Analysis of correlation between thyroglobulin and papillary thyroid microcarcinoma / 中华内分泌外科杂志

Objective:To investigate the relationship of papillary thyroid microcarcinoma (PTMC) with serum thyroglobulin.Methods:Data of 539 patients with papillary thyroid nodule (≤1cm) in Department of Thyroid and Breast Surgery of the Second Hospital of Anhui Medical University and the Department of Oncology Surgery of Suzhou Municipal Hospital for thyroidectomy were retrospectively analyzed. All of the nodules were classified as TI-RADS 4b with ultrasound. According to the postoperative pathological results, patients were divided into PTMC group (experiment group) and benign tumor group (control group) . The PTMC patients were also divided into lymph node metastasis group (experiment group) and no lymph node metastasis group (control group) based on the cervical lymph node metastasis. Then we analyzed the relationship between thyroid stimulating hormone (TSH) , thyroglobulin antibody (TgAb) , thyroid peroxidase antibody (TPOAb) and thyroglobulin (Tg) with PTMC and lymph node metastasis by SPSS.Results:Age, TSH, Tg and TgAb were independent risk factors for PTMC, B: -0.020, 0.192, 0.026, 0.008, 95% CI: 0.962-0.998, 1.045-1.404, 1.015-1.038, 1.003-1.014, both P<0.05. The relations between PTMC and TSH, Tg and TgAb were positive, while age was in negative correlation with PTMC. Meanwhile, age and thyroglobulin (Tg) were also independent risk factors for lymph node metastasis in PTMC patients, B: -0.025, 0.014, 95% CI: 0.957-0.994, 1.008-1.021, both P<0.05. Age was negatively correlated with lymph node metastasis and Tg was positively correlated with lymph node metastasis. Tg level higher than 26.520 ng/ml indicated that the nodule was PTMC (sensitivity: 0.560, specificity: 0.719) , and Tg level higher than 36.695 ng/ml predicted lymph node metastasis in PTMC patients (sensitivity: 0.532, specificity: 0.788) . Conclusion:Tg is a sensitive serum index for identifying PTMC from benign thyroid nodule, and it is also related to lymph node metastasis in PTMC patients.

Inhibition of iNOS protects cardiomyocytes against coxsackievirus B3-induced cell injury by suppressing autophagy.

BACKGROUND: Coxsackievirus B3 (CVB3), a member of the picornavirus family, is one of the major causative enteroviruses of viral myocarditis. The aim of the current study was to investigate the role and underlying mechanism of iNOS and autophagy in CVB3 infected cardiomyocytes. METHODS: Myocardial cell H9c2 were randomly divided into four groups: control group, CVB3 group, CVB3+L-NAME group and the CVB3+iNOS siRNA group. Cell proliferation was detected by MTT method and cell apoptosis was determined by flow cytometric. The protein expression levels were determined by Western blot. Anisomycin was used to activate JNK pathway in CVB3 infected H9c2 cells. RESULTS: The results demonstrated that the inhibition of iNOS significantly elevated cell proliferation and suppressed cell apoptosis of CVB3-induced H9c2 cells. The production of MDA was obviously decreased, while the activity of SOD was increased by the addition of L-NAME or iNOS siRNA compared with the CVB3 group. Expression of the autophagy marker proteins LC3 II and Beclin 1 was significantly decreased, and the autophagy substrate p62 was dramatically increased in iNOS inhibition groups compared with the CVB3 group. Moreover, iNOS inhibition suppressed the JNK pathway in CVB3-infected H9c2 cells. Furthermore, administration of the JNK pathway stimulator, anisomycin, counteracted the effect of iNOS inhibition in CVB3-infected H9c2 cells. CONCLUSION: The inhibition of iNOS protects cardiomyocytes against CVB3-induced cell injury by regulating autophagy and the JNK pathway, which may provide a novel therapeutic strategy for treating CVB3-induced myocarditis.

Dynamic changes of complement level in patients with acute coronary syndrome and its relationships with myocardial injury / 中华危重病急救医学

Objective To study relationships between myocardial injury and the levels of serum complement C3, C4 and C5b-9 in patients with acute coronary syndrome (ACS). Methods A retrospectively analysis was conducted. 170 ACS patients [including 110 cases of ST-segment elevation myocardial infarction (STEMI) and 60 cases of non-ST-segment elevation acute coronary syndrome (NSTE-ACS)] with ischemic chest pain or chest discomfort onset within the prior 12 hours admitted to the cardiology department of Tianjin Union Medicine Center from January 2014 to July 2016 were enrolled. Thirty-six healthy cases were enrolled as control during the same time. The levels of serum complement C3, C4 and C5b-9 on 1, 3 and 7 days after admission and myocardial function indicators were analyzed. Major adverse cardiovascular events (MACE) and readmission rate were analyzed after 1 year follow-up. The correlation between serum complement levels and myocardial function indicators was analyzed by Pearson correlation analysis. Results ① The levels of serum C3, C4 and C5b-9 on the first day in NSTE-ACS group and STEMI group were significantly higher than control group [C3 (g/L): 1.04±0.33, 1.26±0.35 vs. 0.39±0.21, C4 (g/L): 0.31±0.14, 0.33±0.10 vs. 0.19±0.07, C5b-9 (g/L): 575.46±197.26, 659.26±160.77 vs. 501.40±141.51, all P 140 scores, 83 cases). TnT and sICAM-1 in intermediate risk group were significantly increased as compared with low risk group. Levels of TnT, sICAM-1, C3, C4 and C5b-9 in the highest group were significantly higher than the low and intermediate risk groups, however the lowest LVEF was found in the highest group. ④ It was shown by Pearson correlation analyses that levels of serum C3, C4, C5b-9 were positively correlated with TnT (r value was 0.481, 0.367, 0.292, respectively, all P <0.01), sICAM-1 (r value was 0.298, 0.249, 0.365, respectively, all P < 0.01), but negatively correlated with LVEF (r value was -0.384, -0.260, -0.200, respectively, all P < 0.01). In addition sICAM-1 positively correlated with TnT (r = 0.536, P = 0.000), but negatively correlated with LVEF (r = -0.341, P = 0.001). Conclusions Serum complements activation was found in the acute phase of ACS patients. Serum complement C3, C4 and C5b-9 are involved in the process of myocardial injury, and may reflect severity of myocardial injury and cardiac dysfunction.

The clinical characteristic analysis of ischemic stroke in patients with non-valvular atrial fibrillation / 天津医药

Objective To analyze the clinical and laboratory characteristics of the ischemic stroke in patients with non-valvular atrial fibrillation (AF), and to provide evidence for the prevention of ischemic stroke. Methods A total of 198 patients with ischemic stroke were chosen and divided into two groups:with AF (71 patients)/and without AF (127 patients) groups. Clinical data and biochemical markers were collected and compared in two groups. CHADS2 and CHA2DS2-VASc score systems were used to determine the risk levels in patients with AF. Finally, related risk factors of ischemic stroke with AF were determined and analyzed. Results The values of age, length of hospital stay, the hypertention history, heart rate and plasma homocysteine (Hcy) were significantly higher in the with-AF group than those in the without-AF group ( P <0.05). The levels of total cholesterol (TC), triglyceride (TG) and very low density lipoprotein cholesterol (VLDL-C) were sig?nificantly lower in the with-AF group than those of the without-AF group (P<0.05). CHA2DS2-VASc scores reached to the moderate-to-high risk level in the with-AF group. Multiple-factor logistic regression analysis showed that age and heart rate were the independent risk factors of the ischemic stroke in patients with non-valvular AF. ROC analysis indicated that age (AUC=0.761, cut-off point=72.50 years old) and heart rate (AUC=0.612, cut-off point=76.50 bit/min) had predictive and di?agnostic value for the ischemic stroke in patients with non-valvular AF. The age of these patients had the best sensitivity (70.4%) and specifity (71.1%), and the cut-off point of which was 72.50 years old. Conclusion The characteristics of isch?emic stroke in patients with non-valvular AF includes older age, faster heart rate, higher CHA2DS2-VASc scores and higher Hcy level.

Immediate postoperative low platelet count is associated with liver failure after partial hepatectomy in patients with hepatocellular carcinoma / 中华肝胆外科杂志

Objective To investigate the correlation between immediate postoperative platelet count with liver failure after partial hepatectomy in patients with hepatocellular carcinoma.Methods The clinical data of 71 patients with hepatocellular carcinoma who underwent liver resection at the Hepatopancreatobiliary Surgery Department of Nanjing Drum Tower Hospital from July 2013 to August 2015 were retrospectively analyzed.The clinical diagnosis was confirmed by pathology of the resected specimens.Based on postoperative platelet count within 2 h,the patients were divided into the low platelet count (PLT ＜ 100 × 109/L) group (n =24,33.8％) and the normal platelet count (PLT ≥ 100 × 109/L) group (n =47,66.2％).The correlations between immediate postoperative platelet count with serum indexes including serum alanine aminotransferase (ALT),aspartate aminotransferase (AST),total bilirubin (TBil) and direct bilirubin (DBil) were analyzed,and the incidences of posthepatectomy liver failure was also evaluated in these two groups.Results There was no re-operation and perioperative death in this study.Among the 71 patients,25 patients (35.2％) developed postoperative complications (grade Ⅰ to Ⅲ),and 8 patients (11.3％) suffered from postoperative liver failure (grade A).When compared with the normal platelet count group,the low platelet count group had significantly increased risks of postoperative liver failure (29.2％ vs 2.1％,X2 =11.618,P ＜ 0.05),increased postoperative peaks of ALT,AST,TBil and DBil levels [(462.5 ±135.7)U/L vs (307.9 ± 192.6) U/L,(440.0 ± 163.3) U/L vs (265.8 ± 155.8) U/L,(29.5 ±9.1) μmol/L vs (17.9 ±8.8) μ mol/L,t =3.507,4.385,5.129,P ＜0.05,respectively] and longer normalization time of liver function.Multiple Logistic regression analyses revealed that an immediate postoperative low platelet count was an independent risk factor of posthepatectomy liver failure.Conclusions The platelet count was associated with the incidence of postoperative liver failure after partial liver resection in patients with hepatocellular carcinoma.Patients with an immediate postoperative low platelet count suffered from a high incidence of posthepatectomy liver failure and delayed liver function recovery.

Clinical value of enhanced recovery after surgery in the radical resection for hilar cholangiocarcinoma / 中华消化外科杂志

Objective To investigate the clinical value of enhanced recovery after surgery (ERAS) in patients undergoing postoperative early enteral nutrition (EEN) with radical resection for hilar cholangiocarcinoma.Methods The clinical data of 48 patients with hilar cholangiocarcinoma who were admitted to the Drum Tower Clinical Medical College of Nanjing Medical University from July 2006 to September 2014 were retrospectively analyzed.All the 48 patients underwent radical resection for hilar cholangiocarcinoma,including 24 patients receiving postoperative EEN (EEN group) and 24 patients receiving total parenteral nutrition (TPN group).The serologic indices and liver function were detected regularly after operation.Ten percent of albumin (Alb) 10 g was administered by intravenous infusion when Alb ＜ 30 g/L.The indexes of all the 48 patients were compared in the 2 groups at postoperative day 3 and 7,including the serologic indices and liver function,the exhaust time,the volume of Alb infusion,the complications (incisional infection,abdominal infection,pleural effusion,peritoneal effusion and bile leakage) and the duration of hospital stay.The patients were followed up by outpatient examination and telephone interview till September 2014.The measurement data with normal distribution were presented as x ± s,comparison between groups and count data were analyzed using the t test and chi-squared test,respectively.Results Patients in the 2 groups were cured successfully and discharged,and no patient died perioperatively.Patients in the EEN group had a good tolerance for EEN and no occurrence of EEN-related complications was detected.The level of the GGT was (108 ± 73) U/L in the EEN group,which was significantly lower than (225 ± 121) U/L in the TPN group at postoperative day 3 (t =4.041,P ＜ 0.05).The level of the GGT was (142 ± 86) U/L in the EEN group,which was no significantly different from (183 ± 107)U/L in the TPN group at postoperative day 7 (t =1.477,P ＞ 0.05).The postoperative time to anal exsufflation and the duration of hospital stay were (73 ± 18) hours and (15 ± 4) days in the EEN group,which were significantly different from (97 ± 21) hours and (18 ± 4) days in the TPN group,and the volume of Alb infusion was (44 ± 29)g in the EEN group,which was significantly lower than (101 ± 92) g in the TPN group (t =4.295,2.615,2.916,P ＜ 0.05).All the 48 patients were followed up for 1 to 71 months (mediantime,10 months),no patients received reoperation or re-admitted to the hospital due to complications.Conclusion The application of postoperative EEN in enhanced recovery of patients undergoing radical resection for hilar cholangiocarcinoma is safe and effective,it could accelerate the recovery of enteral function,shorten the postoperative duration of hospital stay and reduce the supplement of extrinsic Alb,which is helpful for the fast recovery of patients.

Values of BNP,IL-6 and IL-10 in Stratification and Prognostic for Patients with Congestvie Heart Failure / 天津医药

Objective:To investigate the changes of left ventricular mass index(LVMI),plasma brain natriuretic peptide (BNP),interJeukin-6(IL-6)and interleukin-10(IL-10)in patients with congestive heart failure(CHF),and their values in risk stratification and prognostic evaluation of CHF thereof.Methods:Ninety-five patients with CHF in accordance with 2001ACC/AHA guidelines were enrolled and stratified as stage A(n=21),B(n=23),C(n=31)and D(n=20).The levels of plasma BNP,IL-6 and IL-10 were measured and compaired with those in 20 healthy subjects(control group).The patients were followed up every three months in two years.The end point was the rehospitalization and the cardiac death.Results:(1)The level of LVMI increased early in patients with CHF at stage B.(2)The plasma BNP levels were initially elevated in CHF patients at stage B,and the concentrations of BNP closely paralleled disease severity.(3)The levels of plasma IL-6 and IL-10 were increased,and the ratio of IL-10/IL-6 was decreased,with the progression of CHF at stage C and D.The plasma BNP level was positively correlated with the levels of IL-6 and IL-10.(4)The new CHF stratification was surperior to NYHA functional classification in regard to CHF prognosis prediction.(5)Multivariate COX regression analysis showed the levels of BNP and IL-6 were the independent risk factors in prognostic evaluation(P＜0.01,P=0.026).(6)Patients in high-risk groups stratified by the combination of BNP and stage classification had obviously higher end point events rate.Conclusion:(1)LVMI was a better marker for the evaluation of left ventrieular remodeling.(2)The intrinsic mechanism of CHF progression was inflammatory reaction deterioration.(3)BNP was a good marker in predicting onset and prognosis of CHF.The combination of BNP and the stage classification could improve the prognostic evaluation in patients with CHF.

Effects of Hypertension and Pharmacological Intervention on the Left Ventricular Remodeling in Neuroendocrine Hypertensive Rats / 天津医药

Objective: To investigate the effect of medication on left ventricular myocardial matrix remodeling in neuroendocrine hypertensive rats and the mechanism and inhibitive method thereof. Methods: A neuroendocrine hypertensive model was established with adult Wistar rat. A total of 34 rats were randomly divided into four groups: parzosin (Hα), cilazapril (Hace), pentoxifylline(Hptx) and hypertensive control group(Hc). Ten normal-tensive Wistar rats were used as normal control (Nc). The systemic blood pressure, serum procollagen type Ⅲ level, serum TNF-α level, collagen volume fraction(CVF) were detected. Results: In Hace group, systolic pressure, left ventricular weight, the levels of serum procollagen type III and TNF-α were all reduced obviously compared to those in Hc group(P < 0.05). In Hα group, the systolic pressure and left ventricular weight were reduced obviously compared to those in Hc group(P < 0.05), however, the levels of serum procollagen type III and TNF-α were higher than those of Nc group(P < 0.05). In group Hptx, the systolic pressure and left ventricular weight were not decreased, while the levels of serum procollagen typeⅢ,TNF-α and CVF were reduced to normal levels. Conclusion:The angiotensin coverting enzyme inhibitor is the effective agent to reverse myocardial fibrosis, which can be achieved mostly by the inhibition of AngⅡ. Pentoxifylline may inhibit and reverse myocardial fibrosis which correlated with inhibiting TNF-α.