Objective To summarize the echocardiographic characteristics and clinical signiifcance of prenatal diagnosis of coronary artery ifstula (CAF). Methods Images and follow-up results of ifve fetuses with CAF diagnosed by fetal echocardiography between January, 2011 and December, 2012 in our department were reviewed. Results Echocardiographic characteristics of CAF were a dilated coronary artery in the four chamber view and the left ventricular outlfow tract view. Track the course of the dilated coronary artery can conifrm the oriifce of the ifstula. Among the ifve cases, the oriifce of the ifstula included the aortic root of left ventricular outlfow tract, right atrium side of interatrial septum, the entrance of superior vena cava to right atrium, right ventricular apex and right ventricle cone. The colour Doppler lfow imaging showed turbulence in the dilated coronary artery. The spectral Doppler with the sampling gate in coronary artery showed the characteristic bidirectional lfow pattern. One case was associated with other complex intracardiac abnormalities and one case with persistent left superior vena cava. Among the ifve cases of CAF diagnosed by fetal echocardiography, one case was missed and four cases were conifrmed by postnatal echocardiography. Conclusion Coronary artery ifstula has special fetal echocardiographic characteristics. The fetal echocardiography plays an important role in early detection, diagnosis and treatment of CAF.

Objective To investigate the echocardiographic features and clinical significance of prenatal diagnosis of fetal double aortic arch (DAA). Methods Totally 21 596 fetuses underwent fetal echocardiography in Nanjing Medical University Afifliated Suzhou Hospital and ifve cases were diagnosed as DAA by echocardiography. Echocardiographic characteristics, types and outcomes of these ifve cases were summarized retrospectively. Results Five fetal cases were diagnosed as DAA by fetal echocardiography. 1. Prenatal echocardiographic features:In three-vessel and trachea view, the normal“V”-shaped conlfuence formed by the aortic arch and ductal arch was absent. However, the ascending aorta bifurcated into the left and right aortic arch and these two arches encircled the trachea. Annular lfow signal around trachea was seen on color Doppler imaging. 2. Types:Among these ifve fetuses, three cases were called right arch predominant type, whose diameters of right arches were larger than those of left arches. The other two were balanced type, whose diameters of right arches were almost equal to those of left arches. 3. Accompanied malformations:Case 2 was accompanied with membranous ventricular septal defect and permanent left superior vena cava. Case 4 was associated by hemivertebrae. The other three cases had no other abnormalities. 4. Follow-up:These five cases were all arranged for MRI subsequently and all were confirmed by follow-up till to the induction of labor or three months after birth. Conclusions Double aortic arch is a kind of severe congenital heart disease. Echocardiography is the ifrst choice to diagnose DAA prenatally and three-vessel and trachea view are the effective cross sections in the diagnosis of double aortic arch.

Objective: To evaluate the effect of Triangle hierarchical management among community patients with hypertension, so as to provide insights into the improvements of standardized hypertension management. Methods: Patients with newly diagnosed hypertension from 2 community health service centers in Qiantang District of Hangzhou City by the end of 2020 were randomly assigned to the conventional group and the Triangle group. Patients in the conventional group were given health management services according to the requirements of basic public health service standard for one year, while patients in the Triangle group were given Triangle hierarchical management. The blood pressure, self-management behaviors, treatment compliance, smoking, alcohol consumption and exercise were collected using the self-management behavior scale, treatment compliance scale and self-designed questionnaires, and were compared before and after intervention with analysis of covariance and generalized estimation equations. Results: Totally 200 patients with hypertension were recruited, including 100 patients in the conventional group and 100 patients in the Triangle group. There were no significant differences between the two groups before implementation of interventions in terms of gender, age, educational level or occupation (P>0.05). The reduction in blood pressure, increase in the score of treatment, diet, exercise and living habitat management and the total score of self-management behaviors, increase in the score of adherence to medication regimens, daily living management behaviors, smoking and alcohol consumption preference and the total score of treatment compliance, and increase in the number of patients with normal standard of quitting smoking, quitting alcohol consumption, exercise and blood pressure were significantly higher in the Triangle group than in the conventional group after intervention (P<0.05). Conclusions Triangle hierarchical management may increase the treatment compliance, improve the self-management behavior and facilitate hypertension control among hypertensive patients, which may be popularized for health management among community patients with hypertension.

Objective We conducted a survey on the awareness rate of stroke in Yangquan residents and analyzed factors affecting awareness to provide basic information for Yangquan residents to prevent and treat stroke in Shanxi.MethodsA questionnaire regarding awareness and basic knowledge of stroke was used in this study and applied to Yangquan residents.A cluster stratified sample of 7983 residents were questionnaired by cross-sectional method.Results7921 returned copies were valid.The awareness rate of stroke in 7921 selected Yangquan residents was 30.14％ (2387/7921). Upon the occurrence of stroke,the awareness rates of the way to see a doctor,the right department to look for medical care and test manners to diagnose the illness as stroke were relatively high in these investigated people,which were 74.03％ (5864/7921),78.17％ (6192/7921) and 84.04％ (6657/7921),respectively.However,the number of people who knew characteristic symptoms and complications of stoke,risk factors that cause stroke and how to treat stroke was 2021 (25.51％),841 ( 10.62％ ),and 902 ( 11.39％ ),respectively,which was relatively low. After multivariate analysis,the awareness rate of stroke in Yangquan residents was positively correlated with an education degree.ConclusionsYangquan residents know little about stroke.Therefore,it is necessary to increase the level of their knowledge regarding stroke by extended propaganda and encourage them to live a healthy life to be able to treat stoke in time and to reduce the possibility of stroke occurring.

Objective To investigate the diagnostic value of detection of protein SP70 in differentiating benign and malignant pleural effusion.Methods A case-control study was conducted from July 2011 to February 2012.108 cases of pleural effusion from patients with clinically proven lung cancers and 122 cases of benign pleural effusion were collected.SP70 was detected by Sandwich ELISA,while CEA,CYFRA21-1,NSE were measured by electrochemiluminescence immunoassay for comparison.Meanwhile,protein SP70 on exfoliated cells in pleural effusion was detected by direct immunofluorescence,and was compared with the results of HE staining.The differences between the groups were evaluated by the chisquare test Fisher' s exact test.Results Positive rates of SP70,CEA,CYFRA21-1,NSE were 72.2％,58.3％,52.8％ and 30.6％ in malignant pleural effusion,obviously higher than benign pleural effusio (9.8％,13.1％,23.0％ and 19.7％).The specificity of SP70,CEA,CYFRA21-1,NSE were 90.2％,86.9％,77.0％ and 80.3％,NSCLC had significantly higher positive rate than SCLC(74.3％ ＞0.0％,P =0.02 ＜ 0.05),detection of protein SP70 in malignant pleural effusion had significantly higher coincidence rate than HE staining(72.2％ vs 47.2％,x2 =14.03,P ＜ 0.05).Conclusion Determination of the protein SP70 in pleural effusion and in exfoliated cells,can improve the sensitivity and specificity of the diagnosis of malignant pleural effusion.

Objective To investigate the efficacy and safety of different course duration of rivaroxaban for deep venous thrombosis (DVT) in elderly patients with femoral neck fractures after artificial femoral head replacement.Methods A prospective case control study was conducted on 95 elderly cases of femoral neck fractures treated from February 2015 to July 2017.There were 18 males and 77 females,with average age of 80.8 years (range,70-98 years).There were 85 patients at stage Ⅲ and 10 at stage Ⅳ according to Garden classification.All patients received artificial femoral head replacement and were randomly divided into 3 groups (Group A:34 cases,rivaroxaban treatment for 2 weeks;Group B:31 cases,rivaroxaban treatment for 3 weeks;Group C:30 cases,rivaroxaban treatment for 5 weeks).At 2,3 and 5 weeks after operation,the patients were given 10 mg oral rivaroxaban once daily.General information,blood transfusion rate,hemoglobin volume,platelet count and DVT rate were recorded before and 6 weeks after operation.Results No significant difference among the groups in terms of division,age,body mass index,fracture classification,time interval from injury,intraoperative blood loss,quantity of drainage fluid after operation,and associated underlying diseases was observed (P ＞ 0.05).The blood transfusion rate of Groups A,B and C within 2 weeks after operation was 9％ (3/34),3％ (1/31) and 3％ (1/30) (P ＞ 0.05) respectively.The comparative difference in hemoglobin and platelet count had no statistical significance (P ＞ 0.05).The DTV rate after operation of Groups A,B and C was 21％ (7/34),13％ (4/31) and 0,respectively.There was no significant difference between Groups B and C (P ＞ 0.05),but the difference between Groups A and C was statistically significant (P ＜ 0.05).Conclusions For elderly patients with femoral neck fracture who underwent the artificial femoral head replacement,it is effective to prevent the occurrence of DVT by extending the course of rivaroxaban treatment to 5 weeks.In addition,it does not increase the risk of bleeding.

Objective:To investigate the efficacy of osettinib in the treatment of first-line tyrosine kinase inhibitor-resistant advanced lung adenocarcinoma and its effects on carcinoembryonic antigen (CEA) and vascular endothelial growth factor (VEGF) levels.Methods:Seventy-two patients with first-line tyrosine kinase inhibitor-resistant advanced lung adenocarcinoma (T790M test negative or rejected) who received treatment in Jinhua Guangfu Cancer Hospital from June 2017 to June 2019 were included in this study. They were randomly assigned to undergo either conventional pemetrexed plus cisplatin (control group, n = 36) or osimertinib mesylate (observation group, n = 36) for 4 successive weeks. Before and after 4 weeks of treatment, serum CEA and VEGF levels were measured. Curative effects were evaluated. Adverse reactions and 6-month, 1-year and 2-year survival rate were recorded. Results:Effective rate and disease-control rate in the observation group were 80.6% (29/36) and 94.4% (34/36) respectively, which were significantly higher than 58.3% (21/36) and 75.0% (27/ 36) in the control group ( χ2 = 4.193, 5.261, both P < 0.05). Before treatment, there were no significant differences in serum CEA and VEGF levels between the two groups (both P > 0.05). Compared with before treatment, serum CEA and VEGF levels were significantly increased after treatment (both P < 0.05). After treatment, serum CEA and VEGF levels in the observation group were (5.36 ± 0.33) U/mL and (121.56 ± 11.57) ng/L respectively, which were significantly lower than those in the control group [(8.25 ± 0.54) U/mL, (163.68 ± 14.59) ng/L, t = 27.399, 13.572, both P < 0.001]. The incidence of adverse reactions in the observation group was significantly lower than that in the control group [19.4% (7/36) vs. 44.4% (16/36), χ2 = 5.173, P = 0.011]. 6-month, 1-year and 2-year survival rate were 94.29%, 77.14% and 60.00% respectively, in the observation group and 91.43%, 54.29% and 34.29% respectively in the control group. There was no significant difference in 6-month overall survival rate between the two groups ( χ2 = 0.352, P = 0.251). 1-year and 2-year survival rate in the observation group were significantly higher than those in the control group ( χ2 = 4.058, P = 0.044; χ2 = 4.644, P = 0.031). Conclusion:Ositinib is effective in the targeted treatment of first-line tyrosine kinase inhibitor-resistant advanced lung adenocarcinoma. It can effectively decrease serum CEA and VEGF levels and prolong the survival of patients, thereby exhibiting a clinical application value.

Objective To analyze the deep venous thrombosis(DVT)after plasma infusion in a patient with congenital dysfibrinogene-mia(CD),and explore the relationship between the CD and DVT.Methods The clinical data were collected and the pedigree was investigated(3 subjects of 2 generations in total).The relevant indexes of coagulation factors of the patient and her family members were detected.The genomic DNA of peripheral blood was extracted for PCR amplification.All the exons,flanking sequences,5'and 3'untranslated regions of FGA,FGB and FGG genes of fibrinogen(Fg)of the patient were analyzed by direct sequencing.The corre-sponding mutation site was subjected to sequence in the other members of this family.The PyMol software was used to construct the pro-tein model before and after gene mutation.Results The patient was admitted to hospital for hysteromyomectomy.DVT appeared in 3 days after surgery.The prothrombin time(PT),thrombin time(TT),Fg activity(Fg∶C)and Fg antigen(Fg∶Ag)of the patient was 14.9 s,33.3 s,0.94 g/L and 2.10 g/L,respectively.The above four indicators in her mother were 14.7 s,32.8 s,0.97 g/L and 2.35 g/L,respectively.Gene sequencing revealed that both the patient and her mother had a heterozygous missense mutation c.2185G＞A(p.Glu729Lys)in exon 6 of the FGA gene.The protein model analysis demonstrated that p.Glu729Lys mutation changed the amino acid side chain and reduced the number of hydrogen bonds originally formed with Arg854.Conclusion A heterozygous missense mutation c.2185G＞A(NM_000508)in exon 6 of the FGA gene should be responsible for the low fibrinogen level in this pedigree,which might be the main reason for DVT after plasma infusion in this patient.

Objective:To evaluate the clinical factors affecting the probability of malignant micro-sized (≤10 mm) solitary pulmonary nodules (≤10 mm, micro-sized SPN), and established a clinical prediction model. Methods:Medical records from 102 patients with a pathological diagnosis of micro-sized SPN (Group A), established between June 2012 and March 2014, were reviewed. Clinical data were collected to evaluate the independent predictors of malignant micro-sized SPN using single factor analysis and Logistic regression analysis. A clinical prediction model was subsequently created. Receiver-operating characteristic (ROC) curves were constructed using the prediction model. Between January 2015 and August 2017, data from an additional 10 patients enrolled from January 2015 to August 2017 from Jinhua Guangfu Hospital (Group B) with a pathological y diagnosed micro-sized SPN were used to validate this clinical prediction model. The model was also compared with the Mayo Clinic Model. Results:Median age of 102 patients (Group A) was 55.31±10.77 years old. There were 75.5％malignant nodules and 24.5％benign ones. Logistic regression analysis identified six clinical characteristics (no symptoms, upper lobe, diameter>5 mm, no clear border, not irregular round, no calcification) as independent predictors of malignancy in patients with micro-sized SPN. The area under the ROC curve for our model was 0.922 (95％CI:0.857-0.986). In our model, the diagnosis sensitivity and specificity were 88.3％and 84.0％, respectively. The test power of the model was better compared with the Mayo Clinic Model. Conclusions:In this study, we had found the independent predictors of malignant micro-sized SPN, and developed a prediction model that could accurately identify malignant micro-sized SPN in patients.

An explicit illustration of pulmonary delivery processes (PDPs) was a prerequisite for the formulation design and optimization of carrier-based DPIs. However, the current evaluation approaches for DPIs could not provide precise investigation of each PDP separately, or the approaches merely used a simplified and idealized model. In the present study, a novel modular modified Sympatec HELOS (MMSH) was developed to fully investigate the mechanism of each PDP separately in real-time. An inhaler device, artificial throat and pre-separator were separately integrated with a Sympatec HELOS. The dispersion and fluidization, transportation, detachment and deposition processes of pulmonary delivery for model DPIs were explored under different flow rates. Moreover, time-sliced measurements were used to monitor the PDPs in real-time. The Next Generation Impactor (NGI) was applied to determine the aerosolization performance of the model DPIs. The release profiles of the drug particles, drug aggregations and carriers were obtained by MMSH in real-time. Each PDP of the DPIs was analyzed in detail. Moreover, a positive correlation was established between the total release amount of drug particles and the fine particle fraction (FPF) values ( = 0.9898). The innovative MMSH was successfully developed and was capable of illustrating the PDPs and the mechanism of carrier-based DPIs, providing a theoretical basis for the design and optimization of carrier-based DPIs.