizures free after surgery in one case. One case had seizure free by corpus callosotomy, but had a relapse after four months. Three cases used ketogenic diet, including one case with epileptic seizure reduction, one case with development progress. All five cases had developmental delays. The exon gene sequencing of four cases was found normal. KRAS gene mutation was found in brain tissue of one patient.Conclusions:ECCL is a rare clinical disease that often involves the nervous system, skin and eyes. The seizures of the patients are often difficult to control and have development delays. Surgery may be necessary to control the seizures. ECCL is thought to be somatic mutations, which are hard to detect in the blood and can be found in affected tissues.

Objective To observe the expression changes ofmiR-34a and its related target genes sirtuin 1 (Sirtl) and nuclear factor-E2-related factor 2 (Nrf2) in subependymal zone (SVZ) of rats after cerebral ischemia,and to explore the effect of miR-34a on proliferation of endogenous neural stem cells (NSCs) after cerebral ischemia.Methods Forty SD rats were randomly divided into control group,cerebral ischemia one d group,cerebral ischemia three d group and cerebral ischemia 7 d group (n=10).Middle cerebral artery occlusion models were established by thread embolization in the latter three groups,and the SVZs were taken one,three and 7 d after model making,respectively.Immunofluorescence staining was used to detect the expression of nestin,real-time PCR was used to detect the mRNA expressions ofmiR-34a,Sirtl and Nrf2,and Western blotting was used to detect the protein expressions of Sirt1 and Nrf2.Results (1) In SVZs of cerebral ischemia one d group,cerebral ischemia three d group and cerebral ischemia 7 d group,the number of nestin positive cells increased gradually ([2.013±0.526],[4.821 ±1.154],and [6.394±1.027]) cells/filed,with statistical differences (P＜0.05).(2) In SVZs of cerebral ischemia one d group,cerebral ischemia three d group and cerebral ischemia 7 d group,the expression levels of miR-34a mRNA increased gradually (0.295±0.145,0.701 ±0.075,and 1.136±0.018),the Sirt1 mRNA expression levels showed a downward trend (0.835±0.024,0.620±0.133,and 0.278±0.110),the Nrf2 mRNA expression levels obviously decreased (1.032±0.256,0.833±0.187,and 0.630±0.123),the Sirt1 protein expression levels showed a downward trend (0.832±0.018,0.731±0.156,and 0.454±0.132),and the Nrf2 protein expression levels obviously decreased (1.003±0.133,0.813±0.111,and 0.671 ±0.071),with statistically significant differences (P＜0.05).(3)Statistical correlation analysis showed that the number of nestin positive cells was positively correlated with miR-34a mRNA expression level and negatively correlated with Sirt1 and Nrf2 mRNA and protein expression levels after cerebral ischemia (r=0.887,P=0.003;r=-0.746,P=0.005;r=-0.521,P=0.013;r=-0.344,P=0.025;r=-0.863,P=0.000).Conclusions MiR-34a may regulate the proliferation of NSCs through Sirt1/Nrf2 pathway after cerebral ischemia.

Objective: The aim of this study was to investigate the effect of co-culture with AEC (amniotic epithelial cell) on the biological characteristics of AMSC (amniotic mesenchymal stem cell), and to investigate the roles of SDF-1/CXCR4 axis in the homing and migration of AMSC. Methods: AMSC andAEC were isolated from human amnion, and then cultured, amplified and identified, respectively. TheAMSC were divided into three groups:AEC co-cultured group, serum-free cultured group and serum cultured group.After culture for 24 h, 48 h, and 72 h, the proliferation viability ofAMSC was measured by CCK-8 assay and trypan blue staining; the expression of CXCR4 mRNAwas analyzed by flow cytometry and Real-time RT-PCR, and the migration ability ofAMSC in vitro was observed by migration assay. Results: Cell viability (48 h and 72 h) and survival rate in the co-culture and serum groups were higher than those in the serum-free group (all P<0.05). The mRNA and protein expressions of CXCR4 in AMSC of the co-culture and serum-free groups were significantly higher than those of the serum group (P<0.05). The migration ability of AMSC in the co-culture and serumfree groups, which increase with the SDF-1 (stromal cell derived factor-1) concentration gradient, were higher than that in the serum group (P<0.05). Conclusion: AMSC co-cultured with AEC still have the basic biological characteristics of MSC, and showed good growth activity. Co-culture withAEC can up-regulate CXCR4 onAMSC surfaces and enhance the migration ability ofAMSC in vitro.

Objective To observe the surface electromyography (sEMG) characteristics of pharyngeal swallowing muscles in different swallowing modes in asymptomatic lacunar infarction (LI) patients. Methods From January, 2015 to January, 2017, a total of 32 asymptom-atic LI patients (LI group) aged over 60 years were consecutively collected, and 30 normal old subjects matched with age and gender (nor-mal group) were also enrolled. The amplitudes of sEMG activity of infrahyoid muscles and submental muscles in different swallowing modes were recorded, and the root mean square (RMS) was analyzed. Results Significant difference was found in both muscle groups in dif-ferent swallowing modes in both groups (F>110.67, P<0.001). There was no significance in the RMS in both two muscle groups in rest and dry swallowing modes between two groups (t<1.484, P>0.05). In the 20 ml water swallowing mode, the RMS was lower in the submental muscles in the LI group than in the normal group (t=3.334, P<0.01), and no significant difference was found in the infrahyoid muscles (t=1.871, P>0.05). In the 100 ml continuous drinking mode, the RMSs were significantly lower in both two muscle groups in LI group than in the normal group (t>3.118, P<0.01). Conclusion Swallow abilities decrease in asymptomatic LI. sEMG could be used to evaluate their swallowing function.

Purpose To investigate the prenatal ultrasonic features of fetal hypospadias and to compare the diagnostic accuracy.Materials and Methods The clinical data of 28 patients with suspected or confirmed hypospadias were retrospectively analyzed.The prenatal ultrasonic features,missed diagnosis and misdiagnosis of the patients were analyzed,and the diagnostic accuracy of different ultrasonic features for hypospadias was compared.Results In 28 cases,21 cases of hypospadias were confirmed by examination after birth or induced abortion with 2 cases of missed diagnosis by ultrasound,and 7 cases of non hypospadias were misdiagnosed by prenatal ultrasound.The diagnostic accuracy rate of 2D ultrasound was 67.9％ (19/28),and that of 3D ultrasound combined with 2D ultrasound was 92.9％ (13/14).The diagnostic accuracy rates of ultrasonic features such as abnormal urinary jet,abnormal urethra,tulip sign,abnormal penis tip,scrotum separation with or without penoscrotal transposition and short penis were 100.0％ (6/6),92.9％ (13/14),88.2％ (15/17),83.3％ (5/6),25.0％ (1/4) and 33.3％ (1/3),respectively.Conclusion The ultrasonic features including abnormal urinary jet,abnormal urethra,tulip sign and abnormal penis tip have great value for prenatal diagnosis of fetal hypospadias.3D ultrasound is more intuitive than 2D ultrasound and provides more details.Comprehensive analysis of all ultrasonic features is helpful for prenatal diagnosis.