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Objective:To investigate the association of time in range with metabolic associated fatty liver disease(MAFLD) and advanced liver fibrosis in patients with type 2 diabetes.Methods:This study was a retrospective study. A total of 494 type 2 diabetic patients were recruited in the Department of Endocrinololgy of Henan Provincial People′s Hospital from November 2019 to April 2022. Time in range(TIR) was calculated with continuous glucose monitoring data. Abdominal ultrasound scan was used to diagnose fatty liver. Liver stiffness measurement(LSM) by transient elastography was used to evaluate liver fibrosis. Pearson and multivariate linear regression analysis was used to evaluate the association between TIR and LSM. Multivariate logistic regression analysis was used to analyze the association of TIR with risk of MAFLD and advanced liver fibrosis.Results:Pearson correlation analysis showed that LSM was negatively correlated with TIR( r=-0.86, P<0.001) and was positively correlated with homeostasis model assessment for insulin resistance(HOMA-IR; r=0.48, P<0.001). After adjusting for confounding factors, multivariate linear regression analysis showed that TIR significantly negatively predicted LSM( β=-0.75, P<0.001), and HOMA-IR significantly positively predicted LSM( β=0.21, P=0.025). After adjusting for confounding factors, logistic regression analysis showed that compared with TIR Q4 patients, TIR Q1 patients had an increased risk of MAFLD( OR=1.96, 95% CI 1.07-3.62, P=0.027), advanced liver fibrosis( OR=3.82, 95% CI 1.17-12.50, P=0.027), and HOMA-IR was an independent risk factor for MAFLD( OR=1.22, 95% CI 1.04-1.43, P=0.005) and advanced liver fibrosis( OR=1.26, 95% CI 1.03-1.54, P=0.025). Conclusions:TIR and insulin resistance are independent risk factors for MAFLD and advanced liver fibrosis in patients with type 2 diabetes. TIR has a significant predictive value for MAFLD and advanced liver fibrosis.
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Objective:To investigate the gut microbiota composition in subclinical hypothyroidism and euthyroidism patients with Hashimoto′s thyroiditis, and its relationship with clinical indicators and inflammatory factors.Methods:A total of 48 patients diagnosed with Hashimoto′s thyroiditis and 28 healthy controls(HC group) were enrolled from Henan Provincial People′s Hospital from July 2019 to March 2022 in this cross-sectional study. According to thyroid function, 18 patients with Hashimoto′s thyroiditis were divided into subclinical hypothyroidism group(SH group) and 30 patients in euthyroidism function group(Eu group). Fecal microbial composition was detected by 16S rRNA sequencing technology, and peripheral blood was collected to test clinical indicators and inflammatory factors.Results:Compared with HC group, there were significant differences in α and β diversity of gut microbiota in SH and Eu group( P=0.045, P=0.037). At the phylum level, Firmicutes, Bacteroidota, and Proteobacteria were the dominant phylum in the three groups. At the genus level, the abundance of 4 bacterial genera increased gradually in HC group, Eu group, and SH group, including Streptococcus, Comamonas, Elizabethkingia, Achromobacter. However, the abundance of the other 9 genera decreased gradually, such as Subdoligranulum, Coprococcus, Oscillospirales_ UCG-010, Clostridia_ UCG-014, Oscillospiraceae_ UCG-002, Alistipes et al. In addition, the level of serum B-cell activating factor was positively correlated with several bacterial genera such as Achromobacter, Streptococcus, Intestinibacter et al. Conclusion:There are differences in the gut microbiota structure of patients with Hashimoto′s thyroiditis in different thyroid functional states, which is correlated with inflammatory factors.
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Objective:To investigate the changes of ocular surface microbiota in obese patients before and after dietary intervention.Methods:From November 1, 2020 to May 1, 2021, 35 obese patients in the obesity management center of the Department of Endocrinology and Metabolic Diseases of Henan Provincial People′s Hospital were selected for a 4-week low-calorie dietary intervention of 1 600-1 800 kcal/day. The body weight, body mass index(BMI), body composition(body fat, body fat percentage, visceral fat grade, total body water, and skeletal muscle) were observed before and after dietary intervention. The characteristics of ocular surface flora in obese patients before and after intervention were analyzed by 16S rRNA sequencing.Results:The body weight, BMI, body fat, percentage of body fat, visceral fat grade and total body water decreased significantly after 4 weeks( P<0.05), while there was no significant difference in skeletal muscle( P>0.05). There was no significant difference of ocular surface flora α and β in diversity( P>0.05). Opportunistic pathogens Pseudomonas and Cutibacterium decreased significantly, while Faecalibacterium, Lachnospiraceae NK4A136 group, Oscillospiraceae UCG 002, and Blautia, which producing short chain fatty acids, increased significantly( P<0.05). Functional prediction analysis showed that the metabolic pathways such as degradation related pathways and insulin signaling pathways of volatile organic compounds(VOCs) were significantly enriched. Conclusion:After dietary intervention, opportunistic pathogenic bacteria decreased and short chain fatty acid producing bacteria increased in obese patients. The altered ocular surface flora may be related to the degradation of VOCs and the improvement of insulin sensitivity.
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Objective:To investigate the association of preoperative neutrophil-lymphocyte ratio combined with platelet-to-lymphocyte ratio (NLR-PLR) score with clinicopathological parameters and prognosis in patients with colorectal cancer.Methods:The retrospective cohort study was conducted. The clinicopathological data of 178 patients with colorectal cancer who were admitted to the First Affiliated Hospital of China Medical University from January 2013 to December 2014 were collected. There were 101 males and 77 females, aged from 21 to 90 years, with an average age of 63 years. All patients underwent radical resection of colorectal cancer. Observation indicators: (1) cutoffs of NLR and PLR and correlation between them; (2) association between preoperative NLR-PLR score and clinicopathological characteristics of patients with colorectal cancer; (3) follow-up and survival; (4) analysis of the risk factors for prognosis of patients with colorectal cancer. Follow-up was performed once every 3 months using outpatient examination or telephone interview including tumor markers, computed tomography and enteroscopy to detect postoperative survival of patients up to June 2017. Overall survival time was defined as the date of surgery to the date of the last valid follow-up or the date of death. Measurement data with skewed distribution were expressed as M (range). Count data were expressed as absolute numbers, and comparison between groups was performed using the chi-square test. Comparison of ordinal data was performed using the Mann-Whitney U test. Kaplan-Meier method was used to draw survival curve, and Log-rank test was used for survival analysis. The COX proportional hazard model was used for univariate and multivariate analyses. Results:(1) Cutoffs of NLR and PLR and correlation between them. Receiver working characteristics of NLR and PLR showed that the NLR had a cutoff of 2.7 [area under curve (AUC)=0.739, 95% confidence interval ( CI): 0.638-0.841, P<0.05] and PLR had a cutoff of 246 (AUC=0.640, 95% CI: 0.521-0.758, P<0.05). There was a correlation between NLR and PLR ( r=0.712, P<0.05). (2) Association between preoperative NLR-PLR score and clinicopathological characteristics of patients with colorectal cancer. Results of preoperative NLR-PLR score showed that the NLR-PLR score was 0, 1, and 2 in 99, 52, and 27 patients, respectively. There were significant differences in tumor diameter, degree of tumor invasion, TNM staging, Dukes staging, and distant metastasis between patients with different preoperative NLR-PLR scores ( χ2=11.294, 10.816, 9.802, 9.525, 8.759, P<0.05). (3) Follow-up and survival: 178 patients were followed up for 1-53 months, with a median follow-up time of 37 months. The average survival time was 37 months for all the 178 patients, 50 months for 99 patients with NLR-PLR score of 0, 44 months for 52 patients with NLR-PLR score of 1, and 35 months for 27 patients with NLR-PLR score of 2. There was a significant difference in survival time between patients with NLR-PLR score of 0 and patients with NLR-PLR score of 1 ( χ2=6.388, P<0.05), between patients with NLR-PLR score of 0 and patients with NLR-PLR score of 2 ( χ2=26.388, P<0.05), between patients with NLR-PLR score of 1 and patients with NLR-PLR score of 2 ( χ2=5.350, P<0.05). (4) Analysis of the risk factors for prognosis of patients with colorectal cancer. Results of univariate analysis showed that degree of tumor invasion, TNM staging, Dukes staging, distant metastasis, NLR-PLR score, and platelet-NLR score were related factors for prognosis of patients with colorectal cancer [ hazard ratio ( HR)=2.439, 2.472, 2.221, 9.020, 2.671, 2.099, 95% CI: 1.443-4.124, 1.413-4.323, 1.282-3.849, 4.449-18.082, 1.742-4.097, 1.339-3.290, P<0.05]. Results of multivariate analysis showed that degree of tumor invasion, distant metastasis, and NLR-PLR score were independent factors for prognosis of patients with colorectal cancer ( HR=2.045, 5.641, 2.271, 95% CI: 1.051-3.979, 2.590-12.288, 1.185-4.354, P<0.05). Conclusions:The preoperative NLR-PLR score is associated with tumor diameter, degree of tumor invasion, TNM staging, Dukes staging, and distant metastasis in patients with colorectal cancer. Patients with higher score have larger tumor diameter, higher degree of tumor invasion, higher stage, and easier distant metastasis. Preoperative NLR-PLR score can effectively evaluate the prognosis of patients with colorectal cancer. Patients with higher NLR-PLR score have shorter survival time. The NLR-PLR score is an independent influencing factor for prognosis of patients with colorectal cancer.
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Objective@#To study the expression of ISYNA1 and association of ISYNA1 with clinicopathological significance in pancreatic ductal adenocarcinoma (PDAC).@*Methods@#Collecting clinical data and specimens of 68 PDAC patients at Department of General Surgery, the First Hospital of China Medical University from March 2008 to December 2017.There were 39 males and 29 females, aged 33 to 81 years(median 59 years).The expression of ISYNA1 in 68 paraffin embedded PDAC specimens was detected by immunohistochemistry,in which 34 had paired non-cancerous pancreatic tissues,the relationship between ISYNA1 expression and clinicopathological parameters was analyzed; and the correlation between ISYNA1 and p53 in 48 PDAC specimens were estimated.qRT-PCR and Western blot were used to examine the expression of ISYNA1 mRNA and protein level in 17 paired fresh PDAC specimens and adjacent non-cancerous pancreatic tissues,respectively.siRNA interference was used to knockdown the expression of p53 in Capan-2,SW1990 and Miapaca-2 cells,and association of p53 with ISYNA1 expression was explored. Statistical methods included Student′s test,χ2 test, Kaplan-Meier curve, Log-rank test and Pearson analysis, respectively.@*Results@#Immunohistochemistry results showed that the expression of ISYNA1 in PDAC(3.681±2.198)was significantly lower than that in normal pancreatic tissues(6.012±3.428)(t=-3.611,P=0.001).In 17 paired fresh PDAC specimens,ISYNA1 mRNA expression in non-cancerous pancreatic tissues(ΔCT: 3.721±2.234)was obviously higher than that in PDAC tissues (ΔCT: 5.889±1.607) (t=-4.636,P<0.01), and ISYNA1 protein level in non-cancerous pancreatic tissues(0.815±0.418)was similarly higher than that in PDAC tissues(0.517±0.240)(t=2.948,P=0.009).χ2 test showed the expression of ISYNA1 was negatively associated with tumor invasion depth(χ2=7.534,P=0.030)and vascular invasion(χ2=5.048,P=0.043);Pearson analysis showed there was no relationship between ISYNA1 and mutant p53(χ2=1.377,P=0.359).In p53 wild-type Capan-2 and SW1990 cells,Knockdown of p53 significantly down regulated ISYNA1 expression, whereas had no effect on ISYNA1 expression in p53 mutant Miapaca-2 cells. Kaplan-Meier survival analysis and Log-Rank test indicated patients with negative ISYNA1 expression had a shorter median survival time and poorer prognosis(χ2=4.953, P=0.026).@*Conclusions@#The expression of ISYNA1 in PDAC tissues is significantly decreased,which is associated with the prognosis of PDAC patients,it is only related to wild type p53,and has no relationship with mutant p53.Abnormal expression of ISYNA1 may play an important role in the progression of PDAC.
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Craniopharyngioma is the most common benign intracranial tumor in children. The major post-operative complication is dysfunction of pituitary, which can result in many complicate clinical manifestations with hormonal deficiencies. Normochromic anemia has been reported as a common hematologic abnormality. However, pancytopenia is rarely reported so far. Here we describe a 21-year-old inpatient with the main complaint of nasal bleeding, who accepted craniopharyngioma surgery 9 years ago. Laboratory tests showed pancytopenia secondary to panhypopituitarism. This paper aims to increasing the awareness of this disease and accumulating clinical experiences for the clinicians.
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Objective To compare the clinical characteristics and influence factors of hyperuricemia between genders,in order to provide references for better controlling and preventing the occurrence and development of hyperuricemiaprovide.Methods A total of 5 783 people who underwent physical examination in two Baoding Health Screening Centers from January 1st to June 1st,2016 were enrolled in this study,and all volunteers completed physical examination,laboratory examination and questionnaire survey.Patients with hyperuricemia were selected to analyse the clinical characteristics and influence factors.Results There were statistically significant differences in clinical characteristics,including obesity,blood pressure,blood glucose,blood lipids,liver function,renal function,anemia,blood rheology examination,thyroid ultrasound and lateral radiographs,between male and female patients with hyperuricemia (P＜0.05).The survey showed that there were statistically significant differences in age,education level,marital status,work status,sleeping status,smoking and drinking between male and female patients with hyperuricemia (P＜0.05).The red blood cells counts,marital status and education level were influence factors for female patients with hyperuricemia,while have little effect on male patients.The smoking,creatinine and diastolic blood pressure were influence factors for male patients with hyperuricemia,while have no effect on female patients.Conclusion The clinical characteristics and the influencing factors of male and female patients with hyperuricemia are different,so corresponding preventive and therapeutic measures should be taken for male and female patients.
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Objective Performing special studies in patients with adenocarcinomas of the esophagogastric junction (AEG) can provide an effective clinical basis for diagnosis and successful treatment.Methods We retrospectively analyzed and summarized the diagnosis,operative procedure,and postoperative complications in 52 cases of AEG in patients who underwent surgical treatment at the First Hospital of China Medical University between June 2011 and May 2016.Results In addition to carcinoembryonic antigen (CEA),carbohydrate antigen 19-9 (CA19-9) is a useful tumor marker with a positively higher rate of preoperative detection of AEG.With respect to choice of surgical approach,type Ⅰ tumors were treated using transthoracic en bloc esophagectomy with resection of the proximal stomach,while type Ⅱ and Ⅲ tumors were primarily treated with an extended total gastrectomy with transhiatal resection of the distal esophagus.We observed in our study that stage Ⅲ tumors were the most common type,and intra-pulmonary infection was the commonest postoperative complication.Conclusion AEG continues to remain one of the most difficult clinical problems.Middle-aged and elderly patients presenting with persistent epigastric and postprandial discomfort require special attention.Adopting a rational surgical strategy is the basis of achieving radical cure.We propose that patients with type Ⅱ tumors should be treated with a radical total gastrectomy,and a distal esophagectomy through the esophageal hiatus,if necessary,should be combined with a thoracic approach to ensure radical surgery.
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The clinical and genetic data were retrospectively analyzed in a pedigree with pseudohypoparathyroidism type Ⅰ a.Clinically typical Albright hereditary osteodystrophy (AHO),hypocalcemia,hyperphosphatemia,and PTH- and TSH-resistance were manifested in the proband,but not in his brother and parents.The proband's symptom of epilepsy was alleviated by treatment with calcium and vitamin D,which was of no avail in regard to AHO.After GNAS1 genes were sequenced and compared with the GenBank data among the family members,a deletion of c.1107_1108 ( p.Glu370ArgfsX11 ) in exon l3 of GNAS1 gene leading to a frameshift mutation was found in the proband and his mother.It suggested that the GNAS1 gene mutation might be related to the pathogenesis of the disease.