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OBJECTIVES This study aimed to indicate the risk factors of atrial fibrillation (AF) in thyrotoxic patients receiving radioactive iodine (RAI) therapy after antithyroid drug and other medication. METHODS This study was a retrospective cohort study. Thyrotoxic patients were divided into two groups, with or without AF. Clinical features were retrospectively analyzed. Univariate and multivariate analyses of data from thyrotoxic patients were performed to evaluate the probability of AF. RESULTS The following clinical factors were found to be correlated with AF: age, gender, duration of hyperthyroidism, coronary artery disease, hypertension, and levels of platelets, creatinine, uric acid (UA), and certain liver enzymes. According to the multiple logistic regression model, age and levels of UA, direct bilirubin (DBIL), and gamma-glutamyl transpeptidase (GGT) were important risk factors for predicting AF. ROC analysis showed that DBIL levels were predictive of AF, with a specificity of 0.813, a sensitivity of 0.767, and an area under the curve of 0.8515 (P < 0.001). CONCLUSION Older age and levels of UA, DBIL, and GGT influenced the occurrence of AF in thyrotoxic patients receiving RAI. DBIL level was an important factor in predicting AF in patients with hyperthyroidism. Thus, thyrotoxic patients who have the above-mentioned risk factors should undergo routine pulse palpation should be considered for active antithyroid drug therapy.

BackgroundThere are no definite recommendations on the optimal time of initiating radioactive iodine (RAI) therapy for differentiated thyroid cancer (DTC) patients in current relevant guidelines. This study aimed to investigate the relationship between the timing of initiating radioiodine adjuvant therapy (RAT) and the clinical outcomes based on dynamic follow-ups and assessments in intermediate- to high-risk DTC patients.MethodsA total of 206 patients with intermediate- to high-risk DTC receiving RAT of 150 mCi were retrospectively reviewed. According to the time interval (TI: between thyroidectomy and initial RAT), the patients were divided into 2 groups: Group 1: TI < 3 months (n=148), and Group 2: TI ≥ 3 months (n=58). The RAT therapy response was evaluated as excellent response (ER), indeterminate response (IDR), biochemical incomplete response (BIR), structural incomplete response (SIR). The univariate and multivariate analyses were conducted to screen out factors associated with incomplete response (IR= BIR+SIR). Finally, the prognostic nomogram was used to explain IR rates as a valuable tool in clinical practice.ResultsResponse to initial RAT was significantly different between 2 groups during dynamic follow-ups (all Pvs 63.5, 52.0 vs 73.9, 64.4 vs 80.3, all Pvs 14.9, 36.0 vs 9.7, 12.2 vs 3.9, all PP=0.001), soft tissue invasion (HR: 7.35, 95%CI: 1.624-33.296, P=0.010), higher sTg (HR: 7.21, 95%CI: 1.991-26.075, P=0.003) were manifested to be independent risk factors for IR. The nomogram showed that soft tissue invasion, sTg, and TI were the top 3 contributors to the IR.ConclusionsEarly RAT is associated with greater biochemical response but has no impact on SIR. Delayed initial RAT (≥3 months after thyroidectomy) related to IR in intermediate- to high-risk DTC.

BackgroundSerum thyroglobulin (Tg) serves as a sensitive and easily available tumor marker for patients with metastatic differentiated thyroid carcinoma (m-DTC). The aim of the present study was to evaluate the predictive value of suppressed Tg changes (Δsup-Tg) and/or stimulated Tg changes (Δsti-Tg) to evaluate the efficacy of radioiodine therapy (RT).MethodsWe studied 117 patients with m-DTC who received RT. Δsup-Tg and Δsti-Tg were compared after the first RT in different therapeutic response groups and a receiver-operating characteristic (ROC) curve was used to determine the cut-off values to predict non-remission. Univariate and multivariate analyses were used to investigate the effects of 17 observed factors on the efficacy of RT.ResultsA total of 218 RT events in 117 patients with m-DTC were analyzed. After the last RT, the remission rate was 70.94% (83/117), and the proportion of remission events accounted for 74.77% (163/218). ROC curve analysis showed that the cut-off values for Δsup-Tg and Δsti-Tg after the first RT to predict the non-remission of RT were 21.54% and 27.63%, respectively. Age, the size of the metastasis, the maximum count of target metastatic lesions and the average count of contralateral non-target tissue on tomographic imaging (Tmax/NTmean) of the first RT, and Δsup-Tg after the first RT were identified as independent factors associated with RT efficacy.ConclusionsTg response was valuable to predict RT efficacy for patients with m-DTC. Age, the size of the metastasis, Tmax/NTmean, and Δsup-Tg after the first RT were verified as independent predictive factors of RT efficacy.

Janus kinases (JAKs) are intracellular tyrosine kinases which play a key role in the signal pathways of many cytokines, such as type l interferons (IFNs), interleukin-6 (IL-6), IL-12 and IL-23.1 All these cytokines participate in the pathogenesis of systemic lupus erythematosus (SLE). Hence, inhibition of JAK signals has provided an attractive therapeutic option in SLE. Tofacitinib can inhibit JAK1/JAK3 and has been proved effective in rheumatoid arthritis (RA),2 psoriatic arthritis and ulcerative colitis. Evidence in murine lupus have shown that tofacitinib can decrease the levels of anti-double-stranded (ds) DNA and proteinuria, remit nephritis and skin rash.3 A case report proved that tofacitinib could decrease anti-dsDNA levels in inactive SLE complicated by RA.4 A phase II randomised controlled trial reported modest efficacy of a JAK1/2 inhibitor, baricitinib, in ameliorating lupus arthritis.5 To better understand the efficacy of tofacitinib in SLE, we describe, to our knowledge for the first time, the efficacy of tofacitinib 5 mg …

Rapid iodine-131(131I) turnover in the thyroid gland is an important feature of Graves’ disease (GD) and also a strong predictor of radioiodine therapy failure. The aim of this study was to explore the predictors of rapid 131I turnover. The clinical data on 2543 patients were retrospectively reviewed. Patients were divided into 2 groups depending on present or absent with rapid 131I turnover defined as a 4-hour to 24-hour 131I uptake ratio of ≥1. Overall, 590 cases (23.2%) had a rapid 131I turnover. In the univariate analysis, gender, age, FT3/FT4 concentration, disease duration, with or without antithyroid drugs (ATD), time of ATD, thyroid weight and thyroid textures displayed significant differences. Cutoff values of age, FT3 and thyroid weight to predict rapid 131I turnover were 38 years, 35 pmol/l and 56 g by receiver operating characteristic curves. Binary logistic regression analysis further revealed higher probability of rapid 131I turnover in patients with thyroid weight ≥56 g (odds ratio [OR]:3.7, 95% confidence interval [CI]: 3.032–4.559), age 3 concentration ≥35 pmol/l (OR:7.6, 95%CI: 5.857–8.563) and females (OR:2.2, 95%CI: 1.757–2.791). In conclusion, larger goiters, younger age, higher FT3 concentration and females are independently associated with rapid 131I turnover in GD patients.

Background Understanding the molecular mechanisms represents an important step in the development of diagnostic and therapeutic measures of esophagus adenocarcinoma (NOS). The objective of this study is to identify the epigenetic regulation on gene expression in NOS, shedding light on the molecular mechanisms of NOS. Methods In this study, 78 patients with NOS were included and the data of mRNA, miRNA and DNA methylation of were downloaded from The Cancer Genome Atlas (TCGA). Differential analysis between NOS and controls was performed in terms of gene expression, miRNA expression, and DNA methylation. Bioinformatic analysis was followed to explore the regulation mechanisms of miRNA and DNA methylationon gene expression. Results Totally, up to 1320 differentially expressed genes (DEGs) and 32 differentially expressed miRNAs were identified. 240 DEGs that were not only the target genes but also negatively correlated with the screened differentially expressed miRNAs. 101 DEGs were found to be highlymethylated in CpG islands. Then, 8 differentially methylated genes (DMGs) were selected, which showed down-regulated expression in NOS. Among of these genes, 6 genes including ADHFE1, DPP6, GRIA4, CNKSR2, RPS6KA6 and ZNF135 were target genes of differentially expressed miRNAs (hsa-mir-335, hsa-mir-18a, hsa-mir-93, hsa-mir-106b and hsa-mir-21). Conclusions The identified altered miRNA, genes and DNA methylation site may be applied as biomarkers for diagnosis and prognosis of NOS.

BACKGROUND Although radioiodine therapy (RIT) efficacy is thoroughly validated for Graves disease (GD), there is a lack of research on the predictive factors of RIT, especially the optimal thyroid-absorbed dose (TD) with a shorter effective half-life (Teff ≤5 days). The goal of this study was to explore the predictive value of TD in GD patients receiving RIT with a shorter Teff. MATERIAL AND METHODS We studied 208 GD patients receiving RIT with a shorter Teff. Plotting the receiver-operating characteristic (ROC) curve verified the accuracy of TD for predicting RIT efficacy in GD patients. In addition, we conducted univariate and multivariate analyses to investigate the influence of 14 factors, including thyroid weight, TD, 24-h radioiodine uptake rate (RAIU), the highest RAIU, thyrotrophin receptor antibody level, thyroglobulin antibody level, thyroid peroxidase antibody level, and others, on curative effects of RIT. RESULTS Of the 208 study participants, complete remission and the total effectiveness rates were 68.3% and 92.3%, respectively. The threshold value of TD to predict RIT efficacy was 70.2 Gy, based on ROC analysis. Univariate analysis showed that 24-h RAIU, Teff, total iodine dose, iodine dose per gram of thyroid tissue, TD, and thyrotropin receptor antibody level were significantly associated with RIT efficacy. Multivariate analysis indicated that 24-h RAIU, total iodine dose, iodine dose per gram of thyroid tissue, and TD were significant independent predictors of RIT efficacy. CONCLUSIONS Predicting RIT efficacy from TD with a shorter Teff was feasible in GD patients, and TD above 70.2 Gy had an especially high predictive accuracy.

Overt hypothyroidism and hyperthyroidism can lead to hyperuricemia. However, few data are available regarding the association between subclinical thyroid dysfunction and hyperuricemia, especially from the perspective of gender impact. This study aimed to investigate the association between subclinical thyroid disorders and hyperuricemia with emphasized focuses on differences resulting from different gender. Eleven thousand four hundred forty-six healthy subjects (6870 male, 4576 female) were enrolled in this cross-sectional study, with exclusions of known thyroid, renal, hepatic, gastrointestinal, or oncological diseases. Clinical data including anthropometric measurements, thyroid function, uric acid, renal and liver function were collected. The associations between thyroid function and hyperuricemia of males and females were analyzed separately. Prevalence of hyperuricemia was substantially higher in male (23.17%) than that in female (9.11%). Serum uric acid was correlated well with various factors, especially with creatinine, whose coefficients were 0.283 and 0.386 for males and females. The significantly elevated risk for hyperuricemia was observed in mild hypothyroidism male participants with an odd ratio of 1.49 (1.10-2.02), whereas no statistical risk was found in female. No meaningful risk was found in mild hyperthyroidism participants. Estimated glomerular filtration rate was significantly depressed in both genders with mild hypothyroidism, while obviously increased in both genders with mild hyperthyroidism. For hyperuricemia, mild hypothyroidism is a risk factor in males while it is not in females. This difference could be caused by the protective effect of estrogen in females. Monitoring serum uric acid in subclinical hypothyroidism is more necessary in males.

OBJECTIVES This study aimed to examine the radioprotective effect of vitamin E on salivary glands after radioactive iodine (I) therapy in patients with differentiated thyroid cancer. PATIENTS AND METHODS Eighty-two patients with differentiated thyroid cancer were enrolled in this study. They were divided randomly into four groups (control group: 22 cases, group A: 23 cases, group B: 22 cases, and group C: 15 cases) before postsurgical ablation therapy with 100 mCi I. The patients in groups A, B, and C received vitamin E 100, 200, and 300 mg/day orally, respectively, for a duration of 1 week before to 4 weeks after I therapy. Salivary gland function was assessed using salivary gland scintigraphy immediately before and 6 months after I therapy. Uptake fraction (UF), uptake index (UI), excretion fraction (EF), and excretion ratio (ER) of each salivary gland were measured and compared. RESULTS On comparison between before and after I therapy in the control group, there was a significant decrease in UF of both right and left parotid glands (all P

The aim of this study was to evaluate the effects of the first radioactive iodine (131I) therapy on functions of salivary glands in patients with differentiated thyroid carcinoma (DTC). There were 36 consented patients with DTC enrolled in this study, who received 3.7 GBq (100mCi) 131I for ablation after total thyroidectomy. Salivary gland function was assessed using salivary gland scintigraphy in two phases, one 4 hours before and the other 6 months after 131I therapy (both under thyrotropin stimulation condition). Quantitative parameters including uptake fraction (UF), uptake index (UI), excretion fraction (EF), and excretion ratio (ER) were measured and compared. Blood parameters were also compared. Associations between sex and outcome of the first 131I therapy as well as individual salivary gland function were measured. Wilcoxon Signed Rank Sum test and χ2 test were used for statistical analysis. When compared between pre-ablation and post-ablation, UF of bilateral parotid and submandibular glands were significantly increased (all P

Serum thyroglobulin (Tg) is the main post-operative tumor biomarker for patients with differentiated thyroid cancer (DTC). However, the presence of thyroglobulin antibodies (TgAb) can interfere with Tg level and invalidate the test. In this study, we aimed to investigate the predicative value of midkine (MK) as a cancer biomarker for DTC patients with positive TgAb before the first 131I therapy. MK levels were measured by enzyme-linked immunosorbent assay in 151 recruited DTC patients after exercising strict inclusion and exclusion criteria. There were 28 TgAb positive DTC patients with metastases and 123 DTC patients without metastases. The value of pre-131I-ablative MK to predict metastasis was assessed by receiver operating characteristic (ROC) curves in these two groups of patients. MK levels in the TgAb positive DTC patients were significantly higher than the DTC patients without metastases. ROC showed good predictability of MK, with an area under the curve of 0.856 (P

Radiation safety is an integral part of targeted radionuclide therapy. The aim of this work was to study the external dose rate and retained body activity as functions of time in differentiated thyroid carcinoma patients receiving 131I therapy. Seventy patients were stratified into two groups: the ablation group (A) and the follow-up group (FU). The patients’ external dose rate was measured, and simultaneously, their retained body radiation activity was monitored at various time points. The equations of the external dose rate and the retained body activity, described as a function of hours post administration, were fitted. Additionally, the release time for patients was calculated. The reduction in activity in the group receiving a second or subsequent treatment was more rapid than the group receiving only the initial treatment. Most important, an expeditious method was established to indirectly evaluate the retained body activity of patients by measuring the external dose rate with a portable radiation survey meter. By this method, the calculated external dose rate limits are 19.2, 8.85, 5.08 and 2.32 μSv·h−1 at 1, 1.5, 2 and 3 m, respectively, according to a patient’s released threshold level of retained body activity &lt, 400 MBq. This study is beneficial for radiation safety decision-making.

The purpose of this study was to systematically provide a database for estimating radiation dose of individuals nearby (131)I-treated hyperthyroid patients. External dose rates were measured on 48 hyperthyroid patients using a survey meter in front of patients' thyroid glands. The initial measurement was recorded within 30 min post radioiodine administration at 0.3 m, 0.6 m, 1 m, and 2 m. Follow-up measurements were carried out up to 12 d post radioiodine administration. In addition, ambient dose rates of different locations such as wards, patients' washrooms, medical staffs' workplaces, and corridors were also measured. The Na131I treatment dose administered in this study ranged from 74-555 MBq. Significant positive correlation between dose rate at 1 m and the administered dose was found in this study. The normalized external dose rates at 0.3 m were 0.234 µSv h(-1) MBq(-1) at 0.5 h, 0.325 µSv h(-1) MBq(-1) at 4 h, 0.308 µSv h(-1) MBq(-1) at 6 h, 0.301 µSv h(-1) MBq(-1) at 24 h, 0.259 µSv h(-1) MBq(-1) at 48 h, 0.234 µSv h(-1) MBq(-1) at 72 h, 0.224 µSv h(-1) MBq(-1) at 96 h, 0.186 µSv h(-1) MBq(-1) at 120 h, and 0.158 µSv h(-1) MBq(-1) at 144 h, respectively. With these results, the authors estimated radioactive radiation dose for the public and medical staffs near (131)I-treated hyperthyroid patients. This study is beneficial for radiation safety decision-making.

131I treatment is an important management method for patients with differentiated thyroid cancer (DTC). Unsuccessful 131I ablation drastically affects the prognosis of the patients. This study aimed to analyze potential predictive factors influencing the achievement of a disease-free status following the first 131I therapy. This retrospective review included 315 DTC patients, and multiple factors were analyzed. Tumor size, pathological tumor stage, lymph node (LN) metastasis, distant metastasis, American Thyroid Association recommended risks, pre-ablation thyroglobulin (Tg), and thyroid stimulating hormone (TSH) displayed significant differences between unsuccessful and successful group. Cutoff values of Tg and TSH to predict a successful outcome were 3.525 ng/mL and 99.700 uIU/ml by receiver operating characteristic curves analysis. Binary logistic regression analysis showed that tumor stage T3 or T4, LN metastasis to N1b station, intermediate and high risks, pre-ablation Tg ≥ 3.525 ng/ml and TSH 1 (LN metastasis) −0.236 X2 (Tg) + 0.015 X3 (TSH). This study demonstrated LN metastasis, pre-ablation Tg and TSH were the most powerful predictors for achieving a disease-free status by the first 131I therapy.

Radioactive iodine (RAI) is considered to be related with hematologic changes. This study aimed to evaluate influence of the first RAI ablation on peripheral complete blood count (CBC) in patients with differentiated thyroid cancer (DTC). Data of CBC at baseline and 6 months after RAI were obtained in 385 patients with DTC with approximately 3700 MBq 131I (ranging 2220–7585 MBq). Further comparison was done in 196 patients with 1-month postablation data available. Routine blood examinations were performed to determine impact of RAI on white blood cell (WBC), red blood cell (RBC), hemoglobin, platelet, neutrophil, lymphocyte, and monocyte in both sexes. Continuous variables were compared by paired t tests and independent samples t test, and categorical variables were compared by chi-square analysis. Data with repeated measurements were analyzed by analysis of variance. The first RAI after thyroidectomy was associated with mild, yet significant declines in WBC, platelet, and lymphocyte, which persisted for 6 months. One month after RAI, significant declines were found in all CBC, including RBC and hemoglobin (all P

Purpose The aim of this study was to investigate the potential link between thyroglobulin antibody (TgAb) titers and papillary thyroid carcinoma (PTC) aggressiveness. Materials and methods This retrospective study included 122 patients who had undergone total thyroidectomy and neck central area lymph dissection followed by radioactive iodine (RAI) ablation for PTC between July 2012 and July 2014. The parameters included clinical characteristics of PTC, TgAb levels and tumor histopathological characteristics. Then, BRAFV600E and NF-κB expression in 113 PTC patients in our hospital were examined by immunohistochemistry. Results and discussion The group of TgAb-positive PTC patients more frequently presented with lymph node metastases (80.0% vs 61.2%, p = 0.000), distant metastases (10.0% vs 1.9%, p = 0.000), more RAI ablation treatments in their treatment history (344.4 ± 88.2 vs 222.5 ± 91.1, p = 0.003) and imaging-documented disease (20.0% vs 7.8%, p = 0.000) after two years’ follow-up. We also found that protein expression levels of BRAFV600E and NF-κB were greater in TgAb-positive patients compared with TgAb-negative PTC patients ( p = 0.005, p = 0.001). Immunoreactivity scores of BRAFV600E and NF-κB in TgAb-positive PTC patients with bilateral tumor foci, lymph node metastases, HT and imaging-documented disease was highest. Multivariate analysis revealed that lymph node metastases significantly correlated with NF-κB levels and TgAb levels (p = 0.004, p = 0.014). Conclusion The expression levels of BRAFV600E and NF-κB were significantly greater in TgAb-positive than in TgAb-negative PTC patients. In PTC, overexpression of NF-κB, as well as positive TgAb, may be a risk factor for cervical lymph node metastasis.

The relationship between thyroid-stimulating hormone (TSH) and hyperlipidemia is still a topic of debate. We aimed to explore the impact of gender and age on the association between serum TSH and lipid profile in a large cohort of Chinese. This cross-sectional study enrolled 13,915 participants (8565 male, 5350 female), who self-reported as healthy without any known previous diseases. Clinical data including anthropometric measurements, thyroid function, and other serum parameters were collected. The associations between TSH and hyperlipidemia of males and females were analyzed separately after dividing TSH and age into subgroups. Odds ratio for hyperlipidemia was calculated by binary logistic regression models. Young males had significantly higher prevalence of hypercholesterolemia, hypertriglyceridemia, and high serum low-density lipoprotein-cholesterol than females, yet after menopause, females had higher prevalence than males. TSH was positively associated with hyperlipidemia independent of thyroid hormones. Males showed more reduced risks of hyperlipidemia in low TSH concentrations, while females demonstrated more enhanced risks of hyperlipidemia in high TSH concentrations. For instance, if TSH was lower than 0.3 μIU/mL, the risks of developing hypercholesterolemia and hypertriglyceridemia in males were only 0.198 (P 0.05), respectively. If TSH was higher than 4.0 μIU/mL, women displayed significantly higher risks of developing hypertriglyceridemia than the reference TSH risks (P

The relationship between thyroid dysfunction and metabolic syndrome (MS) is complex. We aimed to explore the impact of gender and age on their association in a large Chinese cohort. This cross-sectional study enrolled 13,855 participants (8532 male, 5323 female), who self-reported as healthy without any known previous diseases. Clinical data including anthropometric measurements, thyroid function, and serum metabolic parameters were collected. The associations between thyroid function and MS of both genders were analyzed separately after dividing thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and age into subgroups. MS risks were calculated by binary logistic regression models. Young males had significantly higher MS prevalence than females, yet after menopause, females had higher prevalence than males. Females had higher incidence of thyroid dysfunction than males. By using TSH quartiles as the categorical variables and the lowest quartile as reference, significantly increased MS risk was demonstrated in quartile 4 for males, yet quartiles 3 and 4 for females. By using FT3 quartiles as the categorical variables, significantly increased MS risk was demonstrated in quartile 2 to 4 for females only. By using age subgroups as the categorical variables, significantly increased MS risk was shown in both genders, with females (4.408–58.455) higher than males (2.588–4.943). Gender and age had substantial influence on thyroid function and MS. Females with high TSH and high FT3 had higher MS risks than males. Aging was a risk for MS, especially for females. Urgent need is necessary to initiate interventional programs.

Iodine-131 (I-131) treatment and subsequent whole body iodine-131 scans (WBSs) are important in the management of differentiated thyroid carcinoma (DTC). Nevertheless, false positive benign lesions in WBS should be interpreted with reliable anatomic imaging methodologies to differentiate from true metastases. We report a DTC case with a concurrent thyroglossal duct cyst (TDC), which is relatively uncommon compared with an accompanying lingual thyroid. After thyroid remnant ablation, subsequent posttherapeutic WBS showed a stable I-131 avid lesion in the neck despite cumulative dosage of 346 mCi I-131. Low level of thyroglobulin indicated that the lesion should be from thyroid origin, yet only a small amount of thyroid remnant should be contained. Magnetic resonance imaging and computed tomography were performed and revealed a dumbbell-shaped TDC. Part of the lesion was behind the hyoid bone, part of it protruded to the anterior surface of the thyroid cartilage, and the isthmus penetrated through the thyrohyoid membrane. Although the shape of this TDC reflects the route of the thyroglossal duct in embryological perspective, its coincidence with DTC is rarely documented. Our case also proved that the possibility of concurrent TDC should be considered as the cause of residual thyroglobulin for an I-131 avid lesion in the midline anterior cervical area, which could show great resistance to I-131 therapy.

Background Tumor differentiation is an important process in the development of cancer. It is valuable to identify key differentiation related genes in the prognosis and therapy of pancreatic adenocarcinoma. Methods The mRNA expression data were downloaded from the Cancer Genome Atlas database. Then, differentially expressed tumor differentiation related genes were identified. Additionally, Gene Ontology functional categories and Kyoto Encyclopedia of Genes and Genomes biochemical pathway was used to explore the function. In addition, receiver operating characteristic and survival analysis were carried out to assess the diagnosis and prognosis value. Finally, the electronic validation of selected tumor differentiation related genes was performed. Results A total of 932 genes were identified. Among which, 8 genes including JUB, ERLIN1, HMGA2, FAM110B, EGFR, MCM2, TCTA and SSTR1 were differentially expressed in all different tumor differentiation grades. Functional analysis revealed those genes between highly differentiated and other differentiation were remarkably enriched in pancreatic adenocarcinoma and cell cycle pathway. Finally, ERLIN1, HMGA2, FAM110B, EGFR, MCM2, BCL2L1, E2F1 and RAC1 were associated with the survival time of pancreatic adenocarcinoma patient. Among these genes, JUB, ERLIN1, FAM110B, MCM2 and BCL2L1 also had a diagnosis value for pancreatic adenocarcinoma. Additionally, the expression trend of JUB, HMGA2 and MCM2 was increased along with the tumor differentiation grades. And the expression trend of FAM110B was decreased along with the tumor differentiation grades. The electronic validation result was consistent with the bioinformatics analysis. Conclusions 12 tumor differentiation related genes including JUB, ERLIN1, HMGA2, FAM110B, EGFR, MCM2, TCTA, SSTR1, BCL2L1, E2F1, RAC1 and STAT1 played crucial roles in the differentiation of pancreatic adenocarcinoma.

Ethnopharmacological relevance Ginsenosides, the major active ingredients of Panax ginseng, produce a variety of pharmacological or physiological responses with effects on the central and peripheral nervous systems. Aim of the Study In this report, we investigated the effects of ginsenoside Rg2 on cerebral ischemia-reperfusion induced impairment of neurological responses, memory and caudate-putamen neuronal apoptosis in a vascular dementia (VD) rat model. Materials and Methods Neurological evaluation was performed 24 h after reperfusion and Y-maze memory performance was assessed at 48 h after reperfusion. Immunocytochemical techniques were employed to check the protein expression of BCL-2, BAX, heat shock protein 70 and P53, which are related with cell apoptosis. Results Neurological responses and memory ability of the ginsenoside Rg2 or nimodipine groups improved significantly compared with the VD group. The expression of BCL-2 and HSP70 were decreased, while BAX and P53 were increased in the VD model. The expression of BCL-2 and HSP70 proteins were increased, while BAX and P53 decreased after ginsenoside Rg2 (2.5, 5 and 10 mg/kg) and nimodipine (50 μg/kg) treatment compared with the VD group. The study suggests that ginsenoside Rg2 improved neurological performance and memory ability of VD rats through mechanisms related to anti-apoptosis. Conclusions The capacity for ginsenoside Rg2 to modulate the expression of apoptotic related proteins suggests that ginsenoside Rg2 may represent a potential treatment strategy for vascular dementia or other ischemic insults.

To assess the efficacy of radioiodine therapy (RIT) and investigate the prognostic factors for patients with pulmonary metastasis secondary to differentiated thyroid carcinoma (DTC) through a retrospective study. A total of 80 patients with radioactive iodine-131 (131I)-avid pulmonary metastasis from DTC treated with 131I from 2007 to 2014 at our institution entered the study. Treatment response was mainly measured by two parameters: serum thyroglobulin (Tg) levels and post-therapeutic 131I whole-body scan (WBS). Treatment variables were assessed for statistical significance using the univariate and multivariate analyses. A receiver-operating characteristic (ROC) curve was also plotted to verify the accuracy of predictors. Of these 80 patients, the overall effective rate was 72.5% (58/80), the rates for complete response (CR), partial response (PR), and no response (NR) were 20.0%, 52.5%, and 27.5%, respectively. Univariate analysis showed that gender, pulmonary nodule size, absence or presence of extrapulmonary distant metastases, age, and Tg level at diagnosis were significantly associated with 131I therapy efficacy. Binary logistic regression analysis revealed that older patients (odds ratio [OR]:1.481, 95% confidence interval [CI]: 1.457–2.091, P = .020), subjects with higher Tg levels at diagnosis (OR: 1.046, 95% CI: 1.016–1.119, P = .014), and those with extrapulmonary distant metastases (OR: 1.185, 95%CI: 1.025–1.463, P = .020) had a higher probability of poor prognosis. The optimal cutoffs for age and Tg level to predict 131I therapy efficacy for DTC with lung metastases were 46 years old and 55.50 ng/mL, respectively, based on ROC analysis. This study indicated that most DTC patients with pulmonary metastases can obtain partial or complete remission after RIT, while older patients with higher Tg levels at diagnosis and extrapulmonary distant metastases more likely show poor prognosis.

Hepatic dysfunction is often observed in patients with Graves’ hyperthyroidism. The aims of this study were to investigate the risk factors for hepatic dysfunction and to analyze the efficacy of 131I (radioactive iodine-131) treatment. In total, 2385 patients with Graves’ hyperthyroidism (478 males, 1907 females; age 42.8 ± 13.5 years) were involved in our study. Of these, 1552 cases with hepatic dysfunction received 131I treatment. All clinical data were retrospectively reviewed to explore the risk factors associated with hepatic dysfunction using logistic regression analysis. Furthermore, we observed thyroid and liver function indices for the 1552 subjects at 3, 6 and 12 months after 131I treatment, in order to evaluate efficacy. Overall, 65% patients were affected by hepatic dysfunction. The most common abnormality was elevated alkaline phosphatase (ALP), of which the prevalence was 52.3%. The percentages of hepatocellular injury type, bile stasis, and mixed type were 45.8%, 32.4%, and 21.8%, respectively. Both univariate and multivariate analyses demonstrated that age, duration of Graves hyperthyroidism, free triiodothyronine (FT3)level, and thyrotrophin receptor antibody (TRAb) concentration were the most significant risk factors predicting hepatic dysfunction. Additionally, the patients with mild hepatic dysfunction, or hepatocellular injury type were more likely to attain normal liver function after 131I treatment. Furthermore, after 131I treatment, liver function was more likely to return to normal in the cured group of patients compared with the uncured group. Older patients and cases with a longer history of Graves’ hyperthyroidism, higher FT3 or TRAb concentration were more likely to be associated with hepatic dysfunction, and the prognosis of hepatic dysfunction was closely associated with the outcomes of Graves’ hyperthyroidism after 131I treatment.

Aims Midkine (MK) is a multifunctional cytokine identified to be a promising cancer biomarker. Nuclear factor-kappa B (NF-κB) is an important transcription factor that plays a pivotal role in tumorigenesis. We aimed to investigate values of MK and NF-κB as markers for diagnosis and synchronous metastasis prediction in papillary thyroid cancer (PTC). Main methods 76 cases of PTC and 70 cases of multi-nodular goiter (MNG) were retrieved. The PTC group was further divided into subgroup 1 (16 cases with synchronous metastases) and subgroup 2 (60 cases without metastases). A retrospective review of demographic and clinical information was performed. Immunohistochemistry of MK, NF-κB p65 and Ki-67 was performed on paraffin-embedded specimens and results were quantified. Diagnostic values of the parameters were conducted by receiver operating characteristic (ROC) curves. Protein levels of MK and NF-κB p65 were then confirmed by Western blot. Key findings Immunoreactivities of MK, NF-κB p65 and Ki-67 were significantly higher in the PTC group than in the MNG group with good differential diagnostic capabilities. Moreover, immunoreactivities of all three parameters were significantly higher in subgroup 1 than in subgroup 2 with good synchronous metastasis predictive efficacies. Western blot showed that MK and NF-κB p65 protein levels in lesions from subgroup 1 were significantly higher than those from subgroup 2, both of which were significantly higher than in MNG lesions. Significance We discovered that MK and NF-κB immunohistochemistries can potentially be used for differential diagnosis between PTC and MNG, and for prediction of synchronous metastases.

Hepatic function injury is one of the common complications of hyperthyroidism (mainly Graves' disease), which affects the choice of treatment and the curative rate. Our goal was to describe clinical and biochemical patterns in patients suffering from Graves' disease (GD) and hepatic function injury and to determine the influential factors. A cohort of 1 070 patients who received (131)I treatment were studied. Many examinations were performed before (131)I therapy, such as: the 24-h radioactive iodine uptake of thyroid (RAIU(24 h)) and serum-free triiodothyronine (FT(3)), free thyroxine (FT(4)), sensitive thyroid-stimulating hormone (sTSH), antithyrotrophin receptor antibody (TRAb), thyroglobulin antibody (TgAb), and antithyroid peroxidase antibody (TPOAb), serum hepatic function tests, etc. Data were analyzed by the unpaired t-test, the independent samples t-test, the χ(2) test, logistic regression, and Pearson bivariate correlation. Age, course of GD, thyroid's weight, FT(4), TPOAb, and TRAb in GD patients with hepatic function injury were higher than those with normal hepatic function patients. The influential factors were age, hyperthyroidism duration, heart rate, thyroid's weight, FT(4), RAIU(24 h), TgAb, TPOAb, and TRAb. RAIU(24 h) was the protecting factor. Age, course of GD, heart rate, thyroid's weight, FT(4), TRAb, and TPOAb were the risk factors. Patients whose age was higher than 45 years old, heart rate above 90 bpm, thyroid weight more than 35 g, the hyperthyroidism duration more than 3 years, FT(4) higher than 70.5 pmol/l, the level of TPOAb above 360 IU/ml, and the level of TRAb above 15 IU/l have increased risk of hepatic function injury. As treatment (131)I therapy was found to be the best choice.

The prevalence of sleep disorders has been shown to be high in patients with chronic dialysis patients and may contribute to impaired quality of life and higher mortality in this population. However, there are few data on the relationship of sleep disorders and their risk factors in chronic dialysis patients. The aim of this study was to evaluate the relationship of sleep disorders and their risk factors in chronic dialysis patients.A total of 42 continuous ambulatory peritoneal dialysis (CAPD) patients were involved in this cross-sectional study. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). Restless legs syndrome (RLS) was diagnosed according to the criteria of the International Restless Legs Syndrome Study Group. And depression was assessed by Hamilton depression scale. General information and laboratory data were collected.The prevalence of sleep disorders was 47.6% in the CAPD patients. According to the PSQI, the 42 CAPD patients were divided into sleep disturbance group and non-sleep disorders group. There were no significant differences in age, gender, dialysis duration, hemoglobin, serum creatinine, urea nitrogen, β2-microglobulin, parathyroid hormone, calcium, and phosphorus between CAPD patients with sleep disorders and those without sleep disorders. But the level of serum albumin (Alb) in CAPD patients with sleep disorders was significantly lower than that in CAPD patients without sleep disorders (31.3 ± 1.4 vs. 34.3 ± 3.7, t = 3.603, P = 0.001) . And the prevalence of RLS and depression was significantly higher than that in CAPD patients without sleep disorders (RLS: 11/22 vs. 1/20, χ(2) = 10.395, P = 0.001; depression: 7/22 vs. 1/20, χ(2) = 4.886, P = 0.027). In CAPD patients with RLS, the prevalence of sleep disorders was significantly higher than that in CAPD patients without RLS (11/22 vs. 11/30, χ(2) = 10.395, P = 0.001). And in CAPD patients with depression, the prevalence of sleep disorders was significantly higher than that in CAPD patients without depression (7/8 vs. 15/34, χ(2) = 4.886, P = 0.027). In CAPD patients, bivariate correlation analysis showed that sleep disorders was negatively correlated with serum Alb (r = -0.606, P = 0.000) and positively correlated with RLS (r = 0.497, P = 0.001) and depression (r = 0.341, P = 0.029). Multivariate regression analysis revealed that the odds ratio of RLS, depression, and low serum Alb was 22.900, 42.209, and 0.597, respectively.The prevalence of sleep disorders was relatively high in CAPD patients. RLS, depression, and low serum Alb were the risk factors for CAPD patients with sleep disorders.

Pulmonary arterial hypertension (PAH) is characterized by a progressive increase in pulmonary arterial pressure and vascular resistance. Despite advances in therapy for PAH, its treatment and prognosis remain poor. We aimed to investigate whether the transplantation of bone marrow mesenchymal stem cells (MSCs) overexpressing hepatocyte growth factor (HGF), alone or in combination with granulocyte colony-stimulating factor (G-CSF), attenuates the development of experimental monocrotaline (MCT)-induced PAH. Three weeks after MCT administration, rats were divided into the following groups: (1) untreated (PAH); (2) HGF treated; (3) MSCs administered; (4) HGF-MSCs treated; and (5) HGF-MSCs plus G-CSF treated. After 3 weeks, hemodynamic changes, histomorphology, and angiogenesis were evaluated. To elucidate the molecular mechanisms of vascular remodeling and angiogenesis, serum levels of transforming growth factor (TGF)-β and endothelin-1 (ET-1) were measured, and the gene and protein expression levels of vascular cell adhesion molecule-1 (VCAM-1) and matrix metalloproteinase-9 (MMP-9) were determined. Compared with the PAH, MSC, and G-CSF groups, the HGF and HGF+G-CSF groups exhibited significantly reduced right ventricular hypertrophy and mean pulmonary arterial pressure (P < 0.05). Histologically, vessel muscularization or thickening and collagen deposition were also significantly decreased (P < 0.05). The number of vessels in the HGF+G-CSF group was higher than that in the other groups (P < 0.05). The TGF-β and ET-1 concentrations in the plasma of pulmonary hypertensive rats were markedly lower in the HGF and HGF+G-CSF groups (P < 0.05). Furthermore, HGF induced the expression of VCAM-1, and HGF treatment together with G-CSF synergistically stimulated MMP-9 expression. Transplanted HGF-MSCs combined with G-CSF potentially offer synergistic therapeutic benefit for the treatment of PAH.

Objective We aimed to measure prevalence of sleep disturbance in patients with differentiated thyroid cancer (DTC) by calculating Pittsburgh Sleep Quality Index (PSQI), and compare these data with patients with benign thyroid nodules or normal participants. Methods Three groups of patients participated in this cross-sectional study. In the first group, 162 patients with DTC received total thyroidectomy, and then 131I therapy. The second group consisted of 84 patients with benign thyroid nodules, who received partial thyroidectomy. The third group was 78 normal healthy control cases. PSQI was used to assess the sleep quality. Inter-group differences were analyzed by Kruskal-Wallis test or independent samples T test. χ2 test was also used to check prevalence differences of poor sleep quality among the groups. Differences of PSQI score and poor sleep quality prevalence before and after 131I therapy in the same group of DTC participants were analyzed by paired T test and Mcnemar's test. Results Higher PSQI score (7.59 ± 4.21) and higher rate of poor sleep quality (54.32%) were shown in DTC patients than in any other group. After 131I therapy, PSQI score and prevalence of poor sleep quality in DTC patients increased significantly to 8.78 ± 4.72 and 70.99%. Then DTC patients were divided into two subgroups based on their metastatic status. DTC patients with metastasis (87/162 cases, 53.70%) had significantly higher PSQI score (10.87 ± 5.18) and higher prevalence of poor sleep quality (79.31%). Conclusion DTC patients suffer from sleep disturbance, 131I therapy and awareness of metastatic status could worsen sleep problem. Psychological fear of cancer, nuclear medicine therapy and metastasis could be one major underlying reason. Longitude and interventional studies are necessary for further investigations.

To test validity and reliability of Personality Diagnostic Questionnaire-fourth vision (PDQ-4) and a self-report DSM-IV axis-II personality disorder (PD) assessing instrument as well as to study the prevalence of personality dysfunction among students of first grade senior high schools in Beijing.Among 100 PD patients, 91 non-PD patients with mental disorder, and 100 normal people, sensitivity, specificity and consistency were tested by ICD-10 criteria. By means of stratified cluster sampling, 10 039 students from 25 senior high schools in urban and rural in Beijing were studied using PDQ-4.PDQ-4 had high sensitivity and moderate specificity for most axis II disorders when compared with ICD-10. Among different samples, PDQ-4 yielded various levels of sensitivity and specificity. Meanwhile, the test-retest consistency was 92.2%. Among 130 adults, the total PDQ-4 score was 18.9 +/- 9.8. The score in males was 20.6 +/- 10.1, versus 17.1 +/- 9.2 in females with significant difference (t = 2.09, P0.05). Scores in different age groups were 21.5 +/- 10.5 in age 16 - 25, 16.9 +/- 11.3 in age 26 - 35, 16.4 +/- 9.7 in age 36 - 45, 16.2 +/- 7.9 in age 46 - 55, and 20.0 +/- 7.8 in age 56 and over respectively. No statistical significant difference of scores at age groups was found (F = 2.07, P0.05). Among 9 547 students, the total PDQ-4 score was 25.4 +/- 9.6, being significantly higher than that of adult sample. The prevalence of personality dysfunction was 5.6%. Regarding the distribution of personality dysfunction in gender, residential area, and type of school, data showed that the prevalence rates were higher in males, rural area and lower-ranking schools.PDQ-4 can be used as a PD screen tool in psychiatric institutions and community settings. The distributions of personality dysfunction in Beijing were significantly different on gender, residential area and type of schools. Attention should be paid to personality dysfunction during adolescence.