Background and purpose:Carcinoembryonic antigen(CEA) is mainly used in post-surveillance of colorectal cancer(CRC). Recently, bile CEA assay was reported to be of value in the diagnosis of OHM(occult hepatic metastasis) in CRC. We measured CEA levels in both peripheral vein and bile from patients with CRC to evaluate the change of bile CEA levels in patients with CRC and its relation to liver metastasis (LM). Methods:Three groups were enrolled in our study. Primary CRC Group: 27 patients with CRC but without LM; LM Group: 14 patients with LM from CRC; Control Group: 20 patients with benign biliary diseases (cholelithiasis or cholecystitis). Both serum and bile were collected to measure CEA levels in all groups but only bile CEA was measured in control group. Results:Bile CEA level in control group, primary CRC group and LM group were 1.73 ng/ml,13.7 ng/ml and314.27 ng/ml respectively, (P

Objective To study the relationship between expression of multidrug resistant 1 ( MDR1) gene encoded P-glycoprotein ( P-gp) and multidrug resistance relation protein ( MRP) in ulcerative colitis and the disease behavior. Methods Sections of endoscopic biopsy samples from patients with ulcerative colitis were studied by immunohistochemistry with monoclonal antibody of MDR1 gene encoded P-gp and MRP. Results Expressions of MDR1 gene encoded P-gp and MRP in the 12th month and 18th month of ulcerative colitis were 40. 5% , 45.9% , 48. 6% and 51.4% , respectively, which were all significantly higher than those of early phase ( P < 0.05). P-gp and MRP expressions in active stage and remission stage of ulcerative colitis were 36.4% , 18. 6% , 46. 1% and 25.4% , respectively, which was significantly different between the two stages (P < 0.05 ). At active stage of ulcerative colitis there was no significant difference in expressions of P-gp and MRP among mild, moderate and severe patients (P > 0. 05 ). Conclusion Examination of P-gp and MRP expressions is feasible and dependable in presenting evidence of drug insistence. However, it is not suitable to be an indicator of severity because of its poor differentiation ability in active stage.

Objective To evaluate the prevalence and clinical significance of IgG,IgA and IgM isotypes of anti-peptidylarginine deiminase 4 (anti-PAD4) antibodies in early rheumatoid arthritis (RA).Methods IgG,IgA and IgM isotypes of anti-PAD4 antibodies were measured in the sera of 88 RA patients with disease duration less than 2 years,62 patients with other rheumatic diseases and 57 healthy subjects.The diagnostic performance of IgG,IgA and IgM isotypes of anti-PAD4 antibodies and their relationship with disease duration,DAS28,ESR,CRP,anti-CCP antibodies and rheumatoid factor (RF) were evaluated.Data analysis were performed using t test,U test and Spearman's association analysis.Results ① The sensitivities of IgG,IgA,and IgM isotypes for early RA were 28.41％,36.36％ and 9.09％ respectively.The specificities of IgG,IgA and IgM isotypes were 94.12％,93.28％ and 95.80％ respectively.② IgA isotype was positively correlated with age (r=0.234,P=0.028),DAS28 (r=0.309,P=0.007),ESR (r=0.382,P=0.000) and CRP (r=0.291,P=0.008),while negatively correlated with disease duration (r=-0.295,P=0.006).③ IgA isotype was positively correlated with IgG isotype (r=0.451,P＜0.01).In the IgG negative patients,the positivity of IgA isotype was 29％(18/63),which indicated that the IgA isotype might be helpful in diagnosing RA in IgG isotype negative patients.Conclusion Anti-PAD4 antibodies can be detected in early RA,primarily with IgA and IgG isotypes.IgA isotype has negative correlation with disease duration,indicating that IgA isotype of anti-PAD4 antibody may play a role in the very early stage RA.

Objective To describe the pathological unit and octagonal en bloc resection for the treatment of ossification ligamentum flavum(OLF)in thoracic spine with spondylotic myelopathy.Methods Ninety-five patients from January 2002 to January 2007 were diagnosed as thoracic OLF,61 males and 34 females with an average age of 53.9 years(range,31-78 years).There were upper thoracic spine OLF in 32 cases,middle thoracic spine OLF in 24 cases and lower thoracic spine OLF in 39 cases.Single-segment OLF was found in 53 cases,double segments OLF was found in 38 cases and three segments OLF was found in 4 cases.CT scan multiplanar co-localized reconstruction was employed to detect the structure of spine with OLF.The Japanese Orthopaedic Association(JOA)lower limb motor function score,sphincter function score and motor function improvement rate were used to evaluate the outcomes.Results CT scan was engaged to observe 141 OLF pathological unite.The OLF pathology unit was defined as all the spine structures between the extension lines of the lower margin of the OLF two adjacent pedicles.Each OLF associates with an OLF pathology unit.The mean follow up duration was 38.3 months(range,24-60 months).Among 86 patients with sensations disturbance before operation,67 totally recovered and 19 relieved after operation.Trunk restrictions in 69 cases before operation were completely recovered after operation.Postoperative JOA sphincter function score was 2.651±0.334,comparing with preoperation score(2.262±0.561),and the difference was statistically significant.Postoperative JOA motor function score was 3.694±0.429,which was significantly increased than preoperative score 1.539±0.873,and motor function recovery rate was 87.57%.There was excellent in 71 cases,good in 17 cases and fair in 5 cases.The excellent and good rate was 94.74%.Conclusion The octagonal en block resection is relative safe for treatment thoracic OLF with myelopathy.Pathological unit of OLF in thoracic spine is more accurate to summarize the pathological contents and features of the OLF and its adjacent structure.

Objective To analyze the changes of varicosis and hemodynamics in cirrhotic patients with portal vein hypertension at different stages after Hassab devascularization, and to evaluate the outcome.Methods Hassab devascularization was performed in 161 patients with portal vein hypertension, who were all evaluated by means of endoscopy, Doppler color imaging and Child-Pugh grading before and 6, 12, 18,24 months after the procedure, respectively.Results The rates of mild esophageal varicosis were 44.0%,34.8% and 28.3% at 6, 12 and 18 months after Hassab devascularization, respectively, which were all significantly higher than that before the operation(7.5%, P ＜ 0.05), while the rates of severe esophageal varicosis were 25.2%, 29.7% and 34.9% at 6, 12 and 18 months after the procedure, which were significantly lower than that before(65.2%, P ＜ 0.05).The incidence of varices in gastric fundus was correlated with the severity of esophageal varices.At 12 months after the operation, the inner diameters of portal vein and its right branch significantly decreased when compared with those before(P ＜ 0.05), the maximal flow rate,volume of portal vein and average flow rate of the left branch also significantly decreased(P ＜ 0.05).At 6 months after the operation, the average flow rate of the right branch slowed down(P ＜ 0.05).Child-Pugh Grade A accounted for 63.5%, 60.6% and 57.9% at 6, 12 and 18 months after the operation, respectively, which were significantly higher than that before(48.4%, P ＜0.05).When evaluated at 24 months after the procedure, all variables were getting close to those before.Conclusion The severity of esophageal varices mitigates in 18 months after Hassab.Hemodynamics of portal vein system decreases in 12 months.The overall liver function improves in 18 months after the operation.

Objective To evaluate the prevalence and clinical values of anti-cyclic citrullinated peptide (anti-CCP) antibodies of IgG,IgA and IgM subtypes in individuals with early rheumatoid arthritis (RA).Methods IgG,IgA and IgM subtypes of anti-CCP antibodies were measured in the sera of 87 RA patients with disease duration shorter than 2 years,61 patients with other rheumatic diseases and 49 healthy subjects.We analyzed the diagnostic value of IgG,IgA and IgM subtypes of anti-CCP antibodies and their relationship with disease duration,DAS28,ESR,CRP,and rheumatoid factor (RF).Chi-square test,t test and Spearman's correlation analysis were used for statistical analysis.Results ① The diagnostic sensitivity of IgG,and IgA subtype for early RA was 75.9％ and 67.8％ respectively,which was higher than IgM subtype (14％,P＜0.01 each).The specificity of IgG,IgA and IgM subtype was 96.4％,91.8％ and 93.6％ respectively.② IgG and IgA subtypes were correlated with CRP (r=0.278,P=0.01； r=0.217,P=0.047) and RF (r=0.430,P=0.000； r=0.271,P=0.012),while IgM subtype was positively correlated with disease duration (r=0.279,P=0.014).③ Patients who had IgG-and IgA subtype had a shorter disease course (3.3±2.3) than those patients who had IgA-and IgG+ (9.5±8.4) and who had IgG+ and IgA+ (8.2±7.0) (P＜0.05).④ IgA subtype was positive in 19.0％ of the IgG negative patients.When combining IgG,and antibodies of IgA subtypes together,the sensitivity and specificity was 63.2％ and 100％,while the sensitivity and specificity was 80.5％ and 85.2％ when either one was positive.Conclusion Both the IgG,and IgA subtypes of anti-CCP antibodies have a good sensitivity for early RA.They are related to disease activity.Measuring IgA subtype of anti-CCP antibody in RA patients with negative IgG subtype may help to identify early RA.IgA subtype of anti-CCP antibody may play a role in very early RA.

Objective To detect v raf murine sarcoma viral oncogene homologue B1 (BRAF) in the synovial fluid of rheumatoid arthritis (RA) and to investigate its clinical significance in RA.Methods Synovial fluid samples were obtained from patients with RA and osteoarthritis (OA).Serum samples were obtained from patients with RA,OA and heathy controls.The presence of BRAF in the synovial fluid and sera were examined by enzyme-linked immunosorbent assay (ELISA).Western blotting was used to detect the expression of BRAF protein in the synovial tissue of RA and OA.The associations between the BRAF and the clinical features and laboratory parameters of RA were evaluated.Data analysis were performed using t test and Spearman's association analysis.Results ① The level of BRAF in the synovial fluid of RA [(84±59) ng/ml] was significantly higher than OA [(38±41) ng/ml] (t=3.290,P=0.002).② The level of BRAF in the sera of RA patients [(22.0±12.5) ng/ml] was also higher than OA [(6.8±7.5) ng/ml,t=3.882,P＜0.01] and healthy controls [(4.8±2.2) ng/ml,t=6.766,P＜0.01].③ In RA patients,the BRAF protein level in the synovial fluid [(102±52) ng/ml] was significantly higher than that in the serum [(21±12) ng/ml] (t=-4.316,P=0.003).④The expression level of BRAF in the synovial tissue of RA (0.284±0.045) was higher than that in OA patients (0.191±0.013,t=3.169,P=0.034).⑤ The level of BRAF in the synovial fluid had a negative correlation with disease duration (r=-0.40,P=0.019) and a positive correlation with rheumatoid factor (RF) levels (r=0.37,P=0.03).Conclusion The presence of BRAF in the synovial fluid and synovium of RA indicates that BRAF may play a role in the pathogenesis of RA,especially in the early stage.

Objective To detect the mutations of RET proto-oncogene in patients with medullary thyroid carcinoma (MTC). Methods Twelve patients with MTC confirmed by pathology and two clinically suspected patients were recruited. Total genomic DNA was extracted from peripheral blood for PCR. PCR products of exon 10, exon 11 and exon 16 of the RET proto-oncogene were purified and direct gene sequencing was performed. Results The genomic mutations were detected in 8 patients, in which direct gene sequencing analysis detected a mutation of TGC to CGC at codon 618 in exon 10 in 1 patient, a mutation of TGC to TAC at codon 634 in exon 11 in 2 cases, a mutation of TGC to CGC at codon 634 in exon 11 in 3 patients and a mutation of ATG to ACG at codon 918 in exon 16 in the remaiming 2 cases. Conclusion MTC can be diagnosed at gene level by direct gene sequencing analysis. It is possible to diagnose MTC before operation by means of molecular genetic analysis.

Objective To explore the correlation between the level of glucagon like peptide-1 (GLP-1) and the extent of coronary lesions in coronary heart disease (CHD).Methods One hundred and ninety-two CHD patients included in the study were divided into simple CHD group (n =60),CHD accompanied with impaired glucose tolerance(IGT) group (n =67),and CHD accompanied with type 2 diabetes mellitus (T2DM) group (n =65).48subjects were used as controls.The levels of GLP-1 in all the patients were analyzed by ELISA.Oral glucose tolerance test (OGTF) was performed.Blood glucose,insulin,and C-peptide levels were measured.The area under curves of insulin(AUCINS),C-peptide (AUCC-P),glucose (AUCGlu),and GLP-1 (AUCGLP-1) were calculated.All the patients underwent coronary angiography and the extent of coronary lesions was analyzed by total amount of coronary narrow degree integral.The association of GLP-1 level with coronary narrow degree was analyzed by correlation analysis and multivariate linear stepwise regression analysis.Results The levels of blood glucose and AUCGlu during OGTT in CHD accompanied with T2DM group were significantly higher than those in CHD with IGT group (P＜0.01),while the levels of insulin and C-peptide,AUCINS,and AUCC-P were decreased (P＜0.05).The levels of blood glucose,insulin,C-peptide,AUCGlu,AUCINs,and AUCC-P in CHD accompanied with IGT group were significantly higher than those in control group and simple CHD group (P＜0.01).Compared with simple CHD group and CHD accompanied with IGT group,GLP-1 level in CHD accompanied with T2DM group was markedly decreased(P＜0.01) while coronary artery narrow degree was raised(P＜ 0.05).Compared with simple CHD group,CHD accompanied with IGT group showed lower GLP-1 level and higher coronary artery narrow degree(P＜0.01).Correlation analysis revealed that GLP-1 level was negatively correlated with the coronary artery narrow degree in CHD patients (P ＜ 0.01).Multivariate linear regression analysis showed that systolic blood pressure,high density lipoprotein-cholesterol,fasting C-peptide and GLP-1 had a predictive effect on the coronary narrow degree integral in CHD patients.Conclusion The level of GLP-1 is closely correlated with the coronary artery narrow degree in CHD patients,especially in patients accompanied by hyperglycemia.

Objective:To explore the value of blood lipids, serum interleukin-6 (IL-6) and thyroid-stimulating hormone (TSH) detection in patients with differentiated thyroid cancer.Methods:From Mar. 2016 to Oct. 2021, 120 cases of DTC were admitted to the DTC group, 138 patients with benign thyroid nodules were included in the benign group, and 100 healthy people undergoing the physical examination in our hospital during the same period. were enrolled in the control group. Triglyceride (TG) , total cholesterol (TC) , high density liptein cholesterol (HDL-C) , low density lipoprotein (LDL-C) , IL-6, and TSH were compared between groups, and statistically significant indexes were included for multivariate analysis of the occurrence of DTC. The sensitivity, specificity and optimal cut-off value were analyzed, and their relationship with the clinicopathological characteristics of DTC patients was analyzed.Results:Serum TSH and IL-6 levels from high to low were malignant group, benign group and control group, and HDL-C levels from high to low were control group, benign group and malignant group ( P<0.05) . There was no significant difference in the levels of TC, TG or LDL-C ( P>0.05) . Multivariate Llogistics regression analysis indicated that TSH and IL-6 may be risk factors for the occurrence of differentiated thyroid cancer (all OR>1, P<0.05) . HDL-C may be a protective factor for the occurrence of differentiated thyroid cancer ( OR<1, P<0.05) . The ROC curve was drawn to determine the optimal cut-off value of TSH for the diagnosis of differentiated thyroid cancer, AUC: 0.985, sensitivity was 93.25%, specificity was 96.34%, 95% CI: 0.949-1.000 ( P<0.001) ; the best cut-off value of IL-6 for the diagnosis of differentiated thyroid cancer was 48.96 ng/L, AUC: 0.980, sensitivity was 96.98%, the specificity was 91.53%, 95%CI: 0.956-1.000 ( P<0.05) ; the best cut-off value of HDL-C for the diagnosis of differentiated thyroid cancer was 1.441 mmol/L, AUC: 0.0.691, the sensitivity was 85.10%, the specificity was 48.06%, 95%CI: 0.563-0.812 ( P<0.05) . The serum levels of TSH and IL-6 in patients with lymph node metastasis were significantly higher than those in patients without lymph node metastasis, and the level of HDL-C was significantly lower than those in patients without lymph node metastasis ( P<0.05) . TNM staging The serum levels of TSH and IL-6 in patients with stage III and IV were significantly higher than those in patients with stage I and II, and HDL-C was significantly lower than that in patients with stage I and II ( P<0.05) . Conclusions:Serum IL-6, TSH and HDL-C are closely related to the occurrence of differentiated thyroid cancer. The detection of serum IL-6, TSH and HDL-C is helpful for the differentiation of benign and malignant thyroid nodules. The presence or absence of lymph node metastasis in patients with differentiated thyroid cancer is related to TNM staging, and the detection value is high.