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OBJECTIVE To investigate the diagnostic efficacy of serum calcitonin(Ctn)in medullary thyroid cancer(MTC),the correlation between preoperative serum Ctn and clinicopathological features,and the risk factors affecting the progression of MTC disease during follow-up.METHODS The clinical data of 50 patients admitted to the Hospital of Integrated Traditional Chinese and Western Medicine of Nanjing University of Chinese Medicine from 2011 to 2022 were systematically reviewed,the ROC curve calculated the diagnostic efficacy of Ctn and CEA levels on MTC,and the risk factors for lymph node metastasis in the central region of MTC were analyzed in univariate and multivariate,and the survival curve without disease progression was drawn to predict risk factors.RESULTS The ROC curve yields the preoperative cut-off value of Ctn was 23.81 pg/ml and the cut-off value of CEA was 3.035 ng/ml for the diagnosis of MTC.The age of disease,tumor diameter,and preoperative serum Ctn and CEA levels in MTC patients were higher than those in non-MTC patients.Ctn≥289.62 pg/ml was an independent risk factor for central lymph node metastasis in MTC.The survival curve showed that invasion of the capsule,central region metastasis,and TNM stage above T2 were risk factors for predicting disease progression(P<0.05).Patients with MTC who have disease progression have higher preoperative Ctn.CONCLUSION Serum Ctn has important clinical value in the differential diagnosis,preoperative evaluation and postoperative follow-up of MTC.
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Objective:To investigate the alteration in iodine nutritional status and influence on thyroid function in the elderly aged≥65 years following water source modification in high iodine areas.Methods:Data from Yaoji Town, Xuzhou, Jiangsu(an area with high iodine due to water sources) of the national epidemiological survey on thyroid diseases, iodine nutrition, and diabetes(TIDE study) in 31 provinces and cities in China from 2015 to 2017 were utilized. Additionally, data from the screening, monitoring, and intervention on thyroid diseases(TOPS study) in the elderly(≥65 years) in Shunhe Town, Suqian, Jiangsu(an area with iodine levels exceeding the recommended amount), and Yaoji Town, Xuzhou from May to August 2021, are included. Each subject completed a questionnaire, physical examination, laboratory tests and thyroid ultrasound examinations. A total of 2 717 subjects aged≥65 years were included, including group 1, 258 subjects in TIDE study; Group 2, 1 313 subjects in TOPS Xuzhou area; Group 3, 1 146 subjects in TOPS Suqian area.Results:The urinary iodine concentration(UIC) in group 2 was significantly lower than that in group 1 [(235.16±67.09)μg/L vs (491.58±384.93)μg/L, P<0.001], but no significant difference compared with group 3 [(235.16±67.09) μg/L vs(231.62±66.11) μg/L, P>0.05]. The serum TSH level in group 2 was significantly lower than that in group 1 [(2.92±5.14)μIU/mL vs (4.15±9.19)μIU/mL, P<0.001]. Compared with group 2 and 3, the prevalence of subclinical hypothyroidism in the elderly in group 1 was the highest(22.48% vs 10.13% and 8.12%, P<0.001). TSH levels were linearly correlated with age in both excessive iodine and more than adequate iodine nutrition areas. TSH level was gradually increased with age. Conclusion:The alteration in TSH levels among the elderly is notably linked to both aging and iodine status. The prevalence of hypothyroidism in the elderly can be significantly reduced when the iodine nutrition status of the elderly returns to normal.
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Objective:To compare the short-term efficacy and the safety of microwave ablation (MWA) and radiofrequency ablation (RFA) in the treatment of benign thyroid nodules (BTNs).Methods:This prospective randomized controlled trial, performed from December 2019 to September 2021, included 36 patients with solid or predominantly solid BTNs who met the eligibility criteria and provided written informed consent at the Nanjing sub-center (Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine). Patients were assigned to either the MWA group or the RFA group (18 patients in each group) at a ratio of 1∶1 using a block randomization design and allocation concealment using sealed envelope randomization. The independent-sample t-test and χ2 test were used to compare the volume reduction rates (VRRs), effective rates (VRRs≥50%), cosmetic scores, and complication rates at 1, 3, and 6 months after treatment between the two groups. Results:The clinical characteristics of the two groups of patients were comparable. After ablation, the nodule volume was significantly reduced in both groups. At 1, 3, and 6 months, there was no significant difference in the volume between the two groups (all P>0.05). At 3 months, the RFA group had a larger VRRs than that in the MWA group (62.08%±12.46% vs. 46.90%±23.16%, t=-2.45, P=0.021). However, at 1 and 6 months, no statistical significance was observed (both P>0.05). No significant difference was observed in the effective rates at the last follow-up (14/18 vs. 18/18, P=0.104). However, the RFA group had a lower cosmetic score than that in the MWA group (1.78±0.43 vs. 2.17±0.51, t=-2.47, P=0.019). There was no statistically significant difference in the complication rates between the two groups (all P>0.05). Conclusions:Both MWA and RFA were effective and safe treatments for BTNs, with no significant differences in short-term efficacy and safety. In addition, the RFA group showed slightly more favorable outcomes than the MWA group in terms of cosmetic improvement.
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In the management of obesity, aside from lifestyle interventions and surgery, pharmacotherapy is the most important choice. In recent years, research on the mechanisms of obesity and weight-loss drugs has been advancing rapidly. Exploring drugs that increase energy expenditure from the perspective of energy balance is beneficial for making clinical decisions based on the mechanisms of drugs and clinical needs in order to treat obesity effectively and improve the quality of life.
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Objective:To compare the efficacy and safety of glucocorticoids (GCs), rituximab (RTX), and GCs combined with RTX in the treatment of active moderate-to-severe Graves′ ophthalmopathy (GO).Methods:A total of 42 patients with GO who were hospitalized in the Endocrinology Department of Jiangsu Integrated Traditional Chinese and Western Medicine Hospital from August 2017 to July 2019 were included and divided into GCs group (18 cases), RTX group (7 cases), GCs combined with RTX group (17 cases). Patients in the GCs group were received 500 mg intravenous methylprednisolone once a week for 6 weeks, followed by 250 mg intravenous methylprednisolone once a week for 6 weeks. In RTX group, patients were given intravenous RTX 100 mg every 2 weeks for 2 times. GCs combined with RTX group, i. e. RTX combined with methylprednisolone pulse therapy. At 12 and 24 weeks after treatment, CAS and NOSPECS classes were evaluated in each group. The altered course of thyroid stimulating receptor antibody were compared among the three groups. All adverse events were recorded.Results:The proportion of CAS decreased≥2 or total scores<3 points in the GCs, RTX and combined groups were 88.9%, 85.7% and 100%, with no statistical difference among the three groups ( P=0.321). At 24 weeks, CAS and NOSPECS classes decreased significantly in all three groups compared with those before treatment ( P<0.05). The reduction of CAS in the combined group was greater than in the GCs group (-3.12±1.02 vs -2.39±1.02, P=0.036) and RTX group (-3.12±1.02 vs -2.14±0.90, P=0.034). One patient in the combined group developed optic neuropathy at 24 weeks after treatment, all other patients had no severe adverse events. Conclusion:Low-dose RTX alone is not inferior to intravenous GCs in the treatment of active moderate to severe GO. GCs combined with RTX is more effective in improving patients′ CAS than either drugs alone.
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Objective:To evaluate the effect of short-term very low-calorie restriction(VLCR) on glycemic control in overweight/obese patients with type 2 diabetes, and to explore mechanisms through identifying markers of gut microbiota.Methods:This trial was conducted in 14 adult overweight/obese patients with type 2 diabetes. They received VLCR for 9 days in the hospital(calorie intake 300-600 kcal/d). Before and after VLCR, body weight(BW), waist circumference(WC), blood pressure(BP), and heart rate(HR) were measured, and body mass index(BMI) was calculated according to their height and weight. Fasting blood glucose(FBG), 2 h postprandial blood glucose(2hPBG), fasting insulin(FINS), triglycerides(TG), total cholesterol(TC), high-density lipoprotein-cholesterol(HDL-C), and low-density lipoprotein-cholesterol(LDL-C) were determined, and yielded the homeostasis model assessment for insulin resistance(HOMA-IR). Additional lab tests such as liver and kidney function and electrolytes were performed. The estimated glomerular filtration rate(eGFR) was calculated to evaluate renal function. All data were analyzed using the SPSS Sample Power software. Feces samples were collected before and after VLCR. Fecal samples were tested for microbial diversity using 16S rDNA technology. Professional software was used to analyze the differences of gut microbiota in feces before and after VLCR.Results:After 9 days of VLCR, BW, BMI, WC, BP, HR, FBG, 2hPBG, FINS, HOMA-IR, alkaline phosphatase, TG, and blood urea nitrogen of 14 overweight/obese patients with type 2 diabetes were significantly reduced( P<0.05). No effect was seen on serum alanine aminotransferase, aspartate amino transferase, gamma glutamyl transferase, TC, HDL-C, LDL-C, creatinine, eGFR, uric acid, albumin, calcium, and phosphorus( P>0.05). The gut microbiota diversity did not differ before and after VLCR. The abundance of Bacteroidetes increased significantly, and the Firmicutes/Bacteroidetes ratio decreased from 11.79 to 4.20. Between groups analysis showed the abundance of Parabacteroides distasonis increased significantly after VLCR. Conclusion:VLCR can improve body weight and glucose and lipid metabolism in overweight/obese patients with type 2 diabetes, with no serious adverse events. Parabacteroides distasonis may be a marker of VLCR.
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Objective:To establish and evaluate a predictive model for recurrence risk of Graves′ disease after antithyroid drugs(ATD) withdrawal.Methods:Among 308 patients with newly onset Graves′ disease taking ATD from 2012 to 2019, 170 patients who completed follow-up were enrolled and divided into relapse and remission groups according to whether hyperthyroidism reoccurred within 2 years after ATD withdrawal to establish the discovery cohort. An internal validation cohort was constructed by repeating the sampling with bootstrap. Cox regression analysis was used to screen risk factors and establish a predictive model, named Graves′ Recurrence Evaluation System(GRES). The differentiation and accuracy of GRES model were evaluated and compared with the GREAT score.Results:Of 170 patients, 90 Graves′ disease cases relapsed within 2 years after ATD withdrawal. According to Cox regression analysis, family history of Graves′ disease, younger age(<30 years), grade Ⅱ-Ⅲ goiter, high level of TRAb(≥13 IU/L), large thyroid volume(≥26.4 cm 3) and low 25(OH) D(<14.7 ng/mL) were included in the predictive model: PI=0.672×family history+ 0.405×age+ 0.491×severity of goiter+ 0.808×TRAb+ 1.423×thyroid volume+ 0.579×25(OH) D. PI≥1.449 was associated with a higher risk of recurrence after drug withdrawal. The GRES model has good prediction in assessing Graves′ disease relapse within 2 years after ATD withdrawal and better than GREAT score. Conclusion:GRES model can be used to evaluate the recurrence risk within 2 years for patients with newly onset Graves′ disease after ATD withdrawal, and facilitate clinicians to reasonably select treatment modalities in order to improve the remission rate.
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Objective:To identify a novel bombesin bioactive peptide from the skin secretion of Hylarana Latouchii, and to explore its effect on insulin secretion in islet cells.Methods:The skin secretion from Hylarana Latouchii was extracted by electrical stimulation, and the single chain of bombesin peptide was cloned and sequenced. The peptide QUB2995 was synthesized via solid-phase synthesis, then purified using reversed-phase high performance liquid chromatography (HPLC). Matrix assisted laser desorption time-of-flight mass spectrometry (MALDI-TOF) was applied to validate. QPCR and ELISA were used to probe the effect of QUB2995 on insulin secretion in MIN6 and INS-1 cells.Results:A novel bombesin peptide named QUB2995 (GAFGDFLKGAAKA GALKILSIAQCKLSGTC) was found in the skin secretion of Hylarana Latouchii through molecular cloning. The bioactive peptide could significantly promote the proliferation and insulin secretion from mouse islet MIN6 cells and rat islet INS-1 cells. The effect reached a climax at the concentration of 10 -5 mol/L. Conclusion:A novel bombesin bioactive peptide named QUB2995 was found from Hylarana Latouchii. It could significantly promote insulin secretion in MIN6 cells of mouse islets and INS-1 cells of rat islets, indicating its potential in the treatment of diabetes.
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Objective:To investigate the correlation between serum insulin-like growth factor 1 (IGF-1), thyroid stimulating hormone (TSH), degree of insulin resistance and thyroid nodule imaging reporting and data system (TI-RADS) grading in patients with type 2 diabetes mellitus (T2DM).Methods:The clinical data of 120 patients with T2DM from February 2020 to November 2021 in Kunshan Hospital of Integrated Traditional Chinese and Western Medicine were retrospectively analyzed. Among them, 56 patients had no thyroid nodules (non-thyroid nodule group), all patients were TI-RADS grade 1; 64 patients had thyroid nodules (thyroid nodule group), including 7 cases of TI-RADS grade 2, 12 cases of TI-RADS grade 3, 20 cases of TI-RADS grade 4, and 25 cases of TI-RADS grade 5. The levels of IGF-1 and TSH were measured by automated biochemical analyzer, the homeostatic model assessment insulin resistance index (HOMA-IR) was calculated. Spearman method was used for correlation analysis; multivariate Logistic regression was used to analyze the independent risk factors of TI-RADS grading in patients with T2DM combined with thyroid nodules; the receiver operating characteristic (ROC) curve was drawn to analyze the efficacy of IGF-1, TSH and HOMA-IR in predicting TI-RADS grading in patients with T2DM combined with thyroid nodules.Results:The IGF-1, TSH and HOMA-IR in thyroid nodule group were significantly higher than those in non-thyroid nodule group: (185.35 ± 45.08) ng/L vs. (168.36 ± 30.25) ng/L, (2.98 ± 0.85) mU/L vs. (2.69 ± 0.35) mU/L and 3.25 ± 0.75 vs. 2.95 ± 0.44, and there were statistical differences ( P<0.05 or <0.01). In patients with T2DM combined with thyroid nodules, with the increase of TI-RADS classification, the IGF-1, TSH and HOMA-IR gradually increased, and there were statistical differences ( P<0.05). Spearman correlation analysis result showed that the levels of IGF-1, TSH and HOMA-IR were positive correlation with TI-RADS grading ( r = 0.918, 0.906 and 0.920; P<0.05). Multivariate Logistic regression analysis result showed that the IGF-1, TSH and HOMA-IR were independent risk factors for TI-RADS grading in patients with T2DM combined with thyroid nodule ( OR = 1.684, 1.044 and 1.851; 95% CI 0.674 to 6.665, 0.032 to 0.055 and 1.212 to 2.298; P<0.01 or <0.05). ROC curve analysis result show that the area under the curve of IGF-1, TSH and HOMA-IR for predicting the TI-RADS grading patients with T2DM combined with thyroid nodule were 0.946, 0.983 and 0.975, with all sensitivity of 100.00%, and specificity of 82.14%, 91.07% and 89.29%. Conclusions:There is a correlation between IGF-1, TSH, HOMA-IR and TI-RADS grading in patients with T2DM combined with thyroid nodule, which has some guiding value for clinical monitoring of thyroid nodule changes.
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Thyroid hormone therapy is the mainstay of differentiated thyroid cancer (DTC) management after surgery. By controlling thyrotropin within target levels, it hopes that patients could restore euthyroidism state and lower recurrence rates. However, thyroid hormone treatment has been facing challenges in termso of lenefit-risk assessment since the improved risk stratification system of persistent/recurrent disease was into use. Clinicians should weigh the potential benefits against downsides based on initial risk of disease and ongoing risk assessment of disease status. The optimal TSH level for patients with an intermediate- or high-risk for recurrence is to maintain the beneficial effects on tumor recurrence without increasing the risk of adverse events. Levothyroxine should be titrated to avoid excessive TSH suppression for low-risk patients. Only with holistic benefit-risk analysis of thyroid hormone therapy, can we further promote the quality of postoperative DTC management.
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In 2020, the French Endocrine Society released a consensus statement on the management of thyroid dysfunction in the elderly. This consensus introduced the physiological evolution of thyroid aging, determined specific reference range of thyroid stimulating hormone in the elderly and provided a standard guidance for diagnosis and treatment of thyroid dysfunction. However, some of these recommendations are still controversial, especially the reference range of thyroid stimulating hormone and interventions for subclinical hypothyroidism in the elderly. Thus, further studies for the elderly in China are reguired in order to promote the standardized management of thyroid dysfunction.
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Objective:To investigate the risk factors for recurrence of Graves′ disease after withdrawal of antithyroid drugs (ATD).Methods:This prospective study recruited 285 patients with newly onset Graves′ disease taking ATD from 2012 to 2018 at Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine. A total of 121 patients who completed follow-up were enrolled and were divided into relapse and remission group according to whether hyperthyroidism reoccurred within 2 years after ATD with drawal. Demographics, clinical manifestations, thyroid serological characteristics, and thyroid color doppler ultrasound at baseline and withdrawal were compared between the two groups. Cox regression analysis was used to analyze the correlation between above factors and recurrence of Graves′ disease.Results:Sixty-five patients relapsed within 2 years after drug withdrawal. Patients with early recurrence were characterized by Graves′ disease genetic history and high baseline thyrotrophin receptor antibody (TRAb) levels. Family history, higher serum FT 3(≥18.1 pmol/L), FT 4(≥49.8 pmol/L), and TRAb(≥16.1 mIU/mL) levels, larger goiter(Ⅱ-Ⅲ) and thyroid volume(≥28.6 cm 3), higher peak velocity of superior thyroid artery (STA-PV; ≥0.6 m/s) before treatment, and higher TRAb(≥0.8 mIU/mL) level after ATD withdraw were risk factors for Graves′ disease recurrence. Higher 25-hydroxy vitamin D(≥14.7 ng/mL) level at baseline, as well as high level of TSH(1.4 μIU/mL) at withdrawal may reduce the risk of relapse. Conclusions:Family history of Graves′ disease, clinical manifestations, thyroid serological indicators and imaging characteristics of severe Graves′ disease before treatment all increased the risk of Graves′ disease recurrence. Patients with aforementioned factors should be actively evaluated in order to choose treatment modalities reasonably. We recommended to maintain lower TRAb titer within normal reference range and TSH level between 1.4 μIU/mL and upper limits of normal reference range at ATD withdrawal to reduce the recurrence rate of Graves′ disease.
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To investigate the effectiveness and safety of ultrasound-guided microwave ablation (MWA) in treatment of primary hyperparathyroidism (PHPT). A total of 12 PHPT patients with parathyroid adenoma were treated with MWA in Nanjing University of Chinese Medicine Affiliated Hospital of Integrated Traditional Chinese and Western Medicine from May 2019 to February 2021. The patients were followed up once every 3 months for 3-12 months. Levels of serum parathyroid hormone (PTH), calcium and phosphorus were detected before and 20 min, 4h and 1day after ablation, and during follow-up period. The volume and volume reduction rate of parathyroid lesion were compared before the treatment and at the end of follow-up. The technical and clinical success of MWA were assessed as well. At the end of follow-up, median serum PTH [66.60 (42.21,80.03) ng/L vs.169.90 (89.01,396.50) ng/L] and calcium [2.39 (2.32,2.49) mmol/L vs. 2.75 (2.57,2.96) mmol/L] levels in 12 patients decreased significantly (all P<0.05). A complete response in terms of PTH and calcium levels was achieved in 6 of the 12 patients, while 4 of the patients had slightly elevated PTH levels just above the upper limit of normal reference range, and 2 of the patients remained abnormal PTH and calcium levels. The clinical cure rate was 50%. The volumes of all lesion after ablation were significantly decreased ( P<0.05), with the technical success rate reaching 92.3%. No serious complications were observed. Ultrasound-guided MWA, thus, is safe and effective in the treatment of PHPT.
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Objective:To investigate the clinical features of Hashimoto′s thyroiditis(HT) with elevated serum IgG4 levels and to guide the clinical practice.Methods:Serum IgG4 concentrations were detected in patients with HT by nephelometric immunoassay. These patients were classified into two groups according to the IgG4 levels: positive group(IgG4≥1.35 g/L), and negative group(IgG4<1.35 g/L). The clinical characteristics of these two groups, including age, gender, medical history, serological features, and ultrasound were compared.Results:Nine out of 111 patients with HT were positive with IgG4(8.11%), all of them were women. There was no significant difference in gender, age, BMI, dose of levothyroxine administration, FT 3, FT 4, and TSH levels between the two groups. The volume of thyroid in positive group was larger than that in negative group [57.81(38.36, 74.93) ml vs 25.07(18.48, 42.14) ml, P=0.015], and the level of thyroglobulin antibodies(TgAb; P=0.011) and thyroid peroxidase antibodies(TPOAb; P=0.025) in positive group were also significantly higher than those in negative group. Moreover, the positive group had a slightly higher risk of PTC than that of negative group(11.1% vs 2.94%, P=0.290), though the difference was not significant. Correlation analysis showed that IgG4 was positively associated with TgAb, TPOAb, and thyroid volume. Conclusions:The levels of TgAb and TPOAb are higher, the volume of thyroid gland is greater, and the risk of PTC with lymph node metastasis is more frequent in HT patients with elevated serum IgG4. For HT patient with elevated serum IgG4, their thyroid function and morphology should be more closely monitored.
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Graves′ orbitopathy is one of the complications related to Graves′ disease. Currently, there is still no available medical therapy provides reliable and safe benefit. Basic and clinical researches on insulin-like growth factor-Ⅰ(IGF-Ⅰ)receptor have found that IGF-Ⅰ receptor has implicated in the pathogenesis of Graves′ orbitopathy. As an IGF-Ⅰ receptor monoclonal antibody, teprotumumab was recently approved for this indication in the United States. It suggested that the therapy targeting on IGF-Ⅰ receptor pathway will soon take its place in the therapeutic armamentarium for active Graves′ orbitopathy.
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In this paper, thyroid peroxidase (TPO) gene mutation was studied in a congenital hypothyroidism (CH) family with 2 patients, to explore the mechanism of c. 2268dupT homozygous mutation leading to thyroid nodules, as well as the relationship between TPO gene mutation and thyroid cancer. The result suggested that TPO gene mutation is one of the reasons for congenital hypothyroidism, TPO gene c. 2268 dupT mutations can lead to thyroid nodules, which may be related to long-term high TSH stimulation and truncated protein accumulation. TPO gene mutations have a certain correlation with thyroid cancer, the risk may increase with the increase of age, but the mechanism is not clear at present. In the future, further research on the correlation and mechanism between the two factors is needed, as well as to determine whether it is necessary to remove the thyroid gland to prevent the accarance of cancer in CH patients with TPO gene mutation with thyroid nodules.
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Objective@#To investigate the clinical features of Hashimoto′s thyroiditis(HT) with elevated serum IgG4 levels and to guide the clinical practice.@*Methods@#Serum IgG4 concentrations were detected in patients with HT by nephelometric immunoassay. These patients were classified into two groups according to the IgG4 levels: positive group(IgG4≥1.35 g/L), and negative group(IgG4<1.35 g/L). The clinical characteristics of these two groups, including age, gender, medical history, serological features, and ultrasound were compared.@*Results@#Nine out of 111 patients with HT were positive with IgG4(8.11%), all of them were women. There was no significant difference in gender, age, BMI, dose of levothyroxine administration, FT3, FT4, and TSH levels between the two groups. The volume of thyroid in positive group was larger than that in negative group [57.81(38.36, 74.93) ml vs 25.07(18.48, 42.14) ml, P=0.015], and the level of thyroglobulin antibodies(TgAb; P=0.011) and thyroid peroxidase antibodies(TPOAb; P=0.025) in positive group were also significantly higher than those in negative group. Moreover, the positive group had a slightly higher risk of PTC than that of negative group(11.1% vs 2.94%, P=0.290), though the difference was not significant. Correlation analysis showed that IgG4 was positively associated with TgAb, TPOAb, and thyroid volume.@*Conclusions@#The levels of TgAb and TPOAb are higher, the volume of thyroid gland is greater, and the risk of PTC with lymph node metastasis is more frequent in HT patients with elevated serum IgG4. For HT patient with elevated serum IgG4, their thyroid function and morphology should be more closely monitored.
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Thyroid nodules are very common in the clinical practice. Fine needle aspiration ( FNA) is a major method for the final diagnosis of thyroid nodules. This review tried to cover the definition, current status, clinical significance, indications, contraindications, ultrasound evaluation, as well as preparations, steps, molecular diagnosis, cytology diagnosis, and possible pitfalls of this technique. Our purpose is trying to make this procedure universalized and standardized in order to serve more patients by providing clinicians with some helpful references and advice.
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Objective@#To study the sensitivity of multi-slice spiral CT in the diagnosis of lymph node metastasis in different lymph node stations of gastric cancer.@*Methods@#A retrospective series of case study was employed in the research. Inclusion criteria: (1) patients undergoing preoperative abdominal CT scan plus enhanced examination, and data in the image archiving and communication system of Sun Yat-sen University Cancer Center; (2) patients undergoing total or subtotal gastrectomy plus D2 or D1+ lymphadenectomy, with more than 15 harvested lymph nodes and more than 1 metastatic lymph node confirmed by postoperative pathology; (3) WHO pathological classification defined as gastric adenocarcinoma; (4) no history of lymph node tuberculosis, giant lymph node hyperplasia, lymphoma or other diseases resulting in enlarged lymph nodes; (5) no history of gastrectomy; (6) no preoperative neoadjuvant therapy. Clinicopathologic data of gastric cancer patients at the Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center from January 2009 to December 2012 were retrospectively analyzed. Using the pathologically positive lymph nodes as a reference, the sensitivity of CT-positive lymph nodes was calculated (total number of positive image lymph nodes/total number of positive pathological lymph nodes) and complete coincidence rate (number of case defined as complete coincidence/number of case with positive pathologic lymph nodes; complete coincidence indicated that the number of positive image lymph nodes was consistent with the number of positive pathologic lymph nodes in each lymph node station). The χ2 test was used to compare the sensitivity of CT in the diagnosis of lymph node metastasis in each lymph node station.@*Results@#A total of 228 patients with pathology-proven gastric cancer were enrolled in the study, including 147 male and 81 female. The overall sensitivity of CT in diagnosis of metastatic lymph nodes in gastric cancer was 68.7% (1769/2576). The sensitivity of CT in diagnosis of lymph node metastasis of groups 1 to 8 from high to low was group 3 [81.1% (506/624)], group 7 [73.9% (246/333)], group 2 [70.3% (111/158)], group 6 [68.7% (248/361)], group 4 [68.1% (262/385)], group 8 [60.4% (116/192)], group 1 [53.8% (155/288)], group 5 [47.1% (82/174)]. The CT diagnostic sensitivity of group 3 was significantly higher than the overall level (χ2=37.689, P<0.001). The CT diagnostic sensitivity of group 5 was significantly lower than the overall level (χ2=34.387, P<0.001). The CT diagnostic sensitivity of group 1 was also significantly lower than the overall level (χ2=25.918, P<0.001). Significant differences were not found in the CT diagnostic sensitivity of group 2, 4, 6, 7, 8 compared with the overall level (all P>0.05). The complete coincidence rate was 56.9% (536/942) between pathological positive lymph nodes and CT positive lymph nodes. The highest complete coincidence rate was observed in group 3 (68.0%, 123/181) and the lowest was in group 1 (41.4%, 46/111), whose difference was statistically significant (χ2=9.673, P=0.002).@*Conclusion@#The sensitivity of CT in diagnosis of lymph nodes in different lymph node stations of gastric cancer is different.
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Objective@#To investigate the occupation stress and job burnout of orphan child care workers in Nanjing and nursing staff in Yangzhong primary hospital, to compare the differences of occupational stress and job burnout between the two social service workers.@*Methods@#From February to May 2017, a cross- sectional survey was conducted. Cluster sampling method was used to investigate the occupation stress and job burnout of orphan child care workers in Nanjing and nursing staff in Yangzhong primary hospital, totally 403 people, by a combination of the Internet of things assessment system of occupational stress and traditional questionnaire.@*Results@#There were statistically significant differences of occupational stress and job burnout scores of both social service workers (P<0.05). Orphan child care workers in job control, technology utilization, job routinization, work risk, role ambiguity and participation decision-making, anxiety state, body complain, life attitude, behavior characteristics, ambition, anxiety trait, social support, logic, family-work relationship and depersonalization were higher than those of Yangzhong primary nurses (P<0.05); Primary nurses in Yangzhong in quantitative load and change, workload, role conflict, job prospects, promotion, depressive symptom, daily stress, self-esteem, task strategy, time management, work input, and personal accomplishment reduction scored higher than those of Orphan child care workers (P<0.05). The logistic regression analysis of the occupational depletion positive rate of the two social service personnel showed that the protective factors of the nursing staff of the orphans and disabled children had behavioral characteristics and family support(OR=0.877, P=0.044; OR=0.691, P=0.001) . The contributing factors of the primary nursing staff in Yangzhong were task control, workload, work psychological control source (OR=1.110, P=0.019; OR=1.128, P<0.001;OR=1.066, P=0.032) . The protection factors were technical utilization, opportunities for improvement, and mental health (OR=0.775, P=0.005; OR=0.765, P=0.006; OR=0.914, P=0.002) .@*Conclusion@#The work content, the service object and the nature of the unit of primary caregivers influence the state of occupational stress and job burnout. The influencing factors of occupational stress and job burnout are not identical, Different social service personnel show occupational stress and occupational exhaustion in different aspects, and it is necessary to propose mitigation measures for two kinds of social service personnel.