Objective To determine the relationship between subclinical hypothyroidism and asymptomatic myocardial ischemia in type 2 diabetes mellitus.Methods All of 399 asymptomatic subjects who underwent coronary CT angiography with type 2 diabetes mellitus but without thyroid disease were enrolled retrospectively.Totally patients were divided into subclinical hypothyroidism group (17 patients,type 2 diabetes mellitus with subclinical hypothyroidism) and euthyroid group(382 patients,type 2 diabetes mellitus with normal thyroid function).Results The incidence of subclinical hypothyroidism in type 2 diabetes mellitus was 4.3％(17/399).The ratio of male and smoking in subclinical hypothyroidism group was significantly lower than that in euthyroid group (3/17 vs.194/382,P =0.007;2/17 vs.136/382,P =0.043).The incidence of asymptomatic myocardial ischemia in subclinical hypothyroidism group was 5 cases and in euthyroid group was 130 cases,and there was no significant difference(P=0.694).The age,course of type 2 diabetes mellitus,level of glycosylated hemoglobin and low density lipoprotein cholesterol between two groups had no significant difference(P＞ 0.05).Conclusion Subclinical hypothyroidism is not an independent risk factor for asymptomatic myocardial ischemia in type 2 diabetes mellitus.

Objective To explore the value of preoperative spleen-liver volume ratio (SLVR) for predicting recurrence of primary liver cancer after hepatectomy.Methods Clinical data of 86 cases of hepatocellular carcinoma undergoing hepatectomy were analyzed retrospectively from January 2009 to December 2014.According to the preoperative SLVR,these patients were divided into two groups:SLVR ＜ 0.8 group (low SLVR group) and SLVR≥0.8 group (high SLVR group).Patients were followed-up until June 2015.Cox ratio risk pattern analysis was used for the recurrent correlative factors.Results The 1-,3-,and 5-year survival rates were 95.5％,88.6％,and 81.8％ in the low SLVR group,and 73.8％,47.6％,and 40.5％ in the high SLVR group,respectively.The difference were statistically significant between two groups (P ＜0.05).Cox regression analysis revealed that SLVR≥0.8,AFP-L3％ ≥10％,the maximum diameter of the tumor ＞ 5 cm,and hepatic or portal vein tumor thrombus were independent predictors of poor disease-free survival after hepatectomy for hepatocellular carcinomas (P ＜ 0.05).Conclusions Preoperative SLVR≥0.8 is an independent adverse predictor of poor disease-free survival.

Objective To explore the safety of the laparoscopic surgery in radical resection for different stage rectal cancer.Methods Clinical data of 200 cases with rectal cancer underwent laparoscopic radical resection(observation group) were analyzed retrospectively,including 52 cases of stage 0-Ⅰ,148 cases of stage Ⅱ-Ⅲ.Two hundred cases patients with rectal cancer underwent open radical surgery were selected as control group,including 44 cases of stage 0-Ⅰ,156 cases of stage Ⅱ-Ⅲ.The length to distal resection margin,the number of harvested lymph nodes,the incidence of postoperative complications and the prognosis of recent situation were observed,the safety of the laparoscopic surgery was analyzed.Results Whether rectal cancer of stage 0-Ⅰ or Ⅱ-Ⅲ,there were no significant differences in terms of the length of distal resection margin((2.5±0.9) cmvs.(2.4±1.1) cm,t=0.490,P=0.625;(3.1±1.0) cm vs.(3.2±1.3) cm,t=0.749,P=0.454),the number of harvested lymph nodes((12.3±4.2) vs.(12.7±3.9),t=0.480,P=0.632;(13.9±5.4) vs.(15.1±4.9),t=2.369,P=0.118),the incidence of postoperative complications (17.3％ vs.18.2％,x2 =0.012,P=0.911;27.7％ vs.28.8％,x2=0.049,P=0.825),the rate of local recurrence(1.9％vs.2.3％,x2 =0.014,P =1.000;4.1％ vs.3.2％,x2=0.157,P=0.692),the distant metastasis (3.8％ vs.2.3％,x2=0.195,P=1.000;5.4％ vs.4.5％,x2=0.137,P=0.712) and 3-year survival rate (96.2％vs.95.5％,x2=0.010,P=0.808;83.8％ vs.85.3％,x2=0.132,P=0.714) between the observation group and control group (P＞0.05).Conclusion For rectal cancer of stage 0-Ⅰ,laparoscopic surgery has good safety,and worthy of popularization and application.For rectal cancer of stage Ⅱ-Ⅲ,due to its operation for a long time as well as the possible risk in postoperative anastomotic fistula,the implementation of laparoscopic surgery should be more cautious.

Objective:To investigate the occurrence of human papillomavirus (HPV) single and multiple infections in different cervical lesions, and to analyze the distribution of HPV types in patients with single infection and the change of viral load before and after treatment.Methods:A total of 4 783 HPV-DNA-positive cases who were detected by cervical exfoliated cells HPV-DNA testing from May 2017 to March 2019 in Shanxi Provincial People's Hospital were retrospectively analyzed, of which 3 728 cases met the criteria and were included in this study. Fluorescence quantitative polymerase chain reaction (PCR) was used to determine HPV genotype and viral load, and liquid-based thin-layer cytology (TCT) test and colposcopic histopathological diagnosis were performed. According to the histopathological results, the patients were divided into chronic cervicitis+cervical intraepithelial neoplasia (CIN) Ⅰ group, CIN Ⅱ+CIN Ⅲ group and cervical cancer group.Results:A total of 3 364 cases had HPV single infection, of which chronic cervicitis+CIN Ⅰ accounted for 78.27% (2 633/3 364), CIN Ⅱ+CIN Ⅲ accounted for 18.73% (630/3 364), and cervical cancer accounted for 3.00% (101/3 364); 364 cases had HPV multiple infections, of which chronic cervicitis+CIN Ⅰ accounted for 51.65% (188/364), CIN Ⅱ+CIN Ⅲ accounted for 42.58% (155/364), and cervical cancer accounted for 5.77% (21/364). The difference in the proportion of cervical lesions with different pathological grades in HPV single infection and multiple infections was statistically significant ( χ2 = 127.21, P < 0.01). The top four HPV single infection genotypes in chronic cervicitis+CINⅠ group and CINⅡ+CINⅢ group were type 16, 52, 58 and 53, and their proportions were 17.05% (449/2 633), 12.91% (340/2 633), 9.08% (239/2 633) and 8.89% (234/2 633) in chronic cervicitis+CINⅠ group, and 32.22% (203/630), 10.32% (65/630), 8.41% (53/630) and 5.87% (37/630) in CINⅡ+CINⅢ group. In the cervical cancer group, the top two HPV single infection genotypes were type 16 and 18, and their proportions were 81.19% (82/101) and 6.93% (7/101). The viral load of 120 patients with HPV infection was 4.89±1.14 before treatment and 2.86±1.63 after treatment, and the difference was statistically significant ( t = 13.260, P < 0.01). Conclusions:HPV multiple infections are more likely to aggravate the degree of cervical lesions than single infection. Common HPV infection subtypes in different cervical lesions include type 16, 52, 58, 53 and 18.

Objective To determine the relationship between subclinical hypothyroidism (SCH) and the prevalence of albuminuria in type 2 diabetes mellitus.Methods A total of 826 type 2 diabetes mellitus patients without thyroid disease were enrolled.Participants were evaluated for glycemic control,thyroid function,and albuminuria in a cross-sectional analysis.Results Of 826 type 2 diabetes mellitus,780 subjects were euthyroid(94.44％,780/826) and 46 had SCH (5.56％,46/826).The patients with SCH had a higher proportion in women and higher body mass index compared with the patients with euthyroid [69.6％(32/46) vs.49.7％(388/780),(26.7 ± 4.0) kg/m2 vs.(25.1 ± 3.8) kg/m2],and there was significant difference(P ＜ 0.01).No significant difference in glycated hemoglobin and the prevalence of albuminuria was found between the patients with SCH and the patients with euthyroid (P ＞ 0.05).Conclusion SCH is not a risk factor for albuminuria in type 2 diabetes mellitus.

Objective:To explore the application value of urine γ-synuclein (SNCG) in the diagnosis of bladder cancer.Methods:A total of urine samples from 129 patients with bladder cancer (malignant lesion group), 157 patients with urinary system benign lesions (benign lesion group), and 177 healthy people (the healthy control group) from January 2017 to April 2020 in the Fifth Clinical Medical College of Shanxi Medical University and Shanxi Provincial Cancer Hospital were collected. The concentration of SNCG in the collected urine was detected by using enzyme-linked immunosorbent assay. The receiver operating characteristic (ROC) curve was drawn to determine its sensitivity, specificity and accuracy for the diagnosis of bladder cancer.Results:The urine SNCG concentration in malignant lesion group [4.28 ng/ml (0.53-8.79 ng/ml)] was higher than that in healthy controls [1.44 ng/ml (0.56-3.51) ng/ml, H = 122.9, P < 0.01] and benign lesion group [1.97 ng/ml (0.51-5.87) ng/ml, H = 88.2, P < 0.01], and the concentration of urine SNCG in benign lesion group was higher than that in healthy controls ( H = 17.1, P < 0.01). ROC area under the curve (AUC) of urine SNCG in differentiating benign lesion group from healthy controls was 0.871(95% CI 0.819-0.923, P < 0.01), the best cut-off value was 2.79 ng/ml, the diagnostic sensitivity and specificity was 0.798 and 0. 977, respectively. AUC of urine SNCG in differentiating malignant lesion group from benign lesion group was 0.823(95% CI 0.769-0.877, P < 0.01), the best cut-off value was 3.54 ng/ml, the diagnostic sensitivity and specificity was 0.713 and 0.917, respectively. AUC of urine SNCG in differentiating malignant lesion group from healthy controls plus benign lesion group was 0.848 (95% CI 0.797-0.899, P < 0.01), the best cut-off value was 2.87 ng/ml, the diagnostic sensitivity and specificity was 0.791 and 0.901, respectively. Conclusions:The concentration of SNCG in urine of patients with bladder cancer is higher than that of patients with benign urinary lesions and healthy people. Urine SNCG has a good application value in the diagnosis of bladder cancer.

Objective:To investigate the association between quantified CT (QCT)-measured body composition and metabolic syndrome (MS) components in obese populations before bariatric surgery.Methods:A cross-sectional study. A retrospective analysis was conducted on a cohort of 97 obese patients scheduled for weight-loss surgery at the First Affiliated Hospital of Wannan Medical College from January 2021 to March 2023. The patients′ body mass index (BMI), biochemical parameters and body composition measurements obtained by QCT were recorded. The patients were stratified into groups based on gender, obesity severity and the number of MS components. Differences in body composition among the groups were compared. Additionally, the correlations between each body composition parameter and metabolic indicators were analyzed. The diagnostic efficacy of each body composition parameter for identifying obese individuals with different MS components was assessed using receiver operating characteristic (ROC) curve analysis.Results:There were 75 females (77.3%). Male obese patients had higher total abdominal fat area [(693.23±148.90) vs (574.99±114.89) cm 2, t=-3.958, P<0.001], visceral fat area [(289.65±57.67) vs (195.60±57.37) cm 2, t=-6.753, P<0.001], fat content of pancreatic head [27.45%(21.65%, 45.48%) vs 21.60%(17.6%, 26.9%), Z=-2.675, P=0.007], and skeletal muscle index [73.36(68.74, 81.26) vs 61.52(55.74, 66.41) cm 2/m 2, Z=-5.246, P<0.001]. With the increase of obesity, abdominal fat mainly increases in subcutaneous fat. With the increase of MS components (MS2 group, MS3 group, MS4 group, MS5 group), the abdominal fat area, abdominal fat/subcutaneous fat, liver fat content, pancreatic head fat content, and skeletal muscle index of patients all increased accordingly. In diagnosing the presence of two components of MS, area under the curve of visceral fat area was the largest (AUC=0.706, 95% CI=0.577-0.834). For diagnosing the presence of three, four and five components of MS, area under curve of liver fat content were all the largest (MS3=0.712, 95% CI=0.605-0.818; MS4=0.652, 95% CI=0.537-0.766; MS5=0.706, 95% CI=0.576-0.836). Conclusion:There are differences in QCT body composition among obese patients with different MS components, and there is a correlation between each body composition and MS component. Among them, intra-abdominal fat area and liver fat content are of great value in evaluating obese patients with different MS components.

Objective:To analyze the clinical characteristics, cerebrospinal fluid (CSF) and other auxiliary examination results of febrile children with convulsions in order to provide the evidence for clinical recognition of central nervous system (CNS) infection and its etiology.Methods:The clinical data of 64 fever patients with convulsions admitted at the Department of Neurology, Shanghai Children′s Medical Center, Shanghai Jiaotong University School of Medicine were analyzed retrospectively.According to the results of the routine biochemical examination of CSF, they were divided into 2 groups as CSF normal group (44/64 cases, 69%) and CSF abnormal group (20/64 cases, 31%). Their age, gender, clinical manifestations, physical symptoms and auxiliary examination results were compared between the two groups. Logistic regression analysis was performed to explore the independent risk factors of abnormal CSF results.Twenty children with abnormal CSF results were divided into the normal glucose group (12/20 cases, 60%) and the glucose reduction group (8/20 cases, 40%) according to the glucose level of CSF.The fever duration, serum inflammation markers, CSF routine and biochemical indexes of the two groups were compared. Results:According to Logistic multivariate unconditional regression analysis, the mental state change ( OR=435.99, P=0.010), abnormal neurological signs ( OR=65.25, P=0.023) and vomiting ( OR=20.56, P=0.048) were the high risk factors of abnormal CSF results.Among the children with abnormal CSF results, in the glucose reduction and normal glucose groups, the fever duration was 12.50 (7.75-16.75) d and 4.00 (3.00-5.75) d, respectively; the level of CSF protein were 3 000 (1 745-3 000) mg/L and 648 (469-1 734) mg/L, respectively; the erythrocyte sedimentation rate (ESR) was 71.50(56.00-97.50) mm/1 h and 20.50 (12.00-26.00) mm/1 h, respectively; the procalcitonin level was 2.76(0.90-20.72) g/L and 0.23 (0.03-1.00) g/L, respectively; the C-reactive protein (CRP) level was 123.00 (33.00-177.75) mg/L and 12.50(4.25-57.75) mg/L, respectively.The fever duration, CSF protein level, ESR, procalcitonin level and CRP level were statistically different between the glucose reduction and normal glucose groups (all P<0.05). Conclusions:In fever children with convulsions, vomiting, the mental state change, and abnormal neurological signs are the high risk factors of abnormal CSF results, suggesting the possibility of CNS infections and the need of early diagnosis by CSF and other auxiliary examinations.In addition, a low level of CSF glucose in children with abnormal CSF results may be a potential and powerful clue for purulent meningitis.Timely etiological tests are required for confirmation, and antibiotics treatments should be applied as early as possible.

Objective:To investigate the surgical situations and perioperative outcome of pancreaticoduodenectomy in Jiangsu Province and the influencing factors for postoperative 90-day mortality.Methods:The retrospective case-control study was conducted. The clinicopathological data of 2 886 patients who underwent pancreaticoduodenectomy in 21 large tertiary hospitals of Jiangsu Quality Control Center for Pancreatic Diseases, including The First Affiliated Hospital of Nanjing Medical University, from March 2021 to December 2022 were collected. There were 1 732 males and 1 154 females, aged 65(57,71)years. Under the framework of the Jiangsu Provincial Pancreatic Disease Quality Control Project, the Jiangsu Quality Control Center for Pancreatic Diseases adopted a multi-center registration research method to establish a provincial electronic database for pancrea-ticoduodenectomy. Observation indicators: (1) clinical characteristics; (2) intraoperative and post-operative conditions; (3) influencing factors for 90-day mortality after pancreaticoduodenectomy. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(IQR), and comparison between groups was conducted using the Mann-Whitney U test. Count data were expressed as absolute numbers or constituent ratio, and comparison between groups was conducted using the chi-square test, continuity correction chi-square test and Fisher exact probability. Maximal Youden index method was used to determine the cutoff value of continuous variables. Univariate analysis was performed using the corresponding statistical methods based on data types. Multivariate analysis was performed using the Logistic multiple regression model. Results:(1) Clinical characteristics. Of the 2 886 patients who underwent pancreaticoduodenectomy, there were 1 175 and 1 711 cases in 2021 and 2022, respectively. Of the 21 hospitals, 8 hospitals had an average annual surgical volume of <36 cases for pancreaticoduodenectomy, 10 hospitals had an average annual surgical volume of 36-119 cases, and 3 hospitals had an average annual surgical volume of ≥120 cases. There were 2 584 cases performed pancreaticoduodenectomy in thirteen hospitals with an average annual surgical volume of ≥36 cases, accounting for 89.536%(2 584/2 886)of the total cases. There were 1 357 cases performed pancrea-ticoduodenectomy in three hospitals with an average annual surgical volume of ≥120 cases, accounting for 47.020%(1 357/2 886) of the total cases. (2) Intraoperative and postoperative conditions. Of the 2 886 patients, the surgical approach was open surgery in 2 397 cases, minimally invasive surgery in 488 cases, and it is unknown in 1 case. The pylorus was preserved in 871 cases, not preserved in 1 952 cases, and it is unknown in 63 cases. Combined organ resection was performed in 305 cases (including vascular resection in 209 cases), not combined organ resection in 2 579 cases, and it is unknown in 2 cases. The operation time of 2 885 patients was 290(115)minutes, the volume of intra-operative blood loss of 2 882 patients was 240(250)mL, and the intraoperative blood transfusion rate of 2 880 patients was 27.153%(782/2 880). Of the 2 886 patients, the invasive treatment rate was 11.342%(327/2 883), the unplanned Intensive Care Unit (ICU) treatment rate was 3.087%(89/2 883), the reoperation rate was 1.590%(45/2 830), the duration of postoperative hospital stay was 17(11)days, the hospitalization mortality rate was 0.798%(23/2 882), and the failure rate of rescue data in 2 083 cases with severe complications was 6.529%(19/291). There were 2 477 patients receiving postoperative 90-day follow-up, with the 90-day mortality of 2.705%(67/2477). The total incidence rate of complication in 2 886 patients was 58.997%(1 423/2 412). The incidence rate of severe complication was 13.970%(291/2 083). The comprehensive complication index was 8.7(22.6) in 2 078 patients. (3) Influencing factors for 90-day mortality after pancreaticoduodenectomy. Results of multivariate analysis showed that age ≥ 70 years, postoperative invasive treatment, and unplanned ICU treatment were independent risk factors for 90-day mortality after pancreaticoduodenectomy ( odds ratio=2.403, 2.609, 16.141, 95% confidence interval as 1.281-4.510, 1.298-5.244, 7.119-36.596, P<0.05). Average annual surgical volume ≥36 cases in the hospital was an independent protective factor for 90-day mortality after pancreaticoduodenectomy ( odds ratio=0.368, 95% confidence interval as 0.168-0.808, P<0.05). Conclusions:Pancreaticoduodenectomy in Jiangsu Province is highly con-centrated in some hospitals, with a high incidence of postoperative complications, and the risk of postoperative 90-day mortality is significant higher than that of hospitallization mortality. Age ≥ 70 years, postoperative invasive treatment, and unplanned ICU treatment are independent risk factors for 90-day motality after pancreaticoduodenectomy, and average annual surgical volume ≥36 cases in the hospital is an independent protective factor.