Objective To investigate the role of BRAFV600E mutation in diagnosis of thyroid nodules when it is inconsonant with cytological results. Methods This study included 9837 patients who underwent US-FNA. We mainly analyzed 239 cases with benign or indeterminate cytology, but having a detection of BRAFV600E muta-tion. BRAFV600E mutation analysis was performed using a Amplification Refractory Mutation System Polymerase Chain Reaction. Results In 93 nodules with benign cytology results but positive BRAFV600E mutation, 84 nodules were malignant. Based on the results, US-FNA combined with BRAFV600E mutation analysis will improve sensitivity (Se=94.03％)and negative predictive value (NPV=2.69％) of the thyroid nodules diagnosis than using US-FNA alone(Se=71.03％, NPV=20.76％). Conclusion BRAFV600E mutation analysis is an important tool in the diagnosis of PTC with high sensitivity and NPV. When facing patients with benign or indeterminate cytology but positive BRAFV600E mutation, thyroidectomy should be considered.

The comprehensive and multiple disciplinary team therapeutic strategies of pancreatic cancer have been accepted as a consensus. Immune checkpoint inhibitors have made great breakthroughs in the treatment of various solid tumors. However, immune checkpoint inhibitors failed to elicit efficacy in patients with pancreatic cancer and how to overcome the immunosuppressive tumor microenvironment may be the crucial event. Combination regimens of immune checkpoint inhibitors with chemotherapy, radiotherapy, and molecular targeted therapy have been underway, but the sample size of the clinical trial was still limited. Considering the current research status and progress of pancreatic cancer, this article further discusses the practical problems of immune checkpoint inhibitors and makes objective evaluation of its value.

Objective: To compare the detection efficiency of the ratio of plasma aldosterone concentration to renin concentration (ARR) measured by imported and domestic chemiluminescent immunoassay kits for screening primary aldosteronism (PA) . Methods: A total of 164 patients with essential hypertension and 64 patients with PA were recruited in this study. Plasma aldosterone concentration (PAC) and renin concentration (PRC) were measured concurrently by imported chemiluminescent immunoassay kit (Diasorin, Italy) and domestic kit (Mindray, Shenzhen, China) , and then ARR were calculated. A ROC curve analysis was performed to compare the screening efficacy of the two kits and the optimal ARR cut-offs for PA screening were recommended according to Youden’s index. Results: The areas under the ROC curves (AUCROC) of ARR were 0.937 (95% CI 0.897-0.965, P<0.0001) detected by imported kit and 0.942 (95% CI 0.903-0.968, P<0.0001) detected by domestic kit. The difference of AUCROC of ARR detected by two kits was 0.00457 (95% CI -0.0210-0.0302, P<0.7263) .The highest Youden’s indexes of ARR were 0.749 (detected by imported kit) with the cut-off value of 12.8 (pg/ml) / (μIU/ml) (sensitivity 96.87%, specificity 78.05%) and 0.756 (detected by domestic kit) with the cut-off value of 12.5 (pg/ml) / (μIU/ml) (sensitivity 89.06%, specificity 86.59%) . Conclusions There was no significant difference between domestic and imported chemiluminescent immunoassays in the screening efficiency of ARR for PA.

Objective: To investigate the incidence and risk factors contributing to post-transplant diabetes mellitus (PTDM) in kidney transplant recipients within one year post-transplantation. Methods: A total of 293 non-diabetic kidney transplant recipients were retrospectively analyzed. Patients were divided into non-PTDM group and PTDM group according to the diagnostic criteria of diabetes mellitus. The incidence of PTDM was calculated and the potential risk factors of PTDM were analyzed by univariate and multivariate Logistic regression analysis. Results: Among the 293 non-diabetic patients, 36 patients developed PTDM within 1 year, with an incidence of 12.3%. Multivariate Logistic analysis showed that age (OR 1.055, 95% CI 1.014-1.098, P=0.009) , body mass index [odd ratio (OR) 1.231, 95% confidence interval (CI) 1.084-1.398, P=0.001], polycystic kidney as the primary disease (OR 1.508, 95% CI 1.006-2.262, P=0.047) , 2-hour postprandial blood glucose (OR 1.186, 95% CI 1.04-1.53, P=0.011) , HbA1c (OR 1.732, 95% CI 1.075-3.428, P=0.015) and 1-hour postprandial blood C-peptide (OR 0.869, 95% CI 0.804-0.939, P=0.001) were independent risk factors for PTDM in kidney transplant recipients within 1-year post-transplantation. Conclusion Patients with older age, obesity, polycystic kidney as the primary disease, higher level of HbA1c and 2-hour postprandial blood glucose, and lower level of 1-hour postprandial blood C-peptide may have higher risk of developing PTDM.

Objective: To analyze the clinical characteristics of pheochromocytoma crisis (PCC) . Methods: Data of 123 cases of pheochromocytoma and paraganglioma (PPGL) admitted from Apr. 2011 to Feb. 2017 were retrospectively analyzed and they were divided into crisis group and noncrisis group according to the patients with or without haemodynamic instability and end-organ damage. The differences of demographics characteristics, presentations, laboratory tests, imaging findings, perioperative clinical conditions and pathological features were compared between the two groups. Results: ①16 cases were enrolled into crisis group, among whom 5 were misdiagnosed, while 107 cases were enrolled into noncrisis group. ②Compared with noncrisis group, the incidence of headache, palpitation, sweating, the classic triad, other presentations of PPGL, severe hypertension and hypotension were higher, and more patients had paroxysmal hypertension and admitted to our hospital for paroxysmal presentations in crisis group (P<0.05) . ③Leukocyte, fasting blood glucose, liver transaminases, troponin and D-dimmer were higher, while estimated glomerular filtration rate (eGFR) was lower, more tumors located in the left of adrenal in crisis group (P<0.05) . ④ Patients in crisis group had higher plasma free metanephrines (MNs) , larger maximal tumor diameter, higher enhanced CT value in each period, more benign tumors and hemorrhage or necrosis in the tumors, but all the differences were not significant when compared with the noncrisis group. ⑤Patients in crisis group were more likely to undergo elective surgery. However, there was no difference in the preoperative time of α-blockade, type of surgery, intraoperative and postoperative complications, mortality among the two groups. Conclusions PCC is a rare endocrinological emergency with a highly variable manifestations, which commonly presents with typical triad, with higher incidence of hemodynamic instability and end-organ damage. Although biochemical and imaging examinations are relatively effective in the diagnosis of PCC, the misdiagnosis remains inappropriate high. Once the diagnosis is established, clinicians should timely start drug preparation while surgical resection is the key to the treatment of PCC.

Objective: To observe the liver histology change of obesity rat induced by high fat diet and discuss its significance. Methods: The rats were divided into 2 groups:12 obesity rats induced by high fat diet and 8 rats for control. Then the fasting blood glucose, lipid, blood uric acid, insulin level were tested while BMI, HOMA-IR and ISI were calculated at 14 week. Also the HE staining of the liver tissue was performed. Results: The baseline parameters including gender, body weigh, body length, tail length and Lee’s Index were similar between the two groups (P>0.05) . But after 14 weeks, the body weigh, body length and Lee’s Index of the obesity rats were higher significantly than the normals[ (367.92±88.88) g vs (252.5±59.47) g, (23.14±2.18) cm vs (20.81±1.71) cm, (328.18±9.82) vs (265.00±38.17) , (P<0.05) ]. The fasting blood glucose of obesity group was higher than that of control group, but the HDL level of obesity group was lower than that of control group[ (7.00±1.81) mmol/L vs (4.21±1.13) mmol/L, (1.24±0.14) mmol/L vs (1.41±0.15) mmol/L, (P<0.05) ]. The insulin, triglycerides, cholesterol, LDL, urimic acide, HOMA-IR and ISI were not different between the two groups. The balloon degeneration and fatty degeneration of the liver tissue were observed under light microscope at the obesity group. Conclusion The balloon-like changes and steatosis of the liver tissue, as well as the high blood sugar and high-density lipoprotein, were the basis of obesity induced abnormal metabolism including fatty liver and glycolipids.

Objective: To study the effects of liraglutide on bone metabolism and Wnt pathway in type 2 diabetic osteoporosis rats. Methods: SD rats were randomly divided into control group, model group and liraglutide group. The latter two groups were fed with high-fat and high-sugar diet and intraperitoneally injected with low-dose streptozotocin to establish type 2 diabetic model. Liraglutide group was subcutaneously injected with 0.6 mg/kg/d liraglutide for 8 weeks. Bone mineral density, calcium and phosphorus content, the expression of Wnt pathway molecule [Wnt3a, low density lipoprotein receptor-related protein 5 (LRP5) , β-catenin] and the contents of bone metabolism indicators [ALP, osteocalcin (OC) , osteoprotegerin (OPG) , receptor activator of nuclear factor-κ B ligand (RANKL) , tartrate-resistant acid phosphatase (TrACP) , cross-linked carboxy-terminal telopeptide of type I collagen (CTX-1) ] in serum were determined. Results: The tibial bone mineral density[left (0.158±0.024) vs (0.232±0.041) g/cm², right (0.152±0.027) vs (0.219±0.038) g/cm², P<0.05) , the content of calcium and phosphorus [ (5.12±0.58) vs (5.93±0.74) mol/g, (2.93±0.41) vs (3.84±0.56) mol/g, P<0.05) , the expression of Wnt3a, LRP5, β-catenin in tibia [ (0.29±0.06) vs (0.78±0.13) , (0.30±0.05) vs (0.73±0.14) , (0.38±0.06) vs (1.01±0.18) , P<0.05], the content of ALP, OC and OPG in serum of model group were significantly lower than those of control group[ (40.27±7.52) vs (59.29±9.19) ng/ml, (252.45±42.95) vs (341.28±52.39) pg/ml, (0.40±0.06) vs (0.78±0.09) ng/ml, P<0.05) , and the contents of RANKL, TrACP and CTX-1 in serum were significantly higher than those of control group [ (17.79±2.84) vs (12.46±2.09) pg/ml, (56.45±7.79) vs (41.38±8.19) μmol/l, (19.26±3.14) vs (11.39±2.25) pg/ml, P<0.05]; the tibial bone mineral density, the content of calcium and phosphorus, the expression of Wnt3a, LRP5, β-catenin in tibia, the content of ALP, OC and OPG in serum of liraglutide group were significantly higher than those of control group, and the contents of RANKL, TrACP and CTX-1 in serum were significantly lower than those of control group. Conclusion Liraglutide can improve bone mineral density and bone metabolism in type 2 diabetic rats with osteoporosis, which may be related to activation of Wnt pathway.

Objective: To retrospectively analyze the detection rate, distribution characteristics of hyperglycemia patients in non-endocrinological departments of first-class hospitals and the related risk factors of hyperglycemia in ICU patients. Methods: 4364 patients with hyperglycemia in non-endocrinology Department of Shanxi People’s Hospital admitted from Feb 1, 2017 to Jan 31, 2018 were selected. The detection rate of hyperglycemia was counted and the distribution characteristics of hyperglycemia were analyzed. The risk factors of hyperglycemia in ICU patients were analyzed by logistic regression. Results: ① General situation: The detection rate of hyperglycemia in non-endocrinological inpatients was 7.57%, with an average age of (60.2±16.14) years and a male-to-female ratio of 1.28:1. ② The detection rate and distribution characteristics of hyperglycemia in the internal medicine department and surgical department: the detection rate of hyperglycemia in internal medicine department was 8.46%; male-to-female ratio was 1.54:1, and the average age was (61.01±13.96) years. The detection rate of surgical department was 6.56%,male-to-female ratio was 1.03:1, and the average age was (59.03±14.14) years. The detection rate of geriatrics in internal medicine department was higher, The detection rate of Neurosurgery in surgical department was higher. ③ Types of hyperglycemia: 2424 cases (55.54%) of diabetes were diagnosed; 757 cases (17.35%) of diabetes were newly diagnosed; 319 cases (7.31%) of stress hyperglycemia. ④ The detection rate of OGTT or HbAlC respectively and both indicators in internal medicine were higher than in surgery (χ²=79.68, 197.29, 67.48, all P=0.00) . ⑤ Logistic analysis revealed that perioperative period, diabetes and the history of glucocorticoid use were independent factors for the prevalence of hyperglycemia in ICU patients[OR (95%CI) respectively, 1.015 (1.169~4.265) , 2.999 (1.487~6.049) , 5.456 (2.067-~14.398) , all P<0.05]. Conclusions The detection rate of hyperglycemia in tertiary is higher. Perioperative period, diabetes and history of glucocorticoid use are closely related to the prevalence of hyperglycemia in ICU patients. Non-endocrine physicians should strengthen the standardized management of hyperglycemia among inpatients.

Objective: To investigate the role of BRAF^V600E mutation in diagnosis of thyroid nodules when it is inconsonant with cytological results. Methods: This study included 9837 patients who underwent US-FNA. We mainly analyzed 239 cases with benign or indeterminate cytology, but having a detection of BRAF^V600E mutation. BRAF^V600E mutation analysis was performed using a Amplification Refractory Mutation System Polymerase Chain Reaction. Results: In 93 nodules with benign cytology results but positive BRAF^V600E mutation, 84 nodules were malignant. Based on the results, US-FNA combined with BRAF^V600E mutation analysis will improve sensitivity (Se=94.03%) and negative predictive value (NPV=2.69%) of the thyroid nodules diagnosis than using US-FNA alone (Se=71.03%, NPV=20.76%) . Conclusion BRAF^V600E mutation analysis is an important tool in the diagnosis of PTC with high sensitivity and NPV. When facing patients with benign or indeterminate cytology but positive BRAF^V600E mutation, thyroidectomy should be considered.

Objective: To investigate the CT features of primary mediastinal neuroendocrine carcinoma and improve the diagnostic accuracy. Methods: CT findings of 12 patients with primary mediastinal neuroendocrine carcinoma diagnosed by clinic and pathology were retrospectively analyzed. The location, size, growth pattern, density, degree of enhancement, invasion of surrounding tissues and metastasis of the tumor were observed, a control analysis was performed. Results: Among the 12 cases, 4 cases were located in the anterior superior mediastinum, 4 cases in the middle superior mediastinum and 4 cases in the middle mediastinum. There were 5 cases on the left side, 4 cases on the right side and 3 cases in the middle. The maximum diameter of the tumor ranged from 1.5 cm to 12.0 cm, with an average of (6.74±3.65) cm. The tumors were round or quasi-round in 6 cases, irregular in 6 cases, clear boundary in 9 cases and unclear in 3 cases. Uniform density was found in 6 cases. The density was heterogeneous in 6 cases, including necrosis and cystic degeneration in 4 cases, and fine-grained calcification in 1 case. The average CT value of plain scan was (38±4.8) HU. There was 1 case of perivascular growth, 2 cases of adjacent vascular compression, 3 cases of adjacent pleural invasion, and 6 cases of infiltrating the surrounding fat space. After contrast enhancement, all cases showed mild and moderate enhancement, including 4 cases with homogeneous enhancement and 8 cases with heterogeneous enhancement. After contrast enhancement, the mean CT value was (55±7.7) HU. There were 9 cases with mild enhancement and 3 cases with moderate enhancement. There were 3 cases with small linear abnormally enhanced vascular shadow in the tumor, and 4 cases with no enhancement both in the central necrosis and the cystic areas. There were 7 cases of typical carcinoid, 2 cases of atypical carcinoid, 2 cases of small cell carcinoma and 1 case of large cell neuroendocrine carcinoma. Conclusion Primary mediastinal neuroendocrine carcinoma is mainly located in the anterior-mediastinum. When the tumor is large, necrosis, cystic degeneration and invasive growth are easy to occur. The enhanced scan shows mild and moderate enhancement. Combined with clinical history, it can improve the accuracy of diagnosis.