Objective:To investigate the perinatal prognosis and its impact factors for premature infants with twin-twin transfusion syndrome (TTTS) who were born at ≤34 weeks of gestation.Methods:A retrospective study was conducted on 68 pregnancies of TTTS with gestational age ≤34 weeks at delivery, among them 106 preterm infants (TTTS group) were admitted to the neonatal intensive care unit of the First Affiliated Hospital, Sun Yat-sen University from January 2003 to February 2019. During the same period, another 178 twins without TTTS, congenital malformation, and intrauterine intervention who matched the TTTS group in maternal age (differences within two years) and gestational age (differences within one week) were assigned as non-TTTS group. Perinatal prognosis of TTTS infants born at ≤34 weeks was analyzed by comparing the differences in postnatal early complications and perinatal outcomes (survival time morn than 28 days or not) between the TTTS and non-TTTS groups, recipient and donor twins, mild and severe TTTS infants, and among TTTS infants with different intrauterine interventions. The risk factors for perinatal survival in TTTS infants with gestational age ≤34 weeks were analyzed. Two independent samples t-test, one-way analysis of variance, rank-sum test, Chi-square test, and ordered logistic regression were used for statistical analysis. Results:(1) Among the 68 pregnancies, the overall perinatal survival rate of the neonates was 72.1% (98/136), the double-twin survival rate was 48.5% (33/68), and the rate of at least one survivor was 95.6% (65/68). (2) In the TTTS group, 62 were recipients and 44 were donors. Stage Ⅰ-Ⅱ TTTS was found in 41 cases (mild TTTS group) and stage Ⅲ-Ⅴ in 65 cases (severe TTTS group). (3) The rate of severe brain injury was higher in the severe-TTTS group than those in the mild-TTTS group [9.2% (6/65) vs. 0.0% (0/41), χ 2=4.01, P=0.045]. (4) Gestational age ≤28 weeks ( OR=101.90, 95% CI: 5.07-2 048.37), stage Ⅳ ( OR=14.04, 95% CI: 1.56-126.32) and stage Ⅴ TTTS ( OR=51.09, 95% CI: 3.58-728.81) were independent risk factors for death within 28 days (all P<0.05). (5) Compared with the non-TTTS group, the TTTS group had higher rates of neonatal anemia [51.9% (55/106) vs. 33.1% (59/178), χ 2=9.71], polycythemia [5.7% (6/106) vs. 0.6% (1/178), χ 2=7.18], neonatal persistent pulmonary hypertension [3.8% (4/106) vs. 0.0% (0/178), χ 2=6.81], sepsis [15.1% (16/106) vs. 7.3% (13/178), χ 2=4.40], state Ⅲ or higher retinopathy of prematurity [3.8% (4/106) vs. 0.0% (0/178), χ 2=6.81], congenital cardiac structural abnormality [19.8% (21/106) vs. 0.6% (1/178), χ 2=33.45], heart failure [8.5% (9/106) vs. 0.6% (1/178), χ 2=12.29], and renal insufficiency [14.2% (15/106) vs. 1.1% (2/178), χ 2=20.04] (all P<0.05). Conclusions:Compared with the twin premature infants without TTTS, those with TTTS and ≤34 gestational age were more likely to have cardiac, cerebral, and renal complications. The more severe the TTTS, the higher the incidence of severe brain injury. TTTS preterm infants with gestational age ≤28 weeks and stage Ⅳ or above have high risk of death.

Objective:The quality of domestic diagnostic accuracy research was evaluated to explore the quality level of domestic diagnostic accuracy research based on Standards for Reporting of Diagnostic Accuracy 2015 (STARD2015).Methods:The Chinese core journals of CNKI and Wanfang Database were searched, and research literature on diagnostic accuracy published from 2017 to 2022 were collected. The main search terms are diagnostic test, sensitivity, specificity, receiver operating characteristic (ROC) curve, etc. The literature was selected according to the inclusion criteria, and the quality of the included literature was evaluated independently by two reviewers, and the conformity rate of the STARD2015 report and the STARD2015 article was calculated. The report quality of the literature was divided into three levels (low, medium and high) according to the conformity rate of the STARD2015 report. The proportion of literature at each level and the proportion of literature at medium and high level in each year were counted. According to quality analysis on the contents of the included articles, articles were divided into standardized reports and unstandardized reports. Intragroup correlation coefficient ( ICC) was used to analyze the consistency of two reviewers. The trend Chi-square test was used to analyze the trend of the proportion of medium and high level literature in each year. One-way analysis of variance was used to compare the coincidence rates evaluated by STARD2015 for each year. Results:A total of 6 771 studies on diagnostic accuracy published from 2017 to 2022 were included. The compliance rate sccording to STARD2015 was 39.56%±4.90%, and the reported compliance rate ranged from 17.65% to 64.71% (the number of reported items ranged from 6 to 22), and 93.53% (6 333/6 771) literatures were in the middle level. Compliance rate of STARD2015 reports varied significantly among different years ( F=25.023, P<0.01), and the compliance rate of 2021 was significantly higher than that of other years ( P<0.01). The proportion of medium and high level literatures according to STARD2015 showed an increasing trend ( χ 2=14.099, P<0.01). The reporting situation of each item varied significantly, and the conformity rate of items raned from 0 to 100%. According to report item, non-standard report rate was 10.34% (569/5 503) for item 6, 4.15% (277/6 677) for item 8, 21.84% (1 447/6 626) for item 20, 66.67% (24/36) for item 22, and 26.03% (877/3 369) for item 26. Conclusions:The overall report quality of published domestic literature on diagnostic accuracy from 2017 to 2022 is at a medium level according to STARD2015, and the reports conformity rate of each item vary significantly, indicating significant knowledge gap on STARD2015 among domestic researchers. The promotion of STARD2015 needs to be strengthened.

OBJECTIVES: To explore the role of mitochondrial CYB 15024G>A mutation in the development of essential hypertension. METHODS: Mitochondrial genome sequences of hypertensive patients were obtained from previous studies. Clinical and genetic data of a hypertensive patient with mitochondrial CYB 15024G>A mutation and its pedigree were analyzed. Lymphocytes derived from patient and family members were transformed into immortalized lymphoblastoid cell lines, and the levels of adenosine triphosphate (ATP), mitochondrial membrane potential and intracellular reactive oxygen species (ROS) were detected. RESULTS: The penetrance of this essential hypertension family was 42.9%, and the age of onset was 46-68 years old. Mitochondrial genome sequencing results showed that all maternal members carried a highly conserved mitochondrial CYB 15024G>A mutation. This mutation could affect the free energy of mitochondrial CYB for secondary and tertiary structure and protein folding, thereby changing its structural stability and the structure of the electron transfer function area around the mutation site. Compared with the control, the cell line carrying the mitochondrial CYB 15024G>A mutation showed significantly decreased levels of mitochondrial CYB, ATP and mitochondrial membrane potential, and increased levels of ROS (P<0.01). CONCLUSIONS Mitochondrial CYB 15024G>A mutation may affect the structure of respiratory chain subunits and mitochondrial function, leading to cell dysfunction, which suggests that the mutation may play a synergistic role in essential hypertension.
Humans ; Middle Aged ; Aged ; Reactive Oxygen Species ; Essential Hypertension/genetics* ; Adenosine Triphosphate ; Cell Line ; Mutation

ObjectiveTo investigate effect of conducting training of autism spectrum disorder （ASD） early screening skill on improving the ability to early identify ASD of medical staffs in primary care hospitals. MethodsIn September 2021， the training of ASD early screening skills was carried out for medical staffs from 20 primary care hospitals in Chengdu. After training， the training effect was evaluated. The numbers of referrals from primary care hospitals to superior hospitals， confirmed ASD as well as their average diagnostic age of children with ASD before and after training were used as evaluation indicators. ResultsAfter training， the number of children with suspected ASD referred by primary care hospitals was more than that before training ［（16.65±11.60） vs. （3.40±2.23）， t=5.431， P<0.01］， the number of children diagnosed with ASD was more than that before training［（6.85±4.93） vs. （2.45±1.67）， t=4.171， P<0.01］， and the differences were statistically significant. As for the diagnosed age of ASD children， after training， the average age was lower than that before training ［（34.95±11.67） vs. （42.2±14.64）， t=-2.553， P=0.019］. ConclusionTraining of ASD early screening skills for medical staffs in primary care hospitals may help to improve their ability to early screening ASD children.

Objective:To explore the effect of micro-video education combined with active psychological management on the rehabilitation effect of hip replacement.Methods:From January to December 2018, 100 patients with total hip arthroplasty were divided into control group and observation group, 50 cases in each group. The control group was given routine nursing, and the observation group was given micro video education combined with positive psychological management. The depression, pain, joint function and complications were evaluated.Results:After the intervention, the Self-rating Depression Scale (SDS) score of patients in the observation group was (34.72±6.83) points, which was significantly lower than (40.58±7.59) points of the control group. The difference was statistically significant ( tvalue was 4.058, P<0.05); pain control education in the observation group and satisfaction scores for pain control or reduction methods were (43.01±5.72) and (63.77±8.62) points respectively, which were better than the control group's (33.96±4.58) and (55.15±9.27) points. The difference was statistically significant ( tvalues were 8.733, 4.815, P<0.05); the excellent and good rate of hip joint function in the observation group was 90.00% (45/50), which was higher than 64.00% (32/50) in the control group. The difference was statistically significant ( χ 2value was 4.336, P<0.05); the complication rate in the observation group was 2.00% (1/50), which was significantly lower than the control group's 18.00% (9/50). The difference was statistically significant ( χ 2value was 7.111, P<0.05); The scores of each item of quality of life in the observation group were higher than those in the control group, and the differences were statistically significant ( tvalues were- 9.859 to- 3.154, P<0.01). Conclusion:Micro video education combined with positive psychological management can improve the depression of patients after hip arthroplasty, reduce the degree of joint pain, promote the function of hip joint and reduce complications.

Objective To investigate the clinical immune status of patients with severe sepsis shock.Methods A total of 45 patients with sepsis in general ward and 45 severe sepsis shock patients treated in our hospital were selected for the study,and were as control group and observation group,respectively.The T lymphocyte,B lymphocyte and CD3+ CD4+,CD3+ CD8+,NK cells,immunoglobulin IgG,IgA,IgM levels,complement C3,C4 were detected in the two groups.The cellular immune function,humoral immune function and inflammatory reactions were compared between the two groups.Results The T lymphocyte count in the observation group and the control group were (60.0 ±16.2)％ and (77.2 ± 18.5)％,respectively,and The B lymphocyte count were (25.1 ± 10.2)％,and (14.3 ±6.9)％,respectively.The CD3+ CD8+ in the observation group was significantly lower,and CD4+/CD8+ was significantly higher than that in the control group (P ＜ 0.05).The percentage of NK cells and CD3 + CD8 + in the two groups showed no significant difference (P ＞ 0.05).The concentration of C4 and IgM in the observation group were significantly lower than that in the control group (P ＜ 0.05),and there was no significant difference between the two groups in C3,IgG and IgA (P ＞ 0.05).The WBC count,procalcitonin and C reactive protein in the observation group were significantly higher than that in the control group (P ＜ 0.05).Conclusion Severe septic shock patients have severe immune disorder.

Objective To investigate the clinical immune status of patients with severe sepsis shock.Methods A total of 45 patients with sepsis in general ward and 45 severe sepsis shock patients treated in our hospital were selected for the study,and were as control group and observation group,respectively.The T lymphocyte,B lymphocyte and CD3+ CD4+,CD3+ CD8+,NK cells,immunoglobulin IgG,IgA,IgM levels,complement C3,C4 were detected in the two groups.The cellular immune function,humoral immune function and inflammatory reactions were compared between the two groups.Results The T lymphocyte count in the observation group and the control group were (60.0 ±16.2)％ and (77.2 ± 18.5)％,respectively,and The B lymphocyte count were (25.1 ± 10.2)％,and (14.3 ±6.9)％,respectively.The CD3+ CD8+ in the observation group was significantly lower,and CD4+/CD8+ was significantly higher than that in the control group (P ＜ 0.05).The percentage of NK cells and CD3 + CD8 + in the two groups showed no significant difference (P ＞ 0.05).The concentration of C4 and IgM in the observation group were significantly lower than that in the control group (P ＜ 0.05),and there was no significant difference between the two groups in C3,IgG and IgA (P ＞ 0.05).The WBC count,procalcitonin and C reactive protein in the observation group were significantly higher than that in the control group (P ＜ 0.05).Conclusion Severe septic shock patients have severe immune disorder.

Objective To study the relationship between insulin resistance with cardiac function and cardiovascular events in the patients with obstructive sleep apnea syndrome(OSAS).Methods Eithy-eight cases of SHAS in our hospital from August 2015 to August 2016 were selected as the research subjects,and contemporaneous 20 persons undergoing healthy physical examination served as the control group.The blood glucose metabolism indicators were detected for evaluiating the level of insulin resistance.The insulin resistance and glucose metabolism indexes were compared between the two groups.The relatioship between insulin resistance with cardiac function and cardiovascular events in the OSAS was investigated.Results BMI,HOMA-IR,FPG and FINS in the observation group were (28.1± 3.9),(4.7 ±1.9),(4.8± 0.9) and (19.8± 3.7) respectively,which were significantly higher than those in the healthy control group,LVEF in the observation group was (58.7±5.6)%,which was significantly lower than that in the control group,LVEDP,RVEDP and mPAP in the observation group were 8.6±1.8,5.4±0.9 and 25.4±1.9 respectively,which were significantly higher than those in the control group,the multivariate analysis results indicated that LVEF<55%(P=0.014) and HOMA-IR>4.5(P=0.04) were the independent risk factors for cardiovascular events in OSAS patients.Conclusion The insulin resistance has obvious correlation with the cardiac function in OSAS patients.

Objective To retrospectively analyzed the echocardiographic characteristics of ventricular diverticula in fetuses ,children and adults ,and discuss the main points of diagnoses and prognoses of ventricular diverticula . Methods Echocardiographic characteristics ,clinical data and intraoperative findings of ventricular diverticula of 8 fetuses ,3 children and 14 adults were summarized . Results The ventricular diverticula in 8 fetuses and 3 children were all single . Twenty five diverticula were found in the 14 adult patients ;in other words ,there were 3 multiple diverticula found in adult group . A statistical difference was found in ratio of diverticula area and corresponding ventricular area ( P = 0 .021 ) ,and corresponding ventricular fractional shortening ( P =0 .003) between fetal and single adult ventricular diverticula . There were 2 cases with ventricular septal defects ,1 with pericardial effusion ,1 with single umbilical artery ,and 2 with atrioventricular valvular regurgitation in fetal cases . Congenital complex cardiac disease and dextrocardia were found in 1 child . There were 1 case with supravalvular aortic stenosis , 1 with nonobstructive hypertrophic cardiomyopathy ,1 with left ventricular noncompaction ,and 1 with mitral reguigitation in adult group . All the 7 diverticula with ventricular arrhythmias ,ST‐T changes and abnormal Q wave were fibrous type . And 2 multiple diverticula were accompanied with ventricular dysfunction . Among the fetal cases ,2 cases were born ,3 cases were terminated pregnancy ,and 3 cases were lost to follow up . Three children and 2 adults were underwent cardiac operations for diverticula with good outcomes . No such complications as cardiac rupture ,thromboembolism ,and sudden death were found . Conclusions Echocardiography is a useful method to diagnose ventricular diverticulum ,especially for fetuses ,and provide the basis for prognosis consultation .

Objective To investigate the changes and correlation of mitral valve coaptation length index CLI and coaptation area index CAI after mitral valvuloplasty MVP Methods A total of 30 subjects undergoing MVP for mitral regurgitation MR were studied Coaptation length CL CLI coaptation area CA and CAI were determined before and after surgery by 2-dimensional transoesophageal echocardiography 2D-TEE and 3-dimensional transoesophageal echocardiography 3D-TEE Results Compared with preoperative measurements CL CLI CA and CAI were significantly increased in postoperative studies CL 4 7±0 7 mm vs 9 4± 1 1 mm CLI 9 1 ±3 3 vs 38 5 ±4 1 CA 148 9 ± 65 3 mm 2 vs 371 9 ± 144 3 mm 2 CAI 9 3 ±3 1 vs 35 9 ± 7 5 all P < 0 05 CLI was significantly correlated with CAI both preoperatively r = 0 770 P < 0 01 and postoperatively r = 0 771 P <0 01 Furthermore CLI and CAI were significantly negative correlated with the degree of MR r =-0 897 P <0 01 r =-0 886 P <0 01 Conclusions Coaptation variables increased significantly in subjects after MVP CLI by 2D-TEE was related to CAI by 3D-TEE and both were useful for the assessment of mitral valve coaptation But CLI by 2D-TEE was more simple and feasible in clinic.