Objective:To summarize the key prenatal ultrasound diagnosis features of Apert syndrome, analyze the causes of missed diagnosis and misdiagnosis, and propose corresponding preventive strategies.Methods:A retrospective analysis was made on the medical records and prenatal ultrasound images of 15 fetuses (including 14 cases referred from other hospitals) who underwent prenatal ultrasound examination in Guangdong Women and Children Hospital from August 2014 to May 2022 and were eventually clinically confirmed as Apert syndrome by induction or after birth. By conducting a comparative analysis, particularly focusing on the initial and final diagnoses of referral cases, the key ultrasound diagnostic points of Apert syndrome and the causes for missed and misdiagnosis were summarized.Results:①Diagnostic accuracy: Among the 15 fetuses, 11 cases (73.3%) were correctly diagnosed by prenatal ultrasound and 4 cases (26.7%) were missed diagnosis and misdiagnosis. For the 14 referral cases, only 2 cases (14.3%) were correctly identified in the initial diagnosis at the referring hospital (14.3%), and 12 cases (85.7%) were missed missed diagnosis and misdiagnosis. ②Detection rate of ultrasound signs: In the 15 fetuses with Apert syndrome, the detection rate of " cloverleaf" skull was 13.3% (2/15), premature coronal suture was 66.7% (10/15), the " brain shadowing sign" and flat occiput were both 93.3% (14/15), prominent forehead, hypertelorism and bilateral syndactyly of hands were all 100% (15/15), and bilateral syndactyly of feet was 73.3% (11/15). ③Analysis of missed diagnosis and misdiagnosis: Among the 4 cases of missed diagnosis and misdiagnosis in our hospital, premature closure of coronal suture, " brain shadowing sign", flat occiput and hypertelorism were all not recognized. Among these, 3 cases also missed the prominent forehead, bilateral syndactyly of hands and feet. Additionally, 1 case of bilateral syndactyly of hands was misdiagnosed as partial absence of metacarpals and phalangess.Conclusions:In the prenatal ultrasound diagnosis of fetal Apert syndrome, the symmetric syndactyly of both hands serves as an extremely important diagnostic clue. The " cloverleaf" skull is not common. The premature closure of coronal suture as a direct diagnostic sign with a high detection rate, highlighting its significance in the diagnostic of Apert syndrome. Furthermore, the high detection rates of characteristic ultrasound features such as prominent forehead, flat occiput, " brain shadowing sign" and hypertelorism could help to improve the accuracy of prenatal ultrasound diagnosis for Apert syndrome and effectively reduce missed and misdiagnosis.

Objective To explore the longitudinal trajectories of symptom clusters in patients with rectal cancer within 6 months after laparoscopic anal preservation surgery,and analyze the predictive factors of each trajectory subgroup.Methods A longitudinal survey was conducted to select 128 patients who underwent laparoscopic anal preservation surgery for rectal cancer at the Department of Gastrointestinal Surgery,a tertiary hospital in Nanchong from November 2021 to April 2022.The general information questionnaire,Chinese version of Anderson Symptom Inventory for Gastrointestinal Cancer and Charlson Comorbidity Index were used to conduct follow-up surveys of the selected patients at 2 weeks,1 month,3 months and 6 months after surgeiy.The symptom cluster were extracted by exploratory factor analysis,and the latent category growth model was constructed to identify the trajectory subgroups of each symptom cluster.The predictive factors of each trajectory subgroup were analyzed by Mplus statistical software.Results There were 4 symptom clusters within 6 months after laparoscopic anus preserving surgeiy for rectal cancer,which were named as sickness symptom cluster,psychological-sleep symptom cluster,gastrointestinal symptom cluster,and psychological-treatment-related symptom cluster.The variance contribution rates were 65.173％,66.225％,62.421％,and 60.492％,respectively.The latent class growth model identified that there are 4 to 5 trajectory subgroups in the symptom cluster.Gender,education level,Charles Comorbidity Index,clinical T stage,medical cost burden,and treatment method were the predictors of high-risk trajectory subgroups in the symptom cluster(P＜0.05).Conclusion There are 4 symptom clusters within 6 months after laparoscopic anus preserving surgeiy for rectal cancer.The gastrointestinal symptom cluster is a specific symptom cluster for this type of patients with the heaviest symptom burden.The overall trajectory of each symptom cluster shows a dynamic decline trend,but individual trajectoiy subgroups still have an exacerbation trend.There are differences in predictive factors for different symptom clusters.Clinical medical staff should pay attention to the management of symptom clusters in patients with female patients,low education level,high Charles Comorbidity Index,high clinical T stage,heavy medical cost burden,and patients whose treatment method is chemotherapy plus surgery.High-risk groups should be timely identified;corresponding intervention methods were dynamically adjusted;the quality of precision nursing was improved.

This article reported a case of fetal giant hepatic hemangioma with cardiomegaly managed with intrauterine treatment. At 23 weeks of gestation, the patient was referred to Guangdong Women and Children Hospital due to abnormal abdominal echogenicity of the fetus, which was suspected to be a hepatic hemangioma or a hepatic arteriovenous fistula. The prenatal ultrasound at 26 weeks of gestation revealed an enlarged fetal hepatic hemangioma of 45 mm×35 mm×42 mm and an enlarged heart (cardiothoracic area ratio of 0.50). So, with the patient's informed consent, the fetus was treated with intrauterine administration of propranolol and dexamethasone and closely monitored by ultrasound. The volume of the lump still increased at the beginning of the medication, but started to shrink in the 7th week. Besides, the fetal cardiac load was reduced and the condition was controlled. The patient delivered at 37 weeks of gestation. The baby received a CT examination on the fourth day after birth which revealed an abdominal mass of 40 mm×30 mm×44 mm requiring no treatment, and no abnormalities were reported during a one-year follow-up.

OBJECTIVE: Flavonoids are the bioactive compounds in safflower (Carthamus tinctorius), in which chalcone synthase (CHS) is the first limiting enzyme. However, it is unclear that which chalcone synthase genes (CHSs) are participated in flavonoids biosynthesis in C. tinctorius. In this study, the CHSs in the molecular characterization and enzyme activities were investigated. METHODS: Putative chalcone biosynthase genes were screened by the full-length transcriptome sequences data in C. tinctorius. Chalcone biosynthase genes in C. tinctorius (CtCHSs) were cloned from cDNA of flowers of C. tinctorius. The cloned gene sequences were analyzed by bioinformatics, and their expression patterns were analyzed by real-time PCR (RT-PCR). The protein of CtCHS in the development of flowers was detected by polyclonal antibody Western blot. A recombinant vector of CtCHS was constructed. The CtCHS recombinant protein was induced and purified to detect the enzyme reaction (catalyzing the reaction of p-coumaryl-CoA and malonyl-CoA to produce naringin chalcone). The reaction product was detected by HPLC and LC-MS. RESULTS: Two full-length CtCHS genes were successfully cloned from the flowers of safflower (CtCHS1 and CtCHS3), with gene lengths of 1525 bp and 1358 bp, respectively. RT-PCR analysis showed that both genes were highly expressed in the flowers, but the expression of CtCHS1 was higher than that of CtCHS3 at each developmental stage of the flowers. WB analysis showed that only CtCHS1 protein could be detected at each developmental stage of the flowers. HPLC and LC-MS analyses showed that CtCHS1 could catalyze the conversion of p-coumaryl-CoA and malonyl-CoA substrates to naringin chalcone. CONCLUSION CtCHS1 is involved in the biosynthesis of naringin chalcone in safflower.

Objective To investigate the current situations and analyse the influencing factors of self-compassion in patients 3 months after colorectal cancer surgery,so as to provide a basis for clinical interventions.Methods This cross-sectional survey was conducted from August 2020 to January 2022 among 190 patients who were at 3 months after colorectal cancer surgery in a tertiary hospital in sichuan.General information questionnaire,self-compassion scale,Connor-Davidson resilience scale and meaning in life questionnaire were used in the survey.Results Total scores of self-compassion,mental toughness and meaning of life after colorectal cancer surgery were 76.69±9.68,58.01±12.54 and 36.02±12.22,respectively.With analysis of multiple linear regression,the influencing factors of self-compassion were found as comorbid chronic diseases,postoperative stoma,postoperative radiotherapy,mental toughness and meaning of life(all P<0.05),toally explaining 58.4%its varience.Conclusions The self-compassion of patients with colorectal cancer is at a moderately lower level and the influencing factors of it include comorbid chronic diseases,postoperative stoma,postoperative radiotherapy,mental toughness and meaning of life.Medical staff should assess the psychological status of the patients,strengthen a psychological care and help patients to gain correct cognitive views for the purpose to improve the self-compassion of patients.

AIM: To investigate the effect of miR-195-5p on ox-LDL-induced vascular endothelial cell injury and its mechanism. METHODS: The expression of miR-195-5p in HUVECs cells induced by ox-LDL was detected by RT-PCR. Cell proliferation, the expression of oxidative stress associated factors (MDA and LDH) and apoptosis were detected by CCK-8, ELISA and flow cytometry, respectively. The potential targets of miR-195-5p were determined by dual luciferase reporter assay. The expression of target protein in ox-LDL-induced HUVECs cells and the relationship between miR-195-5p and FBXW7 expression were detected by Western blotting. RESULTS: The expression of miR-195-5p in ox-LDL-induced HUVECs cells was significantly higher than that in normal HUVECs cells. Subsequently, miR-195-5p silencing in ox-LDL-induced HUVECs cells effectively promoted the proliferation of HUVECs cells, whereas suppressed the expression of oxidative stress associated factors (MDA and LDH) and apoptosis level. Luciferase reporter assay and Western blot results showed that miR-195-5p could directly target FBXW7 protein gene and negatively regulate its expression. Finally, miR-195-5p modulated the proliferation, oxidative stress and apoptosis of HUVECs cells induced by ox-LDL by regulating the expression of FBXW7. CONCLUSION: miR-195-5p is highly expressed in HUVECs cells induced by ox-LDL. In addition, miR-195-5p can aggravate ox-LDL-induced cytotoxicity, oxidative stress and apoptosis of HUVECs cells by inhibiting the expression of FBXW7.

Objective:To evaluate the effect and safety of adjustable closed loop(ACL) in the treatment of short bowel syndrome (SBS).Methods:From January 2017 to December 2017, the clinical data of 2 cases with ostomy in continuity after surgery in Children's Hospital Affiliated to Xi'an Jiaotong University were analyzed.The age was 1 and 3 months, both were females, and preservation of intestinal tube length were 65 cm and 60 cm respectively.They were all diagnosed SBS with a lot of stool like water.Self-made ACL was installed to maintain SBS.The blood circulation of stoma, weight, BMI, defecating, abdomen, nutrition status changes, nursing convenience, intestinal infection susceptibility were observed.Results:There was no necrosis in stoma, and the overall condition was improved, and no significant increase in abdominal distension.ACL used in babies with ostomy in continuity could improve the anus stool, weight, nursing convenience.Conclusion:ACL installed in baby with SBS could contribute to intestinal management, and is easy to install.

OBJECTIVE：To investigate the correlation of storage life and effective composition content with color value of Carthamus tinctorius ，and to provide reference for the quality evaluation of C. tinctorius with different years of storage. METHODS：Using 24 batches of C. tinctorius from same place of production with different years of storage （0，1，2 years，8 batches each type ）as samples ，the contents of hydroxysafflor yellow A （HSYA）and kaempferol were determined by HPLC. Color value [lightness value （L*），red-green value （a*），yellow-blue value （b*）] were determined by spectrophotometer. SPSS 19.0 statistical software was used to analyze the correlation of storage life and effective composition content with color value. RESULTS：Kaempferol content was still high after 1 year or 2 years of storage （0.161％，0.061％，respectively）. However ，the content of HSYA decreased with the prolongation of the storage life （the average content of HSYA were 2.46％，1.58％，and 1.51％ after storage 0，1 and 2 years，respectively），and the color of the drug became darker （a* value decreased ）. Results of correlation analysis showed that the content of HSYA was positively associated with color value L*，a*（r＝0.430，0.781，P＜0.05 or P＜0.01）；the content of HSAY was negatively associated with storage life （r＝－0.777，P＜0.01）. There was no correlation between the remaining variables （P＞0.05）. CONCLUSIONS ：The longer the storage life ，the darker the color and the lower the content of HSYA ，so it is not suitable for over year and multiyear preservation.

Objective:To observe the dynamic changes in specific IgG antibodies induced by recombinant hepatitis E vaccine using different immunization strategies in BALB/c mice.Methods:BALB/c, C57BL/6, NIH and KM mice were immunized intraperitoneally with serially diluted hepatitis E vaccine to select a mouse strain appropriately responding to hepatitis E vaccine. Then the selected BALB/c mice were randomly divided into three experimental groups, one-dose immunization group (0 week), two-dose immunization group (0 and 4 weeks) and three-dose immunization group (0, 4 and 12 weeks), and three adjuvant control groups with the same immunization strategy as the corresponding experimental group. Blood samples were collected from the intraocular canthus at different time points and serum antibody levels were detected quantitatively.Results:The BALB/c and NIH mice had proper responses to hepatitis E vaccine administrated at different doses than the C57BL/6 and KM mice, and the antibody positive conversion rates also showed a certain dose-effect relationship. Thus, the BALB/c mice were used as the animal model. The level of specific IgG antibodies in BALB/c mice immunized with one dose of vaccine reached a peak of 44.35 U/ml around the 10th week after the immunization, and then maintained at (5.52-13.28) U/ml after a decrease. The antibody level in the two-dose immunization group increased rapidly after the second immunization and peaked at the 8th week. From the 10th week, it gradually decreased and maintained at (16.50-32.54) U/ml. The trend of antibody changes in the three-dose immunization group was similar to that of the two-dose immunization group during the first 12 weeks, but a significant increase was induced after the third immunization and the level maintained at (62.65-72.61) U/ml for a long time, which was about nine times higher than that of the one-dose immunization group and three times of the two-dose immunization group.Conclusions:This study showed that BALB/c mice were suitable models to study the dynamic changes in specific IgG antibodies elicited by hepatitis E vaccine using different immunization strategies, which provided reference for future research on its in vivo efficacy.

Objective To establish domestic expected fetal lung volume (FLV) regression formula according to gestational week (GW) with large sample and data distributed evenly. Methods Prenatal MRI of 457 fetuses from 18 to 39 gestational weeks with normal chest was collected. FLV was measured on the axial images of single shot fast spin echo sequence. All FLV data were used for regression analysis. The regression model was determined according to the degree of fitting and test results, and the expected FLV regression formula based on GW was obtained. Results The mean GW of 457 fetuses was (29.44±4.61) weeks. There were 43.11% (197/457) fetuses at 28 weeks and below. FLV based on MRI measurement ranged from 9.47 ml to 131.48 ml, mean (50.78±23.76) ml. The final regression formula was expected FLV=0.004g2.76 (g=GW, R2=0.845, P<0.001). Conclusion The final regression formula of expected FLV is simple, practical and applicable to most fetuses, and is helpful to the research on prenatal assessment of domestic fetuses lung.