Objective To explore the correlation between the joint detection of cholinesterase(CHE),alpha-L-fucosidase(AFU) and alpha-fetoprotein(AFP)and primary hepatic cancer(PHC).Methods 56 cases of patients with PHC(PHC group),52 cases of patients with liver cirrhosis(LC group)and 60 cases of healthy individuals(control group)were enrolled in this study,and serum levels of CHE,AFU and AFP were detected and statistically analysed.Results Serum levels of CHE in patients with PHC were negatively correlated with levels of AFU and AFP(correlation coefficient was -0.889 and -0.797 respectively,P <0.05),the ser-um levels of CHE in patients with LC were also negatively correlated with levels of AFU and AFP (correlation coefficient was-0.598 and -0.653 respectively,P <0.05).The positive rates of joint detection of CHE,AFU and AFP in PHC group and LC group were higher than that in the control group,had statistically significant differences(P <0.05 ).Conclusion CHE,AFU and AFP are sensitive indicators of liver lesions,and the joint detection could provide reference value for diagnosis and monitoring pro-gression of PHC.

Objective To evaluate the effect of mind mapping-oriented health education on patient's fluid intake during hemodialysis intervals. Methods From June 2015 to April 2016, 72 patients with poor compliance with fluid intake were randomly divided into control group (n=36) and observation group (n=36). In the control group, routine health education was used and the observation group was treated with mind mapping-oriented health education. The two groups were compared before intervention and 6 months after that in terms of compliance with fluid intake and daily fluid intake, ultrafiltration volume and body weight gain/dry weight ratio and incidence of complications. Results In the observation group, the fluid intake compliance, daily fluid intake, ultrafiltration volume and body weight gain/dry weight ratio 6 months after intervention were superior to those of the control group (all P<0.05). The incidences of complications such as hypotension, hypertension, muscle spasms and cardiac arrhythmia were also significantly lower than those of the control group (P<0.05). Conclusion The health education based on mind mapping is helpful to enhance the degree of cognition of fluid intake compliance, improve self-efficacy of chronic diseases, control the growth of body weight during dialysis and reduce the incidence of complications.

Objective To investigate the serum level of placental growth factor (PLGF) and explore its relationship with left ventricular structure and function in chronic kidney disease (CKD) patients.Methods Seventy-two non-dialysis CKD patients and sixteen age-and sex-matched healthy controls were included in this study.Serum PLGF level was measured by ELISA.Cardiac structure and function were assessed by two dimensional echocardiography.Results (1)The serum level of PLGF in CKD patients[3.32(2.97,19.77) ng/L] was significantly higher compared to the healthy controls [2.33(2.27,2.49) ng/L] (P ＜ 0.01).It progressively increased with the decline of renal function (P＜ 0.05/6).(2)The interventricular septum (IVS),left ventricular posterior wall (LVPW) was significantly higher while the ejection fraction was significantly lower in CKD patients.(3)The serum PLGF level was higher in patients with left ventricular hypertrophy (LVH) than those without LVH [19.05(3.31,21.05) ng/L vs 2.99(2.60,3.32) ng/L,P ＜ 0.05].The prevalence of LVH in the group above median PLGF level was significantly higher than that in the group below the median PLGF level (70％ vs 18％,P ＜ 0.01).(4)PLGF level was positively correlated with left ventricular mass index (LVMI),systolic pressure,diastolic pressure,24 h urine protein,Scr,UA,BUN,iPTH,the history of high blood pressure and was negatively correlated with LVEF,hemoglobin,albumin,eGFR (P ＜ 0.05).Multiple regression results showed that UA,Scr,LVEF,Hb were associated with PLGF level independently (P ＜ 0.01).Conclusions CKD patients have elevated level of PLGF.It has a relationship with cardiac structure and function.It may participate in the occurrence of cardiovascular events.

Objective: To examine the association between serum vitamin D level and thyroid function indicators among elderly patients with type 2 diabetes mellitus (T2DM), so as to provide the evidence for the prevention and treatment of thyroid function abnormality among elderly patients with T2DM. Methods: Inpatients aged 60 years and older and admitted to the department of endocrinology of Zhejiang Hospital were selected as the study subjects. Gender, age, course of disease and other basic information were collected through questionnaire surveys. The serum 25-hydroxyvitamin D[25-(OH) D], thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), total triiodothyronine (TT3), and total thyroxine (TT4) were measured. The correlation between serum vitamin D level and thyroid function indicators in elderly patients with T2DM was evaluated by a multiple linear regression model. Results: A total of 402 elderly patients with T2DM were surveyed, including 210 males (52.24%) and 192 females (47.76%), and had a median age of 70.00 (interquartile range, 12.00) years and a median course of disease of 14.00 (interquartile range, 14.00) years. There were 162 patients with insufficiency of vitamin D (40.30%) and 182 patients with deficiency (45.27%). The levels of TSH and glycated hemoglobin in the vitamin D deficiency group were (2.34±1.66) μIU/mL and (8.83±2.14) %, respectively, which were higher than those in the normal group [(1.74±1.10) μIU/mL and (8.11±1.75) %; P<0.05]. The levels of FT3 and FT3/FT4 in the vitamin D deficiency group were (2.86±0.48) μIU/mL and 2.85±0.71, respectively, which were lower than those in the vitamin D insufficiency group [(3.09±0.47) pg/mL and 3.14±0.81, P<0.05]. Multiple linear regression analysis showed a negative correlation between 25- (OH) D and TSH (β'=-0.159, P=0.001). Conclusion The vitamin D deficiency may be associated with the increase of TSH level among the elderly patients with T2DM.

Objective To explore the echocardiographic features and pregnant outcomes in fetuses with complete closure of the ductus arteriosus ( DA) . Methods The echocardiographic data and follow-up materials were retrospectively reviewed in 28605 fetuses . Of all the fetuses ,6 fetuses had complete closure of the DA . The echocardiographic features and pregnant outcomes of the 6 fetuses with complete closure of the DA were summarized . Results Of all the 6 fetuses ,4 cases were found in the third trimester and 2 cases in the second trimester . There was no the lumen of the DA in the three vessel view on the two dimensional echocardiography ,demonstrating the line-like low echogenicity in the DA area . No DA flow signal was found on the color and spectral Doppler imaging . Four cases had dilated right heart .Six cases had thickened wall of the right ventricle ( WRV ) ,and hypokinetic motion of the WRV . Moderate to severe tricuspid regurgitation were found in 5 cases and disappeared or reversal a-wave of the ductus venosus were found in 5 cases . The mild pericardial effusion was found in 2 cases . Of all the 6 cases ,4 cases were delivered by cesarean section and the echocardiographic findings were unremarkable at the follow -up of six months . Conclusions Intrauterine complete closure of the DA can be accurately diagnosed by fetal echocardiograph in the 2-3 trimesters . If indicated ,elective delivery results in good outcome .

Objective:To summarize the etiological mechanism, echocardiographic and clinical features of fetal cardiomyopathies (FCMs).Methods:According to the data of echocardiography in Maternal-Fetal Medicine Center in Fetal Heart Disease of Beijing Anzhen Hospital during 2015 January to 2020 December, 70 cases with FCMs were retrospectively reviewed, and the clinical, ultrasonic, pathological and clinical outcome data were collected. Whole exome sequencing and whole genome sequencing were used to identify the genetic changes.Results:Primary FCMs were diagnosed in 55 cases (78.6%, 55/70), including 39 fetuses with non-compaction of the ventricular myocardium (NVM), 10 with dilated cardiomyopathy (DCM), 5 with hypertrophic cardiomyopathy (HCM), and 1 with restricted cardiomyopathy (RCM). Secondary FCMs were diagnosed in 15 cases (21.4%, 15/70), including 7 fetuses with maternal anti-Ro/La antibodies (presenting with DCM), 4 with twin-twin transfusion syndrome (2 with DCM and 2 with HCM), 2 with fetal anemia (presenting with DCM), 1 with maternal diabetes (presenting with HCM) and 1 with chorioangioma of the placenta (presenting with DCM). In all cases, 9 cases were born, 3 cases died in perinatal period, and 58 pregnancies were terminated due to ineffective treatment or the decisions of pregnant women. Thirty cases with primary FCMs were performed with genetic tests, and 13 of them were identified with positive genetic changes related to FCMs, including 12 cases with NVM and 1 with HCM.Conclusions:Primary FCMs are more common than secondary FCMs in fetal period. The genetic disorders have a high proportion in fetal NVM. Fetal DCM and HCM have a large spectrum of intrinsic and extrinsic causes.