58例产后甲状腺炎患者的2年随访研究

目的 对1组58例产后甲状腺炎(PPT)患者随访观察24个月,确定其持续性甲状腺功能减退(甲减)的发生率及与持续性甲减发生相关的临床和生化因素.方法 本研究是在前期PPT患病率调查基础上进行的前瞻性研究.对58例PPT患者在产后12、18和24个月进行随访,询问临床症状、进行体格检查并留取空腹血清,以测定血清促甲状腺素(TSH)、抗甲状腺过氧化物酶抗体(TPOAb)、抗甲状腺球蛋白抗体( TgAb),TSH异常者加测FT4、FT3和TSH受体抗体(TRAb).以50名健康产妇为对照.结果 58例PPT患者的随访率为91.4％ (n=53),产后24个月时持续性甲减的发生率为20.8％(n=11),对照组无甲减发生.甲状腺功能亢进(甲亢)甲减双相型PPT患者持续性甲减的发生率为26.7％ (4/15),甲减单相型PPT患者持续性甲减的发生率为63.6％ (7/11),而表现为甲亢单相型的27例PPT患者无1例发生持续性甲减.所有发生持续性甲减的PPT患者,在产后6个月时TSH水平均高于4.8mU/L,并且其分娩时和产后12个月时的TSH均显著高于仅发生一过性甲减的PPT患者(均P＜0.01).53例PPT患者产后12、18、24个月时TPOAb阳性率分别为56.6％、50.9％和52.8％,TgAb阳性率分别为35.8％、30.2％和30.2％,均显著高于对照组;临床PPT患者各月份TPOAb阳性率和滴度均高于亚临床PPT患者,其中产后18个月和24个月时点的比较差异有统计学意义(均P＜O.05).结论 20.8％的PPT患者在产后24个月时持续甲减,持续性甲减的发生与PPT的病程特点、分娩时及产后的TSH水平有关.     

碘摄入量对产后甲状腺炎发生、发展的影响

目的　探讨碘摄入量对产后甲状腺炎(PPT)的发生、发展以及甲状腺自身抗体的影响。方法　610例产妇进入队列研究, 488例(80% )达到随访6个月以上。进入队列的孕产妇均在分娩前、产后3个月和6个月时留取空腹血清,测定血清TSH、甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TgAb)、FT4、FT3、甲状腺球蛋白(Tg)和TSH受体抗体(TRAb)。每次采血的同时留取空腹尿,以多次尿碘的均值作为判定该孕产妇个体碘营养水平的依据。同时进行体格检查和甲状腺B超检查。PPT产妇继续接受产后9个月和12个月的随访。结果　488例产妇的尿碘中位数为201μg/L。临床和亚临床PPT患者的尿碘中位数显著高于非PPT者(232μg/Lvs200μg/L,P<0. 05),根据尿碘水平将产妇分为低碘组(尿碘<100μg/L)、适碘组(尿碘100~300μg/L)和高碘组(尿碘>300μg/L),高碘组PPT(包括临床和亚临床PPT)患病率为18. 02%,显著高于适碘组(10. 56%,P<0. 05)。产后6个月TPOAb阳性者尿碘水平显著高于TPOAb阴性者(尿碘240μg/Lvs198μg/L,P<0. 05 )。结论　孕产妇尿碘>300μg/L可能导致PPT发病率增加。产后6个月时TPOAb阳性者尿碘水平高于TPOAb阴性者。     

230例住院2型糖尿病患者甲状腺功能分析

目的调查陕西凤翔地区住院2型糖尿病患者甲状腺疾病的患病情况。方法回顾性分析2013年4月—2015年3月在陕西省凤翔县医院内五科住院治疗的230例2型糖尿病患者的甲状腺功能。结果 230例2型糖尿病患者中甲状腺疾病的患病率为28.70%,其中甲亢2.17%,亚临床甲亢0.43%,甲减5.22%,亚临床甲减20.87%。145例检测甲状腺抗体的2型糖尿病患者中,甲状腺抗体(TPOAb或TgAb)阳性率为12.41%。女性2型糖尿病患者甲状腺疾病患病率、亚临床甲减患病率及甲状腺抗体阳性率明显高于男性(P0.05)。随着年龄增长,2型糖尿病患者中亚临床甲减患病率呈升高趋势(P0.05)。结论 2型糖尿病患者甲状腺疾病的患病率高,对于2型糖尿病患者积极检测甲状腺功能很有必要。     

亚临床甲状腺功能异常临床细胞病理学分析

目的 探讨亚临床甲状腺功能减退症(亚临床甲减)和亚临床甲状腺功能亢进症(亚临床甲亢)的病因及临床特点.方法 对1994年9月至2005年12月北京大学第一医院符合诊断标准的90例亚临床甲减和48例亚临床甲亢患者的细针穿刺细胞病理学检查(FNAC)结果进行分析,同时测定甲状腺球蛋白抗体(TGAb)和甲状腺过氧化物酶抗体(TPOAb).结果 (1)根据细胞病理学诊断,亚临床甲减最多见于桥本甲状腺炎(81.71%),其次为甲状腺肿(12.19%),甲状腺腺瘤(3.66%)较少见;亚临床甲亢多见于桥本甲状腺炎(41.86%)、甲状腺肿(34.88%)、甲状腺腺瘤(13.95%).(2)亚临床甲减TGAb和TPOAb阳性率明显高于亚临床甲亢(P<0.01);桥本甲状腺炎TGAb和TPOAb阳性率在亚临床甲减中分别为83.08%和84.62%,在亚临床甲亢中分别为77.78%和55.56%.(3)桥本甲状腺炎的病理类型、相同病因的细胞病理形态在亚临床甲减和亚临床甲亢中未见明显差异.结论 桥本甲状腺炎是亚临床甲减的最常见病因,在亚临床甲亢的病因中也占有重要地位;亚临床甲减自身抗体阳性率明显高于亚临床甲亢;从细胞病理学上不能区分亚临床甲状腺疾病的功能状态.     

249名老年人中甲状腺疾病的发生及转归临床分析

目的研究老年人甲状腺疾病的患病率和发生发展特点。方法249例来自我国辽宁省、河北省的老年人(男102名,女147名;年龄60~88岁)参加了1999年的横断面调查,5年后进行了随访。初访和随访时均测定血清促甲状腺激素(TSH)、甲状腺过氧化物酶抗体(TPOAb)和甲状腺球蛋白抗体(TgAb),TSH异常者加测游离甲状腺激素(FT3、FT4)。结果该研究人群TSH正常范围为0.28~4.75mU/L。甲状腺功能异常(含临床和亚临床型)的总患病率10.84%,TPOAb和TgAb的阳性率分别为12.85%和11.65%。初访时确定为正常甲状腺功能的老年人(n=222,随访率79.7%),5年后新发临床甲状腺功能亢进(甲亢)1例、亚临床甲亢2例(均为男性),亚临床甲减3例(均为女性)。初访时甲状腺自身抗体阴性者,随访时有6例出现抗体的阳转,但未伴有甲状腺功能的异常。结论老年人甲状腺疾病患病率较高,应当开展甲状腺疾病筛查;老年人的亚临床甲状腺疾病多数可自行缓解,可采取以观察为主的处理方式。     

太原地区健康体检人群甲状腺功能紊乱患病情况调查

目的　调查太原地区人群中甲状腺功能紊乱的患病率。方法　测定太原地区 812 5名体检人群的TSH ,然后再测定FT3、FT4 和甲状腺抗体。结果　在此体检人群中 ,甲状腺功能亢进(甲亢 )患病率为 1.2 0 % ,亚临床甲亢患病率为 0 .87% ,甲状腺功能减退 (甲减 )患病率为 1.0 3 % ,亚临床甲减患病率为 0 .95 %。各种甲状腺功能紊乱的患病率女性均高于男性 (P <0 .0 5～ <0 .0 1)。结论　报道太原地区人群中甲状腺功能紊乱的患病率 ,无论是甲亢和亚临床甲亢或甲减和亚临床甲减 ,女性的患病率均高于男性     

妊娠糖尿病和糖尿病合并妊娠患者的甲状腺功能与抗体的变化分析

目的观察妊娠12周和24周的妊娠糖尿病和糖尿病合并妊娠妇女,FT3、FT4和TSH的变化,及各组人群在妊娠过程中甲状腺抗体的变化。方法对2010～2012年在吉林市中心医院妇产科、内分泌科门诊及病房就诊的妊娠妇女(糖尿病和妊娠糖尿病),共184名,在G12和G24分别测FT3、FT4、TSH、TPO、TG-ab。结果 1型糖尿病31例:2例甲减,3例亚临床甲减,占16.13%(5/31),4例甲状腺抗体阳性,占13.90%(4/31),其中1例产后甲状腺炎。2型糖尿病53例:1例亚临床甲减,占1.89%(1/51);1例甲亢,占1.89%(1/51);2例抗体阳性,占3.92%(2/53)。其中1例患产后甲状腺炎,占1.89%(1/51);2例糖尿病酮症酸中毒,其中1例,低T3综合征,后来引产。妊娠糖尿病49例:1例亚临床甲减,占2.04%(1/49);4例抗体阳性,占8.16%(4/49);1例糖尿病酮症酸中毒,死胎引产,其中1例产后甲状腺炎,占2.04%(1/49)。健康对照组51例:抗体阳性3例,占5.88%(3/51)。结论 1型糖尿病亚临床甲减发生率高;FT4G12时高于G24;既往无糖尿病病史,但有流产、死胎病史的患者有血糖高的原因;甲状腺抗体阳性的患者发生产后甲状腺炎的可能性大。     

碘普罗胺对合并T3减低的稳定型心绞痛患者甲状腺功能的影响

目的:探讨冠心病介入术前后合并三碘甲状腺原氨酸(T3)减低的稳定型心绞痛患者甲状腺功能及自身抗体的变化。方法:选取合并T3减低、甲状腺素(T4)与促甲状腺激素(TSH)正常的稳定型心绞痛患者154例,分别于术前及术后1 d、1个月、3个月、6个月测定游离T3(FT3)、反T3(rT3)、游离T4(FT4)、T3总量(TT3)、T4总量(TT4)与TSH,术前及术后6个月测定甲状腺过氧化物酶抗体(TPOAB)、甲状腺球蛋白抗体(TGAB)。结果:154例患者中,术后1 d出现甲状腺功能减低(甲减)6例(3.9%)、亚临床甲状腺功能减低(亚甲减)30例(19.5%),术后1个月出现甲减6例(3.9%)、亚甲减6例(3.9%)、亚临床甲状腺功能亢进(亚甲亢)18例(11.7%),术后6个月出现亚甲减6例(3.9%)、亚甲亢23例(14.9%)。术后1 d及1、3、6个月时TT3、TSH水平均较术前显著改变(均P0.005),rT3水平与术前比较差异无统计学意义。分组显示,高剂量组(碘普罗胺用量≥100 ml者113例)的T3水平在术后1 d及3个月时改变较低剂量组(用量100 ml者41例)显著。术后6个月时TGAB及TPOAB平均水平均较术前显著降低(均P0.001)。随访中未见需要药物干预的严重甲状腺功能异常者。结论:冠心病介入诊治过程中单次大剂量碘负荷增加T3减低患者出现一过性甲状腺功能异常的风险,但未出现需要药物干预的严重甲状腺功能异常者。     

不同孕期孕妇甲状腺功能相关指标分析

目的 探讨不同孕期孕妇甲状腺激素水平变化及其与抗甲状腺过氧化物酶抗体(TPOAb)之间的关系.方法 377例不同孕期的孕妇,采用固相化学发光酶免疫分析法( ICMA)测定血清促甲状腺激素(TSH)、游离甲状腺激素(FT4)、游离三碘甲状腺原氨酸(FT3)、总甲状腺素(TT4)、总三碘甲状腺原氨酸(TT3)、TPOAb.结果 正常组孕妇早、中、晚期TSH中位数依次上升(均P＜0.05).TPOAb阳性组TSH中位数高于TPOAb阴性组(P＜0.05),TPOAb阳性组中临床和亚临床甲状腺功能减退症(甲减)的患病率高于TPOAb阴性组(P＜0.05).采用FT4及TT4诊断法诊断亚临床甲减患病率分别为18.04％及23.61％;采用TT4及FT4诊断临床甲减的患病率分别为0.27％及5.84％( P＜0.05).结论 应当重视FT4和TT4在妊娠中晚期甲减诊断的差异;应建立孕期正常的甲状腺激素切点值并开展TPOAb的筛查.     

93例亚临床甲状腺功能减退症的随访研究

目的 研究不同碘摄入量地区亚临床甲状腺功能减退症(甲减)的流行病学特点和影响转归的因素。方法 选择盘山、彰武和黄骅3个农村社区(分别为低碘、适碘和高碘地区)，在入户调查的基础上行采样调查。测定血清TSH、甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)、尿碘浓度及进行甲状腺B超检查，TSH异常者测定FT3、FT4，筛选出118例亚临床甲减患者。盘山和彰武社区于2年后、黄骅社区于1年后进行随访，再次进行以上检查。结果 盘山、彰武和黄骅社区亚临床甲减的患病率分别为0．73％、2．90％和5．96％。亚临床甲减的病因33．1％是自身免疫性甲状腺疾病。在随访到的93例亚临床甲减患者中有4例女性进展为临床甲减。结论 随着碘摄入量的增加亚临床甲减的患病率增加，但无明显性别差异。随访研究证实女性、甲状腺自身抗体阳性是亚临床甲减患者进展至临床甲减的危险因素，碘摄入量与亚临床甲减的转归无关。     

MUTATION FREQUENCY IN NURSES AND PHARMACISTS WORKING WITH CYTOTOXIC DRUGS

Individuals occupationally exposed to cytotoxic drugs may be at risk owing to the effects of these agents on DNA. As an index of DNA damage, in vivo mutations were measured in lymphocytes from 24 oncology nurses or pharmacists and 24 matched controls. Mutation frequency was significantly increased in exposed individuals and appeared to be related to duration of exposure. However, the overall magnitude of the increase was small and its biological significance remains to be determined.     

A single injection of adrenergic agonists enhances pineal melatonin production in Turkish hamsters

Abstract: The purpose of this study was to determine whether the pineal gland of Turkish hamsters (Mesocricetus brandti) responds to adrenergic agonists with an increase in melatonin production, and, if it does, whether the sensitivity of the pineal gland to agonists would differ throughout the dark phase. Adult Turkish hamsters weighing 110–210 g received a subcutaneous injection of isoproterenol (ISO, 1 mg/kg B.W.) or norepinephrine (NE, 1 mg/kg B.W.) at different times of night. Animals exposed to LD 16:8 responded to ISO or NE with increased pineal melatonin content only when injected at dawn, when endogenous melatonin is at basal or near-basal levels. When the 8 hr scotophase was entirely replaced with light, the responsiveness to ISO injections at dawn disappeared. In animals exposed to light from 30 min prior to injection to the time of sacrifice, ISO injections increased pineal melatonin content (P < 0.005, three-way ANOVA), which varied, depending on the specific time of injection (effect of time of night, P < 0.05, three-way ANOVA). These results demonstrate that (1) adrenergic agonists enhance the production of pineal melatonin in Turkish hamsters, (2) this stimulatory effect takes place late, but not early in the 8 hr scotophase, and (3) the adrenergic induction of pineal melatonin production in Turkish hamsters requires priming by darkness during the appropriate circadian phase.     

Immune effector mechanisms in malaria: An update focusing on human immunity

The past decade has witnessed dramatic decreases in malaria‐associated mortality and morbidity around the world. This progress has largely been due to intensified malaria control measures, implementation of rapid diagnostics and establishing a network to anticipate and mitigate antimalarial drug resistance. However, the ultimate tool for malaria prevention is the development and implementation of an effective vaccine. To date, malaria vaccine efforts have focused on determining which of the thousands of antigens expressed by Plasmodium falciparum are instrumental targets of protective immunity. The antigenic variation and antigenic polymorphisms arising in parasite genes under immune selection present a daunting challenge for target antigen selection and prioritization, and is a given caveat when interpreting immune recall responses or results from monovalent vaccine trials. Other immune evasion strategies executed by the parasite highlight the myriad of ways in which it can become a recurrent infection. This review provides an update on immune effector mechanisms in malaria and focuses on our improved ability to interrogate the complexity of human immune system, accelerated by recent methodological advances. Appreciating how the human immune landscape influences the effectiveness and longevity of antimalarial immunity will help explain which conditions are necessary for immune effector mechanisms to prevail.     

Secondary aortoduodenal fistula

Aorto-duodenal fistulae （ADF） are the most frequent aorto-enteric fistulae （80%）, presenting with upper gastrointestinal bleeding. We report the first case of a man with a secondary aorto-duodenal fistula presenting with a history of persistent occlusive syndrome. A 59-year old man who underwent an aortic-bi-femoral bypass 5 years ago, presented with dyspepsia and biliary vomiting. Computed tomography scan showed in the third duodenal segment the presence of inflammatory tissue with air bubbles between the duodenum and prosthesis, adherent to the duodenum. The patient was submitted to surgery, during which the prosthesis was detached from the duodenum, the intestine failed to close and a gastro-jejunal anastomosis was performed. The post-operative course was simple, secondary ADF was a complication （0.3%-2%） of aortic surgery. Mechanical erosion of the prosthetic material into the bowel was due to the lack of interposed retroperitoneal tissue or the excessive pulsation of redundantly placed grafts or septic procedures. The third or fourth duodenal segment was most frequently involved. Diagnosis of ADF was difficult. Surgical treatment is always recommended by explorative laparotomy. ADF must be suspected whenever a patient with aortic prosthesis has digestive bleeding or unexplained obstructive syndrome. Rarely the clinical picture of ADF is subtle presenting as an obstructive syndrome and in these cases the principal goal is to effectively relieve the mechanical bowel obstruction.     

Married to M. tuberculosis: risk of infection and disease in spouses of smear-positive tuberculosis patients

Objectives To quantify the risk of infection and disease in spouses of tuberculosis patients and the extent to which intervention could reduce the risk in this highly exposed group. Methods We compared HIV prevalence, TB prevalence and incidence and tuberculin skin test (TST) results in spouses of TB patients and community controls. HIV‐positive spouses were offered isoniazid preventive therapy (IPT), and TST was repeated at 6, 12 and 24 months. Results We recruited 148 spouses of smear‐positive patients ascertained prospectively and 3% had active TB. We identified 203 spouses of previously diagnosed smear‐positive patients, 11 had already had TB, and the rate of TB was 2.4 per 100 person years(py) over 2 years (95% CI 1.15–5.09). 116 were found alive and recruited. HIV prevalence was 37% and 39% in the prospective and retrospective spouse groups and 17% in controls. TST was ≥10 mm in 80% of HIV negative and in 57% of HIV‐positive spouses ascertained retrospectively; 74% HIV negative and 62% HIV‐positive spouses ascertained prospectively, and 48% HIV negative and 26% HIV‐positive community controls. Of 54 HIV‐positive spouses, 18 completed 6‐month IPT. At 2 year follow‐up, 87% of surviving spouses had TST ≥10 mm and the rate of TB was 1.1 per 100 py (95% CI 0.34–3.29). Conclusions Spouses are a high‐risk group who should be screened for HIV and active TB. TST prevalence was already high by the time the spouses were approached but further infections were seen to occur. Uptake and adherence to IPT was disappointing, lessening the impact of short‐duration therapy.     

Dénervation rénale pour HTA réfractaire sans anesthésie générale : intérêt d’un protocole MEOPA Morphine. Expérience préliminaire

Renal denervation using the technique of radiofrequency is used only recently for the treatment of resistant hypertension. Normally, it is done under general anesthesia because the ablation point technique is painful. We suggest an alternative to general anesthesia comprising an association of morphin 0.1 mg/kg IV to MEOPA (gas combining oxygen and azot protoxyd) delivered through an oxygen mask. Our series includes 12 consecutive patients treated between October 2011 and June 2013, the first five patients (group 1) have received only an hydroxizin and morphin sedation. Every five have felt the ablation painful, in two cases bearable pain (EVA < 5), in three cases intense (EVA > 5) pain leading to increasing doses of morphin, (total dose of 0.25 mg/kg in two cases, 0.17 mg in one case). For the seven following patients, a protocol including hydroxyzin, morphin and MEOPA given through a mask has been set up. Only one patient has felt a mild pain (EVA 5) leading to an increasing dose of morphin (total dose 0.17 mg/kg). None of the six other patients has felt any pain during the procedure. The average dose of morphin is 0.17 mg/kg in group 1, 0.11 mg/kg in group 2. This is a preliminary study; if confirmed, it will allow a lot of hospitals without on-site possibilities of general anesthesia, to realize such procedures. Conclusion: regarding pain, the procedure of renal ablation was well tolerated for six among seven patients receiving the association MEOPA and IV morphin. In contrast, in the five patients treated only with IV morphin, we observed a less good tolerance to pain and the need to increase the doses of IV morphin.     

Scale‐up of TB and HIV programme collaborative activities in Zambia – a 10‐year review

Objective To review the activities, progress, achievements and challenges of the Zambia Ministry of Health tuberculosis (TB)/HIV collaborative activities over the past decade. Methods Analysis of Zambia Ministry of Health National TB and HIV programme documents and external independent programme review reports pertaining to 2000–2010. Results The number of people testing for HIV increased from 37 557 persons in 2003 to 1 327 995 persons in 2010 nationally. Those receiving anti‐retroviral therapy (ART) increased from 143 in 2003 to 344 304 in 2010. The national HIV prevalence estimates declined from 14.3% in 2001 to 13.5% in 2009. The proportion of TB patients being tested for HIV increased from 22.6% in 2006 to 84% in 2010 and approximately 70% were HIV positive. The proportion of the HIV‐infected TB patients who: (i) started on ART increased from 38% in 2006 to 50% in 2010; (ii) commenced co‐trimoxazole preventive therapy (CPT) increased from 31% in 2006 to 70% in 2010; and (iii) were successfully treated increased to an average of 80% resulting in decline of deaths from 13% in 2006 to 9% in 2010. Conclusions The scale‐up of TB/HIV collaborative programme activities in Zambia has steadily increased over the past decade resulting in increased testing for TB and HIV, and anti‐retroviral (ARV) rollout with improved treatment outcomes among TB patients co‐infected with HIV. Getting service delivery points to adhere to WHO guidelines for collaborative TB/HIV activities remains problematic, especially those meant to reduce the burden of TB in people living with HIV/AIDS (PLWHA).     

C-MET在非小细胞肺癌对表皮生长因子受体酪氨酸激酶抑制剂耐药中的作用研究进展

以表皮生长因子受体(EGFR)为靶点的酪氨酸酶抑制剂(TKI)是近年来非小细胞肺癌(NSCLC)治疗的重大突破.但是随着临床的广泛应用,耐药成为新的难点.新近研究已发现对EGFRTKI的耐药产生主要涉及原癌基因C-MET的扩增突变.C-MET是原癌基因,是蛋白产物肝细胞生长因子/离散离子(HGF/SF)的受体,具有酪氨酸酶活性,C-MET基因扩增激活ErbB3-PI3K信号途径导致NSCLC对EGFR-TKI产生耐药,大量研究证实NSCLC患者对EGFR-TKI耐药约20％归因于C-MET基因扩增.     

Artificial intelligence in pancreaticobiliary endoscopy

Artificial intelligence (AI) applications in health care have exponentially increased in recent years, and a few of these are related to pancreatobiliary disorders. AI‐based methods were applied to extract information, in prognostication, to guide clinical treatment decisions and in pancreatobiliary endoscopy to characterize lesions. AI applications in endoscopy are expected to reduce inter‐operator variability, improve the accuracy of diagnosis, and assist in therapeutic decision‐making in real time. AI‐based literature must however be interpreted with caution given the limited external validation. A multidisciplinary approach combining clinical and imaging or endoscopy data will better utilize AI‐based technologies to further improve patient care.