血清IL-10和IL-12在自身免疫性甲状腺疾病中的表达特征

目的：研究自身免疫性甲状腺疾病中血清白细胞介素－10（IL－10）和白细胞介素－12（IL－12）的表达特征及其在免疫反应发生中的作用和机制。方法：对38例Graves病（GD）患者（18例未治疗的初诊患者，为GDa组；20例抗甲亢药物治疗的患者，为GDb组）、24例慢性淋巴细胞性甲状腺炎（HD）患者及22例正常者（对照组）检测了血清中IL－10，IL－12的表达水平及甲状腺功能的变化。IL－10和IL－12采用酶联免疫法（ELISA）测定。血清游离T3（FT3），游离T4（FT4）和促甲状腺激素（TSH）测定用化学发光免疫分析法。抗甲状腺球蛋白抗体（TgAb)和抗甲状腺微粒体抗体（TmAb)用放射免疫法。结果：GDa组的IL－10、IL－12均高于对照组（P＜0．05，P＜0．01），但以IL－12的增高占优势，IL－12／IL－10比值增高（P＜0．05）。GDb组的IL－12水平和IL－12／IL－10比值较GDa组显著降低（P＜0．05，P＜0．01），与对照组比较无显著差异。IL－10水平较GDa组有上升趋势但无统计学意义，但高于对照组（P＜0．01），HD患者IL－12水平和IL－12／IL－10比值均较对照组增高（P＜0．01，P＜0．01），较GDb组也显著增高（P＜0．05，P＜0．01），IL－10水平与对照组比较无显著差异，但显著低于GDb组（P＜0．05）。结论：GD患者，在甲状腺功能亢进状态时，由Thl细胞产生的IL－12水平和低表Th2细胞活力的IL－10水平均明显增高，提示Th1和Th2的表达均增高，细胞免疫和体液免疫均参入了甲亢的自身免疫反应过程。在HD患者也有IL－12水平的显著增高，表明了Th1细胞因子所介导的细胞免疫在HD的病理反应中起主导作用。在GD和HD患者，均表现有IL－12／IL－10比值的变化，提示Th1/Th2间的平衡紊乱可能对介导甲状腺自身免疫炎症反应的产生起关键作用。     

Graves' disease (clinical aspects of Graves' disease)]

Graves' disease (GD) is an autoimmune thyroid disease. In addition to the etiology of hyperthyroidism, TSH receptor antibodies play an important role in the pathogenesis of pretibial myxedema, ophthalmopathy, and neonatal GD. The previous epidemiological surveys have revealed that 0.08-0.6% of the population were affected by GD in Japan. Clinical signs and symptoms as well as laboratory abnormalities are described with emphasis on elevated serum VEGF and G-CSF levels in untreated GD patients. It should be noted that elderly patients may not have typical symptoms of hyperthyroidism, but cardiac symptoms and weight loss usually predominate. Abnormal laboratory findings may help to make a diagnosis in asymptomatic patients. Patients with ophthalmopathy may have antibodies to 64 kD/55 kD external orbital muscle proteins.     

甲状腺功能测定对内分泌突眼的诊断价值

目的探讨三碘甲状腺原氨酸(T3)、游离三碘甲状腺原氨酸(FT3)、甲状腺素(T4)、游离甲状腺素(FT4)、促甲状腺素(TSH)测定对内分泌性突眼的诊断价值。方法采用化学发光法检测130例Graves病(GD)伴眼球突出患者、127例单纯性GD患者、128例正常人血清T3、FT3、T4、FT4、TSH水平,并对检测结果进行比较分析。结果与正常对照组相比,GD伴眼球突出患者和单纯GD患者血清T3、FT3、T4、FT4、TSH水平明显升高(P<0.05),GD伴眼球突出患者和GD患者血清T3、FT3、T4、FT4、TSH水平无明显差异,这些指标水平与突眼呈相关关系。结论甲状腺功能的测定虽然对GO的诊断作用无明显帮助,却有助于临床医生判断突眼的严重程度,从而制定合理的治疗方案。     

Treatment of hypothyroidism.

Thyroid disease affects up to 0.5 percent of the population of the United States. Its prevalence is higher in women and the elderly. The management of hypothyroidism focuses on ensuring that patients receive appropriate thyroid hormone replacement therapy and monitoring their response. Hormone replacement should be initiated in a low dosage, especially in the elderly and in patients prone to cardiac problems. The dosage should be increased gradually, and laboratory values should be monitored six to eight weeks after any dosage change. Once a stable dosage is achieved, annual monitoring of the thyroid-stimulating hormone (TSH) level is probably unnecessary, except in older patients. After full replacement of thyroxine (T4) using levothyroxine, the addition of triiodothyronine (T3) in a low dosage may be beneficial in some patients who continue to have mood or memory problems. The management of patients with subclinical hypothyroidism (a high TSH in the presence of normal free T4 and T3 levels) remains controversial. In these patients, physicians should weigh the benefits of replacement (e.g., improved cardiac function) against problems that can accompany the excessive use of levothyroxine (e.g., osteoporosis).     

老年2型糖尿病与非酒精性脂肪性肝病相关性研究

[目的]探讨老年2型糖尿病（T2DM）合并非酒精性脂肪肝的临床相关因素.[方法]对老年T2DM合并非酒精性脂肪性肝病（NAFLD）或无NAFLD患者及健康对照志愿者进行血脂水平、空腹血糖（FBG）及空腹胰岛素（FINS）的测定,并计算体质量指数（BMI）,腰臀比值（WHR）及胰岛素敏感指数（HOMA-IR）,并进行分析.[结果]与对照组（n=35）、不合并NAFLD组比较（n=40）,合并NAFLD的T2DM患者（n=42）的BMI、WHR、血甘油三酯（TG）、收缩压（SBP）、HOMA-IR显著增高,HOMA-β降低（P〈0.05或P〈0.01）.[结论]T2DM患者合并NAFLD,与肥胖（主要是腹型肥胖）、血脂紊乱、血压增高相关;导致糖尿病合并NAFLD的最主要原因为胰岛素抵抗及其所包含的脂代谢紊乱.     

老年非酒精性脂肪性肝病的临床特征

目的分析老年非酒精性脂肪性肝病(NAFLD)的临床表现、实验室检查、超声及合并疾病等特征。方法对临床诊断NAFLD的128例患者临床资料进行回顾性分析,比较48例老年(≥60岁)患者和80例中青年患者的一般资料、临床表现、血常规、血糖、血脂、肝功能化验、超声及合并疾病等特征。结果确诊NAFLD时,老年组患者的女性比率高于中青年组(分别为60.4%和26.3%,P<0.05),临床表现相似,但空腹血糖、总胆固醇和低密度脂蛋白胆固醇水平较高,白蛋白水平较低,合并高血压、2型糖尿病等代谢综合征相关疾病的比率高于中青年组(分别为85.4%和36.3%,P<0.01)。结论和中青年患者比较,老年NAFLD的女性比率更高,更常合并高血压、2型糖尿病等疾病。     

Hyperthyroidism affects arterial stiffness, plasma NT-pro-B-type natriuretic peptide levels, and subendocardial perfusion in patients with Graves' disease

BACKGROUND: Arterial stiffness is thought to play a critical role in the pathogenesis of cardiovascular events, and in hyperthyroidism increased cardiovascular event rates have been reported. AIM: To investigate markers of systemic arterial stiffness, volume homeostasis, and subendocardial perfusion and its interrelationship in patients with Graves' disease (GD) in hyperthyroidism and euthyroidism. METHOD: Aortic augmentation index (AIx@75) as a measure of systemic arterial stiffness and subendocardial viability ratio (SEVR) as a surrogate measure of subendocardial perfusion were assessed by applanation tonometry in 59 patients with GD in hyperthyroidism and euthyroidism, and measurements were compared to plasma levels of NT-pro-B-type natriuretic peptide (NT-ProBNP). RESULTS: AIx@75 and NT-ProBNP levels were significantly increased in hyperthyroidism compared to euthyroidism and were positively correlated with each other. SEVR was significantly decreased in hyperthyroidism compared to euthyroidism, mainly due to increased heart rates as shown by the heart rate-corrected SEVR75. CONCLUSIONS: In hyperthyroidism, patients with GD exhibited increased systemic arterial stiffness, paralleled by increased levels of NT-ProBNP, a marker of volume overload. The decreased subendocardial perfusion in hyperthyroidism seemed to be mainly due to increased heart rates. The observed unfavorable hemodynamic alterations in hyperthyroidism may serve to explain increased cardiovascular event rates in patients with GD.     

Prognostic predictors of technique and patient survival in elderly Southeast Asian patients undergoing continuous ambulatory peritoneal dialysis

The population of elderly patients entering chronic dialysis programmes is increasing. Elderly patients are susceptible to malnutrition and have multiple complicating disorders in addition to uraemia. Selecting appropriate dialysis modality is particularly critical in elderly patients. Continuous ambulatory peritoneal dialysis (CAPD) has many advantages to elderly patients; however, the clinical outcome varies for elderly CAPD patients. In comparison with Westerners, Southeast Asians have a small body mass index and may be more suited to CAPD therapy. To identify the prognostic predictors in elderly Southeast Asian patients, this historical cohort study analysed 144 patients aged > or = 65 years at initiation of CAPD. A group of haemodialysis (HD) patients aged > or = 65 years was utilised as the control group. Survival curves for patient and technique were derived from Kaplan-Meier analysis and were further analysed by Cox-Mantel log-rank test. To elucidate the impact of individual factors on patient survival, various significant univariables were further subjected to multivariate analysis. No significant increase existed for relative risk of technique failure in elderly patients compared with younger patients. This analytical data indicates that CAPD was as good as HD for elderly uraemic patients regarding to the patient survival. Diabetes, dependent patients, low albumin levels and previous HD history were significant poor prognostic factors for survival of elderly CAPD patients. In conclusion, CAPD is an effective modality of renal replacement therapy for Southeast Asian elderly patients. The technique survival was not affected by patient age.     

老年原发性高血压与代谢异常的关系

目的 探讨老年高血压患者胰岛素、碳水化合物和脂质等代谢的变化。方法 对29例老年高血压和17例非高血压人群进行口服75g葡萄糖耐量试验,同时测定血胰岛素、血脂、尿酸和纤维蛋白原。两组比较显示,高血压组患者糖代谢受损发生率,空腹、餐后2小时和3小时血糖和胰岛素水平,甘油三脂、血尿酸和纤维蛋白原均明显升高(P<0.05),胰岛素敏感指数和高密度脂蛋白降低(P<0.05)。结论 老年高血压患者常伴有多种代谢紊乱,应加强监测。     

非甲状腺疾病综合征对老年住院患者预后判断价值

目的了解非甲状腺疾病综合征(NTIS)老年患者的甲状腺素水平变化,评估其在疾病预后判断中的价值。方法 2001年6月~2010年6月共448例老年患者纳入研究。住院期间检测患者血清游离三碘甲腺原氨酸(FT3)、血清游离甲状腺素(FT4)、促甲状腺激素(TSH)水平和炎症指标。了解NTIS的发病率并分析预后因素。结果 NTIS组患者C反应蛋白(CRP)、乳酸脱氢酶(LDH)、纤维蛋白原、血沉(ESR)水平明显高于非NTIS组。甲状腺水平越低,炎症标志物种类越多。NTIS组FT3水平明显低于非NTIS组,低FT3水平是唯一死亡预测因子。结论老年NTIS患者中低FT3水平是最敏感的独立的短期死亡预测因子。低FT3可以作为NTIS的预后指标。     

Significance of thyroid blood flow as a predictor of methimazole sensitivity in untreated hyperthyroid patients with Graves' disease.

OBJECTIVE: The peak systolic velocity (PSV) of the inferior thyroid artery (ITA) is increased in untreated hyperthyroid patients with Graves' disease (GD). We investigated the clinical significance of the ITA-PSV and its determinants in hyperthyroid GD patients. PATIENTS AND METHODS: ITA-PSV, together with thyroid volume, was measured by ultrasonography in untreated hyperthyroid GD patients (n=49) and healthy subjects (n=22). Established markers of GD activity such as TSH receptor antibody (TRAb), thyroid stimulating antibody (TSAb), vascular endothelial growth factor (VEGF) and immunoglobulin E (IgE) were simultaneously determined. RESULTS: ITA-PSV, thyroid volume, VEGF and IgE were significantly higher in hyperthyroid GD patients than in normal subjects. ITA-PSV in hyperthyroid GD patients was correlated positively with serum levels of FT(3), FT(4) and IgE, smoking index and thyroid volume, and negatively with total, HDL- and LDL-cholesterols, but did not correlate significantly with age, triglyceride, TRAb, TSAb or VEGF. In stepwise regression analysis, ITA-PSV showed significant positive and negative associations with IgE and LDL-cholesterol, respectively, in hyperthyroid GD patients. In the pre-treatment hyperthyroid state, FT(4) and ITA-PSV, but not IgE, were found to be significantly and positively associated with the maintenance dose of methimazole (MMI) required to keep serum TSH within normal range for at least 12 months. CONCLUSION: These results suggest that ITA-PSV in untreated hyperthyroid GD patients may reflect GD activity and thus MMI sensitivity.     

A review of heart failure management in the elderly population

Background: In the United States, the incidence of heart failure (HF) in the elderly population (age, ≥65 years) approached 10 per 1000 population in 2006, and HF was a common reason for hospitalization. Many clinical features and the management of HF differ in elderly patients compared with their younger counterparts due to changes in physiology and the presence of comorbidities.Objective: The aim of this review was to explore the risks and benefits of different classes of HF pharmacotherapy for chronic HF management in the elderly population.Methods: Peer-reviewed articles were identified from MEDLINE and Current Contents database (both, 1966–May 21, 2009) using the search terms HF, elderly, geriatrics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), β-blockers, aldosterone antagonists, diuretics, digoxin, and vasodilators. Citations from available articles were also reviewed for additional references. Randomized, double-blind, controlled studies that assessed the effects of HF pharmacotherapy on morbidity and mortality outcomes were included. The American College of Cardiology/American Heart Association (ACC/AHA) Clinical Guidelines on Management of Chronic HF and associated studies are discussed.Results: A total of 40 clinical studies were included in the present review. The ACC/AHA recommended that evidence-based therapy for HF be used in elderly patients, with individualized consideration of the elderly patient's altered ability to metabolize or tolerate standard medications. HF pharmacotherapies that have been associated with mortality benefits in elderly patients with left ventricular systolic dysfunction include ACE inhibitors or ARBs; β-blockers; aldosterone antagonists; and, in patients who cannot tolerate ACE inhibitors or ARBs or who are black, a combination of hydralazine and nitrates. For symptom control and morbidity benefit, therapies include diuretics and digoxin. For HF with preserved ejection fraction (HF-PEF), no particular pharmacotherapeutic agent has been found to have mortality benefits. Managing the underlying cause for the HF symptoms is the key approach to treatment of HF-PEF. There was a lack of clinical trials that assessed the effects of HF treatment exclusively in elderly patients. Most clinical trials of HF pharmacotherapy have not specified the number of elderly patients included, or they included 30% to 50% elderly patients. This lack of data in the elderly leads to the necessity of applying clinical judgment to individual patient cases, together with consideration of their altered ability to metabolize or tolerate standard medications. Elderly patients also have variable responses to HF pharmacotherapy and might be susceptible to adverse events, such as orthostatic hypotension, renal dysfunction, electrolyte disturbances, and interactions with medications being received for the treatment of comorbidities. Elderly patients undergoing HF therapy should be closely monitored. The HF-related mortality rate is high in elderly patients. Discussing end-of-life issues and providing palliative care in patients with advanced disease are parts of an optimal care plan.Conclusions: HF therapy that has published mortality and morbidity benefits in nonelderly patient populations has been associated with benefits in elderly patients. Elderly patients may have variable pharmacologic responses to these agents and may be susceptible to adverse events and drug-drug interactions due to concurrent treatments for comorbidities. Close monitoring of elderly patients undergoing HF treatment is essential to ensure optimal outcomes.     

Graves' disease in interferon-alpha-treated and untreated patients with chronic hepatitis C virus infection.

An association between Graves' disease (GD) and chronic hepatitis C (C-HC) has been observed both in the presence and the absence of recombinant interferon-alpha (rIFN-alpha) treatment. rIFN-alpha-induced GD is characterized by suppressed thyroid-stimulating hormone levels; normal or elevated free triiodothyronine (FT3) and free thyroxine (FT4) values; the presence of thyroid peroxidase antibodies, antithyroglobulin antibodies, and thyroid receptor antibodies; and high iodine thyroid uptake. In contrast, GD developed during C-HC without rIFN-alpha is less clearly defined. In this study, we examined two groups of patients: group A, 28 patients with C-HC treated with rIFN-alpha who developed GD after 1 to 9 months, and group B, 10 patients with C-HC who developed GD without a previous rIFN-alpha treatment. At the time of GD, both groups started methimazole therapy; thyroid function was reevaluated after 3, 6, 9, and 12 months. Group A patients continued IFN. After 12 months, all patients of group A were euthyroid, and 21 of them (75%) had already stopped methimazole treatment, whereas all patients of group B were euthyroid and only 2 (20%) had stopped methimazole. In conclusion, the data show a better course of GD, with a more precocious and significantly higher number of recoveries in patients with rIFN-alpha-induced GD than in rIFN-alpha-unrelated disease. Further studies are needed to establish whether the two types of GD differ not only from a clinical point of view but also because of different underlying pathogenetic mechanisms.     

Low levels of serum IL‐39 are associated with autoimmune thyroid disease

BackgroundInterleukin (IL)‐39 is a novel member of IL‐12 cytokine family, but its role in autoimmune thyroid diseases (AITD) is unclear. The aim of the present study was to determine serum levels of IL‐39 in Hashimoto''s thyroiditis (HT) and Graves'' disease (GD) patients.MethodsA total of 48 patients with HT, 50 patients with GD, and 45 healthy controls (HCs) were recruited for this study. Levels of serum IL‐39 were determined by ELISA.ResultsCompared with HC group, levels of serum IL‐39 in patients with HT (p < 0.05) and GD (p < 0.01) were drastically reduced. Among patients with HT, serum IL‐39 levels had a positive correlation with white blood cell count (WBC) count and free triiodothyronine level. Among patients with GD, the levels of IL‐39 in serum were positively correlated with WBC count and C‐reactive protein levels.ConclusionsIL‐39 may be a new potential predictor for patients with HT and GD.     

Peripheral blood T lymphocyte sensitization to thyroid microsomal antigen from patients with Graves' disease negative for circulating anti-thyroid microsomal antibodies

We have studied thyrocyte HLA-DR expression induced by supernatants of peripheral blood mononuclear cells (PBMC) stimulated by thyroid microsomal antigen (TMA), as an index of sensitization of the T lymphocyte in autoimmune thyroid diseases; we have studied PBMC from 11 normal control persons and 19 patients with Graves' disease (GD) in whom serum anti-thyroid microsomal antibodies (AMA) were either not detectable (9 patients) or were positive (10 patients). Thyrocyte HLA-DR induction in response to TMA-treated PBMC supernatants from GD was significantly different from that of normal controls (p less than 0.05, ANOVA). TMA-stimulated GD PBMC supernatants increased thyrocyte HLA-DR index [TMA 1 ng/ml, SI 143 +/- 82 (mean +/- SD), p less than 0.05], but normal PBMC supernatants did not. However there was no significant difference in response in terms of the thyrocyte HLA-DR expression induced by TMA-stimulated PBMC supernatants between AMA seronegative vs seropositive GD. These results suggest the possibility of some dissociation of the activities of T lymphocytes and B lymphocytes in patients with GD in response to thyroid microsomal antigen with or without anti-thyroid microsomal antibodies.     

Effect of fenoprofen on thyroid function tests

We observed that a few patients taking the anti-inflammatory drug fenoprofen showed increases in total and free T3 serum levels without convincing evidence of an associated thyrotoxicosis. To confirm these findings, two volunteers were given fenoprofen for two weeks. Within this time total T3 levels almost doubled and free T3 levels increased threefold. Administration of fenoprofen did not have any measurable effect on T4 or TSH estimations. Cross-reactivities of fenoprofen and 4'-hydroxyfenoprofen were studied with antisera from various total and free T3 assays. Results show that the metabolite cross-reacts with the antisera from Amerlex total and free T3 assay kits. A lesser degree of interference was observed with the Corning total and free T3 assays. 4'-hydroxyfenoprofen had no effect on an 'in house' total T3 assay. Laboratories should therefore be aware of the possibility that their assay may be subject to interference by fenoprofen or its metabolites while clinicians should be aware of this interference in order that they may avoid unnecessary and harmful treatment.     

老年男性骨关节炎骨密度变化相关研究

目的探讨老年男性骨关节炎（osteoarthritis,OA）患者骨密度（Bone mineral density,BMD）变化相关因素。方法选择老年男性膝骨关节炎（Knee osteoarthritis,KOA）患者72例（男性组）、老年女性KOA患者60例（女性组）,检测两组的BMD及男性组生活方式情况、血生化指标、骨代谢指标、双膝数值化X射线、KOA WOMAC（Western Ontario and McMaster Uni-versities）评分等临床资料,应用SPSS 13.0软件包进行统计学分析。结果①男性组BMD高于女性组（P=0.002）,骨量变少率低于女性组（P〈0.001）;②男性组腰椎、股骨颈、Wards三角、大转子、股骨干BMD差异有统计学意义（P〈0.001）,其中Wards三角BMD值最低,腰椎BMD值最高;③喝牛奶、户外运动在男性骨量正常组高于骨量变少组（P=0.031,0.002）;④骨量正常组低密度脂蛋白胆固醇（LDL-C）低于骨量减少组和骨质疏松（osteoporosis,OP）组（P〈0.05）,而碱性磷酸酶（ALP）高于骨量减少组和OP组（P〈0.01）,骨钙素（OC）高于OP组（P=0.01）;⑤老年男性KOA的BMD与体质量指数（BMI）、OC呈正相关,与年龄、LDL-C呈负相关。结论老年男性OA较老年女性OA患者更少伴发OP,老年男性OA患者喝牛奶、户外运动者更不易伴发OP,LDL-C越高、年龄越大越易患OP,老年男性OA伴发的OP主要是成骨细胞活性减低所致,属低转换型,在诊治男性OA过程中更应关注OP。     

The effect of age on the development and outcome of adult sepsis

OBJECTIVE: Sepsis is an increasingly common and lethal medical condition that occurs in people of all ages. The influence of age on sepsis risk and outcome is incompletely understood. We sought to determine the independent effect of age on the incidence, severity, and outcome of adult sepsis. DESIGN: Longitudinal observational study using national hospital discharge data. SETTING: Approximately 500 geographically separated nonfederal acute care hospitals in the United States. PATIENTS: Patients were 10,422,301 adult sepsis patients hospitalized over 24 yrs, from 1979 to 2002. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Incident sepsis cases were age adjusted and characterized by demographics, sources and types of infection, comorbid medical conditions, and hospital discharge status. Elderly patients (> or = 65 yrs of age) accounted for 12% of the U.S. population and 64.9% of sepsis cases, yielding a relative risk of 13.1 compared with younger patients (95% confidence interval, 12.6-13.6). Elderly patients were more likely to have Gram-negative infections, particularly in association with pneumonia (relative risk, 1.66; 95% confidence interval, 1.63-1.69) and to have comorbid medical conditions (relative risk, 1.99; 95% confidence interval, 1.92-2.06). Case-fatality rates increased linearly by age; age was an independent predictor of mortality in an adjusted multivariable regression (odds ratio, 2.26; 95% confidence interval, 2.17-2.36). Elderly sepsis patients died earlier during hospitalization, and elderly survivors were more likely to be discharged to a nonacute health care facility. CONCLUSIONS: The incidence of sepsis is disproportionately increased in elderly adults, and age is an independent predictor of mortality. Compared with younger sepsis patients, elderly nonsurvivors of sepsis die earlier during hospitalization and elderly survivors more frequently require skilled nursing or rehabilitative care after hospitalization. These findings have implications for patient care and health care resource prioritization and provide insights for expanded scientific investigations and potential patient interventions.     

Hyperthyroidism affects arterial stiffness,plasma NT‐pro‐B‐type natriuretic peptide levels,and subendocardial perfusion in patients with Graves' disease

Background. Arterial stiffness is thought to play a critical role in the pathogenesis of cardiovascular events, and in hyperthyroidism increased cardiovascular event rates have been reported.

Aim. To investigate markers of systemic arterial stiffness, volume homeostasis, and subendocardial perfusion and its interrelationship in patients with Graves' disease (GD) in hyperthyroidism and euthyroidism.

Method. Aortic augmentation index (AIx@75) as a measure of systemic arterial stiffness and subendocardial viability ratio (SEVR) as a surrogate measure of subendocardial perfusion were assessed by applanation tonometry in 59 patients with GD in hyperthyroidism and euthyroidism, and measurements were compared to plasma levels of NT‐pro‐B‐type natriuretic peptide (NT‐ProBNP).

Results. AIx@75 and NT‐ProBNP levels were significantly increased in hyperthyroidism compared to euthyroidism and were positively correlated with each other. SEVR was significantly decreased in hyperthyroidism compared to euthyroidism, mainly due to increased heart rates as shown by the heart rate‐corrected SEVR₇₅.

Conclusions. In hyperthyroidism, patients with GD exhibited increased systemic arterial stiffness, paralleled by increased levels of NT‐ProBNP, a marker of volume overload. The decreased subendocardial perfusion in hyperthyroidism seemed to be mainly due to increased heart rates. The observed unfavorable hemodynamic alterations in hyperthyroidism may serve to explain increased cardiovascular event rates in patients with GD.     

Increased pedestrian mortality among the elderly

Elderly pedestrians struck by motor vehicles have the highest mortality rate of all pedestrian injury victims. One thousand eighty-two motor vehicle-pedestrian accidents occurring in a metropolitan area over a 5-year period were studied. Age-specific injury rates and fatality rates were evaluated with respect to the injury severity scores (ISS) for all fatally injured autopsied pedestrians. Of the 1,082 injuries, 131 fatalities occurred. Mean ISSs were found to be significantly higher for pedestrians dying at the scene of the accident (mean ISS, 54.83) and higher for those dying in the emergency department (mean ISS, 45.18), than for pedestrians who died in the hospital (mean ISS, 30.57) (P less than .0001). The mortality rate for pedestrians aged greater than or equal to 60 years was substantially higher than for those adults aged less than 60 years of age (P less than .001). Elderly patients involved in accidents were much more likely to die than younger pedestrians (44.6% v 10.4%; P less than .0001). Elderly pedestrians were significantly overrepresented in the group of pedestrians dying in the hospital compared with younger injury victims (52.5% v 21.5%; P less than .008). This study shows that elderly pedestrians struck by motor vehicles die at a higher rate because they succumb to injuries in the hospital more frequently than younger pedestrians. This may reflect the greater susceptibility of the elderly to metabolic, surgical, and infectious complications after admission to the hospital. A decrease in mortality rates of elderly patients suffering pedestrian injuries will probably follow improved in-hospital intensive care services for the elderly.