Objective Based on the intervention map to develop a comprehensive nutrition education program for pancreaticoduodenectomy patients and to explore the effect of its clinical application,aiming at providing references for clinical nursing practice.Methods A convenience sampling method was used to select 76 patients who were to undergo pancreaticoduodenectomy in the department of hepatobiliary and pancreatic surgery of a tertiary hospital in Anhui Province as the study subjects.The 38 patients admitted from October 2021 to September 2022 were in a control group,and the 38 patients admitted from October 2022 to July 2023 were in an experimental group.The experimental group received the comprehensive nutritional education programme constructed in this study,and the control group used conventional nutrition health education measures,and the length of intervention for both groups was from pre-hospitalization to discharge for 6 months.Nutrition-related indicators,postoperative complications,hospitalisation time,hospitalisation costs and satisfaction were compared between the 2 groups.Results A total of 64 patients completed this study,with 33 in the experimental group and 31 in the control group.Repeated measurement analysis of variance showed that the interaction effects of BMI,total serum protein and serum preprotein were statistically significant(P＜0.05).The incidence of complications,hospitalization days and hospitalization costs of the experimental group were lower than those of the control group(P＜0.05).The scores of nutrition education-related satisfaction in the experimental group were higher than those in the control group(P＜0.001).Conclusion A comprehensive nutritional education program based on intervention map can improve the nutritional status of pancreaticoduodenectomy patients to a certain extent,reduce the occurrence of complications,and promote patients'recovery.

Objective:To investigate the clinical characteristics and prognosis of fetuses with HNF1B gene variants. Methods:Fifty-two fetuses with HNF1B gene variants diagnosed by chromosomal copy number variation sequencing and/or whole exome sequencing at the First Affiliated Hospital of Zhengzhou University from January 2018 to June 2024 were retrospectively enrolled in this study, including 47 cases of 17q12 microdeletion and five cases of HNF1B point mutations. Prenatal ultrasound features, pregnancy outcomes, and postnatal manifestations were summarized and analyzed using descriptive statistics. Results:The prenatal ultrasound features of the 52 fetuses included enhanced renal parenchymal echo in 43 cases (82.7%), renal cysts in 15 cases (28.8%), enlarged kidney volume in 14 cases (26.9%), and pyelectasis in 13 cases (25.0%). Parental verification was completed for 35 cases, with 71.4% (25/35) being de novo mutations and 28.6% (10/35) inherited from either parent. Apart from eight cases with unknown pregnancy outcome (six cases were lost to follow-up, two cases refused to be followed up), the other 44 cases were successfully followed up, among which 68.2% (30/44) terminated the pregnancies and 31.8% (14/44) continued, resulting in live births. Prenatal ultrasound indicated renal abnormalities in all 14 live births, while postnatal follow-up showed seven cases with normal kidneys, one with reduced bilateral renal cysts, one with alleviated bilateral pyelectasis, four with unimproved renal structural abnormalities, and one who did not undergo a re-examination. Conclusion:The rate of renal abnormalities diagnosed by prenatal ultrasound in fetuses with HNF1B gene variants is high, and most of the pregnancies are terminated, although the renal sturctural abnormalities may improve after birth.

Objective:To investigate the clinical characteristics and genetic etiology of fetal Dandy-Walker spectrum (DWS) anomalies.Methods:This retrospective cohort study analyzed 28 fetuses with ultrasonographically confirmed DWS (ten classic Dandy-Walker malformations and 18 Dandy-Walker variants) at the First Affiliated Hospital, Zhengzhou University from January 2019 to June 2024. All cases underwent systematic ultrasonographic evaluation. Genetic analyses included chromosomal karyotyping alone ( n=4) or combined with copy number variation sequencing (CNV-seq) ( n=10). Descriptive statistics and Chi-square tests (or Fisher's exact test) with Bonferroni correction were applied. Results:(1) Among 28 fetuses, seven (25.0%) had isolated DWS and 21 (75.0%) non-isolated DWS. Central nervous system anomalies were most common (53.6%, 15/28). (2) Karyotyping identified abnormalities in four cases (4/14), including two triploidies, one case of mosaicism for a derivative chromosome der(1;10), and one 17p deletion. CNV-seq detected anomalies in six cases (25.0%, 6/24), four of which were missed by karyotyping: 3q23 deletion (encompassing ZIC1/ ZIC4), 13q11 duplication, and other critical variants. (3) Combined testing yielded a higher detection rate (28.6%, 8/28) than karyotyping alone (4/14, χ2=4.62, P=0.032) or CNV-seq alone (25.0%, 6/24, χ2=4.83, P=0.028) ( P=0.048 and 0.044 after Bonferroni correction). Conclusions:DWS demonstrates significant genetic heterogeneity, primarily involving chromosomal numerical anomalies (e.g., triploidy) and copy number variations (e.g., 3q23 deletion). Combined karyotyping and CNV-seq improves detection rates of genetic abnormalities.

Objective:To identify latent profile types of self-acceptance among newly diagnosed young and middle-aged patients with type 2 diabetes mellitus (T2DM), and to analyze the influencing factors.Methods:A convenience sampling method was used to recruit 162 patients with T2DM who visited the Department of Endocrinology at the First Affiliated Hospital of Zhengzhou University between March 2023 and August 2024. A general information questionnaire was used to collect demographic and clinical data. The Acceptance and Action Diabetes Questionnaire (AADQ), Type 2 Diabetes Stigma Assessment Scale (DSAS-2), Diabetes Knowledge Test 2 (DKT2), and e-Health Literacy Scale (eHEALS) were used to assess self-acceptance, diabetes-related stigma, diabetes knowledge, and electronic health literacy, respectively. Latent profile analysis (LPA) was performed to identify categories of self-acceptance based on AADQ scores. Logistic regression analysis was conducted to examine the influencing factors of self-acceptance profiles in young and middle-aged patients with T2DM. A total of 162 questionnaires were distributed, and 157 valid responses were collected, with an effective response rate of 96.91% (157/162) .Results:The mean AADQ score of the 157 patients was (46.64±10.34), ranging from 20 to 63, with a mean item score of (4.24±1.16). Three latent profile categories of self-acceptance were identified: the "high avoidance-low self-acceptance group" (28.66%, 45/157), the "moderate self-acceptance group" (47.13%, 74/157), and the "low avoidance-high self-acceptance group" (24.20%, 38/157). Logistic regression analysis showed that age, body mass index (BMI), diabetes-related stigma, diabetes knowledge, and electronic health literacy were significant influencing factors of self-acceptance profiles in young and middle-aged patients with T2DM ( P<0.05) . Conclusions:The level of self-acceptance in newly diagnosed young and middle-aged patients with type 2 diabetes mellitus remains suboptimal. Particular attention should be paid to patients who are younger, have a BMI below 24.0 kg/m 2, experience high levels of diabetes-related stigma, and have low levels of diabetes knowledge and electronic health literacy. Targeted education and management should be implemented based on patient characteristics.

Objective:To identify latent profile types of self-acceptance among newly diagnosed young and middle-aged patients with type 2 diabetes mellitus (T2DM), and to analyze the influencing factors.Methods:A convenience sampling method was used to recruit 162 patients with T2DM who visited the Department of Endocrinology at the First Affiliated Hospital of Zhengzhou University between March 2023 and August 2024. A general information questionnaire was used to collect demographic and clinical data. The Acceptance and Action Diabetes Questionnaire (AADQ), Type 2 Diabetes Stigma Assessment Scale (DSAS-2), Diabetes Knowledge Test 2 (DKT2), and e-Health Literacy Scale (eHEALS) were used to assess self-acceptance, diabetes-related stigma, diabetes knowledge, and electronic health literacy, respectively. Latent profile analysis (LPA) was performed to identify categories of self-acceptance based on AADQ scores. Logistic regression analysis was conducted to examine the influencing factors of self-acceptance profiles in young and middle-aged patients with T2DM. A total of 162 questionnaires were distributed, and 157 valid responses were collected, with an effective response rate of 96.91% (157/162) .Results:The mean AADQ score of the 157 patients was (46.64±10.34), ranging from 20 to 63, with a mean item score of (4.24±1.16). Three latent profile categories of self-acceptance were identified: the "high avoidance-low self-acceptance group" (28.66%, 45/157), the "moderate self-acceptance group" (47.13%, 74/157), and the "low avoidance-high self-acceptance group" (24.20%, 38/157). Logistic regression analysis showed that age, body mass index (BMI), diabetes-related stigma, diabetes knowledge, and electronic health literacy were significant influencing factors of self-acceptance profiles in young and middle-aged patients with T2DM ( P<0.05) . Conclusions:The level of self-acceptance in newly diagnosed young and middle-aged patients with type 2 diabetes mellitus remains suboptimal. Particular attention should be paid to patients who are younger, have a BMI below 24.0 kg/m 2, experience high levels of diabetes-related stigma, and have low levels of diabetes knowledge and electronic health literacy. Targeted education and management should be implemented based on patient characteristics.

Objective Based on the intervention map to develop a comprehensive nutrition education program for pancreaticoduodenectomy patients and to explore the effect of its clinical application,aiming at providing references for clinical nursing practice.Methods A convenience sampling method was used to select 76 patients who were to undergo pancreaticoduodenectomy in the department of hepatobiliary and pancreatic surgery of a tertiary hospital in Anhui Province as the study subjects.The 38 patients admitted from October 2021 to September 2022 were in a control group,and the 38 patients admitted from October 2022 to July 2023 were in an experimental group.The experimental group received the comprehensive nutritional education programme constructed in this study,and the control group used conventional nutrition health education measures,and the length of intervention for both groups was from pre-hospitalization to discharge for 6 months.Nutrition-related indicators,postoperative complications,hospitalisation time,hospitalisation costs and satisfaction were compared between the 2 groups.Results A total of 64 patients completed this study,with 33 in the experimental group and 31 in the control group.Repeated measurement analysis of variance showed that the interaction effects of BMI,total serum protein and serum preprotein were statistically significant(P＜0.05).The incidence of complications,hospitalization days and hospitalization costs of the experimental group were lower than those of the control group(P＜0.05).The scores of nutrition education-related satisfaction in the experimental group were higher than those in the control group(P＜0.001).Conclusion A comprehensive nutritional education program based on intervention map can improve the nutritional status of pancreaticoduodenectomy patients to a certain extent,reduce the occurrence of complications,and promote patients'recovery.

Objective:To investigate the clinical characteristics and prognosis of fetuses with HNF1B gene variants. Methods:Fifty-two fetuses with HNF1B gene variants diagnosed by chromosomal copy number variation sequencing and/or whole exome sequencing at the First Affiliated Hospital of Zhengzhou University from January 2018 to June 2024 were retrospectively enrolled in this study, including 47 cases of 17q12 microdeletion and five cases of HNF1B point mutations. Prenatal ultrasound features, pregnancy outcomes, and postnatal manifestations were summarized and analyzed using descriptive statistics. Results:The prenatal ultrasound features of the 52 fetuses included enhanced renal parenchymal echo in 43 cases (82.7%), renal cysts in 15 cases (28.8%), enlarged kidney volume in 14 cases (26.9%), and pyelectasis in 13 cases (25.0%). Parental verification was completed for 35 cases, with 71.4% (25/35) being de novo mutations and 28.6% (10/35) inherited from either parent. Apart from eight cases with unknown pregnancy outcome (six cases were lost to follow-up, two cases refused to be followed up), the other 44 cases were successfully followed up, among which 68.2% (30/44) terminated the pregnancies and 31.8% (14/44) continued, resulting in live births. Prenatal ultrasound indicated renal abnormalities in all 14 live births, while postnatal follow-up showed seven cases with normal kidneys, one with reduced bilateral renal cysts, one with alleviated bilateral pyelectasis, four with unimproved renal structural abnormalities, and one who did not undergo a re-examination. Conclusion:The rate of renal abnormalities diagnosed by prenatal ultrasound in fetuses with HNF1B gene variants is high, and most of the pregnancies are terminated, although the renal sturctural abnormalities may improve after birth.

Objective:To investigate the clinical characteristics and genetic etiology of fetal Dandy-Walker spectrum (DWS) anomalies.Methods:This retrospective cohort study analyzed 28 fetuses with ultrasonographically confirmed DWS (ten classic Dandy-Walker malformations and 18 Dandy-Walker variants) at the First Affiliated Hospital, Zhengzhou University from January 2019 to June 2024. All cases underwent systematic ultrasonographic evaluation. Genetic analyses included chromosomal karyotyping alone ( n=4) or combined with copy number variation sequencing (CNV-seq) ( n=10). Descriptive statistics and Chi-square tests (or Fisher's exact test) with Bonferroni correction were applied. Results:(1) Among 28 fetuses, seven (25.0%) had isolated DWS and 21 (75.0%) non-isolated DWS. Central nervous system anomalies were most common (53.6%, 15/28). (2) Karyotyping identified abnormalities in four cases (4/14), including two triploidies, one case of mosaicism for a derivative chromosome der(1;10), and one 17p deletion. CNV-seq detected anomalies in six cases (25.0%, 6/24), four of which were missed by karyotyping: 3q23 deletion (encompassing ZIC1/ ZIC4), 13q11 duplication, and other critical variants. (3) Combined testing yielded a higher detection rate (28.6%, 8/28) than karyotyping alone (4/14, χ2=4.62, P=0.032) or CNV-seq alone (25.0%, 6/24, χ2=4.83, P=0.028) ( P=0.048 and 0.044 after Bonferroni correction). Conclusions:DWS demonstrates significant genetic heterogeneity, primarily involving chromosomal numerical anomalies (e.g., triploidy) and copy number variations (e.g., 3q23 deletion). Combined karyotyping and CNV-seq improves detection rates of genetic abnormalities.

Objective:To summarize the ultrasonographic characteristics, genetic etiology, and perinatal prognosis of fetuses with absence of ductus venosus (ADV).Methods:A retrospective study enrolled 84 singleton pregnancies that underwent prenatal ultrasound examination and were diagnosed with fetal ADV at the First Affiliated Hospital of Zhengzhou University from June 2017 to July 2022. Based on prenatal ultrasonographic findings, the cases were divided into isolated ADV group ( n=37), ADV with ultrasound soft markers group ( n=9), and ADV with definite ultrasound abnormalities group ( n=38). According to the gestational age at the initial diagnosis of ADV, they were categorized into early pregnancy group (11-13 weeks of 6 days) with 17 cases, mid-pregnancy group (14-27 weeks of 6 days) with 45 cases, and late pregnancy group (≥28 weeks) with 22 cases. Depending on the direction of blood flow in the intra-abdominal segment of the umbilical vein, they were classified into umbilical vein directly entering the portal sinus group ( n=75), intrahepatic umbilical vein abnormal shunt group ( n=4), and extrahepatic umbilical vein shunt group ( n=5). The clinical characteristics of each group were summarized, and compared using the Chi-square, trend Chi-square tests, Fisher's exact test and Bonferroni correction test. Results:The common ultrasonographic abnormalities in the 84 cases of ADV fetuses were cardiac anomalies (27.4%, 23/84), cystic hygroma (10.7%, 9/84), fetal hydrops (9.5%, 8/84), and body cavity effusion (8.3%, 7/84). The proportions of fetuses with ADV and definite ultrasound abnormalities detected in the early, mid, and late pregnancy were 16/17, 44.4% (20/45), and 9.1% (2/22), respectively, with a higher proportion of definite ultrasound abnormalities associated with earlier detection of ADV ( χ 2trend=27.25, P<0.001). Among them, 21 cases underwent chromosomal karyotyping and/or chromosomal copy number variation sequencing or expanded non-invasive prenatal testing, with five abnormalities detected, including 45,X, trisomy 13, trisomy 22 mosaicism, trisomy 7 mosaicism, and a 14 Mb duplication at 22q12.3q13.33. The neonatal survival (28 days after birth) rates with ADV detected in the early, mid, and late pregnancy gradually increased, at 1/17, 43.9% (18/41), and 90.5% (19/21), respectively ( χ 2trend=27.04, P<0.001). The neonatal survival rates of the isolated ADV group and the group with ultrasound soft markers were higher than that of the group with definite ultrasound abnormalities [93.9% (31/33) and 6/9 vs. 2.7% (1/37), Bonferroni corrected, both P<0.001]. The neonatal survival rates of the umbilical vein directly entering the portal sinus group, intrahepatic umbilical vein abnormal shunt group, and extrahepatic umbilical vein shunt group were 50.0% (35/70), 0/4, and 1/5, respectively, with no statistically significant difference (Fisher's exact test, P=0.105). Conclusions:The earlier the detection of fetal ADV, the more likely it is to be associated with definite ultrasound abnormalities and have lower neonatal survival rates. This highlights the importance of ultrasonographic examination of the fetal ductus venosus. Once ADV is detected, attention should be paid to other potential ultrasound abnormalities, and genetic testing should be completed.

Objective:Progressive bone resorption and destruction is one of the most critical clinical features of middle ear cholesteatoma,potentially leading to various intracranial and extracranial complications.However,the mechanisms underlying bone destruction in middle ear cholesteatoma remain unclear.This study aims to explore the role of parathyroid hormone-related protein(PTHrP)in bone destruction associated with middle ear cholesteatoma. Methods:A total of 25 cholesteatoma specimens and 13 normal external auditory canal skin specimens were collected from patients with acquired middle ear cholesteatoma.Immunohistochemical staining was used to detect the expressions of PTHrP,receptor activator for nuclear factor-kappa B ligand(RANKL),and osteoprotegerin(OPG)in cholesteatoma and normal tissues.Tartrate-resistant acid phosphatase(TRAP)staining was used to detect the presence of TRAP positive multi-nucleated macrophages in cholesteatoma and normal tissues.Mono-nuclear macrophage RAW264.7 cells were subjected to interventions,divided into a RANKL intervention group and a PTHrP+RANKL co-intervention group.TRAP staining was used to detect osteoclast formation in the 2 groups.The mRNA expression levels of osteoclast-related genes,including TRAP,cathepsin K(CTSK),and nuclear factor of activated T cell cytoplasmic 1(NFATc1),were measured using real-time polymerase chain reaction(real-time PCR)after the interventions.Bone resorption function of osteoclasts was assessed using a bone resorption pit analysis. Results:Immunohistochemical staining showed significantly increased expression of PTHrP and RANKL and decreased expression of OPG in cholesteatoma tissues(all P<0.05).PTHrP expression was significantly positively correlated with RANKL,the RANKL/OPG ratio,and negatively correlated with OPG expression(r=0.385,r=0.417,r=-0.316,all P<0.05).Additionally,the expression levels of PTHrP and RANKL were significantly positively correlated with the degree of bone destruction in cholesteatoma(r=0.413,r=0.505,both P<0.05).TRAP staining revealed a large number of TRAP-positive cells,including multi-nucleated osteoclasts with three or more nuclei,in the stroma surrounding the cholesteatoma epithelium.After 5 days of RANKL or PTHrP+RANKL co-intervention,the number of osteoclasts was significantly greater in the PTHrP+RANKL co-intervention group than that in the RANKL group(P<0.05),with increased mRNA expression levels of TRAP,CTSK,and NFATc1(all P<0.05).Scanning electron microscopy of bone resorption pits showed that the number(P<0.05)and size of bone resorption pits on bone slices were significantly greater in the PTHrP+RANKL co-intervention group compared with the RANKL group. Conclusion:PTHrP may promote the differentiation of macrophages in the surrounding stroma of cholesteatoma into osteoclasts through RANKL induction,contributing to bone destruction in middle ear cholesteatoma.