Objective To examine the effect of metformin on serum thyrotropin (TSH) level in diabetic patients with subclinical hypothyroidism (SCH).Methods The long-term effects of metformin on thyroid axis hormones were assessed in 55 diabetic patients with primary SCH who were untreated with L-T4(study group),as well as in 31 diabetic patients with normal thyroid function (control group).According to using metformin or not,patients of study group were divided into the metformin group (group 1,n =28),and the non-metformin group(group 2,n =27).Serum TSH levels were compared between baseline and follow-up in patients receiving metformin treatment.Results After 30 weeks of metformin administration,a significant TSH decrease(t =2.91,P ＜ 0.05) was observed in group 1 [from(6.98 ± 1.92) to(2.44 ± 0.61) mIU/L].After stopping metformin therapy,the level of TSH at 52 weeks fol low-up was back to the baseline level [(6.99 ± 1.76) mIU/L,P ＞ 0.05].There was no significant difference in TSH level between baseline and after 30 weeks follow-up in group 2[(6.01 ± 1.63) mIU/L vs(6.21 ± 1.71) mIU/L,P ＞0.05].At the end of 30 weeks follow-up,no significant differences were found in body mass index and thyroid func tion in both metformin group and non-metformin group.In control group,metformin administration for 30 weeks had no effect on TSH level(P ＞ 0.05).Conclusion Metformin administration influences TSH without change of FT4 level in type 2 diabetic patients with primary SCH.

Objective To investigate and analyze the behavior and therapeutic status of rheumatoid arthritis (RA) patients. Methods Out patients diagnosed with rheumatoid arthritis in our hospital from May to August 2007 were enrolled. The data including sex, age of onset, site of first hospitalization and medication status were collected and analyzed. Results In this 181 RA patients, the mean age of onset was (53±11) year-old, mean history duration was (10±8) years, the ratio of male to female was 1:4.2. The orthopedics department was the most common site of first hospital visit (32.0%, 58/181) and rheumatology department was the most common site to clarify the diagnosis (62.4% ,113/181). The diagnosis delay caused by patients themselves was (5.9±17.2) months and the delay caused by doctors was (9.0±22.0) months. More than half of the patients were not treated appropriately before they came to our hospital. Methotrexate was the most commonly used DMARDs (67.3%), followed by leflunomide (46.4%), sulfasalazine (37.5%) and hydroxyehloroquine (19.6%). Conclusion In this cohort, the proportion of patients who come to rheumatology department immediately after disease onset is low. There is delay between symptoms and final diagnosis. More than half of the patients are not treated appropriately.

Objective To investigate the clinical and laboratory features of male patients with anti-phospholipid syndrome (APS).Methods Thirty-three male APS patients admitted to Peking University People's Hospital from January 2003 to April 2015 were enrolled.One hundred and fourteen female APS patients were selected as controls.Female patients with thrombosis were analyzed.x2 test, Fisher's exact test and t test were used for statistical analysis.Results Among male patients, 39.4％ were primary APS and 60.6％ were secondary APS.Compare with female patients,the prevalence of venous thrombosis was significantly higher than that in male APS (72.7％ vs 29.8％,x2=19.719, P=0.000).The male APS patients experienced more episodes of thrombosis (75.8％ vs 22.8％, x2=31.669, P=0.000) and not less than two locations of thrombosis than female (69.7％ vs 22.8％, x2=25.321, P=0.000), there was still significant difference between male patients and female patients with thrombosis.There was no difference of antiphopholipid antibodies between the two groups.Conclusion Male patients with antiphospholipid syndrome are more prone to have thrombosis.More clinical interventions should be implemented in male patients with APS.

Objective To assess the value of spiral CT in the diagnosis of hilar cholangiocarcinoma.Methods 13 patients of hilar cholangiocarcinoma underwent CT plain and dynamic enhanced scan.CT findings were analysed in comparison with that of surgery and pathology.Results On plain scan,the lesions appeared as soft tissue mass with low density in hepatic hilar(n=11),bile duct wall irregularly thickened and bile duct narrowed(n=2).On dynamic enhanced scan,delayed enhancement was seen in 13 cases.Conclusion Plain spiral CT and dynamic enhanced scan have great value in showing the morphological features and improving the diagnosis of hilar cholangiocarcinoma.

0.05). ②Among 30 pilots with abnormal vestibular functions,19 were permanently grounded and 11 were permitted to return their flying station. 36 pilots returned to fly in 45 cases with normal vestibular functions. The permanently grounded rate had significant differences between the two groups with normal and abnormal vestibular functions. (P

Objective:To evaluate the therapeutical effects of diplopore puncture of tympanum and intratympanic administration(DPTIA) on patients with acute secretory otitis media(ASOM).Method:One hundred and forty -one cases with ASOM were divided into two groups randomly,with 69 cases(80 ears) in group A(experimental group) and 72 cases(84 ears) in group B(control group).Group A was treated with DPTIA combined with medication, group B was treated with haplopore puncture of tympanum combined with medication. All patients accepted 1 to 3 courses of treament,and were observed during the period of treatment and 3 months after treatment.Result:The factors (including gender, age, side of ailing ear, course of disease, air-bone gap in the pure tone average,and acoustic immitance type in ailing ear) which may impact the prognosis were matched in two groups prior treatment(P＞0.05). While there was a significant difference in the cure rate and the total effective rate respectively between two groups after treatment(P＜0.05).No adverse reaction or complication was seen.Conclusion:DPTIA is a safe, reliable and effective way to manage patients with ASOM.

Objective To better understand the clinical features and the diagnosis of monoclonal gammopathy of undetermined significance (MGUS) associated with systemic lupus erythematosus (SLE).Methods A case of MGUS with SLE were described including clinical manifestations and pathologic data.Literatures were also reviewed.Results The patient was admitted because of proteinuria.Laboratory findings showed monoclonal gammopathy.However,both bone marrow exam and iconography showed no signs of multiple myeloma.Lupus nephritis Ⅳ + Ⅴ was proved by kidney biopsy.Prednisone and tacrolimus were used with significant clinical improvement.Conclusion MGUS associated with SLE is not rare.MGUS criteria based on 2003 international MM working group should be used to differentiate MGUS from MM.Monoclonal protein level,plasma cell in bone marrow and free light chain are risk factors for MM progression.Treatment is based on lupus disease activity and organ damage severity.

Objective To investigate the clinical and serologic features of patients with Sj(?)gren′s syndrome (SS) associated with systemic lupus erythematosus (SLE), and to compare with patients of primary Sjgren′s syndrome (pSS) and systemic lupus erythematosus. Methods Two hundred and eighteen unselected SLE patients were evaluated for the presence of SS. The SLE patients with SS (SLE-SS) were compared with SLE patients without SS on clinical and laboratory parameters. Results SS was identified in 22 SLE patients (10.1%). The SS preceded the development of SLE in 8 (36%), the SS secondary to SLE in 7 (32%), and in 7 (32%) patients, the SS and SLE occurred at the same time. Compared with the SLE patients without SS group, patients with SLE-SS were older, with a higher frequency of Raynaud′s phenomenon, pulmonary involvement, anti-SSA, anti-SSB, and rheumatoid factor, but with a significantly lower frequency of renal involvement. Compared with the pSS patients group, SLE-SS patients were younger, with a higher frequency of Raynaud′s phenomenon, arthritis, mucocutaneous involvement and anti-SSA. Conclusions SLE-SS patients have distinct clinical and laboratory features that differ from SLE or pSS patients.

OBJECTIVE To evaluate the clinical application of flow-through hybridization to human papillomavirus(HPV) subtype detection.METHODS A total of 305 female patients infected with HPV were selected for HPV subtype analysis using flow-through hybridization and the assessment of HPV subtype on cervical lesions was analyzed.RESULTS All 21 different subtypes were found.From 305 cases 173 patients were infected with single-type HPV and 132 patients were infected with multiple-type HPV.The most commonly found high-risk types were HPV16(17.6%),HPV52(9.8%),HPV58(9.0%),HPV33(6.3%),HPV18(5.4%) and HPV68(5.2%) and the low-risk types were HPV11(14.3%) and HPV6(6.5%).The high-risk HPV increased and the low-risk HPV declined along with the upgrade of the cervical lesions.CONCLUSIONS Technology of flow-through hybridization is able to detect multiple HPV subtype.The distinction between low and high-risk HPV subtypes is seemed useful in prevention and management of cervical cancer.

Objective To investigate and analyze the adverse effect(AE) of methotrexate(MTX)in rheumatoid arthritis(RA).MethodsThree hundred and twenty-five RA patients were investigated with a questionnaire in clinical service of department of Rheumatology and Immunology, Peking University People's Hospital. SPSS 11.5 software was used for statistical analysis. Results① The total prevalence of AE was 34.2％. Among these, gastrointestinal AE were the most common, others included elevated liver enzymes,leucocytopenia,alopecia and dental ulcer. The incidence of drug withdrawal of MTX was 13.2％, elevated liver enzymes was the most common reason of withdrawal, other reasons were gastrointestinal AE, leucocytopenia,dental ulcer and alopecia. The gastrointestinal AE and dental ulcer occurred within one week after initiating the medication in average, while elevated liver enzymes and leucocytopenia usually occurred at about 1～2 months after the medication. ②The incidence of AE increased with the dosage. ③ Folic acid could significantly decrease the total incidence of AE(P＜0.05). The incidence of gastrointestinal AE, elevated liver enzymes,leucocytopenia and dental ulcer couldbe reduced by folic acid supplementation(P＜0.05).Conclusion The AE of MTX in RA treatment are common, many of which are slight and could be improved by reducing the dosage or symptomatic treatment. The AEs of MTX can be improved by folic acid supplement treatment.