Gender and metabolic differences of gallstone diseases

AIM： To investigate the risk factors for gallstone disease in the general population of Chengdu, China. METHODS： This study was conducted at the West China Hospital. Subjects who received a physical examination at this hospital between January and December 2007 were included. Body mass index, blood pressure, fasting plasma glucose, serum lipid and lipoproteins concentrations were analyzed. Gallstone disease was diagnosed by ultrasound or on the basis of a history of cholecystectomy because of gallstone disease. Unconditional logistic regression analysis was used to investigate the risk factors for gallstone disease, and the Chi-square test was used to analyze differences in the incidence of metabolic disorders between subjects with and without gallstone disease. RESULTS： A total of 3573 people were included, 10.7% （384/3573） of whom had gallstone diseases. Multiple logistic regression analysis indicated that the incidence of gallstone disease in subjects aged 40-64 or ≥65 years was significantly different from that in those aged 18-39 years （P 〈 0.05）; the incidence was higher in women than in men （P 〈 0.05）. In men,a high level of fasting plasma glucose was obvious in gallstone disease （P 〈 0.05）, and in women, hypertriglyceridemia or obesity were significant in gallstone disease （P 〈 0.05）. CONCLUSION： We assume that age and sex are profoundly associated with the incidence of gallstone disease; the metabolic risk factors for gallstone disease were different between men and women.

Weekend and nighttime effect on the prognosis of peptic ulcer bleeding

AIM:To evaluate whether weekend or nighttime admission affects prognosis of peptic ulcer bleeding despite early endoscopy.METHODS:Retrospective data collection from four referral centers,all of which had a formal out-of-hours emergency endoscopy service,even at weekends.A total of 388 patients with bleeding peptic ulcers who were admitted via the emergency room between January 2007 and December 2009 were enrolled.Analyzed parameters included time from patients' arrival until endoscopy,mortality,rebleeding,need for surgery and length of hospital stay.RESULTS:The weekday and weekend admission groups comprised 326 and 62 patients,respectively.There were no significant differences in baseline characteristics between the two groups,except for younger age in the weekend group.Most patients (97%) had undergone early endoscopy,which resulted in a low mortality rate regardless of point of presentation (1.8% overall vs 1.6% on the weekend).The only outcome that was worse in the weekend group was a higher rate of rebleeding (12% vs 21%,P = 0.030).However,multivariate analysis revealed nighttime admission and a high Rockall score (≥ 6) as significant independent risk factors for rebleeding,rather than weekend admission.CONCLUSION:Early endoscopy for peptic ulcer bleeding can prevent the weekend effect,and nighttime admission was identified as a novel risk factor for rebleeding,namely the nighttime effect.

甲状腺乳头状癌颈淋巴结清扫策略的再探讨

目的探讨甲状腺乳头状癌(papillary thyroid carcinoma,PTC)颈淋巴结转移的影响因素,为PTC颈淋巴结的清扫策略提供更精准的意见。方法回顾性分析武汉科技大学附属孝感医院2013年6月至2019年6月期间经病理诊断为PTC患者的病例资料,探索中央区淋巴结转移和颈侧区淋巴结转移的影响因素。结果多因素分析结果显示,年龄≤55岁、肿瘤>1 cm、外周侵犯、双侧癌及多灶癌患者的中央区淋巴结转移率较高(P<0.05),而中央区淋巴结转移与患者的性别和被膜侵犯无关(P>0.05);当上述危险因素的数量为0、1、2、3、4、5及6个时,中央区淋巴结转移率分别为:3.5%(4/113)、25.2%(72/286)、30.0%(70/233)、38.6%(76/197)、52.5%(53/101)、76.9%(20/26)及100%(13/13)。随危险因素数量增加,中央区淋巴结转移率增高(X^2趋势=236.894,P<0.001)。在颈侧区淋巴结转移方面,多因素分析结果显示,肿瘤直径>1 cm、被膜侵犯及中央区淋巴结转移≥2枚患者的颈侧区淋巴结转移率较高(P<0.05),而颈侧区淋巴结转移与患者的年龄、性别、外周侵犯及多灶癌均无关(P>0.05)。当患者累计危险因素数量为0、1、2、3、4、5及6个时,颈侧区淋巴结转移率分别为:11.1%(1/9)、29.4%(5/17)、79.2%(19/24)、89.6%(43/48)、96.4%(27/28)、100%(21/21)及100%(3/3)。随危险因素数量增加,颈侧区淋巴结转移率增高(X^2趋势=101.094,P<0.001)。结论颈部淋巴结转移率与相应危险因素数量成正相关,随着危险因素的增多,颈部淋巴结转移率也增高。危险因素数量可以为颈部淋巴结转移提供一个简洁和直观的指标,更有利于制定个体化及精准的手术方案。