OBJECTIVE:This research investigates the prevalence of thyroid nodules and their association with anxiety and depression disorders in Eastern China. It also investigates the potential factors influencing this relationship, focusing on demographics and thyroid function. METHODS:As part of the SPECT-China project, a cross-sectional survey was conducted with 5497 participants from both urban and rural regions in Shanghai, Zhejiang, and Jiangxi provinces. Participants received thyroid ultrasonography and laboratory tests for thyroid function, while their mental health was evaluated using the Zung Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS). Data analysis employed descriptive statistics, Student's T-test, Chi-square test, and logistic regression. RESULTS:The study found a high prevalence of TNs (57.5%) among participants, with a higher incidence in females, older individuals, and those with lower education levels. Anxiety and depression disorders were diagnosed in 4.8% and 5.2% of participants, respectively, with higher rates in females and older individuals. Logistic regression analysis, controlling for age and gender, showed no significant link between TNs and anxiety or depression disorders in the general population. However, a significant association was observed in females. No significant correlation was identified between thyroid function (as measured by TSH levels) and the presence of TNs or mental disorders. CONCLUSION:Thyroid nodules are prevalent in Eastern China, particularly among females, older individuals, and those with lower education. TNs show a significant correlation with anxiety and depression disorders in females, although not in the general population. This study emphasizes the significance of examining gender differences in the link between thyroid nodules and mental health, and calls for additional research in this domain.

Variations in the POU Class 3 Homeobox 4 ( POU3F4 ) gene are associated with X-linked mixed deafness. Here, the identification of a novel variant of POU3F4 in a male paediatric patient (the proband) with incomplete partition type III (IP-III) hearing impairment, is described. Clinical data were collected from the proband and his biological parents. Whole exome sequencing of the proband revealed a novel frameshift insertion mutation in POU3F4 (c.717_718ins GTGCCTTGCAG : p.Leu240Valfs*5) in a hemizygous state. This variant likely truncates the protein within the POU-specific domain, and the proband’s biological mother was found to be a carrier of this variant. After excluding all contraindications, the proband underwent cochlear implantation in the right ear in June 2020. Cerebrospinal fluid (CSF) gushing was observed during surgery, but there were no postoperative complications, such as CSF leak, meningitis, or facial nerve stimulation. A novel pathogenic frameshift variant of POU3F4 was identified, enriching the known mutation spectrum of POU3F4 . Effective perioperative prevention and response measures should be taken to reduce the incidence of CSF gushing and meningitis in patients receiving IP-III cochlear implantation. Keywords Incomplete partition type III , POU3F4 , Novel variant , Cochlear implantation , X-linked deafness , Frameshift

Variations in the POU Class 3 Homeobox 4 (POU3F4) gene are associated with X-linked mixed deafness. Here, the identification of a novel variant of POU3F4 in a male paediatric patient (the proband) with incomplete partition type III (IP-III) hearing impairment, is described. Clinical data were collected from the proband and his biological parents. Whole exome sequencing of the proband revealed a novel frameshift insertion mutation in POU3F4 (c.717_718ins GTGCCTTGCAG: p.Leu240Valfs*5) in a hemizygous state. This variant likely truncates the protein within the POU-specific domain, and the proband's biological mother was found to be a carrier of this variant. After excluding all contraindications, the proband underwent cochlear implantation in the right ear in June 2020. Cerebrospinal fluid (CSF) gushing was observed during surgery, but there were no postoperative complications, such as CSF leak, meningitis, or facial nerve stimulation. A novel pathogenic frameshift variant of POU3F4 was identified, enriching the known mutation spectrum of POU3F4. Effective perioperative prevention and response measures should be taken to reduce the incidence of CSF gushing and meningitis in patients receiving IP-III cochlear implantation.

Noonan syndrome is a multisystem disease with widespread heterogeneity regarding the genetic and clinical characteristics, which can be accompanied by distinctive facial dysmorphism, congenital heart defects, short stature, cryptorchidism, lymphatic malformations, bleeding disorders and skeletal malformations. Some patients have hearing impairment. Noonan syndrome is a rare cause of sensorineural hearing loss. The study describes a Noonan syndrome patient with profound bilateral hearing loss. He received a cochlear implantation successfully. The patient had clinical characteristics of Noonan syndrome, and the diagnosis was confirmed by the detection of pathogenic variants in PTPN11 by whole exome sequencing. According to the authors' knowledge, this is the first report regarding cochlear implantation in a Noonan syndrome patient in China.

耳聋可由遗传因素或环境因素导致,至少一半的耳聋可归因于遗传因素,其中同时具备其他特殊临床特征的称为综合征性耳聋(syndromic hearing loss, SHL),不具备其他临床特征的称为非综合征性耳聋(nonsyndromic hearing loss, NSHL)[1, 2].前庭水管扩大(enlarged vestibular aqueduct, EVA)是导致NSHL的常见内耳畸形,典型特征为进展性感音神经性听力下降[3],诊断主要依靠颞骨CT及MRI影像学检查[4].

多烯磷脂酰胆碱(PPC)其主要活性成分为多聚磷脂酰胆碱二酰甘油或多聚乙酰卵磷脂,化学结构与内源性卵磷脂相同,是临床常用保肝药物.目前上市的化学性、生物性药物中有1 100多种具有潜在肝毒性[1],使得药物性肝损伤发病率有所增长.本研究旨在分析多烯磷脂酰胆碱对急性肝损伤患者的治疗效果,并观察患者治疗前后血清中 NO、NOS表达的变化.现报道如下.

Objective: To study the guiding value of the improved HEART score in treating patients with acute chest pain. Methods:197 cases of patients with acute chest pain in our hospital emergency department were selected and divided into the cardiac chest pain group (n=132) and the non cardiac chest pain group (n=65) according to the cause of disease, all the patients were given improved HEART scoring and conventional HEART scoring, risk stratification according to the HEART score the destination was compared between the two groups of patients, the receiver-operating characteristic (ROC) curve was build to evaluate the value of improved HEART scoring for the risk stratification and prognosis. Results: The improved HEART score and HEART score of cardiac chest pain group were higher than those of the non cardiac chest pain group (P＜0.05). 100％ patients with low risk of improved HEART score was not hospitalized, and 62.71％ of the patients were hospitalized, the proportion of high-risk hospitalization and ICU were 73.17％ and 36.59％. The proportion of hospitalized patients admitted to the ICU were 57.38％ and 6.56％, and the proportion of high-risk hospitalization and ICU were 68.57％ and 31.43％ (P＜0.05). The AUC value of improved HEART score for risk stratification of patients with cardiac chest pain was 0.916 and the sensitivity was 0.883, which was significantly higher than of the HEART score (0.831 and 0.765). Conclusion: The improved HEART score can improve the accuracy of risk stratification for he emergency chest pain patients, and it is of high value in guiding patients' prognosis and treatment.

目的 检测急性药物性肝损伤小鼠在诱导发病后不同时间点血清中Betacellulin表达的变化以及此变化是否可作为肝损伤的预后指标.方法 利用对乙酰氨基酚(APAP)灌胃野生型昆明鼠诱导急性肝损伤模型,利用酶联免疫吸附法(ELISA)和实时定量PCR(qPCR)法分别检测不同发病时间点小鼠血清和肝细胞中Betacellulin的水平.结果 急性药物性肝损伤小鼠随着发病时间变长,血清内Betacellulin水平逐渐升高.结论 发病一定时间后的急性药物性肝损伤小鼠血清Betacellulin明显升高(与诱导发病前相比),与Betacellulin在肝细胞表达变化相一致,提示其可作为急性药物性肝损伤预后的一个标志物.

Objective To investigate the effect of Captopril on plasmic homocysteine(Hcy)and renal function in rats with diabetic nephropathy(DN)and its mechanism. Methods The diabetes mellitus models were established in 30 Sprague Dawley(SD)rats with Streptozotocin(STZ),and were randomly divided into control group,DN group and Captopril group(n = 10 for each group). Captopril group was lavaged with 17. 5 mg /( kg·d)Captopril(1 / d),while the control and DN groups were lavaged with same volume of physiological saline(1 / d). In all groups,contents of plas-ma Hcy and angiotensin Ⅱ(AngⅡ)in nephridial tissue,levels of urea and creatinine,urinary albumin excretion rate (UAER)and kidney weight / body weight were detected,relative expression levels of mRNA in protein kinase C(PKC) and isoforms PKCα in nephridial tissue were detected using real-time polymerase chain reaction(PCR)after 12 weeks of treatment. Results Compared with those in control group,the values of Hcy and AngⅡ contents,levels of urea and creatinine,UAER,kidney weight / body weight,relative expressions of mRNA in PKC and PKCα were significantly in-creased in DN group(P ﹤ 0. 05). Compared with those in DN group,the above values were significantly decreased in Captopril group(P ﹤ 0. 05). Conclusion Captopril may decrease level of Hcy expression and protect renal function of diabetic nephropathy rats,and its mechanism may exert its effect by inhibiting PKCα signal activation.

•Pancreatic neuroendocrine tumors (PNETs) are uncommon neoplasms that could cause a specific type of diabetes.•We describe a diabetes patient combined with tumor in pancreatic head.•After biochemical and immunohistochemistry test, pancreatic somatostatin tumor is diagnosed.

目的：分析不同危重评分对急性肾功能衰竭（Acute renal failure，ARF）预后判断价值，为A R F患者预后判断提供参考依据。方法：选取我院2013年5月—2015年5月收治的129例A R F患者，均于其确诊后24 h内行急性生理学和慢性健康状况评分（APACHE II）、简化急性生理评分（SAPS II）及序贯器官衰竭估计评分（SOFA），并按照其预后情况分为存活组与病死组，比较2组患者各项评分差异，并以受试者工作特征曲线（ROC）分析不同危重评分判断患者预后价值。观察APACHE II评分与病死率、死亡风险的关系。结果：129例患者病死86例，病死率66.7%。存活组APACHE II、SAPS II评分显著低于病死组，差异有统计学意义（P＜0.05），2组患者SOFA评分比较，差异无统计学意义（P＞0.05）。APACHE II评分的ROC曲线下面积显著高于SAPS II评分、SOFA评分，差异有统计学意义（P＜0.05），SAPS II评分与SOFA评分的ROC曲线下面积比较，差异无统计学意义（P＞0.05）。随着患者APACHE II评分的增加，其病死率、R值均呈上升趋势。结论：APACHE II对ARF患者预后的判断价值最高，建议作为临床预测患者预后的首选评分手段。

OBJECTIVE:To explore the best administration for the differentiated thyroid cancer in children under 14 years by reviewing of their clinical characteristics, treatment methods and results.METHODS:Clinical data of 29 patients under 14 years with differentiated thyroid cancer in Xinhua Hospital, Shanghai Jiao Tong University School of Medicine between January 1998 and July 2014 were reviewed respectively.RESULTS:Neck mass was the chief complaint in 27 of 29 patients. Unilateral thyroid carcinoma was found in 16 cases, and bilateral in 13 cases. Solid tumor with multiple punctate calcification was observed in 21 cases (72.4%). Cervical lymph nodes enlargement was found in 24 cases (82.8%), and 15 cases (62.5%) were bilateral. Among 20 patients received primary thyroid surgery in our hospital, 18 cases presented with T2 or advanced diseases and 16 cases had cervical lymph nodes enlargement. The resection of unilateral lobe with isthmus was performed in 2 cases, and total thyroidectomy in 18 patients, including 1 case with partial trachea resection. Neck dissection was performed in 16 patients. Of 9 patients received primary thyroid surgery in other hospitals, 8 cases presented with cervical lymph node enlargement after surgery and 6 cases with pulmonary metastasis, of them 5 patients received neck dissection, 4 patients underwent resection of residual thyroid cancer plus neck dissection. Twenty-seven of all patients were treated postoperatively with 131I. All patients received follow-up, and the meaning follow-up time was 6 years and 10 months (0.5 years-16 years). No cases with death, local recurrence, and metastasis were observed in the follow-up period.CONCLUSIONS:Differentiated thyroid cancer is more invasive in children compared with adults. Comprehensive treatment including total thyroidectomy, neck dissection and postoperative 131I therapy may be a basic approach for the differentiated thyroid cancer in children.

OBJECTIVETo investigate the clinical features, minimally invasive treatment, and outcomes of subglottic hemangioma in infants.METHODSFifteen cases of infantile subglottic hemangioma treated from January 2009 to December 2012 were retrospective analysed. Average time of onset was within 43 days-5 months of age. Seven cases had symptoms of laryngeal obstruction one week after birth, and 8 cases had symptoms within three weeks to six weeks after birth. Fourteen cases were unilateral and 1 case bilateral. No case had tracheotomy. Seven cases were hospitalised after intubation. Of which 5 cases with subglottic hemangiomas who failed to respond to pharmacologic treatment were treated by microdebrider under suspension laryngoscope. Ten cases accepted suction cutter suction.RESULTSAfter surgery, nine cases were confirmed pathologically as capillary hemangioma. Average bleeding was 1-3 ml during operation, surgery usually lasted 10-15 minutes. No complications were found. Five cases required orotracheal intubation for 24 or 48 h after surgery, and no reintubation or tracheotomy was required in this series. Symptoms such as stridor and inspiratory retraction resolved approximately 12-72 h after surgery. Follow-up was 12-18 months after surgery, no systemic or local complications were observed, and no recurrence.CONCLUSIONSThe treatment of subglottic hemangioma is individualised. If the tracheal stenoses ≥ 50%, with recurrent infection and acute laryngeal obstruction, removal of tumor with microdebrider is the minimally invasive, safe, simple and effective method with less complications. It is important that the anaesthetist should work well with otolaryngologist during operation.

OBJECTIVE:To explore the injury of vascular endothelium in male castrated rats. METHODS:A total of 30 eight-week-old adult male SD rats were randomly divided into 3 groups:control (n = 8); castration (n = 11) (low androgen) and replacement (n = 11) (androgen dosing after castration). After 10 weeks of treatment or castration, the rats were sacrificed to obtain aortic specimens. Arterial morphological changes were observed by hematoxylin and eosin staining and electron microscope. Endothelial cell chromatin degradation was detected by the assay of terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL). The mRNA level of bcl-2 was analyzed by reverse transcription-polymerase chain reaction (RT-PCR). RESULTS:Compared with the control group, the arterial structure was disorderly and had shedding of endothelium in the castration group. More apoptotic endothelial cells were found in the castration group (61% ± 20%) than the other two groups (P < 0.05). Compared with the control group, the bcl-2 mRNA level decreased significantly in the castration group (P < 0.05). However no significant difference existed in the replacement group (P > 0.05). CONCLUSION:Low androgen may damage the structure of vascular endothelium in male castrated rats.

Objective To investigate the changes of plasma somatostatin,glucagon-like peptide-1(GLP-1) and glucagon in patients with type 2 diabetes in early stage.Methods Forty-nine patients with diabetes in early stage(diabetes group) and 21 normal controls(control group) were selected.Oral glucose tolerance tests(OGTT) were performed,the fasting plasma somatostatin,GLP-1 and glucagon and those 2 h after glucose load were measured,the increase ratios were calculated,and the correlation was analysed.Results The fasting plasma somatostatin,GLP-1 and glucagon and plasma somatostatin and GLP-1 2 h after glucose load in diabetes group were significantly lower than those in control group(P0.05),and plasma somatostatin,GLP-1 and glucagon 2 h after glucose load were higher than fasting ones in both groups.The increase ratios of plasma somatostatin and glucagon in diabetes group were significantly higher than those in control group(P0.05),and there was no significant difference in the increase ratio of plasma GLP-1 between two groups(P0.05).The increase ratio of plasma somatostatin was significantly positively related to that of plasma GLP-1 in diabetes group(r=0.367,P=0.015).Conclusion The reduction of inhibition of somatostatin on GLP-1 may be the compensatory response in patients with type 2 diabetes in early stage.In the early stage of type 2 diabetes,improper increase of glucagon secretion has already existed,and plasma glucose and insulin may play a more important role than GLP-1.

The fasting and 2 h levels of glucagon, somatostatin ( SS), and C-peptide during 75 g oral glucose tolerance test in 60 patients with type 2 diabetes and 34 normal subjects were determined. Compared with control group, the fasting levels of glucagon and SS and 2 h levels of SS after glucose loading significantly decreased,while the fasting and 2 h levels of C-peptide increased in diabetes group. The 2 h levels of these hormones were significantly higher than the fasting levels in two groups. Compared with control group, the increased folds of glucagon ( 1.40±0.48 vs 1.20±0. 30, P＜0. 05 ) and SS( 2.79±2. 17 vs 1.14±0. 22, P＜0. 01 ) levels after glucose loading were higher and that of C-peptide level ( 3.58 ±3. 10 vs 8. 33 ± 6. 99, P＜0. 01 ) was lower in diabetes group. The levels of fasting glucagon were positively correlated with that of fasting SS in two groups( both P＜0. 01 ). These results suggest that disturbance exists in hormones from α and δ cells besides the dysfunction of β cells in patients with type 2 diabetes.

目的 通过建立高脂饮食和低雄激素水平SD大鼠模型,探讨高脂和低雄激素对SD雄性大鼠阴茎结构及其COX-2(环氧化酶-2)表达的影响.方法 将10周龄SD大鼠随机分为6组:正常饮食对照组,正常饮食去势组,正常饮食去势+激素替代治疗组,高脂饮食对照组,高脂饮食去势组,高脂饮食去势+激素替代治疗组.10周后,检测各组大鼠体内雄激素水平,及其阴茎结构和海绵体中COX-2的表达.结果 去势组大鼠体内雄激素水平明显下降,替代治疗组激素水平有所升高.高脂饮食喂养组中,阴茎结构破坏明显,海绵体中COX-2表达呈阳性.结论 去势手术可以导致SD雄性大鼠体内雄激素水平低下的模型,低雄激素水平可导致阴茎海绵体结构损伤,高脂饮食大鼠组的COX-2表达阳性,提示高脂诱导低雄激素大鼠炎症激活.

Background: Endomorphins are endogenous ligands selective for mu-opioid receptors, which have been reported to stimulate appetite and regulate glucose homeostasis. But there are no reports about changes in peripheral endomorphin-1 (EM-1) levels in diabetic patients. The aim of this study was to measure plasma EM-1 levels in fasting and postprandial conditions in diabetic patients.Methods: After an overnight fast, 38 patients (mean age, 67 +/- 8 years; 17 males and 21 females) and 22 healthy volunteers (mean age, 64 +/- 9 years; 9 males and 13 females) received a standard breakfast meal with total energy content of 476.1 kcal. Blood samples were drawn from each subject in heparinized tubes before breakfast and 2 h postprandially. Plasma concentrations of EM-1 were measured by radioimmunoassay (RIA).Results: Comparing with healthy volunteers, EM-1 levels were significantly lower in diabetic patients at both time-points (fasting: 48.38 +/- 14.13 pg/ml vs. 72.71 +/- 19.62 pg/ml, p < 0.0001; postprandial: 39.80 +/- 12.28 pg/ml vs. 62.93 +/- 21.95 pg/ml, p = 0.0001). When compared with fasting levels, the postprandial concentrations of EM-1 decreased in both diabetic patients, as well as healthy controls. The absolute value of decrease was not significantly different between the two groups.Conclusions: Peripheral EM-1 levels were suppressed in diabetic patients and the levels decreased postprandially in both diabetic and healthy volunteers. This implies that EM-1 concentration has correlation with the change in glucose level. Thus, EM-1 could play a role in energy metabolism. (C) 2009 Elsevier Ireland Ltd. All rights reserved.

Objective To investigate the effects of rosiglitazone on vascular lesions in rats with diabetes mellitus,and explore its possible mechanism.MethodsTwenty-four SD rats were randomly divided into normal control group,diabetes mellitus group and diabetes mellitus rosiglitazone treatment group.Rat models of type 1 diabetes mellitus were established in diabetes mellitus group and diabetes mellitus rosiglitazone treatment group by intraperitoneal injection of 60 mg/kg of streptozocin(STZ),and intragastric administration of rosiglitazone(1mg/kg) was conducted in diabetes mellitus rosiglitazone treatment group for 8 weeks from the second week after glucostasis.At the end of the eighth week,heart blood samples were collected from each group of rats,and ELISA was employed to detect the levels of phospholipase A2(PLA2).Besides,thoracoabdominal aorta were obtained,histomorphology and ultrastructure changes of vessel wall were observed,and expression of PLA2 protein of vessel wall was detected by immunohistochemistry.ResultsCompared with normal control group,the vascular structure of rats in diabetes mellitus group was damaged severely,both local PLA2 protein expression and serum PLA2 level increased.The vascular lesions in diabetes mellitus rosiglitazone treatment group were less severe than those in diabetes mellitus group.The expression of PLA2 protein of vessel wall and serum PLA2 level in diabetes mellitus rosiglitazone treatment group were significantly higher than those in control group,and significantly lower than those in diabetes mellitus group(P<0.05).ConclusionRosiglitazone has protective effects on vascular structure of rats with diabetes mellitus,and the mechanism may relate to the inhibition of PLA2 expression and reduction of inflammation.