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Background@#Subclinical hypothyroidism (SCH) is the most common thyroid dysfunction, and its relationship with blood pressure (BP) has been controversial. The aim of the study was to analyze the association between SCH and newly-diagnosed hypertension. @*Methods@#Based on data from the Thyroid disease, Iodine nutrition and Diabetes Epidemiology (TIDE) study, 49,433 euthyroid individuals and 7,719 SCH patients aged ≥18 years were enrolled. Patients with a history of hypertension or thyroid disease were excluded. SCH was determined by manufacturer reference range. Overall hypertension and stage 1 and 2 hypertension were diagnosed according to the guidelines issued by the American College of Cardiology/American Heart Association in 2017. @*Results@#The prevalence of overall hypertension (48.7%), including stage 1 (28.9%) and 2 (19.8%) hypertension, increased significantly in SCH patients compared with euthyroid subjects. With elevated serum thyroid stimulating hormone (TSH) level, the hypertension prevalence also increased significantly from the euthyroid to different SCH subgroups, which was more profound in females or subjects aged <65 years. The age- and sex-specific regression analysis further demonstrated the same trends in the general population and in the 1:1 propensity matched population. Similarly, several BP components (i.e., systolic, diastolic, and mean arterial BP) were positively associated with TSH elevation, and regression analysis also confirmed that all BP components were closely related with SCH in female subjects aged <65 years. @*Conclusion@#The prevalence of hypertension increases for patients with SCH. SCH tends to be associated with hypertension and BP components in females younger than 65 years.
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Background@#Subclinical hypothyroidism (SCH) is the most common thyroid dysfunction, and its relationship with blood pressure (BP) has been controversial. The aim of the study was to analyze the association between SCH and newly-diagnosed hypertension. @*Methods@#Based on data from the Thyroid disease, Iodine nutrition and Diabetes Epidemiology (TIDE) study, 49,433 euthyroid individuals and 7,719 SCH patients aged ≥18 years were enrolled. Patients with a history of hypertension or thyroid disease were excluded. SCH was determined by manufacturer reference range. Overall hypertension and stage 1 and 2 hypertension were diagnosed according to the guidelines issued by the American College of Cardiology/American Heart Association in 2017. @*Results@#The prevalence of overall hypertension (48.7%), including stage 1 (28.9%) and 2 (19.8%) hypertension, increased significantly in SCH patients compared with euthyroid subjects. With elevated serum thyroid stimulating hormone (TSH) level, the hypertension prevalence also increased significantly from the euthyroid to different SCH subgroups, which was more profound in females or subjects aged <65 years. The age- and sex-specific regression analysis further demonstrated the same trends in the general population and in the 1:1 propensity matched population. Similarly, several BP components (i.e., systolic, diastolic, and mean arterial BP) were positively associated with TSH elevation, and regression analysis also confirmed that all BP components were closely related with SCH in female subjects aged <65 years. @*Conclusion@#The prevalence of hypertension increases for patients with SCH. SCH tends to be associated with hypertension and BP components in females younger than 65 years.
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Objective To investigate the diagnostic value of endoscopic ultrasound-guided fine needle aspiration ( EUS-FNA) on malignant lesions in gastrointestinal adjacent tissue, and further to analyze the risk factors influencing positive rate of EUS-FNA. Methods The clinical data of 171 patients undergoing EUS-FNA from January 2009 to May 2016 were collected. The lesion location, size and characteristics, the number of needle passes, puncture suction negative pressure, size of puncture needle, and years of operator experience in EUS were retrospectively analyzed. Results The overall sensitivity, specificity, and accuracy of EUS-FNA in the diagnosis of malignant lesions were 78. 3％ ( 83/106) , 100. 0％ ( 65/65) , and 86. 5％( 148/171) , respectively. The univariable logistic regression analysis demonstrated that the risk factors of EUS-FNA were lesion location, lesion characteristics, and lesion size. In multivariate analysis, larger lesion size ( OR=1. 029, 95％CI: 1. 011-1. 047, P=0. 001) and lesion characteristics of solid ( OR=5. 098, 95％CI:1. 324-19. 633, P=0. 018) were independent factors affecting the positive rate of EUS-FNA. Among 171 cases performed by EUS-FNA, the incidence of postoperative complications was 1. 75％ ( 3/171 ) included 2 cases of fever and 1 case of acute pancreatitis, which were improved after conservative treatment. Conclusion EUS-FNA is a safe and effective method of cytological and histological diagnosis with high accuracy and sensitivity, importantly in distinguish malignancy from benign lesion in gastrointestinal adjacenttissue. Positive rate of diagnosis on malignant lesions by EUS-FNA is positively correlated with lesion size, and EUS-FNA positive rate of solid malignant lesions is significantly higher than that of cystic lesions.
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<p><b>OBJECTIVE</b>To identify the predictive factors for differentiating pancreatic ductal adenocarcinoma (PDAC) from other neoplastic solid pancreatic lesions and assess the accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for diagnosis of PDAC.</p><p><b>METHODS</b>We retrospectively analyzed the clinical data of patients referred for EUS-FNA evaluation of pancreatic lesions in the Digestive Endoscopic Center of Nanfang Hospital between January, 2009 and May, 2016. The cases with unknown diagnosis, missing data, repeated punctures, cystic lesions and benign lesions were excluded from the analysis. The positivity rates of EUS-FNA were compared between patients with PDAC and those with non-PDAC lesions, and the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of EUS-FNA were assessed in the diagnosis of PDAC. Univariate and multivariate logistic regression analyses were used to identify the factors for differentiating PDAC from non-PDAC lesions based on the demographic characteristics, clinical presentations, laboratory data, and endoscopic ultrasonography imaging features of the patients.</p><p><b>RESULTS</b>Among the 75 patients with solid neoplastic pancreatic lesions, 54 (72.0%) were found to have PDAC and 21 (28.0%) had non-PDAC lesions. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of EUS-FNA for the diagnosis of PDAC were 77.8%, 100.0%, 100.0%, 63.6% and 84.0%, respectively. No significant difference was found in the positivity rate of EUS-FNA between patients with PDAC and those with non-PDAC lesions (77.8% 76.2%, > 0.05). Multivariate regression analysis identified abdominal pain (=5.163, 95%: 1.093-24.389, =0.038), lesion size (=0.926, 95%: 0.877-0.978, =0.006), characteristics of the solid lesions (=7.105, 95%: 1.440-35.043, =0.016), and evidence of metastases (=6.165, 95%: 1.332-28.533, =0.020) as the independent factors for predicting PDAC.</p><p><b>CONCLUSIONS</b>The pretest characteristics including abdominal pain, evidence of metastases, and lesion size and lesion characteristics defined by endoscopic ultrasonography findings can reliably predict a diagnosis of PDAC. EUS-FNA has a high sensitivity and a high specificity for the diagnosis of PDAC.</p>
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To investigate the association of the gene polymorphism of cytotoxic T lymphocyte-associated antigen-4(CTLA-4)with Graves'ophthalmopathy(GO)in Qinghai Tibetans. 130 case of Graves'disease(GD)were selected from June 2013 to November 2016 in The People's Hospital of Qinghai Province. These patients were assigned into 2 groups,GO(n=71)and GD without GO(n=59). The genotypes and alleles of CTLA-4 gene were detected by polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP). Distribution of CTLA-4 exon 1 (+49A/G)genotype frequencies(AA,AG,and GG)was different between 2 groups.
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Objective To investigate the correlation between gene polymorphism of protein tyrosinephosphatase,non-receptor type22 (PTPN-22) and Graves disease (GD) in Qinghai Tibetan.Methods One hundred and thirty Tibetan cases of GD were selected randomly from July 2012 to November 2016 in the People's Hospital of Qinghai Province;meanwhile,110 normal control cases were selected randomly fron the Qinghai Tibetan.All the subjects were non-related Tibetan residents of Qinghai nationality,who had no thyroid disease and other autoimmune diseases,and had no family history of autoimmune diseases.Then genotype and allele of PTPN-22 were detected by the method of polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP).Results The Hardy-Weinberg balance test was used to examine the representativeness of the control group and the GD group (P ＞ 0.05).The suggested samples have population representativeness and can be used in population genetics research.The distribution of PTPN-22 exon 14 (1 858C/T) genotype frequencies (CC,CT,TT) did not differ between normal control cases and GD in Qinghai Tibetan [95.45％ (105/110) vs 93.08％ (121/130),4.55％ (5/110) vs 6.92％ (9/130),0 (0/110) vs 0 (0/130),x2 =0.613,P ＞ 0.05].The distribution of PTPN-22 exon 14 (1 858C/T)allele frequencies (C,T) did not differ between nornal control cases and GD in Qinghai Tibetan [97.73％(215/220) vs 96.54％ (251/260),2.27％ (5/220) vs 3.46％ (9/260),x2 =0.015,P ＞ 0.05].Conclusion There is no significant relationship between the polymorphisms of PTPN-22 gene exon 14 (1 858C/T) and GD.
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Objective To study the diagnostic value and clinical efficacy of endoscopic ultrasound-guided fine needle aspiration ( EUS-FNA ) for mediastinal and abdominal lymphadenopathy. Methods Thirty patients who underwent EUS-FNA for mediastinal or abdominal lymphadenopathy between May 2009 and December 2015 were reviewed. The clinical efficacy of EUS-FNA was evaluated by pathological results and the follow-up. The EUS-FNA effect on clinical decision was also analyzed. Results Lesions were located in the mediastinum in 10 cases and in the abdomen in 20 cases. The total diagnostic accuracy, sensitivity, specificity, positive predictive value ( PPV) and negative predictive value ( NPV) of EUS-FNA were 96. 7%, 94. 7%, 100. 0%, 100. 0% and 91. 7%, respectively. Of all the 30 cases, 20 lymph glands were of unknown origin. The diagnostic accuracy, sensitivity, specificity, PPV and NPV of EUS-FNA in these lesions were 95. 0%, 88. 9%, 100. 0%, 100. 0% and 91. 7%, respectively. The combination of cytological and histological examination had higher accuracy ( 96. 7% VS 73. 3%, P=0. 026) and sensitivity ( 94. 7%VS 57. 8%, P= 0. 019 ) than cytological examination only. Immunohistochemistry stains were performed in 12 neoplastic cases, and 11 ( 91. 7%) were confirmed. The diagnosis by EUS-FNA had positive impact on clinical decisions in 27 patients ( 90. 0%) . Conclusion EUS-FNA is an effective approach for mediastinal and abdominal lymphadenopathy, and the result has a positive impact on clinical decisions. The combination of cytological and histological examination and application of ancillary techniques, such as immunohistochemistry stains, can improve the diagnostic efficacy of EUS-FNA.
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Objective To investigate the correlation between gene polymorphism of protein tyrosinephosphatase,non-receptor type22 (PTPN-22) and Graves disease (GD) in Qinghai Tibetan.Methods One hundred and thirty Tibetan cases of GD were selected randomly from July 2012 to November 2016 in the People's Hospital of Qinghai Province;meanwhile,110 normal control cases were selected randomly fron the Qinghai Tibetan.All the subjects were non-related Tibetan residents of Qinghai nationality,who had no thyroid disease and other autoimmune diseases,and had no family history of autoimmune diseases.Then genotype and allele of PTPN-22 were detected by the method of polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP).Results The Hardy-Weinberg balance test was used to examine the representativeness of the control group and the GD group (P ＞ 0.05).The suggested samples have population representativeness and can be used in population genetics research.The distribution of PTPN-22 exon 14 (1 858C/T) genotype frequencies (CC,CT,TT) did not differ between normal control cases and GD in Qinghai Tibetan [95.45％ (105/110) vs 93.08％ (121/130),4.55％ (5/110) vs 6.92％ (9/130),0 (0/110) vs 0 (0/130),x2 =0.613,P ＞ 0.05].The distribution of PTPN-22 exon 14 (1 858C/T)allele frequencies (C,T) did not differ between nornal control cases and GD in Qinghai Tibetan [97.73％(215/220) vs 96.54％ (251/260),2.27％ (5/220) vs 3.46％ (9/260),x2 =0.015,P ＞ 0.05].Conclusion There is no significant relationship between the polymorphisms of PTPN-22 gene exon 14 (1 858C/T) and GD.
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Objective To study the diagnostic value and clinical efficacy of endoscopic ultrasound-guided fine needle aspiration ( EUS-FNA ) for mediastinal and abdominal lymphadenopathy. Methods Thirty patients who underwent EUS-FNA for mediastinal or abdominal lymphadenopathy between May 2009 and December 2015 were reviewed. The clinical efficacy of EUS-FNA was evaluated by pathological results and the follow-up. The EUS-FNA effect on clinical decision was also analyzed. Results Lesions were located in the mediastinum in 10 cases and in the abdomen in 20 cases. The total diagnostic accuracy, sensitivity, specificity, positive predictive value ( PPV) and negative predictive value ( NPV) of EUS-FNA were 96. 7%, 94. 7%, 100. 0%, 100. 0% and 91. 7%, respectively. Of all the 30 cases, 20 lymph glands were of unknown origin. The diagnostic accuracy, sensitivity, specificity, PPV and NPV of EUS-FNA in these lesions were 95. 0%, 88. 9%, 100. 0%, 100. 0% and 91. 7%, respectively. The combination of cytological and histological examination had higher accuracy ( 96. 7% VS 73. 3%, P=0. 026) and sensitivity ( 94. 7%VS 57. 8%, P= 0. 019 ) than cytological examination only. Immunohistochemistry stains were performed in 12 neoplastic cases, and 11 ( 91. 7%) were confirmed. The diagnosis by EUS-FNA had positive impact on clinical decisions in 27 patients ( 90. 0%) . Conclusion EUS-FNA is an effective approach for mediastinal and abdominal lymphadenopathy, and the result has a positive impact on clinical decisions. The combination of cytological and histological examination and application of ancillary techniques, such as immunohistochemistry stains, can improve the diagnostic efficacy of EUS-FNA.
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Objective To investigate the association between gene polymorphism of cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) and Graves ophthalmopathy (GO) in Qinghai Han population.Methods Ninety cases of Graves disease were selected from June 2011 to February 2014 in The People's Hospital of Qinghai Province,and the 90 patients were divided into two subgroups according to GO (49 cases) and GD without GO(41 cases).Then the genotype and allele of CTLA-4 exon 1 (+ 49A/G) were detected in surum by the method of polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP).Results The distribution of CTLA-4 exon 1 (+ 49 A/G) genotype frequencies (AA,AG,GG) was not different between GO and GD without GO subgroups [4.1％ (2/49) to 7.3％ (3/41),44.9％ (22/49) to 61.0％ (25/41),51.0％ (25/49) to 31.7％ (13/41),Fisher exact probability,P =0.180 ＞ 0.05]; the distribution of CTLA-4 exon 1 (+ 49A/G) allele frequencies (A,G) was not different between GO and GD without GO subgroups [26.5％ (26/98) to 37.8％ (31/82),73.5％ (72/98) to 62.2％ (51/ 82),x2 =2.622,P＞ 0.05].Conclusion CTLA-4 gene exon 1 (+ 49A/G) may not be a candidate susceptibility gene for Qinghai Han GO.
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Objective To evaluate the value of endoscopic ultrasonography (EUS) in the diagnosis of Crohn's Disease (CD).Methods A total of 436 patients with endoscopically suspected CD underwent EUS and the clinical data of these patients were analyzed retrospectively.Changes of gastrointestinal wall stratification and perienteric complications detected by EUS were documented systematically.The consistency between the diagnosis of EUS and the results of pathology were recorded.Results A total of 297 cases of CD and 139 cases of non-CD were clinically diagnosed,while 277 CDs (including 17 non-CDs clinically diagnosed) and 159 non-CDs (including 37 CDs clinically diagnosed) were diagnosed by EUS.The sensitivity,specificity and accuracy rate of EUS in diagnosing CD were 87.5％ (260/297),87.8％ (122/139) and 87.6％ (382/436),respectively.Dilated vessels in submucosa were detected in 40 patients,fistulae in 13,abscesses in 5 and enlarged lymph nodes in 75.Conclusion EUS can show gastrointestinal wall stratification of CD clearly with high diagnostic accuracy.Meanwhile,EUS can detect extraluminal complications well to help in providing useful information for surgery.
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ObjectiveTo detect the changes of gastroesophageal reflux disease (GERD) with high resolution endoscopy,and to explore its diagnostic value for nonerosive reflux disease (NERD). Methods From April 2007 to January 2008, consecutive out-patients visiting the Department of Gastroenterology due to continuous or recurrent symptoms of acid reflux, heartburn, cardiac-like chest pain for at least three months and volunteer healthy controls were recruited to the study. The subjects were classified into the normal group ( n =48 ), the NERD group ( n =70), the erosive esophagitis (EE) group ( n =70), and the Barrett esophagus (BE) group ( n =48). All subjects underwent endoscopy, and the shape of Z-lines, the shape of mucosal pits, mucosa roughness above Z-line and the shape of mucosal blood vessels were observed. The NERD changes were analyzed with optimal scale. ResultsZ-line shape of NERD group showed a significant difference from that of EE and BE groups ( P ＜ 0. 01 ), which was not different from that of normal controls ( P ＞0. 01 ). The shape of mucosal pits of NERD group was different from that of EE and BE (P ＜0. 01 ), which also was not different from that of control (P＞0. 01 ). Roughness of the mucosa above Z-line of NERD group was different from other 3 groups (P ＜0. 05). And the shape of mucosal blood vessels of NERD was different from the control (P＜0. 05), but was not from two others. Features of NERD relative images were thin,straight and spiral blood vessels, bar-like pits, plat mucosa, round, smooth and wide tooth-like Z-line and mucosa of white particle hypertrophy. ConclusionHigh resolution endoscopic features of most NERD patients are cloudy, white and rough mucosal surface, with white particular hypertrophy, spiral vascular dilation, extending to Z-line. These features can be indicators of NERD.
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Objective To investigate pathological chan ges in stomach during long-term Helicobacter pylori (H.pylori) infection in Mongolian gerbil model. Methods Mongolian gerbils were inoculated with H.pylori NCTC 11637. Results Mongolian gerbil model of long-term H.pylori infecti on was successfully established. It was shown that H.pylori could induce the pro cess progressing from normal gastric mucosa to chronic gastritis, glandular atro phy, intestinal metaplasis, and atypical hyperplasia, though no adenocarcinoma w as found in the experimental animals. Conclusions H. pylori NC TC 11637 can colonize easily in the glandular stomach mucosa of Mongolian gerbi ls. The stability of this model is excellent, and th e histological chang es are similar to those of humans with H. pylori infection.
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The purpose of this study was to explore the role of cyclin E and c fos in Helicobacter pylori ( H. pylori ) induced gastric precancerosis. The expression of cyclin E and c fos in mucosa of gastric antrum was determined by RT PCR and immunohistochemistry staining in Mongolian gerbil with H. pylori induced gastric precancerosis. Cyclin E mRNA levels were increased 2 2 fold 25 weeks ( P