Objective To investigate the application value of combined detection of serum human epididymis protein 4 (HE4),cancer antigen 125 (CA125) and cancer antigen 19-9 (CA 19-9) in early endometrial carcinoma.Methods Two hundred and six patients with early endometrial carcinoma (endometrial carcinoma group) and 118 patients with uterine fibroids (uterine fibroids group) were selected.Serum level of HE4 was measured by enzyme linked immunosorbent assay (ELISA),and serum levels of CA 125 and CA 19-9 were measured by chemiluminescence immunoassay(CLIA).The positive rates of serum HE4,CA125 and CA19-9 in the 2 groups were compared.The changes between pre-and post-operative in the serum levels of serum HE4,CA125 and CA19-9 were compared in 147 endometrial carcinoma patients.Results The serum levels of HE4 and CA19-9 in endometrial carcinoma group were significantly higher than those in uterine fibroids group [76.57 (56.92-104.60) pmol/L vs.56.75 (48.33-68.91) pmol/L,13.26(6.07-25.90) kU/L vs.7.64(3.76-16.45) kU/L],there were statistical differences (P =0.000),there was no statistical difference in serum level of CA125 between the 2 groups (P=0.106).In endometrial carcinoma group,the positive rates of serum HE4 and HE4 + CA125 + CA19-9 were significantly higher than the positive rates of serum CA125,CA19-9,CA125+CA19-9,there were statistical differences (P ＜ 0.01).The positive rates of serum HE4,CA19-9,HE4 +CA125,HE4 +CA19-9 and HE4 +CA125 +CA19-9 in endometrial carcinoma group were significantly higher than those in uterine fibroids group,there were statistical differences (P ＜ 0.01).The serum levels of HE4,CA125 and CA19-9 in post-operative in 147 endometrial carcinoma patients were significantly lower than those in pre-operative,there were statistical differences (P ＜ 0.01).Conclusion The diagnostic value of serum HE4 in early endometrial carcinoma is better than CA125 and CA19-9,while combined detection of serum HE4,CA125 and CA19-9 can raise the positive rate and be helpful for therapeutic effect evaluation.

Objective To establish the blood Septin9 methylation detection system for early screening of colorectal cancer based on fluorescence PCR technology .Methods The PCR primer of Septin9 was designed by searching the CpG island site of Septin9 methylation in the NCBI database .The high methylation site of Septin9 gene promoter region was confirmed by PCR amplification and sequencing after extracting DNA from colorectal cancer and para-carcinoma tissues .The fluorescence PCR and TaqMan probe detection technique was designed by aiming at high methylation site for constructing the plasma sample methylation detection sys-tem .Then its accuracy ,specificity ,repeatability and minimum detectable amount were performed the assess-ment and analysis .The SETP9 methylation detection was performed in plasma samples from 57 cases of color-ectal cancer and 30 healthy persons .Results The high methylation site of Septin9 gene in tissue samples was confirmed by sequencing .This site served as the target for designing fluorescence PCR detection system .After assessment ,the accuracy ,specificity and repeatability of this detection system were 100％ ,the lowest detection amount reached 0 .1 ng/μL .Among the plasma samples in 57 cases of colorectal cancer ,the positive rate of Septin9 methylation site detection was 71 .92％ (41/57) and the positive rate of in the patients with pathologi-cal stage Ⅰ and Ⅱ of colorectal cancer reached 64 .2％ .But Septin9 gene had no methylation in plasma of healthy population .Conclusion The plasma fluorescence PCR detection system with Septin9 gene methylation as the target has the characteristics of high sensitivity ,high specificity and high accuracy ,which is the reliable detection technique for the early screening of colorectal cancer and has good clinical application prospect .

Objective:To explore accurate prenatal diagnosis, full-coverage graded counseling and follow-up for the fetus with cardiac birth defects (CBD).Methods:CBD fetus diagnosed prenatal by echocardiography from January 2018 to December 2020 in Guangdong Provincial People's Hospital were enrolled. Fetal CBD was graded (Ⅰ-Ⅵ) according to prognosis and possible operation time after birth, and the classification criteria and common diseases included were proposed. After the prenatal grading counseling, the outcome of the fetus was followed-up. The induced labor rate, live birth rate, prenatal and postnatal ultrasound diagnosis coincidence rate and other indicators were calculated. The disease composition ratio, prognosis of fetus with different grades and the outcome of integrated treatment were analyzed.Results:The detection rate of fetal CBD was up to 16.2% (1 971/12 188), 30 cases of which were excluded. A total of 1 941 cases were included in this study, including 196 cases (10.1%) of gradeⅠ, 433 cases (22.3%) of gradeⅡ, 615 cases (31.7%) of grade Ⅲ, 261 cases (13.4%) of grade Ⅳ, 388 cases (20.0%) of gradeⅤ, 48 cases (2.5%) of grade Ⅵ. Grade Ⅱ and gradeⅢ (the operation time was within 1 year after birth) accounted for 54.0% (1 048/1 941). The distribution of some diseases in different grades had obvious proportion advantage, which was representative. Among 1 747 CBD fetus, 736 cases (induced labor rate 42.1%) chose to terminate pregnancy due to CBD. Of the 1 010 live births, 975 cases (96.5%) had the same prenatal and postnatal diagnosis, 3 cases were missed diagnosis and 32 cases were misdiagnosed. The diagnostic accuracy of live births with severe and complex congenital heart disease was 383 out of 389 (98.5%). A total of 258 cases have received surgery or intervention. The age at the time of surgery or intervention was different among grades（ χ2 =47.3， P<0.001）. With the improvement of prognosis from gradeⅠ to Ⅴ, the live birth rate increased and the induced labor rate decreased accordingly; the difference between grades was significant（ χ2 =623.6， P<0.001）. Conclusions:Prenatal diagnosis and graded counseling is important in the integrated model. Fetal CBD grading could refine post-natal treatment strategies, guide delivery decisions and become an evaluation standard.

OBJECTIVE To investigate the expression of serum miR-222-3p in papillary thyroid carcinoma and its clinical significance.METHODS Total RNA in serum was extracted from 121 patients of papillary thyroid carcinoma and benign thyroid diseases.The reverse transcription quantitative real-time polymerase chain reaction(qRT-PCR) method was used to detect the expression of miR-222-3p,and then the potential correlation between serum miR-222-3p and clinical pathological characteristics of papillary thyroid carcinoma was analyzed.The receiver operating characteristic area under the curve(ROCAUC) and their index for diagnosis evaluation were also calculated.RESULTS The median expression level of serum miR-222-3p in papillary thyroid carcinoma patients was significantly higher than that of control group (2.2188 vs 0.7022,P=0.002).Although the expressions of serum miR-222-3p was not associated with the gender,age,capsule invasion,TNM stage,but it was positively correlated with tumor size,bilateral involvement,lesion quantity and lymph node status.ROC curve analysis showed that the specificity and sensitivity of the miR-222-3p diagnosis of papillary thyroid cancer were 79.75％ and 61.90％,respectively,while the ROC-AUC was 0.717.CONCLUSION The serum miR-222-3p is over expressed in papillary thyroid carcinoma and its expression is significantly correlated with tumor progression.It will be helpful for PTC diagnosis.

OBJECTIVE To explore the feasibility of detection for mutated BRAF V600E gene based on amplification refractory mutation system(ARMS),and to evaluate its clinical significance of BRAF V600E gene mutation in thyroid nodules.METHODS The method of ARMS was used to detect BRAF V600E mutation status in 179 patients with PTC and 115 patients with benign lesions.The diagnosis index of BRAF V600E mutation status for identifying the nature of the thyroid nodule was calculated.The potential correlation between BRAF V600E mutation and PTC clinicpathological characteristics was also analyzed.RESULTS Detection of BRAF V600E mutation status in thyroid lesions based on ARMS was feasible and believable.The positive rate of mutated BRAF V600E gene in PTC was 82.68％,whereas the rate in benign lesions was only 1.74％,indicating statistical differences between the two groups(x2=183.568,P＜0.01).The diagnostic sensitivity of BRAF V600E mutation was 82.68％,specificity was 98.26％,accuracy was 88.76％,and Youden index was 0.8094.There was no associations between the BRAF V600E mutation status and PTC clinicpathological characteristics(eg.gender,age,tumor size,numbers of lesions,bilateral lesions,extrathyroidal extension and lymph node metastasis).CONCLUSION Detection of BRAF V600E mutation based on ARMS has higher sensitivity and specificity in distinguishing PTC from benign lesions,indicating BRAF V600E gene is an ideal marker of PTC for clinical early diagnosis.

We report the management of a fetus diagnosed with critical pulmonary stenosis, right ventricular hypoplasia, severe tricuspid regurgitation and severe hydronephrosis. After echocardiography and multidisciplinary team consultation, fetal pulmonary valvuloplasty was performed at 30 +3 weeks of gestation, to facilitate the development of the right ventricle and tricuspid valve. Fetal transdermal renal puncture performed at 31 weeks of gestation showed that the hydronephrotic fluid was urine. The mother gave birth vaginally at 37 +3 weeks. Prostacyclin was given to the baby to keep the ductus arteriosus open and maintain oxygen saturation above 80%. Nephrostomy was performed on the 6th day after birth for improvement of the hydronephrosis and renal function. Biventricular correction (percutaneous balloon pulmonary valvuloplasty) and left dismembered pyeloureteroplasty were successfully performed on 16 and 37 d after birth, respectively. Ultrasound follow-ups showed the structure and function of both heart and kidney recovered. We summarized the characteristics and management of fetal critical pulmonary stenosis complicated by severe hydronephrosis in this case, aiming to enhance experiences for appropriate treatment of similar cases in the future.

Objective:To investigate the clinical significance of Delphian lymph node (DLN) dissection in papillary thyroid cancer (PTC) .Methods:The correlation of DLN detection and metastasis in 208 PTC patients with various clinical and pathological features was analyzed retrospectively. The value of DLN metastasis in predicting PTC high-risk features was evaluated, and the tendency of surgical selection for PTC with DLN metastasis was also discussed.Results:① Of 208 PTC patients, DLN was detected in 144 patients (69.23%) . The detection rate of DLN was related to gender, number of central lymph nodes (excluding DLN) removed and metastasis (all P<0.05) . Male, greater number of nodes in the central compartment (excluding DLN) was more favorable for DLN detection. ② The rate of DLN metastasis was 18.27% (38/208) . In the univariate analysis, DLN metastasis was significantly associated with the following variables:gender, whether it is microcarcinoma, isthmus involvement, number of lesions, extrathyroidal extension, tumor size, number of central lymph nodes (excluding DLN) removed and metastasis (all P<0.05) . In the multivariate analysis, tumor size larger than 1 cm, isthmus involvement and greater number of central lymph nodes (excluding DLN) metastasis were independent risk factors of DLN metastasis ( P<0.05) . ③ The sensitivity of DLN metastasis to predict extranodal invasion, central and lateral lymph node metastasis was 54.54%, 37.36% and 62.86%, with specificity of 78.69%, 92.45% and 55.56%, respectively. ④ Patients with DLN metastasis were more likely to receive total thyroidectomy, bilateral central lymph node dissection, and lateral cervical lymph node dissection. Conclusions:Due to high rate of DLN detected and metastasis, DLN should be routinely dissected. Patients with DLN metastasis predict high risk characteristics of PTC and extensive lymph node metastasis, which is of clinical significance for lymph node dissection.

To improve the accuracy of prenatal diagnosis for coarctation of the aorta ( CoA ) by comparatively analyzing the relevant factors and their application value . Methods Cases of disproportion of ventricles and great vessels were selected between January 2011 and July 2018 . Only liveborn fetuses with complete postnatal follow‐up were included in the study . One hundred and twelve cases were retrieved and analyzed . According to the postnatal ultrasound and CT results ,the patients were divided into gruop A and goup B . Different fetal echocardiography parameters and features were selected to evaluate the diagnostic value . Logistic regression analysis was used to select the best predictors of CoA and optimal cut‐offs for these parameters were identified by ROC analysis . Results One hundred and thirty eight fetuses were suspected to be CoA ,and 112 of them were born . T hey included 59 cases ( 52 .9% ) with CoA ( Group A ) and 53 cases ( 47 .3% ) without CoA ( Group B ) . T here were statistically significant differences between the two groups in gestational age ,Z‐score of diameter of left ventricle ,ascending aorta ( AAO ) and aortic arch isthmus ,main pulmonary artery ( M PA )/AAO diameters ratio ,and arterial duct/isthmus diameters ratio . T he parameters most predictive of postnatal CoA selected by logistic regression and the cut‐off values identified by ROC analysis were :gestational age at first diagnosis ≤34 .5 weeks ,Z‐score of diameter of left ventricle ＜ －1 .8 ,Z‐score of diameter of isthmus ＜ －2 .7 ,M PA/AAO diameters ratio＞1 .6 . AUC yielded by these parameters in combination was 0 .94 ( 95% CI :0 .89 －0 .99) . T he study group were divided into two subgroups by gestational age at first diagnosis .T he parameters and cut‐off values in subgroups were selected by the same analysis as above :Group Ⅰ ( ≤ 34 .5 weeks ) ,Z‐score of diameter of right ventricle ＞2 .1 ,M PA/AAO diameters ratio＞1 .6 ; Group Ⅱ( ＞34 .5 weeks) ,M PA/AAO diameters ratio ＞ 1 .7 ,arterial duct/isthmus diameters ratio ＞ 2 .3 . Meanw hile ,some ultrasound features ( including aortic arch hypoplasia ,retrograde blood flow of aortic isthmus ) should also be considered to improve diagnostic accuracy . Conclusions Combined with the use of different ultrasound parameters and features at different gestational weeks can improve the accuracy of the prenatal diagnosis of CoA in the right heart dominant fetus .

OBJECTIVE: To investigate the effect of obstructive sleep apnea (OSA) on different sleep stages, and the relationship between N3 stage of non-rapid eye movement sleep and respiratory abnormal events. METHODS: A total of 188 adult patients who underwent overnight polysomnography(PSG)monitoring in Sir Run Run shaw Hospital of Zhejiang University from June 24th to December 26th 2019 were enrolled in the study. OSA patients were classified into 3 groups (mild, moderate and severe) according to the apnea-hypopnea index (AHI). PSG data, AHI and the lowest SPO in each stage of sleep were compared among three groups. RESULTS: There was no significant difference in total sleep time and sleep efficiency among patients with different severity of OSA (all >0.05). The proportion of N3 stage in moderate and severe OSA groups were significantly smaller than that in mild OSA group (all <0.05). The proportion of N3 stage in severe OSA group was also smaller than that in moderate OSA group (<0.05). In addition, severe OSA group had a longer latency of N3 stage than mild and moderate OSA groups (all <0.05). The latency of N3 stage in moderate OSA group was longer than that in mild OSA group (<0.05). The AHI in N3 stage was markedly lower than that in other sleep stages (all <0.01), regardless of the severity of OSA. Supine AHI in N3 stage in mild and moderate groups was significantly lower than that in N1, N2 and rapid eye movement (REM) stages (all <0.01). Supine AHI in N3 stage in severe group was also lower than that in N2 and REM stages (<0.05 or <0.01). The lowest SPO in N3 stage was significantly higher than that in N1, N2 and REM stages (<0.05 or <0.01), regardless of the severity of OSA. CONCLUSIONS s The proportion of N3 stage is lower in OSA patients, and N3 stage has less sleep respiratory events than non-N3 stages. The results suggest that the increased N3 stage proportion may indicate less severity of OSA.

OBJECTIVE: To investigate the clinical features and implication of restless legs syndrome (RLS) in ischemic stroke patients. METHODS: A total of 199 ischemic stroke patients were enrolled and assessed by polysomnography (PSG). RLS was identified according to criteria of International Restless Legs Syndrome Study Group. Epworth Sleepiness Scale (ESS), Mini-mental State Examination (MMSE) and Patient Health Questionnaire (PHQ-9) were used to evaluate the sleep quality, cognitive function and post-stroke depression, respectively. The National Institute of Health Stroke Scale (NIHSS) was used to evaluate the neurological function 3 months after stroke onset. Gender-and age-matched non-ischemic stroke patients with RLS (primary PLS) were selected as controls. RESULTS: Twenty-two cases of RLS were identified among 199 ischemic stroke patients (11.1%). Generalized linear model and logistic regression showed that low serum ferritin level (=-133.3 mg/L, 95%:-200.4--0.1, <0.01), subcortical infarction (=4.05, 95%:1.15-14.18, <0.05) and female (=2.54, 95%:1.04-6.23, <0.05) were identified as the risk factors of RLS in ischemic stroke patients. Compared with ischemic stroke patients without RLS, ESS increased by 4.37 (95%:2.33-6.41, <0.01), PHQ-9 increased by 2.17 (95%:0.39--3.94, <0.05), and reduced NIHSS from the baseline deceased by 0.97 (95%:-1.79--0.15, <0.05) in ischemic stroke patients with RLS. In addition, the incidence of moderate-severe depression increased (=4.27, 95%:1.40-13.10, <0.05) in ischemic stroke patients with RLS. The index of periodic leg movements of sleep (PLMS) with arousal in ischemic stroke patients with RLS was significantly higher than that in patients with primary RLS (=12.85, 95%:2.04-23.67, <0.05). CONCLUSIONS RLS is common in ischemic stroke patients and has adverse influences on patients.
Brain Ischemia ; complications ; pathology ; Depression ; complications ; Female ; Humans ; Male ; Polysomnography ; Restless Legs Syndrome ; complications ; pathology ; Stroke ; complications ; pathology