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Objectives To evaluate the relationship between body mass index (BMI) and the incidence risk of papillary thyroid microcarcinoma (PTMC).Methods This retrospective study included 1210 PTMC patients who underwent surgery between November 2013 and October 2014 in Peking Union Medical College Hospital,China Academy of Medical Science.A population-based 1∶1 matched case-control study was conducted,and each PTMC patients was matched with one who received thyroid function and ultrasonic to confirm that there was no disease in the thyroid.The clinical profiles of these patients were collected.According to Guidelines for Prevention and Control of Overweight and Obesity in Chinese Adults,all subjects were divided into three groups:underweight (BMI ≤ 18.5 kg/m2),normal(18.5 kg/m2 ＜ BMI ≤ 23.9 kg/m2),overweight (24.0 kg/m2 ＜ BMI ＜ 27.9 kg/m2) and obese group(BMI≥28.0 kg/m2).The relationship between BMI and PTMC incidence risk was analyzed by casecontrol study.Univariate and multivariate logistic regression analysis was applied to analyze the relationship between BMI and PTMC severity.Results The BMI of PTMC patients was significant higher than in normal control [(24.30 ±3.33) kg/m2 vs (23.31 ± 3.50) kg/m2,P ＜ 0.0001].Compared with BMI normal group,the incidence risk of PTMC in underweight group was significantly lower (OR =0.449,95 ％ CI:0.270-0.747),which is higher in overweight and obese group (OR =1.559,95％ CI:1.261-1.928;OR =2.059,95％ CI:1.501-2.823).Histopathological review of 1210 PTMC patients with surgical resection revealed.The proportions of underweight,normal,overweight and obese group of the patients with extrathyroid extension (3.1％,48.0％,36.7％,12.2％) have significant differences with those in the patients whose tumor are limited to the thyroid (0.7％,45.2％,36.0％,18.1％) (P =0.0090).The proportions of 4 group of the patients with multiple lesions (3.2％,49.0％,35.6％,12.2％) were significantly differences to those in the patients with single lesion (0.8％,43.3％,38.7％,17.2％) (P =0.0050).Multivariate analysis showed that underweight is a protective factor of extrathyroidal extension (OR =0.219,95 ％ CI:0.051-0.932;OR =0.279,95 ％ CI:0.085-0.935) and mulifocality,and obese is an independent risk factors(OR =1.556,95％CI:1.047-2.312;OR =1.764,95％CI:1.204-2.584).Conclusions This study identified that the incidence risk of PTMC is positive related with BMI.In PTMC patients,obesity increases the risk of mulifocality and extrathyroidal extension.Attention should be paid to the effect of obesity on the incidence risk of PTMC and the diagnosis and treatment in clinical practice.
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Objective To investigate the relationship between abnormal bone mineral density (BMD) and subclinical thyroid dysfunction. Methods Thyroid function, biochemical indicators of bone metabolism and BMD were reviewed retrospectively in the subjects who received health checkups from July 1, 2009 to January 31, 2017 in the Health Check-up Department of Peking Union Medical College Hospital. People who had thyroid dysfunction, recognized risk factors for osteoporosis, and medication history were excluded. A cross-sectional analysis of thyroid status and biochemical indicators of bone metabolism was performed by the standard methods. BMD at the lumbar spine and femoral neck was measured using dual energy X-ray absorptiometry. Results A total of 6884 subjects (3726 women and 3158 men) were enrolled in the study, with an average age of (50.74 ± 10.41) years. They were divided into three groups:subclinical hyperthyroid, subclinical hypothyroid, and euthyroidism. The alkaline phosphatase in subclinical hyperthyroid group was higher than that in the euthyroidism group[ (67.95±20.64)U/L vs. (63.88±18.99)U/L]. Calcium and phosphorus in blood were higher in both subclinical hyperthyroid and subclinical hypothyroid groups. The rate of abnormal BMD in male euthyroidism, subclinical hyperthyroid and subclinical hypothyroid groups were 36.10％(1049/2906), 29.27％(12/41) and 27.01％(57/211), respectively. The rate of abnormal BMD showed no difference between subclinical hyperthyroid group and euthyroidism group (P>0.05). The rate of abnormal BMD was lower in subclinical hypothyroid group than in euthyroidism group (χ2=7.0901, P0.05). Conclusion There is no significant difference in the rate of abnormal BMD between subclinical thyroid dysfunction group and euthyroidism group, possibly because abnormal serum biochemical indicators preceded the presence of low BMD. More sensitive methods used to determine the status of bone metabolism await to be developed.
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Objective To explore the fasting blood glucose (FBG) variation trends and the prevalence of impaired fasting blood glucose(IFG)among medical staff in Beijing, 2009-2015.Methods A prospective cohort study, using seven years of follow-up data, was conducted in a large-scale tertiary hospital in Beijing.A total of 1 284 medical staff aged 35 to 60 years were recruited.We divided them into 4 groups according to age and occupational categories,and the level of FBG was tested at the same time each year. Results The number of medical staff who completed all 7 annual FBG tests was 403. There was a stepwise increase in the levels of FBG (4.92 mmol/L, 5.26 mmol/L, and 5.60 mmol/L in the years 2009, 2012,and 2015,respectively;F=100.643,P<0.001).An increasing trend in the prevalence of IFG was also evident (3.7%, 7.7%, and 13.4% in the years 2009, 2012, and 2015, respectively; χ2=39.099, P<0.001). Compared with baseline levels(in 2009),the average levels of FBG and the prevalence of IFG in men and women, as well as in all occupational classes (doctors, nurses, technicians, and other medical employees), were significantly elevated by the year 2015 (all P<0.05). The levels of FBG in male medical staff were higher than that in female medical staff,in both 2009 and 2015(both P<0.001).Conclusion The trend of increasing FBG levels and IFG cases in medical staff,especially in men,has been a problem for hospitals. Health policy action is urgently needed to deflate the IFG bubbles.
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Objective To investigate the relationship between carotid artery atherosclerosis and risk factor in a young and middle-aged population in China who received health checkup.Methods A total of 762 cases of young and middle-aged adult were recruited between April and October in 2013.These subjects had no hypertension,diabetes,coronary heart disease,cerebrovascular disease,and connective tissue disease,etc.Their Blood pressure,serum glucose (Glu),total cholesterol (TC),triglyceride (TG),and low density lipoprotein cholesterol (LDL-C) were measured and carotid artery ultrasonography was performed.Of the 762 cases,589 were male,173 were female,mean age was (46 ± 9) years.For blood pressure,blood lipids,the t test was performed to detect the difference between arteriosclerosis group and non arteriosclerosis group in different age groups.Logistic regression was performed to reveal the risk factors with carotid arteriosclerosis.Results Of the 762 subjects,205 had carotid artery atherosclerosis; 30.2％ (178/589) of them were men and 15.6％(27/173) of them were women,with a significant difference between two groups,(x2=14.522,P=0.000).In the younger than 40 years old group,the diastolic blood pressure has statistical significance between carotid arteriosclerosis and non carotid arteriosclerosis group (t=-2.789,P＜ 0.05); blood sugar had statistically significant difference between the two groups (t value was-2.256,-2.930,-2.174,respectivly,P＜0.05).Multiple regression analysis revealed that the independent risk factors for carotid artery arteriosclerosis were age,sex,DBP,and Glu.The regression coefficients were 0.993,0.711,0.047,0.334 seperately.The ROC curve of age was analyzed,the area under the ROC curve was 0.731,cut-off was 51 years old.Conclusions Routine carotid artery ultrasound should be performed for older than 50 healthy middle-aged men,to determine whether arteriosclerosis exists,especially for people with abnormal blood glucose or elevated DBP.
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Objective To investigate the diagnostic value of capsule endoscopy (CE), CT enterography (CTE), ileocolonoscopy and small bowel follow through (SBFT) for small bowel Crohn's disease (CD). Methods Fifty-seven consecutive patients with CD underwent ileocolonoscopy, CTE, CE, and SBFT. It included the presence of the following symptoms and signs: abdominal pain, weight loss,diarrhea, fever and positive fecal occult blood test. The location and the characteristics of intestinal and extra-intestinal lesions detected by four techniquks were compared. The proportions of patients with positive findings using each examination were compared. Results Of the 57 patients, 50 underwent ileocolonoscopy, terminal ileum lesion was found in 33 patients (66. 00% ), the remaining 17 (34.0%)were normal; among 34 patients who had CTE, 29 of small bowel lesion were found (85. 29% ); CE were performed in 27 patients, due to prolonged gastric transit one time, the capsule did not reach the cecum in one patient during battery lifetime. CE showed small bowel lesion in 26 patients (96.30% ); SBF was performed in 39 patients and 26 of small bowel lesion were detected (66. 67% ). CE had the highest diagnostic yield for CD and ileocolonoscopy had the lowest, and there were statistically significant difference among the 4 examinations (P = 0. 006 ). The combinded positive rates of two methods were: CE + CTE 92. 86% (13/14), SBFT + CTE 90. 91% (20/22), CE + ileocolonoscopy 95. 65% (22/23), CE + SBFT100% (17/17), ileocolonoscopy + CTE 89. 66% ( 26/29 ), ileocolonoscopy + SBFT 77.78% ( 28/36 ), but there were no significant differences between each two examinations. Conclusion CE, CTE have a higher yield in depicting mild to moderate finding of CD than SBFT. CE is better for assessing early mucosal disease,whereas CTE is better for detecting transmural and extraluminal abnormalities. Most important, CE plus CTE may depict nonobstructive CD of the small bowel when conventional techniques such as ileocolonoscopy or SBFF have negative or inconclusive finding. CE provides us explanations for the symptoms of patients, decision to follow up or therapy.
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<p><b>OBJECTIVE</b>To explore new methods for the early diagnosis of pancreatic cancer through detection of K-ras and p53 mutations in pancreatic juice and stool.</p><p><b>METHODS</b>201 patients in PUMC Hospital from 1994 - 2000 and 60 control individuals were enrolled in this study. K-ras point mutation was detected by PCR-RFLP while p53 mutation was detected by PCR-SSCP.</p><p><b>RESULTS</b>K-ras mutation was found in pancreatic juice in 87.8% (36/41) of pancreatic cancer patients and 23.5% (4/17) of benign pancreatic disease patients. In 261 stool specimens, amplification found mutations successfully in 235 patients (90%). K-ras mutation was found in stool in 88% (66/75) of pancreatic cancer patients, 51.1% (24/47) of benign pancreatic disease patients and 19.6% (9/46) of normal individuals. p53 mutation was found in pancreatic juice in 47.4% (18/38) of pancreatic cancer patients and 12.5% (2/16) of benign pancreatic disease patients. p53 mutation was found in stool in 37.1% (23/62) and 19.1% (4/21) of chronic pancreatitis patients.</p><p><b>CONCLUSION</b>K-ras mutation in pancreatic juice has higher diagnosis sensitivity and specificity, and therefore may be used as a supplement in the diagnosis of pancreatic cancer. Detection of K-ras mutation combined with p53 mutation in stool can aid in the screening of pancreatic cancer.</p>