Objective To explore the risk factors of early hypocalcemia after endoscopic thyroidectomy by breast approach(ETBA)and establish a predictive model to evaluate its occurrence risk.Methods A total of 155 patients with thyroid nodules who underwent ETBA were selected.Patients were divided into the low calcium group(＜2 mmol/L,n=41)and the normal group(≥2 mmol/L,n=114)according to the serum calcium level 24 hours after the operation.Before the operation,thyroid function and parathyroid hormone(PTH)were detected,and ultrasound was performed to evaluate cervical lymph node enlargement.Meanwhile,nodule location,maximum tumor diameter,nodule adhesion to the capsule,calcification and the edge of the nodule were also detected.The surgical conditions such as gland resection(unilateral or bilateral),operation time and misresection of parathyroid glands were recorded.PTH and serum calcium were detected 24 hours after the operation.Pathological assessment was used to evaluate benign and malignant conditions,Hashimoto's thyroiditis,multifocal lesions,thyroid capsule invasion and lymph node metastasis.Results Compared with the normal group,the cervical lymph node metastasis,malignant nodules,multifocal lesions,cervical lymph node enlargement,bilateral gland resection,parathyroid gland resection by mistake,combined Hashimoto's thyroiditis,maximum tumor diameter and operation time were increased in the hypocalcemia group,but PTH at 24 hours after the operation was decreased(P＜0.05).Multivariate Logistic regression analysis showed that cervical lymph node metastasis,long operation time,parathyroid resection by mistake,combined Hashimoto's thyroiditis and maximum tumor diameter were independent risk factors for early hypocalcemia in ETBA.Based on this,a visual nomogram model was constructed,with excellent discrimination[the area under the receiver operating characteristic(ROC)curve was 0.920(95%CI:0.834-0.971)],and the calibration curve showed that the predicted values were highly consistent with the measured values(Hosmer-Lemeshow χ2=0.007,P=0.087).Conclusion The nomogram model constructed based on multivariate Logistic regression can effectively predict the risk of early hypocalcemia after ETBA.

Objective To explore the risk factors of early hypocalcemia after endoscopic thyroidectomy by breast approach(ETBA)and establish a predictive model to evaluate its occurrence risk.Methods A total of 155 patients with thyroid nodules who underwent ETBA were selected.Patients were divided into the low calcium group(＜2 mmol/L,n=41)and the normal group(≥2 mmol/L,n=114)according to the serum calcium level 24 hours after the operation.Before the operation,thyroid function and parathyroid hormone(PTH)were detected,and ultrasound was performed to evaluate cervical lymph node enlargement.Meanwhile,nodule location,maximum tumor diameter,nodule adhesion to the capsule,calcification and the edge of the nodule were also detected.The surgical conditions such as gland resection(unilateral or bilateral),operation time and misresection of parathyroid glands were recorded.PTH and serum calcium were detected 24 hours after the operation.Pathological assessment was used to evaluate benign and malignant conditions,Hashimoto's thyroiditis,multifocal lesions,thyroid capsule invasion and lymph node metastasis.Results Compared with the normal group,the cervical lymph node metastasis,malignant nodules,multifocal lesions,cervical lymph node enlargement,bilateral gland resection,parathyroid gland resection by mistake,combined Hashimoto's thyroiditis,maximum tumor diameter and operation time were increased in the hypocalcemia group,but PTH at 24 hours after the operation was decreased(P＜0.05).Multivariate Logistic regression analysis showed that cervical lymph node metastasis,long operation time,parathyroid resection by mistake,combined Hashimoto's thyroiditis and maximum tumor diameter were independent risk factors for early hypocalcemia in ETBA.Based on this,a visual nomogram model was constructed,with excellent discrimination[the area under the receiver operating characteristic(ROC)curve was 0.920(95%CI:0.834-0.971)],and the calibration curve showed that the predicted values were highly consistent with the measured values(Hosmer-Lemeshow χ2=0.007,P=0.087).Conclusion The nomogram model constructed based on multivariate Logistic regression can effectively predict the risk of early hypocalcemia after ETBA.

Objective:To investigate the ultrasonographic features of internal jugular venous vein pseudo-aneurysm.Methods:The ultrasonographic and clinical features of a patient with internal jugular venous vein pseudo-aneurysm in Union Hospital Affiliated to Huazhong University of Science and Technology were retrospectively analyzed. These characteristics of this patient combined with cases from literatures were summarized.Results:Ultrasound showed that the 38.6 mm×14.0 mm×29.9 mm anechoic area in the soft tissue layer of the left neck communicated with the left internal jugular vein through the 3.8 mm wide breach, and a 12.9 mm×6.6 mm slightly hyperechoic mass was found in the anechoic area. Color Doppler flow imaging showed that the internal jugular vein communicated with the anechoic area through the crevasse. There was no obvious blood flow signal in slightly hyperechoic mass. The bidirectional burr-like blood flow signal could be detected by pulse-wave Doppler. Contrast enhanced ultrasound showed that the contrast agent flowed into the mass from the internal jugular vein through the breach, and the slightly hyperechoic mass appeared the contrast filling defect, and contrast agent was well filled in the rest of the anechoic area. Ultrasound diagnosis: left internal jugular vein pseudoaneurysm with thrombosis. 35 cases of cervical vein pseudo-aneurysm patients were finally included in 23 documents, including 12 males, 23 females, 15 cases on the left side, 20 cases on the right side, 6 cases of the internal jugular vein, 27 cases of the external jugular vein; one case only describes the neck veins and supraclavicular vein in another one case. Among them, 34 cases showed subcutaneous anechoic masses on ultrasound, 1 case showed slightly hyperechoic masses, and 35 cases showed venous wall breaches.Conclusions:Ultrasound examination has high diagnostic value for vein pseudo-aneurysm owing to its convenience, fast and serial observation. Therefore, it is the preferred method and can be widely used in clinical practice. Contrast-enhanced ultrasound can clearly show the blood perfusion, and help to improve the diagnostic confidence of the operator.

OBJECTIVETo evaluate the role of methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms and plasma homocysteine levels in patients with type 2 diabetes mellitus and diabetic retinopathy (DR).

METHODSTotal of 208 patients with type 2 diabetes mellitus and 57 controls were recruited into the study. MTHFR genetic C677T polymorphisms were determined by PCR-RFLP. Plasma total homocysteine levels were measured using high-performance liquid chromatography (HPLC) with fluorescence detection.

RESULTSThe frequencies of MTHFR TT homogeneous type, CT heterogeneous type and allele T (28.18%, 41.82%, 49.09%) were significantly higher in the type 2 diabetes mellitus with diabetic retinopathy group than those without retinopathy (18.37%, 29.59%, 33.16%) and those of controls (17.54%, 28.07%, 31.58%). The presence of the T allele appeared to have a strong association with the development of diabetic retinopathy. The odds ratio was 1.94 with a 95% confidence interval of 1.31 - 2.88. Moreover, plasma homocysteine levels were remarkably higher in patients with TT or CT genotype than in patients with the CC genotype.

CONCLUSIONMTHFR gene C677T mutation associated with a predisposition to increased plasma homocysteine levels may be considered as a genetic risk factor for diabetic microangiopathy (such as DR) in Chinese patients with type 2 diabetes mellitus.

Aged ; Diabetes Mellitus, Type 2 ; complications ; Diabetic Retinopathy ; etiology ; Female ; Genotype ; Homocysteine ; blood ; Humans ; Male ; Methylenetetrahydrofolate Reductase (NADPH2) ; Middle Aged ; Mutation ; Oxidoreductases Acting on CH-NH Group Donors ; genetics ; Polymorphism, Genetic

OBJECTIVETo evaluate the role of methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms and plasma homocysteine levels in Chinese patients with type 2 diabetes mellitus and diabetic retinopathy (DR).

METHODSMTHFR genetic C677T polymorphisms were determined by PCR-restriction fragment length polymorphism. Total plasma homocysteine levels were measured using high-performance liquid chromatography (HPLC) with fluorescence detection.

RESULTSThe frequencies of MTHFR T homogenetic type and CT heterogenetic type and allele T (28.18%, 41.82%, 49.09%) in type 2 diabetic patients with diabetic retinopathy were significantly higher than those in diabetic patients without retinopathy (18.37%,29.59%,33.16%) or the normal controls (17.54%, 28.07%, 31.58%). Howerver, there were no significant differences in the frequency of MTHFR genotype and allele between the type 2 diabetic patients without retinopathy and the normal controls. The presence of T allele appeared to have a strong association with the development of diabetic retinopathy. The odds ratio was 1.94 and the 95% confidence interval was 1.31-2.88. Moreover, the plasma homocysteine levels in patients with TT or CT genotype were markedly higher than those in patients with CC genotype.

CONCLUSIONMTHFR gene C677T mutation associated with a predisposition to increase of plasma homocysteine may represent a genetic risk factor for diabetic retinopathy in Chinese type 2 diabetes mellitus.

Adult ; Alleles ; DNA ; genetics ; metabolism ; Deoxyribonucleases, Type II Site-Specific ; metabolism ; Diabetes Mellitus, Type 2 ; blood ; complications ; genetics ; Diabetic Retinopathy ; blood ; etiology ; genetics ; Female ; Gene Frequency ; Genotype ; Homocysteine ; blood ; Humans ; Male ; Methylenetetrahydrofolate Reductase (NADPH2) ; Middle Aged ; Oxidoreductases Acting on CH-NH Group Donors ; genetics ; Point Mutation ; Polymorphism, Genetic

OBJECTIVETo evaluate the role of polymorphism in the neurogenic differentiation factor 1(Neuro D) gene in Chinese patients with type 2 diabetes mellitus.

METHODSThe genotypes of codon 45 variant (GCC-->ACC) in the Neuro D gene were determined by mismatch PCR-restriction fragment length polymorphism assay in 448 Chinese, including 124 subjects with normal glucose tolerance and 324 patients with type 2 diabetes mellitus. The diabetic patients were divided into two groups cutting off with the age of 40 at onset.

RESULTSNo homozygote of the Ala45Thr variant was found in these subjects. The frequencies of AT heterozygous type were significantly higher in early-onset type 2 diabetic group than those in the control group and in the late-onset type 2 diabetic group (chi(2)=7.85, P=0.005; chi(2)=8.81, P=0.003). The frequencies of Thr45 allele in the early-onset type 2 diabetic group were significantly different from those of the control group (13.4% vs 5.2%, chi(2)=7.15, P=0.008) and the late-onset type 2 diabetic group (13.4% vs 5.8%, chi(2)=8.13, P=0.004). The presence of Thr45 allele was shown to have an association with early-onset type 2 diabetes (OR=2.52, 95% CI: 1.42-4.49). Furthermore, the subjects carrying the variant appeared to have lower serum concentration of C-peptide in diabetic group. However, the frequencies of polymorphism genotypes of Neuro D gene showed no difference between the late-onset type 2 diabetic group and the control group.

CONCLUSIONThe genetic polymorphism in the Neuro D is associated with the development of early-onset type 2 diabetes. The presence of Thr45 allele may represent a risk factor for early-onset type 2 diabetes among Chinese.

Alleles ; Basic Helix-Loop-Helix Transcription Factors ; DNA ; genetics ; metabolism ; DNA Restriction Enzymes ; metabolism ; DNA-Binding Proteins ; genetics ; Diabetes Mellitus, Type 2 ; genetics ; Female ; Gene Frequency ; Genotype ; Humans ; Male ; Middle Aged ; Mutation, Missense ; Polymorphism, Genetic ; Trans-Activators ; genetics