Gansu Provincial Maternal and Child Health Hospital

Fetal abdominal aorta-hepatic artery-umbilical vein fistulas are rare congenital vascular-related malformations. This study aimed to assess the diagnostic efficacy of ultrasound in detecting fetal aorta-hepatic artery-umbilical vein fistulas using high-definition flow (HD-flow) render mode and spatiotemporal image correlation (STIC) technology. The study emphasizes six case analyses of abdominal aorta-hepatic artery-umbilical vein fistula using HD-flow render mode and STIC. Postnatal outcome evaluations were performed at our medical facility. The fistulas formed a connection between the abdominal aorta and the umbilical vein. HD-flow render mode and STIC were acquired in all six cases. In three cases, fistulas with a diameter >3 mm were associated with extracardiac structural abnormalities and congenital heart defects. The incidence of heart failure was higher when the ratio of the fistula diameter to the umbilical vein diameter was >0.65 and to the abdominal aorta diameter was >0.9. Three fetuses were viable to survive, while three did not, including one that died in utero. HD-flow render mode and STIC facilitate a more accurate and comprehensive observation of the hemodynamics of the fetal abdominal aorta-hepatic artery-umbilical vein fistula, enabling the early diagnosis of related complications and determination of prognosis.

Colorectal cancer (CRC) exhibits high incidence and mortality rates, and current therapeutic approaches remain limited, underscoring the urgent need for novel treatment strategies. Astragali Radix, a traditional Chinese medicine with diverse pharmacological properties, has shown potential in cancer therapy; however, its anti-CRC mechanisms remain poorly understood. This study investigated the active components of A. Radix and their anti-CRC mechanisms using an integrated approach combining network pharmacology, molecular docking, and in vitro and in vivo experiments. Twenty active components of A. Radix with high oral bioavailability and drug-likeness were screened from databases, and relevant networks were constructed to identify core targets, including SRC, PIK3CA, and AKT1. Enrichment analysis revealed that these targets are primarily involved in the regulation of the PI3K-Akt signaling pathway. Molecular docking confirmed strong binding affinity between the active components of A. Radix and the core targets. In vitro experiments on HCT 116 and HT 29 cells demonstrated that A. Radix and quercetin inhibited cell proliferation in a concentration- and time-dependent manner, downregulating the mRNA expression of key genes (PIK3CA, PIK3R1, AKT1) in the PI3K-Akt pathway, and A. Radix showed superior efficacy compared with quercetin. Western blot analysis confirmed that the protein levels of PI3K, p-PI3K, AKT, p-AKT, PIK3CA, PIK3R1, and AKT1 were reduced in A. Radix-treated cells, as were the ratios of p-PI3K/PI3K and p-AKT/AKT. In vivo experiments on MC38 tumor-bearing mice further revealed that A. Radix significantly suppressed tumor growth and reduced pathway-related protein levels, outperforming quercetin. Additionally, acute toxicity experiments confirmed the favorable safety profile of A. Radix. This study demonstrates that A. Radix inhibits tumor cell proliferation through multi-component targeting of the PI3K-Akt signaling pathway, providing new therapeutic targets and theoretical evidence for CRC treatment. Furthermore, it establishes a methodological framework for the modern investigation of traditional Chinese medicine formulations.

ObjectiveTo investigate the etiology of recurrent severe pneumonia and pleural effusion in a pediatric patient through pathogenic gene testing and bioinformatics analysis.MethodsClinical characteristics and laboratory findings were retrospectively reviewed. Peripheral blood samples were collected from the patient and both parents. Genomic DNA was extracted and subjected to trio whole-exome sequencing (WES) using high-throughput sequencing technology. Sanger sequencing was used to validate suspected pathogenic variants.ResultsWhole-exome sequencing revealed a homozygous variant c.427C>T (p.Q143*) in exon 6 of the CYBA gene, inherited from both parents. This variant has not been previously reported in the literature. According to the American College of Medical Genetics and Genomics (ACMG) guidelines, c.427C>T(p.Q143*) was assessed as a likely pathogenic variant (PVS1_Strong+PM2_Supporting+PM3_Supporting). This variant is associated with autosomal recessive chronic granulomatous disease type 4(A22° CGD).ConclusionThis study identified a novel CYBA gene variant in a pediatric patient with recurrent severe pneumonia and pleural effusion, expanding the spectrum of pathogenic variants in this gene and providing evidence for clinical diagnosis and genetic counseling.

This case report describes a prenatal diagnosis of sirenomelia sequence at 12 weeks and 4 days of gestation using two-dimensional (2D) and three-dimensional (3D) ultrasound. The case highlights the importance of First Trimester ultrasound screening and the value of 3D ultrasound in early diagnosis. The etiology of this condition is discussed, with a focus on its potential association with embryonic layer development abnormalities. Ultimately, the patient opted for termination of pregnancy. This report provides valuable clinical experience in the early ultrasound diagnosis of sirenomelia sequence and discusses the importance of its ultrasound manifestations and clinical management.

ObjectivePerioperative prophylactic antimicrobial use for hysteroscopic surgery is suboptimal, even with guidelines and official policies in place. This study aimed to assess the role of clinical pharmacists in the management of perioperative prophylactic antimicrobial therapy in hysteroscopic surgery and to analyze its impact on clinical outcomes and cost-effectiveness.MethodsThis retrospective study reviewed hysteroscopic surgery cases at a tertiary-level Class A hospital from September to December 2022 and September to December 2023. The cases were divided into routine and intervention groups on the basis of the involvement of clinical pharmacists. The primary outcomes assessed included the rational use of antimicrobial drugs, postoperative infections, and economic benefits. To control for confounding factors, a 1:1 propensity score matching method was applied.ResultsA total of 849 patients were included in this study, with 226 patients in each group after propensity score matching. Significant differences were observed between the conventional and intervention groups in several areas: unreasonable timing of preoperative drug administration (22.7% vs 0%, p < 0.001), prolonged duration of prophylaxis (32.6% vs 11.5%, p = 0.029), unindicated prophylaxis (69% vs 28.8%, p < 0.001), and inappropriate dosing regimens (61.5% vs 14.6%, p < 0.001). In terms of economic benefits, the intervention group showed a significant reduction in the length of hospitalization (3.15 vs 2.15 days, p < 0.001). Additionally, significant differences were found in the costs of patient medications ($53.17 vs $42.66, p < 0.001) and antimicrobials ($8.16 vs $2.18, p < 0.001).ConclusionClinical pharmacist interventions can significantly enhance the rational use of perioperative antimicrobial drugs in hysteroscopic surgery, leading to notable clinical outcomes and economic benefits.

PurposeThis study dosimetrically compares hypofractionated VMAT plans using the updated ESTRO-ACROP guidelines versus conventional delineation in patients undergoing immediate implant-based breast reconstruction after mastectomy.MethodsWe retrospectively enrolled 22 patients with immediate implant-based reconstruction post-mastectomy (12 left-sided, 10 right-sided), treated between January 2022 and June 2025. All patients underwent CT simulation; those with left-sided cancer were positioned using deep inspiration breath-hold (DIBH), and those with right-sided cancer under free breathing. For each patient, conventional (C-TVD) and ESTRO-ACROP guideline-based (E-TVD) target volumes were independently delineated on the same CT dataset. Hypofractionated VMAT plans were designed using a 6-MV beam, single-isocenter, dual-arc technique, prescribing 40.05 Gy in 15 fractions to the planning target volume (PTV). All plans were normalized to ensure ≥95% PTV coverage by the prescribed dose. Dose-volume parameters for targets and organs at risk (OARs) were then compared between the two delineation approaches.ResultsThe conformity index (CI) of E-TVD was inferior to that of C-TVD; however, E-TVD achieved superior 95% prescription dose coverage of the target volume. Compared with C-TVD, E-TVD resulted in significantly lower V20 and Dmean to the ipsilateral lung, with differences reaching statistical significance (P < 0.05). For the heart, E-TVD was associated with significantly lower V20, as well as lower Dmax and Dmean to the left anterior descending coronary artery (LAD), with all differences reaching statistical significance (P < 0.05). Subgroup analyses stratified by left versus right breast cancer revealed that in left breast cancer patients, E-TVD resulted in statistically significant reductions in ipsilateral lung V20, V10, and Dmean; bilateral lung V20; heart V20; LAD Dmax and Dmean; and contralateral breast Dmean (all P < 0.05). In right breast cancer patients, E-TVD was associated with significantly lower ipsilateral lung Dmean and contralateral breast Dmean (both P < 0.05).ConclusionsIn patients with breast cancer who undergo total mastectomy followed by immediate implant-based breast reconstruction, the E-TVD approach confers superior protection to organs at risk.