Purpose To explore the diagnostic value of beak sign in fetal annular pancreas by analyzing the ultrasonographic features of fetal annular pancreas.Materials and Methods The ultrasound images and clinical data of 13 cases of fetal annular pancreas diagnosed by prenatal ultrasound in Shandong Provincial Maternal and Child Health Hospital from September 2019 to December 2021 and confirmed by surgery after birth were retrospectively analyzed.The degree of duodenal stenosis at the obstruction site was observed,especially whether the angle formed by the intestinal wall could identify the fetal annular pancreas,and the ultrasonic characteristics were summarized and analyzed.Results A total of 13 fetuses with annular pancreas showed double bubble sign,3 cases showed clamp sign,and 7 cases showed beak sign at the end of duodenal dilatation.All the 13 cases underwent surgical treatment after birth,including 2 cases with duodenal atresia and 1 case with atypical intestinal malrotation.All the children had good prognosis after operation.Conclusion By observing the dilated end of duodenum and the relationship with pancreatic head,prenatal ultrasound combined with beak sign and double bubble sign could improve the diagnostic accuracy of fetal annular pancreas,which has significant value in prenatal diagnosis of fetal annular pancreas.

Objective To systematically evaluate the risk factors for pulmonary infection after cardiac surgery. Methods A computer search was performed to collect researches on risk factors for pulmonary infection in patients after cardiac surgery from the databases, including CNKI, Wanfang, VIP, CBM, PubMed, The Cochrane Library, EBSCO, CINAHL, Web of Science, EMbase from the inception to August 2023. Two researchers independently extracted data and assessed the literature according to the inclusion and exclusion criteria, and the quality of the literature was evaluated using the Newcastle-Ottawa Scale (NOS). The meta-analysis was performed using RevMan 5.4 software. Results A total of 23 studies covering 24348 patients were selected, including 21 case-control studies and 2 cohort studies. The NOS scores were≥6 points. The results of meta-analysis showed that age (OR=2.16, 95%CI 1.80 to 2.59, P<0.001), smoking history (OR=1.91, 95%CI 1.67 to 2.18, P<0.001), pulmonary disease (OR=1.61, 95%CI 1.40 to 1.85, P<0.001), diabetes mellitus (OR=1.62, 95%CI 1.26 to 2.08, P<0.001), operation time (OR=2.54, 95%CI 1.86 to 3.46, P<0.001), cardiopulmonary bypass (CPB) (OR=3.78, 95%CI 2.11 to 6.77, P<0.001), CPB time (OR=2.30, 95%CI 1.94 to 2.71, P<0.001), blood transfusion (OR=2.55, 95%CI 2.04 to 3.20, P<0.001), postoperative mechanical ventilation time (OR=2.78, 95%CI 2.34 to 3.30, P<0.001), tracheal intubation time (OR=3.93, 95%CI 2.45 to 6.31, P<0.001) and repeated tracheal intubation (OR=8.74, 95%CI 4.17 to 18.30, P<0.001) were independent risk factors for pulmonary infection in patients after cardiac surgery. Conclusion Age, smoking history, pulmonary disease, diabetes mellitus, operation time, CPB, CPB time, blood transfusion, postoperative mechanical ventilation time, tracheal intubation time, and repeated tracheal intubation are risk factors for pulmonary infection in patients after cardiac surgery. It can be used as a reference to strengthen perioperative evaluation and nursing of high-risk patients and reduce the incidence of pulmonary infection.

Objective:To discuss the synergistic inhibitory effect of apatinib mesylate(apatinib)combined with radiotherapy(RT)on the hepatocellular carcinoma(HepG2)cells in vitro,and to clarify its related antitumor mechanism.Methods:The HepG2 cells were cultured in vitro and treated with different concentrations of apatinib and/or varying doses of X-rays.MTT method was used to detect the survival rates of the cells in various groups;the inhibitory rates of cell proliferation and the 20％inhibitory concentration(IC20)of apatinib were calculated;the X-ray irradiation dose for subsequent experiments was detected.The HepG2 cells were divided into apatinib group,RT group,and apatinib+RT group(combined group).Flow cytometry was used to detect the apoptotic rates of the cells in various groups;wound healing assay was used to detect the migration rates of the cells in various groups;ELISA method was used to detect the levels of vascular endothelial growth factor(VEGF)in the cell culture supernatant in various groups.Results:The MTT results showed that the IC20 of apatinib was 1.32 μmol·L-1,and this concentration was used for subsequent experiments,and the X-ray irradiation dose for the follow-up experiments was 2 Gy.Compared with control group,the apoptotic rates of the cells in apatinib group and RT group had no significant differences(P＞0.05),while the apoptotic rate of the cells in combined group was increased(P＜0.05).Compared with control group,the migration rates of the cells in apatinib group,RT group,and combined group were decreased(P＜0.05);compared with apatinib group and RT group,the migration rate of the cells in combined group was decreased(P＜0.05).Compared with control group,the levels of VEGF in the cell culture supernatant in apatinib group and combined group were decreased(P＜0.05);compared with apatinib and RT group,the level of VEGF in the cell culture supernatant in combined group was decreased(P＜0.05).Conclusion:Apatinib combined with radiotherapy significantly inhibits the proliferation and migration of the HepG2 cells in vitro and induces the apoptosis;its effect may be related to the inhibition of VEGF secretion by cells.

OBJECTIVE To provide a reference for the safe use of drugs in patients with complex venous thromboembolism （VTE） and acute renal insufficiency. METHODS Clinical pharmacists participated in the management of anticoagulant therapy for a patient with complex VTE complicated with acute renal insufficiency， and evaluated the patient as high-risk thrombosis and bleeding based on their medical history， laboratory test results， etc.； combined with the complexity of thrombosis and renal insufficiency， clinical pharmacists suggested that enoxaparin sodium should be used in the acute stage of thrombosis （5 to 21 days after onset）， and then warfarin should be adopted for oral anticoagulation treatment. Because the patient’s anticoagulation was not up to the standard （the target range of the international normalized ratio was 2-3）， clinical pharmacists suggested increasing the warfarin dose， detecting the warfarin metabolism genotype， and adjusting the warfarin dose according to the genotype； at the same time， clinical pharmacists developed an anticoagulation monitoring plan to ensure the safety of anticoagulation treatment. RESULTS Doctors had adopted all the recommendations of clinical pharmacists. The patient did not experience adverse events such as bleeding or worsening of thromboembolism during anticoagulation in the hospital. When the anticoagulation met the standards， the patient was allowed to be discharged with medication. CONCLUSIONS By participating in the anticoagulation treatment management of patients with complex VTE and acute renal insufficiency， clinical pharmacists have assisted doctors in formulating personalized anticoagulation plans to promote the compliance with the anticoagulation treatment standard and ensure the safety and effectiveness of medication for patients.

The cultivation of medical students' scientific research and innovation ability is the need of our country to accelerate the construction of an innovative country. This paper starts from the significance of strengthening the cultivation of medical students' scientific research and innovation ability, emphasizes participation in teacher's scientific research in colleges and universities to strengthen the feasibility of the medical students' scientific research and innovation ability cultivation, and summarizes the practical experience of cultivating medical students' scientific research ability based on scientific research projects of teachers in colleges and universities, which can provide reference for peers.

Ferroptosis is a type of cell death accompanied by iron-dependent lipid peroxidation, thus stimulating ferroptosis may be a potential strategy for treating gastric cancer, therapeutic agents against which are urgently required. Jiyuan oridonin A (JDA) is a natural compound isolated from Jiyuan

New Delhi metallo-β-lactamase-1 (NDM-1) is capable of hydrolyzing nearly all β-lactam antibiotics, posing an emerging threat to public health. There are currently less effective treatment options for treating NDM-1 positive “superbug”, and no promising NDM-1 inhibitors were used in clinical practice. In this study, structure–activity relationship based on thiosemicarbazone derivatives was systematically characterized and their potential activities combined with meropenem (MEM) were evaluated. Compounds 19bg and 19bh exhibited excellent activity against 10 NDM-positive isolate clinical isolates in reversing MEM resistance. Further studies demonstrated compounds 19bg and 19bh were uncompetitive NDM-1 inhibitors with Ki = 0.63 and 0.44 μmol/L, respectively. Molecular docking speculated that compounds 19bg and 19bh were most likely to bind in the allosteric pocket which would affect the catalytic effect of NDM-1 on the substrate meropenem. Toxicity evaluation experiment showed that no hemolysis activities even at concentrations of 1000 mg/mL against red blood cells. In vivo experimental results showed combination of MEM and compound 19bh was markedly effective in treating infections caused by NDM-1 positive strain and prolonging the survival time of sepsis mice. Our finding showed that compound 19bh might be a promising lead in developing new inhibitor to treat NDM-1 producing superbug.

Endophytic fungi are promising producers of bioactive small molecules. Bioinformatic analysis of the genome of an endophytic fungus

Objective:To investigate the application of local rotation flap with subcutaneous pedicle for breast conservation in central breast cancer.Methods:Retrospective analysis of clinical data of 14 patients with stage Ⅰor Ⅱ central breast cancer was performed. The local rotation flap with subcutaneous pedicle was used for breast conservation in Jiangxi Provincial Breast Specialist Hospital (Nanchang Third Hospital) from January 2017 to December 2018. The postoperative complications were recorded. One year after operation, the aesthetic result, satisfactory and comfort index were evaluated. Two years after operation, local tumor recurrence and metastasis were followed.Results:All patients were women, aged 37-75 years old with the median age as 47. First-stage healing was achieved in 12 patients. Wound infection happened in one case and necrotic in one case. They were all healed after secondary suture. Fourteen patients were followed up for 1 year, the suprasternal notch-nipple length was (22.27±2.38) cm at the operative side, and (23.33±2.22) cm at the healthy side, showing no statistical significance ( t=-1.253, P=0.242). The nipple-midsternal line length was(10.12±0.91) cm at the operative side, and (10.68±1.09) cm at the healthy side, showing no statistical significance ( t=-1.937, P=0.094). The nipple-inframammary fold length was (6.94±0.95) cm at the operative side, and (7.05±1.30) cm at the healthy side, showing no statistical significance ( t=-0.478, P=0.645). The patient’s breast satisfaction was 60.2±11.4 points before operation and 61.7±12.7 points after operation, with no difference between them ( t=-0.330, P=0.744). The overall postoperative comfort index was 62.05±4.40 points, which indicates a moderate comfort state. The physiological comfort index was 6.52±2.05 points, the mental and psychological comfort index was 15.13±2.56 points, the social comfort index was 19.09±1.57 points, and the environmental comfort index was 21.29±2.11 points. There was no local recurrence and no systemic metastasis 2 years after operation. Conclusions:The breast conservation in central breast cancer with local rotation flap with subcutaneous pedicle is less invasive with few complication and satisfactory results in cosmetic appearance. The moderate comfort index and good prognosis can be prospected.

Objective:To investigate the application of local rotation flap with subcutaneous pedicle for breast conservation in central breast cancer.Methods:Retrospective analysis of clinical data of 14 patients with stage Ⅰor Ⅱ central breast cancer was performed. The local rotation flap with subcutaneous pedicle was used for breast conservation in Jiangxi Provincial Breast Specialist Hospital (Nanchang Third Hospital) from January 2017 to December 2018. The postoperative complications were recorded. One year after operation, the aesthetic result, satisfactory and comfort index were evaluated. Two years after operation, local tumor recurrence and metastasis were followed.Results:All patients were women, aged 37-75 years old with the median age as 47. First-stage healing was achieved in 12 patients. Wound infection happened in one case and necrotic in one case. They were all healed after secondary suture. Fourteen patients were followed up for 1 year, the suprasternal notch-nipple length was (22.27±2.38) cm at the operative side, and (23.33±2.22) cm at the healthy side, showing no statistical significance ( t=-1.253, P=0.242). The nipple-midsternal line length was(10.12±0.91) cm at the operative side, and (10.68±1.09) cm at the healthy side, showing no statistical significance ( t=-1.937, P=0.094). The nipple-inframammary fold length was (6.94±0.95) cm at the operative side, and (7.05±1.30) cm at the healthy side, showing no statistical significance ( t=-0.478, P=0.645). The patient’s breast satisfaction was 60.2±11.4 points before operation and 61.7±12.7 points after operation, with no difference between them ( t=-0.330, P=0.744). The overall postoperative comfort index was 62.05±4.40 points, which indicates a moderate comfort state. The physiological comfort index was 6.52±2.05 points, the mental and psychological comfort index was 15.13±2.56 points, the social comfort index was 19.09±1.57 points, and the environmental comfort index was 21.29±2.11 points. There was no local recurrence and no systemic metastasis 2 years after operation. Conclusions:The breast conservation in central breast cancer with local rotation flap with subcutaneous pedicle is less invasive with few complication and satisfactory results in cosmetic appearance. The moderate comfort index and good prognosis can be prospected.