Prevention of the risk of "substitution" in health examination / 中华医院管理杂志

The paper described the presence and characteristics of " substitution " in health examinations, and analyzed the consequences and hazards of such a phenomenon. It is held that substitution will incur conflicting results of those receiving such examination, constituting medical risk and legal risk exposure as well. Due preventions should be taken in the rules and regulation of medical practice, with enhanced personnel management and ensured quality of health examination.

Clinical effects of continuous sequential therapy of femoston in 121 cases of meno-pausal syndrome / 药学实践杂志

Objective To explore the clinical efficacy and safety of continuous sequential hormone replacement therapy of femoston for menopausal syndrome .Methods 121 cases of menopausal syndrome at expert outpatient service in our hospital from January 2014 to October 2015 received hormone replacement therapy of femoston for 24 weeks .Before and after treat-ment ,Kupperman score ,blood follicle stimulating hormone (FSH) ,estradiol (E2 ) ,luteinizing hormone (LH) and endometri-al thickness were determined .Results With the prolonging of treatment time ,patient's menopausal symptoms gradually re-lieved .Kupperman scores were declining .After 6 courses of treatment ,patient's menopausal symptoms completely eased . Kupperman scores decreased by 95 .0% (P<0 .01) ,serum FSH and LH decreased significantly (P<0.05 and P<0 .01) and serum E2 increased notably (P<0 .01) without endometrial thickness changes (P>0.05) .Conclusion Continuous sequential therapy of femoston can effectively relieve menopausal syndrome and control the menstrual cycle and the endocrine level without stimulating the endometrium excessively .

Retrospective epidemiological study of thyroid nodules by ultrasound in asymptomatic subjects / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The purpose of this study was to conduct thyroid ultrasound examinations on a large sample of subjects and explore the occurrence, distribution, and characteristics of thyroid nodules and thyroid cancer to provide some information on the epidemic trend of thyroid nodules and cancer.</p><p><b>METHODS</b>The thyroid ultrasonic examination results of 19 895 healthy physical examinees who visited the Department of Health Management, Peking Union Medical College Hospital from January 2009 to December 2011 were analyzed retrospectively to determine the detection rate and characteristics of thyroid nodules. Fine needle aspiration or surgical resection was suggested to subjects suspected of having thyroid cancer.</p><p><b>RESULTS</b>The detection rate of thyroid nodules was 42.6% (8 480/19 895), 40.0% (4 661/11 678) in men and 46.5% (3 819/8 217) in women. The detection rate noticeably increased with increasing age. The detection rate of thyroid nodules by palpation was obviously lower than by ultrasonic examination in various age groups. Among those with thyroid nodules, 61.3% were multiple and 38.7% were solitary; multiple nodule was the major type both in men and women. Twenty-nine cases of malignant nodules were solitary, and 30 cases of malignant nodules were multiple. There was no significant difference. The detection rate of thyroid cancer was 0.30% for the entire group of examinees, and 0.15% in men and 0.50% in women. Among all sex and age groups, 30- to 40-year-old women had the highest detection rate (0.76%). The detection rate of thyroid nodules correlated with age, systolic blood pressure, height, and weight. Increasing age and/or higher systolic blood pressure correlated with a higher detection rate, while smaller height and weight also correlated with a higher detection rate with significant differences. However, there were no significant correlations between the detection rate and diastolic blood pressure or body mass index.</p><p><b>CONCLUSIONS</b>The detection of thyroid cancer increased significantly, especially in women. Thus, precautions needed to be taken. Regular physical examination and timely intervention after detection of malignant nodules are critical to improve the prognosis in thyroid cancer patients.</p>

Relationship between normal serum uric acid levels and nonalcoholic fatty liver disease in postmenopausal women / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To analyze the relationship between normal serum uric acid (SUA) levels and nonalcoholic fatty liver disease (NAFLD) among postmenopausal women, and determine the possible risk factors of NAFLD in this patient population.</p><p><b>METHODS</b>Chinese postmenopausal women who participated in the annual health check-up program from March 2009 to February 2010 were retrospectively assessed to identify individuals with SUA within normal range for study inclusion. For the total 1425 study participants, the recorded data of anthropometric parameters, metabolic factors, and serum biochemical parameters were collected. Results from abdominal ultrasonography examination were used to group participants according to presence of fatty liver. Women with fatty liver were divided into NAFLD and non-NAFLD groups. Further sub-grouping was performed according to SUA quartiles, as follows: Q1 group: less than 226.1 mumol/L); Q2 group: 226.1 mumol/L less than or equal to SUA less than 267.8 mumol/L; Q3 group: 267.8 mumol/Lless than or equal to SUA less than 303.5 mumol/L); Q4 group: 303.5 mumol/Lless than or equal toSUAless than or equal to357.0 mumol/L. The independent-sample t-test was used to compare normally distributed variables between groups, and the Mann-Whitney U test was used to analyze variables with skewed distribution. Categorical variables were examined by the R * C x2 test. Binary logistic analysis was used to determine the risk factors for fatty liver and to adjust for possible confounders. The multiple non-parameter independent-sample test (Kruskal-Wallis test) was used to compare the differences of SUA levels among NAFLD groups with different disease severity.</p><p><b>RESULTS</b>The prevalence of NAFLD among Chinese postmenopausal women with normal SUA was 32.8%, with NAFLD prevalences of 20.4% (70/343) in women with Q1 SUA, 26.3% (104/395) with Q2 SUA, 35.2% (128/364) with Q3 SUA, and 51.4% (166/323) with Q4 SUA. The prevalence of fatty liver showed a significant increasing trend according to the SUA quartile (x2 = 76.470, P-trend less than 0.01). Women in the SUA Q3 and Q4 groups had significantly higher risk of fatty liver presence than women in the Q1 group (P less than 0.01 for both, with or without adjustment of confounders). Disease severity did not appear to be related to disease severity, as the SUA levels in women with mild, moderate or severe fatty liver were not significantly different (286.8+/-48.2 mumol/L vs. 277.9+/-53.0 mumol/L vs. 281.4+/-48.2 mumol/L, respectively; x2 = 3.025, P more than 0.05).</p><p><b>CONCLUSION</b>SUA levels were independently correlated with NAFLD in Chinese postmenopausal women. SUA levels in the higher quartiles of the normal range may be an independent risk factor of NAFLD.</p>

Bone mineral density and biochemistry data of health checkup receivers / 中华健康管理学杂志

ObjectiveTo analyze the correlations between bone mineral density and biochemistry data of health checkup receivers.MethodsA total of 3025 sets of medical measurements,including blood glucose,lipid profiles,blood uric acid,blood pressure and bone mineral density,were collected from January 2008 to November 2010 in Medical Examination Center of Peking Union Medical College Hospital.Bone mineral density of lumbar vertebra 1 - 4 (L1-4) and hip were recorded.Linear correlation analysis was used to investigate the correlation between bone mineral density and other factors. Results In multiple regression analysis,age,body weight,and alkaline phosphatase level were found to be related to male hip bone mineral density; age,body weight,alkaline phosphatase,and glutamyltranspetidase level were related to male L2-4 bone mineral density; age,body weight,alkaline phosphatase,and glutamyltranspetidase level were indicated to be related to female hip bone mineral density; age,body weight,alkaline phosphatase,and the ratio of neutrophile granulocyte were related to female L2-4 bone mineral density.ConclusionIn thisstudygroup, bodyweightwaspositivelycorrelatedwithbonemineraldensity, although alkalinephosphatase was negatively associated with bone mineral density.The role of blood glucose and lipid in the regulation of bone mineral density remains inconclusive.

Analysis of risk factors and body composition in elderly patients with type 2 diabetes complicated nonalcoholic fatty liver disease / 中华老年医学杂志

Objective To investigate the probable risk factors for type 2 diabetic patients complicated nonalcoholic fatty liver disease (NFLD)in elderly, through comparing the body composition, serum lipid profile, incidences of abdominal obesity and metabolic syndrome (MS) between elderly type 2 diabetic patients with and without NFLD. Methods The enrolled elderly type 2 diabetic patients were divided into NFLD group (n=83) and non-NFLD group (n=85). Their clinical data including body composition, serum lipid profile, incidences of abdominal obesity and MS were analyzed retrospectively and compared. Results Compared with non-NFLD group, the BMI [(26.9±2.5) kg/m~2 vs. (24.1±2.5) kg/m~2, P=0.000], waist-hip ratios (WHR) ((0.92±0.07) vs. (0.87±0.06), P=0.000], total body fat percentage [(29.6%±6.6%) vs. (25.3%±5.5%),P=0.000], abdominal fat [(11.0±2.5) kg vs. (8.7±2.3) kg, P=0.000], visceral fat [(3.0±0.7) kg vs. (2.3±0.6)kg, P=0.000], visceral fat area [(97.6±22.2) cm~2 vs. (75.5±21.1) cm~2,P=0. 000], serum triglyceride [(1.98±0.94) mmol/L vs. (1.22±0.61) mmol/L, P=0.000]were all increased, while serum HDL [(1.23±0.32) mmol/L vs. (1.40±0.37) mmol/L, P=0.002]was decreased in NFLD group. The incidences of over-body fat (68.7% vs. 36.5%, P=0. 000),dyslipidemia (47.0% vs. 21.2%, P=0. 000), abdominal obesity (69.9% vs. 43.5%, P=0.001) and MS (49.4% vs. 9.6%, P=0.000) were obviously increased. But there were no statistical differences in serum TC [(4.93±0.94) mmol/L vs. (4. 73±1.07) mmol/L, P=0.219]and LDL [(3.23±0.80) mmol/L vs. (3. 07±0.89) mmol/L, P=0. 229]between the two groups. Logistic regression showed that high BMI (β=1.268, P=0.000, OR=3.56), over-total body fat percentage (β=0.902, P=0.023, OR=2.47)and the existence of MS (β=1. 664, P=0. 000, OR=5.28) were related to elderly type 2 diabetic patients complicated NFLD. Conclusions The high BMI, over-total body fat percentage are related to elderly type 2 diabetic patients complicated NFLD, and NFLD is probably one of components of metabolic syndrome.

Our hospital's ways of and experience in holding clinical pathological congresses / 中华医院管理杂志

The paper describes the significance of clinical pathological congresses in clinical work. It argues that at present there is the tendency of laying stress on modern advanced diagnostic means at the expense of basic physical diagnostic means and traditional therapies, and traditional conduction of clinical pathological congresses for the purpose of summarizing medical experience and promoting medical advancement has even become a rarity, which is very harmful to the cultivation of qualified clinical doctors. The paper gives an account of how the authors' hospital encouraged performance of autopsies and persisted in holding clinical pathological congresses. Its experience is that clinical pathological congresses have many functions in clinical work, including solving knotty problems like multidisciplinary and multisystematic pathological changes by drawing upon all useful opinions; exchanging information, which is beneficial to doctors learning from one another and making common progress; cultivating personnel via tempering young doctors and updating senior doctors'knowledge; and strengthening the hospital's cohesive force.