Objective:To summarize the characteristics and management experience of pregnancy after bariatric surgery.Methods:A retrospective analysis was conducted on four pregnant patients who had undergone pre-pregnant bariatric surgery and delivered at the Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, from January 2021 to December 2023. The analysis included the type of bariatric surgery, the interval between bariatric surgery and pregnancy, pregnancy complications, and neonatal birth conditions. Descriptive statistical analysis was used.Results:Among the four patients, two were primiparas and two were multiparas. All patients were obese (body mass index≥27.5 kg/m2) before undergoing sleeve gastrectomy. Before the current pregnancy, three patients had a normal body mass index, while one patient remained obese (body mass index 30.5 kg/m2). The interval between bariatric surgery and pregnancy exceeded one year for three patients (14, 14, and 60 months, respectively), while one patient became pregnant 10 months after surgery. Three patients developed normocytic anemia in early pregnancy, with the lowest hemoglobin levels of 101 to 106 g/L. After nutritional guidance and medication, hemoglobin levels returned to normal before delivery. One patient experienced a threatened late miscarriage at 26 weeks of gestation, which was successfully managed with tocolytic therapy. One patient was diagnosed with gestational diabetes at 27 weeks of gestation and achieved satisfactory blood glucose control through dietary and exercise guidance. Oral glucose tolerance tests for all four patients showed low fasting blood glucose levels (3.8-4.5 mmol/L) and 2-hour postprandial blood glucose levels (3.5-6.1 mmol/L). All four patients delivered at term, with no cases of small for gestational age infants.Conclusions:Pregnancy after bariatric surgery is prone to maternal nutrient deficiencies and blood glucose fluctuations. Multidisciplinary collaborative management and individualized nutritional guidance are recommended to reduce the risk of related complications.

Objective To investigate the effect of β-arrestin1(ARRB1)on cell proliferation,migration and invasion in oral squamous cell carcinoma(OSCC).Methods Based on The Cancer Genome Atlas(TCGA)database,the expression profiles of ARRB1 in OSCC were analyzed,and then Gene Set Enrichment Analysis(GSEA)was used to suggest the possible signaling pathways involved,and to explore its potential impact on the prognosis of OSCC patients.Immuinohistochemistry(IHC)was performed to detect the expression of ARRB1 in OSCC tumor tissues and adjacent tissues,and the correlation between ARRB1 expression and clinicopathological features was statistically analyzed.The expression profiles of ARRB1 in SCC-15,CAL-27 and HOK cell lines were verified by qPCR and Western blotting.The ARRB1 overexpression plasmid model was constructed,and its effects on the proliferation,migration and invasion of OSCC cells were analyzed by clone formation,EdU,scratch and Transwell assays.Results TCGA showed that the expression level of ARRB1 was significantly lower in head and neck squamous cell carcinoma(HNSC)and OSCC tissues than the corresponding normal tissues(P<0.01).The expression of ARRB1 in OSCC tissues was correlated with tumor differentiation,lymph node metastasis and TNM stage(P<0.05).The OSCC patients with high expression of ARRB1 had a lower survival rate than those with low expression(P<0.01),which was consistent with the results of bioinformatics analysis.The expression level of ARRB1 in SCC-15 and CAL-27 cells was lower than that of HOK cells(P<0.01),and its overexpression significantly inhibited cell proliferation(P<0.05),migration(P<0.01)and invasion(P<0.01).Conclusion ARRB1 is lowly expressed in OSCC,its overexpression inhibits the proliferation,migration and invasion of OSCC cells,and it is related to prognosis improvement.

Objective To explore the application effects of an innovative teaching model(blended 5MP)that organically combines blended teaching and the five-minute teaching method in clinical teaching for operating room nursing students.Methods Using convenience sampling,94 nursing students who interned in operating room of Kunming Children's Hospital from July 2023 to March 2024 were randomly assigned to observation and control groups,with 47 students in each group.For the control group,a traditional blended learning approach was utilized,whereas the observation group implemented a blended 5MP teaching model.Results The observation group's post-class assignment scores,theoretical exam scores,and practical skills assessment scores were all significantly higher than those in the control group,with a statistically significant difference(P<0.05).The observation group also had higher scores in the Self-Assessment of Clinical Reasoning and Reflection Scale,with a statistically significant difference(P<0.05).Furthermore,the observation group reported higher satisfaction rates regarding teaching methods,teaching formats,theoretical instruction,practical instruction,and overall satisfaction compared to the control group,with statistically significant differences(P<0.05).Conclusion The blended approach combines online and offline instructional modalities,allowing for a more strategic allocation of educational resources.This methodology enables students to thoroughly acquire essential knowledge and skills while simultaneously fostering advanced clinical reasoning and reflective competencies.By adopting this innovative educational model,institutions can significantly enhance the academic experience and professional development of nursing students.

Objective:To summarize the characteristics and management experience of pregnancy after bariatric surgery.Methods:A retrospective analysis was conducted on four pregnant patients who had undergone pre-pregnant bariatric surgery and delivered at the Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, from January 2021 to December 2023. The analysis included the type of bariatric surgery, the interval between bariatric surgery and pregnancy, pregnancy complications, and neonatal birth conditions. Descriptive statistical analysis was used.Results:Among the four patients, two were primiparas and two were multiparas. All patients were obese (body mass index≥27.5 kg/m2) before undergoing sleeve gastrectomy. Before the current pregnancy, three patients had a normal body mass index, while one patient remained obese (body mass index 30.5 kg/m2). The interval between bariatric surgery and pregnancy exceeded one year for three patients (14, 14, and 60 months, respectively), while one patient became pregnant 10 months after surgery. Three patients developed normocytic anemia in early pregnancy, with the lowest hemoglobin levels of 101 to 106 g/L. After nutritional guidance and medication, hemoglobin levels returned to normal before delivery. One patient experienced a threatened late miscarriage at 26 weeks of gestation, which was successfully managed with tocolytic therapy. One patient was diagnosed with gestational diabetes at 27 weeks of gestation and achieved satisfactory blood glucose control through dietary and exercise guidance. Oral glucose tolerance tests for all four patients showed low fasting blood glucose levels (3.8-4.5 mmol/L) and 2-hour postprandial blood glucose levels (3.5-6.1 mmol/L). All four patients delivered at term, with no cases of small for gestational age infants.Conclusions:Pregnancy after bariatric surgery is prone to maternal nutrient deficiencies and blood glucose fluctuations. Multidisciplinary collaborative management and individualized nutritional guidance are recommended to reduce the risk of related complications.

Objective:To compare the training effect between the laparoscopic simulated uterine model (LSUM) with multi-angle suture and the traditional surgical model and to identify a laparoscopic model more suitable for gynecological resident training.Methods:Forty-eight residents who were trained in Sir Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine from February 2021 to February 2023 were selected. They were trained in batches, with each batch randomly divided into two groups of the same size. The observation group was trained with the traditional surgical model and general surgical videos, while the experimental group was trained with a self-developed LSUM with multi-angle suture and corresponding surgical videos. Finally, the two groups were compared for the assessment results, and a questionnaire survey was conducted in the experimental group. The statistical software SPSS 20.0 was used for t-test or chi-square test of the results. Results:There were no significant differences between the two groups in age, gender distribution, education level, and clinical experience. In theoretical assessment results, no significant difference was shown between the experimental group and the observation group [(82.63±3.93) vs. (85.00±6.15), P>0.05]. In skill assessment results, there was no significant difference between the two groups in the anterior wall assessment [(83.08±4.47) vs. (82.79±3.58), P=0.804]. However, in the assessment of the lateral and posterior walls, the proficiency, accuracy, and degree of coordination between two hands of the experimental group were better than those of the observation group, with the total score being significantly different [(64.13±3.34) vs. (46.75±3.50), (62.25±4.41) vs. (45.00±2.89), P<0.001]. In the questionnaire survey, the experimental group had a high degree of satisfaction with the LSUM and thought that the highly simulated model was beneficial to their training. Conclusions:Compared with the traditional surgical model, the LSUM with multi-angle suture can effectively improve the operation level of residents, which provides a new idea for the laparoscopic simulation training of gynecological residents in the future.

In this study, the mechanism of Xiaoyan Lidan formula (XYLDF) against 3,5-diethoxycarbonyl-1,4-dihydro-2,4,6-collidine (DDC)-induced chronic intrahepatic cholestasis (CIHC) in mice was investigated based on metabolomics, molecular docking and pharmacological methods. In the pharmacodynamics study, a dosage of 5 g·kg^-1 (clinical equivalent) XYLDF was administered in DDC-induced mice, then the effect of XYLDF against CIHC was evaluated by measuring the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (AKP) as well as total bilirubin (TBIL) in serum and observing liver histopathological changes. All experiments were approved by the Ethical Committee Experimental Animal Center of Guangzhou University of Chinese Medicine (ZYD-2021-001). The serum metabolites of mice in each group were detected and identified based on ultra-performance liquid chromatography quadrupole time-of-flight tandem mass spectrometry, and the relevant biological pathways and molecular key targets were further enriched. Molecular docking technology was used to further evaluate the binding activity of the main active ingredients of XYLDF with potential targets. Subsequently, the in vitro experiment was conducted for the validation of the vital target. The results showed that compared with the model group, XYLDF significantly decreased the levels of ALT, AST, AKP and TBIL in the serum of CIHC mice, as well as alleviated inflammatory infiltration and hepatocyte necrosis in liver tissue. According to the metabonomic study, a total of 35 differential metabolites was identified as biomarkers associated with cholestasis, 12 of which were significantly recovered by XYLDF treatment. These biomarkers were involved in the pathways of primary bile acid biosynthesis and linoleic metabolism, which are closely related to the mechanism of XYLDF against CIHC. Protein-protein interaction network indicated that cytochrome P450 3A4 (CYP3A4) and cytochrome P450 1A1 (CYP1A1) are significant potential targets with good binding properties with six major active ingredients of XYLDF. Furthermore, it was found that 4-methoxy-5-hydroxycanthin-6-one, dehydroandrographolide and isodocarpin, three of the main active components in XYLDF, markedly induced the expression of CYP3A4 mRNA in vitro. This study revealed that XYLDF mainly mediates the biosynthesis of bile acids in CIHC mice to improve liver tissue lesions and bile efflux disorders, among which, CYP3A4 is the key target in the protection of XYLDF against CIHC. This research provides a reference for further elucidation of the pharmacological mechanism of XYLDF.

Pulmonary vein stenosis (PVS) is an extremely rare and lethal disease caused by multiple etiologies. PVS has a bimodal distribution in the population, affecting children and adults. Congenital PVS is the usual PVS type in children, which sometimes develops after cardiothoracic surgery. Acquired PVS, in turn, is the most common PVS type in adults. A review of the relevant literature has shown that PVS after radiofrequency ablation of atrial fibrillation is the most common, as well as that caused by compression of proliferative fibrous tissues or tumor in the mediastinum (eg, PVS caused by fibrosing mediastinitis, lung tumors, metastases, etc). This article provides a comprehensive review of PVS in terms of embryology and anatomy, etiology and triggers, classification, clinical symptoms and signs, treatment, and prognosis, intending to promote the understanding and treatment of this disease.

Pulmonary vein stenosis (PVS) is an extremely rare and lethal disease caused by multiple etiologies. PVS has a bimodal distribution in the population, affecting children and adults. Congenital PVS is the usual PVS type in children, which sometimes develops after cardiothoracic surgery. Acquired PVS, in turn, is the most common PVS type in adults. A review of the relevant literature has shown that PVS after radiofrequency ablation of atrial fibrillation is the most common, as well as that caused by compression of proliferative fibrous tissues or tumor in the mediastinum (eg, PVS caused by fibrosing mediastinitis, lung tumors, metastases, etc). This article provides a comprehensive review of PVS in terms of embryology and anatomy, etiology and triggers, classification, clinical symptoms and signs, treatment, and prognosis, intending to promote the understanding and treatment of this disease.

OBJECTIVE: To study the genotype and phenotype of fetuses with 22q11.2 microdeletion and other abnormalities such as cardiac malformation and cleft palate. METHODS: Fetal ultrasound was carried out at 12 weeks to 20 to 24 weeks of gestation. After excluding the chromosomal karyotype abnormality, single nucleotide polymorphism (SNP) array was used to detect copy number variations of 5 fetuses with heart development abnormality or other structural abnormalities. The fetus with 22q11.2 microdeletion and its parents were also subjected to multiplex ligation-dependent probe amplification (MLPA) assay. RESULTS: SNP array analysis showed that the 5 fetuses had all carried a 2.27-3.02 Mb deletion of the 22q11.2 region. MLPA assay confirmed that LCR22-A-B was involved in all cases, and that all deletions were de novo in origin. CONCLUSION It is of great significance to exclude 22q11.2 microdeletions in fetuses with cardiac malformations. The deletion regions of these fetuses are similar but different, and the phenotypic difference is related to their genotypes.

Objective: To evaluate the feasibility and safety percutaneous pulmonary vein intervention in patients with severe pulmonary vein stenosis (PVS) caused by fibrosing mediastinitis(FM). Methods: This retrospective analysis included 5 FM patients (2 male, 3 female, 54-77 years old) confirmed by clinical presentation and chest computed tomography (CT) scan from January to June 2018 who were from Gansu Provincial Hospital and Shanghai Chest Hospital. CT pulmonary angiography (CTPA) further revealed severe PVS caused by fibrotic tissue compression in mediastinum. After selective pulmonary vein angiography, gradually balloon angioplasty was used to expand the pulmonary vein and then stents were implanted in the pre-dilated stenotic pulmonary veins. Evaluation of therapeutic effect was made at 6 months after the procedure. Results: All of 11 serious compression PVS were treated with stent implantation (diameter: 7-10 mm, length: 17-27 mm). After stenting, degree of pulmonary vein stenosis decreased from (83±16)% to (12±4)% (P<0.01). The minimal diameter of the stenotic pulmonary vein was significantly increased from (0.8±0.5)mm to (7.5±0.8)mm (P<0.01). Trans-stenotic gradient decreased from (27.0±15.1)mmHg (1 mmHg=0.133 kPa) to (2.50±0.58)mmHg (P<0.05). Mean pulmonary pressure measured by cardiac catheter decreased from (45.0±9.0)mmHg to (38.7±8.4)mmHg (P<0.05). One patient experienced cardiac arrest due to vagal nerve reflex during big sizing balloon stent dilation and recovered after cardiopulmonary resuscitation. There were no other serious procedure related complications. During the follow-up, severe stenosis at end of proximal stent was evidenced in 1 patient due to fibrotic compression, and another patient developed in-stent thrombosis due to discontinuation of prescribed anticoagulant. Conclusion Percutaneous intervention for severe pulmonary vein stenosis caused by FM is feasible and safe, and can improve hemodynamic caused by the compression of mediastinal vascular structures in these carefully selected patients.