论声乐演唱中的“高喉器”现象

在声乐演唱中有一种现象叫做"高喉器","高喉器"是语言习惯或者"降肌"的天生无力以及歌唱支点不合理等因素造成的。解决"高喉器"最直接的办法就是加强降肌的力量,使之与提肌的力量平衡,同时协调歌唱三个支点的配合使用,最终达到将喉器放下的目的。

Association between thyroid function and gallstone disease

AIM： To investigate those associations using data of the population-based Study of Health in Pomerania. METHODS： A study population of 3 749 residents aged 20-79 years without previously diagnosed thyroid disease was available for analyses. Serum TSH was used to assess thyroid function. Cholelithiasis was defined by either a prior history of cholecystectomy or the presence of gallstones on ultrasound. Logistic regression was performed to analyze independent associations between thyroid function and cholelithiasis. RESULTS： There were 385 persons （10.3%） with low （〈0.3 mIU/L）, 3 321 persons （88.6%） with normal and 43 persons （1.2%） with high serum TSH levels （〉3 mIU/L）. The proportion of cholelithiasis among males and females was 14.4% and 25.3%, respectively. Among males, there was an independent relation between high serum TSH and cholelithiasis （OR 3.77; 95%-CI 1.06-13.41; P〈0.05）. Also among males, there was a tendency towards an elevated risk of cholelithiasis in persons with low serum TSH （OR 1.40; 95%-CI 0.96-2.02; P= 0.07）. In the female population, no such relation was identified. CONCLUSION： There is an association between thyroid and gallstone disease with a gender-specific relation between hypothyroidism and cholelithiasis.

Crohn's disease and risk of fracture: does thyroid disease play a role?

AIM: To assess the role of thyroid disease as a risk for fractures in Crohn's patients.METHODS: A cross-sectional study was conducted from 1998 to 2000. The study group consisted of 210 patients with Crohn's disease. A group of 206 patients without inflammatory bowel disease served as controls. Primary outcome was thyroid disorder. Secondary outcomes included use of steroids, immunosuppressive medications, surgery and incidence of fracture.RESULTS: The prevalence of hyperthyroidism was similar in both groups. However, the prevalence of hypothyroidism was lower in Crohn's patients (3.8 % vs 8.2 %, P=0.05).Within the Crohn's group, the use of immunosuppressive agents (0 % vs11 %), steroid usage (12.5 % vs37 %), small bowel surgery (12.5 % vs 28 %) and large bowel surgery (12.5 % vs27 %) were lower in the hypothyroid subset as compared to the euthyroid subset. Seven (3.4 %) Crohn'spatients suffered fracture, all of whom were euthyroid.CONCLUSION: Thyroid disorder was not found to be associated with Crohn's disease and was not found to increase the risk for fractures. Therefore, screening for thyroid disease is not a necessary component in the management of Crohn's disease.

DIAGNOSIS AND SURGICAL MANAGEMENT FOR RETROSTERNAL THYROID MASS

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EFFECTS OF LEVOTHYROXINE ON BONE METABOLISM IN PATIENTS WITH DIFFERENTIATED THYROID CANCER AFTER OPERATION AND ^(131)I ABLATION

Objective To investigate the effects of substitutive and suppressive doses of levothyroxine on bone metabolism in patients with differentiated thyroid carcinoma after surgery and 131I ablation. Methods The patients, who had received levothyroxine(L-T4) for at least 3 years for treating their differentiated thyroid carcinoma after surgery and 131I therapy, were classified into substitutive group and suppressive group according to the levels of serum free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH). We compared the levels of FT3, FT4, TSH, serum parathyroid hormone (PTH), serum calcium (Ca), serum phosphate (P), serum alkaline phosphates (ALP) and Bone mineral density (BMD) to those of healthy volunteers well matched for sex, age, menopausal status, and body mass index (BMI). Results No significant differences were found in the bone density and biochemical parameters of bone metabolism of the subjects treated with substitutive or suppressive doses of L-T4 compared with the control subgroup. No significant differences were observed among the subgroups according to accumulative doses of 131I. No bone fracture was found in all the patients. Conclusion The substitutive and suppressive doses of L-T4 are safe and necessary for patients with differentiated thyroid carcinoma after surgery and 131I therapy. Such treatment for 3 years is not associated with increased risk of osteoporosis. Much longer term of follow up is still needed in patients receiving substitutive and suppressive doses of L-T4.

Management of differentiated thyroid carcinoma with bone metastasis: a case report and review of the Chinese literature

Differentiated thyroid carcinoma （DTC） is a common malignancy. The general treatments are thyroidec- tomy of the affected lobe along with lymphadenectomy. However, bone metastasis is rare in DTC compared with other malignancies and the management of metastasis loci is still controversial. Here we present a case of follicular thyroid carcinoma with the 6th cervical vertebra body metastasis successfully treated by total thyroidectomy, cervical corpectomy, and intemal fixation, followed by hormone replacement therapy and radioiodine therapy. Eleven additional patients diagnosed as thyroid carcinoma with bone metastasis collected from Chinese literature between January 1996 and December 2013 were also reviewed. The mean age of the 12 patients at presentation was （53.9±9.2） years （rang, 42-72 years） and the male to female ratio was 1：2. Nine cases received total/near-total thyroidectomy or Io- bectomy while the other three patients refused for personal reasons. The interventions for bone metastasis were one-stage operation （9/12）, ITM adjuvant therapy （3/12）, chemotherapy （1/12）, and no intervention （1/12）. During the follow-up, two patients died of metastatic carcinoma recurrence, one died of multiple organ metastasis, and one with an unknown reason. We conclude that the management of thyroid carcinoma with bone metastasis needs multidisci- plinary cooperation. Surgical resection is still the first choice for cure, while the combined one-stage operation on the primary and metastatic sites followed by hormone replacement therapy and radioiodine therapy is an applicable treatment.

Algal oligosaccharides ameliorate osteoporosis via up-regulation of parathyroid hormone 1-84 and vascular endothelial growth factor

OBJECTIVE: To determine whether algal oligosaccharide affects the levels of parathyroid hormone 1-84(PTH1-84) and vascular endothelial growth factor(VEGF).METHODS: An osteoporosis rat model was established via bilateral ovariectomy. The model rats were fed algal oligosaccharides(molecular weights:600-1, 200 Da) for 4 months. Bone mineral density(BMD) was then measured. MG-63 human osteoblastic cells were treated with algal oligosaccharides. The expression of PTH1-84 and VEGF was then examined. Oligosaccharide-treated cells were transfected with PTH1-84 short hairpin RNA(sh RNA), VEGF sh RNA, and PTH1-84-VEGF small interfering RNA(si RNA). The growth rates were then compared between transfected and non-transfected cells.RESULTS: Algal oligosaccharides increased the BMD of the osteoporosis rat model compared with untreated controls(P < 0.05). When MG-63 cells were treated with algal oligosaccharides, the growth rate increased by 25% compared with the control group at day 3(P < 0.05). In addition, the expression of PTH84 and VEGF was enhanced. Con-versely, when the cells were transfected with PTH84 sh RNA, VEGF sh RNA, or PTH1-84-VEGF si RNA, the growth rate was decreased by 17%, 35% and 70%, respectively, compared with controls at day 3(P < 0.05).CONCLUSION: Algal oligosaccharides ameliorate osteoporosis via up-regulation of PTH1-84 and VEGF. Algal oligosaccharides should be developed as a potential drug for osteoporosis treatment.