不同碘摄入水平对儿童甲状腺功能及智力的影响

目的通过对山西省平遥县不同水碘含量地区儿童智商和甲状腺功能的调查,进一步探讨高碘对人体造成的危害。方法郝开村、郝家堡、左家堡的水碘、尿碘、盐碘含量测定均采用国标法,智力测验采用瑞文测验,甲状腺肿大采取触诊法,血清TT4、TSH采用化学发光法测定。结果郝开村、郝家堡、左家堡3个村的水碘分别为28.7μg/L、147.5μg/L、1 476.6μg/L、997.3μg/L、802.6μg/L 儿童尿碘中位数分别为237.9μg/L、357.8μg/L、1 362.7μg/L 盐碘平均值分别为24.86 mg/kg、28.28 mg/kg、1.96 mg/kg 儿童智商分别为100.1、108.2、105.5 甲状腺肿大率分别为2.5%、11.27%、24.05% TSH平均值分别为2.88 MIU/L、3.63 MIU/L、4.82 MIU/L。结论摄入过量的碘可以导致血清TSH水平增高、甲状腺肿大。     

成人亚临床甲状腺机能减退症115例治疗研究

目的探讨治疗成人亚临床甲状腺机能减退症(SCH)的有效方法.方法将115例SCH分成两大组,随机分成四个亚组,进行替代和非替代治疗.分别观察其症状变化及血清总甲状腺素(TT4),促甲状腺激素(TSH),血甘油三脂(TG),胆固醇(CH),高密度脂蛋白(HDL-CH),低密度脂蛋白(LDL-CH)的变化.结果(1)SCH临床症状在采用替代治疗后明显改善(P＜0.05);而非替代治疗组则改善不明显(P＞0.05).(2)采用替代治疗后,从半年开始TSH下降,至两年后TSH平均水平趋于正常,非替代治疗组,则无明显变化.(3)通过替代治疗两组血脂皆有明显下降,而非替代治疗组则无变化.(4)替代治疗两组,经过两年观察,SCH治愈明显增高,与非替代治疗组比较,差异显著(P＜0.05).结论SCH早期给予替代治疗,可使症状缓解,血脂下降,SCH治愈率明显升高.     

食用合格碘盐后部分人群尿碘、血清TSH和TG状况分析

目的 研究食用合格碘盐后部分人群尿碘、血清促甲状腺激素（TSH）和甲状腺球蛋白（TG）状况及其之间的关系，评价现行浓度的碘盐是否能满足不同人群对碘的需求。方法 按日需碘量不同将人群分为学龄儿童、成人、孕妇3组，给以32mg/kg碘盐食用4周，观察这期间的尿碘水平、血清TSH和TG状况。结果 干预后3组人群尿碘均维持在100μg/L以上，成人组尿碘水平比较理想。3组人群血清TSH碘干预前后变化不明显；成人组TSH较儿童组和孕妇组低；34例成人碘干预前后TSH差异有显著意义，干预后TSH略有上升。3组人群血清TG中位数碘干预前后差异无显著意义；成人组TG下降幅度较大一些，达25％；儿童组TG明显高于成人组和孕妇组；32例成人碘预前后TG差异有显著意义，呈下降趋势。结论 32mg/kg浓度的碘盐对于饮食单一、碘源不足的人群比较合适，而对于经济状况较好，碘源充足的人群尤其是儿童则有偏高的倾向。血清TSH和TG在短期内的改变，贫碘人群较富碘人群明显，尤其贫碘人群的TG改变，有较TSH更敏感的倾向。     

碘酸钾和碘化钾对碘缺乏大鼠甲状腺抗氧化能力的影响

目的 研究碘酸钾和碘化钾两种碘剂对碘缺乏大鼠甲状腺抗氧化能力的影响。方法 Wistar大鼠低碘喂养3个月，复制出低碘模型后，随机分为4组：适碘碘化钾组（NI），适碘碘酸钾组（NO），高碘碘化钾组（HI），高碘碘酸钾组（HO），喂养22周后测定尿碘排泄情况、甲状腺重量、血清甲状腺激素水平和甲状腺组织抗氧化能力改变，观察甲状腺形态变化。结果 HO与HI两组补碘后尿碘显升高；与NI组相比，HO组甲状腺湿重及相对重量均明显增加，HI组甲状腺相对重量明显增加，与NI相比，HO、HI组T3显升高；与NI组相比，NO、HO、HI组GPX、SOD和TAOC均显降低，HO组MDA显升高，但NO、HI组MDA无明显升高；与HI组相比，HO组的GPX、TAOC显降低。结论 碘缺乏大鼠补充大剂量碘酸钾或大剂量碘化钾后，甲肿消退速度慢；无论补充生理或大剂量碘剂，与碘化钾相比，补充碘酸钾甲状腺抗氧化物酶持续降低，大剂量碘酸钾导致甲状腺MDA含量升高。     

限制碘摄入量对老年亚临床甲状腺功能减退症患者的影响

目的 探讨限制碘摄入量对老年亚临床甲状腺功能减退症(亚临床甲减)患者的影响.方法 选择老年亚临床甲减患者86例,随机分为治疗组(43例)和对照组(43例),治疗组限制碘摄入量.随访1年,观察2组患者尿碘中位数(MUI),促甲状腺激素(TSH)、游离T3(FT3)、游离T4(FT4)、甲状腺过氧化物酶抗体(TPOAb),血脂的变化.结果 ①治疗组尿碘水平较治疗前明显降低(P＜0.01).②治疗组TSH缓解率65.1%(28/43),对照组TSH自然缓解率为37.2%(16/43),两组比较差异显著(χ2=6.70,P＜0.05).③治疗组总胆固醇(TC)、低密度脂蛋白(LDL)、脂蛋白[LP(a)]较治疗前明显下降,且与TSH呈正相关(r=0.52,P＜0.05).结论 对非自身免疫原因所致的老年亚临床甲减患者,限制碘摄入量可能是一种有效的防治措施.     

左旋甲状腺激素对妊娠伴亚临床甲状腺功能减退症患者妊娠结局、新生儿及甲状腺功能的影响

目的探讨左旋甲状腺激素对妊娠伴亚临床甲状腺功能减退症患者妊娠结局、新生儿及甲状腺功能的影响。方法480例妊娠伴亚临床甲状腺功能减退症(SCH)患者,按照随机数字表法分为对照组与观察组,各240例。观察组采用左旋甲状腺激素治疗,对照组无任何治疗;另选择同期正常健康孕妇及新生儿240例为健康组,比较三组妊娠结局,并测量新生儿身高、体重及1min阿普加评分,收集三组新生儿脐带血,并检测其甲状腺功能。结果对照组自然顺产率明显低于健康组、观察组(P0.05);对照组流产率、并发症率及早产率明显高于健康组、观察组(P0.05);观察组各指标与健康组比较,差异无统计学意义(P0.05)。对照组新生儿脐带血TSH水平明显高于健康组、观察组,而新生儿体重明显低于健康组、观察组(P0.05);然健康组新生儿体重、脐带血TSH与观察组比较,差异无统计学意义(P0.05)。三组新生儿身高及1min阿普加评分、脐带血FT4及FT3比较,差异无统计学意义(P0.05)。结论采用左旋甲状腺激素可显著改善SCH患者不良妊娠结局及新生儿状况,同时有利于促进TSH下降,从而改善患者临床症状。     

社区居民高TSH水平下甲状腺结节与碘营养状况调查

目的调查兰州市社区居民高促甲状腺激素(TSH)水平下甲状腺结节患病率与碘营养状况。方法对兰州市社区常住居民整群分层抽样,按照高TSH组与正常TSH组进行甲状腺结节患病情况和碘营养状况调查。结果①男性甲状腺结节患病率为17.98%,男性高TSH率占16.85%。女性分别为23.43%和25.31%。甲状腺结节患病率、TSH水平具有性别差异(P0.05)。②加碘盐政策施行后,相较于37岁以上人群,37岁以下人群的尿碘水平升高,TSH数值降低(P0.05)。高TSH水平下甲状腺结节患病率与年龄,性别显著相关(P0.05),但正常水平没有此相关性(P0.05)。③年龄是发生甲状腺结节的危险因素。TSH水平与收缩压、低密度脂蛋白、空腹血糖、总胆固醇、年龄相关。④尿碘中位数为197.00μg/L,高于其他地区,施行加碘盐政策后尿碘水平显著升高(P0.05)。尿碘水平与TSH、甲状腺结节的患病率没有相关性;高TSH下单发结节与多发结节患病率不受尿碘影响。结论高TSH可增加甲状腺结节的患病率,同时年龄、性别影响甲状腺结节患病率。目前状态下,居民尿碘和TSH、甲状腺结节患病率均没有相关性。     

高碘与高氟对儿童智力及甲状腺功能的影响

目的探讨高碘、高氟对儿童智力及甲状腺功能的影响.方法选择庆云县水碘、水氟较高的李店小学为调查点,水碘、水氟基本正常的大丁小学为对照点,对8～12岁学生进行了甲状腺肿、氟斑牙、儿童智商及甲状腺功能代谢指标的调查.结果高碘、高氟地区儿童甲状腺肿大率为29.8%,氟斑牙患病率为72.98%,明显高于对照点(P＜0.01);学生平均智商为76.76±7.75,与对照点差异无显著意义(P＞0.05),但智力低下者占16.67%;机体尿碘、尿氟分别为(816.25±1.80)μg/L和(3.08±1.03)mg/L,明显高于对照点(P＜0.005);甲状腺吸131     

亚临床甲状腺功能减退症对经皮冠状动脉介入治疗患者临床结局的影响

目的:分析亚临床甲状腺功能减退症(SCH)对经皮冠状动脉介入治疗(PCI)患者术后临床转归的影响。方法:连续入组2012年1月至2017年12月在定安县人民医院诊断并在海南省人民医院心导管室行冠状动脉造影检查并接受PCI治疗的936例冠心病患者。根据促甲状腺激素(TSH)水平,分为甲状腺功能正常组(ET组,n=836)和亚临床甲状腺功能减退症组(SCH组,n=100);SCH组进一步分为两个亚组:SCH组1(TSH 4.5～6.9 mIU/L)和SCH组2(TSH≥7.0 mIU/L)。比较各组之间PCI后不良临床结局(包括非致命性心肌梗死、再次血运重建、心原性死亡以及上述终点的复合心血管事件)的差异,并使用多因素Cox回归分析评估SCH与不良临床结局之间的独立相关性。结果:中位随访321天(170～473天),SCH组心原性死亡(3.0%vs 1.2%,P=0.006)、非致命性心肌梗死(4.0%vs 3.1%,P=0.018)、再次血运重建(17.0%vs 16.1%,P=0.017)和复合心血管事件(20.6%vs 3.0%,P=0.002)的发生率均高于ET组。多因素Cox回归分析显示,SCH与复合心血管事件的风险独立相关(HR=1.52,95%CI:1.04～2.22,P=0.0293)。血清TSH≥7.0 mIU/L与复合心血管事件的风险显著相关(OR=2.07,95%CI:1.28～3.34,P=0.0029)。结论:SCH患者PCI术后预后较差,TSH≥7.0 mIU/L时复合心血管事件风险明显增加。     

广州市某小学学习障碍儿童碘营养状况调查

目的了解广州市某小学学习障碍(LD)儿童碘营养状况。方法用砷-铈接触法测定尿碘,用放射免疫分析法(RIA)测定静脉血清T4,用免疫放射分析法(IRMA)测定静脉血清TSH。用学习困难儿童筛查量表结合平时成绩选出ID组及对照组。用瑞文智力测验测定智商。结果学习障碍组尿碘中位数为216．6 μg／L,<100μg／L者占22．8％;对照组尿碘中位数为247．9μg／L,<100μg／L者占3．7％。两组尿碘中位数差异无统计学意义(Z=-1．37．P>0．05),但两组尿碘值<100μg/L与≥100μg/L的人数构成差异有统计学意义 (X2=8．65,P<0．01)。两组血清T4均在正常范围(54-174 nmol／L)内。学习障碍组血清TSH(中位数2．2 mU／L)>3．1 mU／L者占18．8％;对照组血清TSH(中位数1．9 mU／L)>3．1 mU／L者占12．9％,两组TSH>3．1 mU/L与<3．1 mU／L人数构成差异无统计学意义(X2=3．85,P>0．05)。学习障碍组智商为97．8±13．1;对照组智商为117．4±1．8;两组智商的差异有统计学意义(t=8．26,P<0．01)。结论广州市学习障碍儿童多数碘营养状况良好;学习障碍组尿碘值<100 μg／L者较对照组多,提示学习障碍儿童部分人缺碘,缺碘与学习障碍的关系,有待进一步探讨。学习障碍儿童智商较对照组低。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.