高碘对大鼠大脑皮层神经细胞凋亡的诱导作用

目的 观察长期高碘对大鼠皮层神经细胞凋亡的影响,并探讨其作用机制.方法 断乳1月龄的SD大鼠随机分为三组,对照组、高碘Ⅰ组、高碘Ⅱ组,分别以含碘量为5μg/L、5000μg/L、10000μg/L的自来水及普通饲料喂养6个月,测定血清甲状腺激素（TT3、TT4）水平;透射电镜观察皮层神经元形态结构的改变;应用流式细胞仪检测细胞凋亡率及细胞周期的变化;采用比色法检测大鼠皮层神经细胞一氧化氮（NO）含量和一氧化氮合酶（nitric oxide synthse,NOS）的活性.结果 与对照组比较,高碘Ⅰ组、高碘Ⅱ组的血清TT3、TT4呈逐渐下降趋势,但各组间差异无统计学意义（P＞0.05）.超微结构观察,高碘组神经细胞核内染色质浓缩成块状,聚集在核膜边缘,形成新月状、马蹄状等不规则形态,核膜内陷、形成凋亡小体.流式细胞仪检测高碘组引起大鼠皮层神经细胞周期改变,细胞凋亡率明显高于对照组（P＜0.01）,同时高碘组NOS活性及NO含量显著降低,但两个高碘组之间无明显差异（P＞0.05）.结论 长期高碘可诱导大鼠皮层神经细胞损伤及凋亡,其机制可能与NOS活性及NO含量降低有关.     

甲状腺99mTcO4-显像ROI比值的作用：估算个体化治疗甲亢的131I剂量

目的 探讨甲状腺99mTcO4-显像ROI比值代替24 h 摄碘率(RAIU)个体化治疗甲亢的可行性。方法 回顾性分析2019年1~6月在南方医科大学南方医院核医学科进行131I治疗132例患者的临床资料,根据患者3 h/24 h RAIU峰值比是否前移分为高峰前移组（≥80%）和无高峰前移组（<80%）。高峰前移组：采用Marinelli公式法,131I治疗剂量=甲状腺质量×计划量/24 h RAIU;无高峰前移组：分析ROI比值与24 h RAIU相关性,依据换算关系代入Marinelli公式,131I治疗剂量=甲状腺质量×计划量（/ ROI比值换算关系）。比较两组患者一般资料（年龄、性别、抗甲状腺药物种类以及停用时间）、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、促甲状腺激素（TSH）、促甲状腺受体自身抗体（TRAb）、抗甲状腺过氧化物酶（TPOAb）、甲状腺面积、甲状腺质量、131I治疗剂量;并随访1年,观察其临床疗效。采用ROC曲线分析治疗后两组ROI比值。结果 ROI比值与24 h RAIU呈显著正相关（Y=58.13+0.2X,R2=0.118,P<0.05）,代入Marinelli公式获新公式：131I治疗剂量=甲状腺质量×计划量（/ 58.13+0.2×ROI比值）%。治疗前两组的131I治疗剂量、FT4、FT3、TRAb、3 h及24 h RAIU、甲状腺面积、甲状腺质量、ROI比值差异具有统计学意义（P<0.05）;治疗3月后两组的FT4、FT3、TRAb、TPOAb、甲状腺面积、甲状腺质量、ROI比值、有效率、甲减率、治愈率、缓解率、无效率差异均无统计学意义（P>0.05）;随访1年,两组的甲亢、甲减、治愈例数构成比比较差异仍无统计学意义（P>0.05）;ROC曲线分析治疗3月后ROI比值预测甲亢复发、甲减最佳临界值分别约15.79、6.33。结论 甲状腺99mTcO4-显像ROI比值可用于个体化治疗甲亢计算131I剂量,该方法有助于患者的协助诊治,可以判断预后。     

新疆乌鲁木齐市常住居民甲状腺功能、甲状腺自身抗体与尿碘变化的分析

目的 了解新疆乌鲁木齐市居民甲状腺疾病知晓率及年龄分布的差异, 分析甲状腺功能、甲状腺自身抗体与尿碘相关性及其变化规律。方法 2013年5月采用横断面方法随机抽取乌鲁木齐市1 995名常住居民, 其中健康成年人1 906名, 年龄18~84岁, 平均(46.3±14.2)岁, 男性占30.4%, 女性占69.6%。采集一次性随机晨尿10 ml测定尿碘, 静脉血测定促甲状腺素(TSH)、血清游离甲状腺素(FT4)、游离三碘甲状腺原氨酸(FT3)、甲状腺球蛋白抗体(TgAb)、甲状腺过氧化物酶抗体(TPOAb)。结果 (1)调查居民中新诊断甲状腺功能异常者213例(11.2%, 其中女性占78.4%), 甲状腺功能亢进(甲亢)者占2.7%, 甲状腺功能减低(甲减)者占8.5%;TgAb阳性率为23.2%, TPOAb阳性率为16.6%;人群尿碘M=134.5 μg/L, 人群中碘缺乏占32%, 碘适宜占58%, 碘过量占10%;甲状腺功能正常组和异常组比较、抗体阳性组与阴性组比较其尿碘水平的差异均无统计学意义。(2)将人群划分18~、45~和≥60岁3个年龄组, 则显示随年龄增长TSH水平有明显差异, 且女性高于男性(P<0.001);甲状腺功能正常人群中, TSH水平为抗体阳性组明显高于阴性组(P<0.000 1)。(3)≥60岁与<60岁人群比较, 甲减患病率显著增加(P=0.008), 但甲亢患病率无明显差别, 抗体阳性率亦无明显差异。结论 乌鲁木齐市社区居民甲状腺功能、自身抗体与尿碘水平无明显相关, 女性甲状腺功能异常、抗体阳性率均高于男性, 抗体阳性组TSH水平明显高于阴性组, 老年人群甲减患病率显著增高, 应对该人群定期监测。     

The effect of povidone iodine flush versus drops on conjunctival colonization before intravitreal injections

Background To determine the most effective method of applying povidone iodine 5% to decrease conjunctival colonization before intravitreal injections. Methods Twenty-eight patients from two tertiary care centers undergoing intravitreal injection for diffuse diabetic macular edema, exudative age-related macular degeneration, venous occlusive disease, or refractory pseudophakic cystoid macular edema were prospectively randomized to two study arms. One arm received 2–3 drops of 5% povidone iodine (drops group) and the second received a 10 ml flush of the same solution (flush group). The inferior conjunctival fornix was cultured before and after antiseptic technique was performed in all patients. Three culture media, thioglycollate broth, chocolate agar and blood agar, were used for each sample. Results Each study group had 14 patients. Prior to antisepsis, 22 of the 28 (78.6%) subjects had positive conjunctival cultures. 16 and 14 bacterial organisms were isolated in the first and second groups, respectively. After using 2–3 drops of 5% povidone iodine in the first study arm of patients, three of 16 (18.7% reduction) bacterial organisms were no longer isolated in thioglycollate broth media. With flush irrigation of 10 ml of 5% povidone iodine, seven of 14 (50% reduction) bacterial organisms were no longer isolated (P-value 0.07) in broth media. No difference in reduction of bacterial colonization was found on plated media (chocolate agar and blood agar). Conclusions Irrigating the conjunctival fornix with 5% povidone iodine results in greater reduction of bacterial colonization compared with drop application of the same solution. Flush irrigation may provide better protection against the risk of endophthalmitis with intravitreal injections.     

碘化汞络合物冷原子汞吸收光谱分析简接测定碘

研究了在高酸度时碘化汞络合物(HgIn,n=1,2,3,4)对汞吸收强度的抑制,用冷原子汞原子吸收光谱简接测定碘的方法。本方法的特征含量(相当于0.0044吸尤度)和检测限分别为1.1×10~(-8)和5×10~(-10)克碘。碘量在0.05—0.20微克范国内,对汞吸收光度的降低成线性。研完了某些贵金属和其它卤素对测定碘的干扰。用此方法成功地测定了美国国家标准局(NBS)标准参考物质牡蛎纤维和柠檬叶,以及挪威鱼肝油中的碘含量。     

碘对人胎大脑神经原特异性烯醇化酶表达的影响

利用生理剂量碘作用于早期人胎大脑神经细胞无血清培养物,经离子交换法分离出神经细胞的神经原特异性烯醇化酶(NSE)和非神经原特异性烯醇化酶(NNE)。两酶的转换方式与体内相似,碘促进神经细胞 NNE(αα,αγ亚基)向 NSE(γγ亚基)转换。培养25天 KI(?)组NSE 含量比培养30天对照组含量高,培养30天 KI_2组 NSE 含量是对照组的3倍,且 NSE 出现提前,活性增高。培养15天时加碘的作用比开始培养时加碘的作用更加明显。     

Povidone iodine in the treatment of adenoviral conjunctivitis in infants

Context: Adenoviral conjunctivitis.

Objective: To examine the effects of conjunctival irrigation with povidone iodine in infants with adenoviral conjunctivitis.

Material and methods: An outbreak of adenovirus conjunctivitis occurred between September and December 2012 at the neonatal intensive care unit of our hospital. Forty-three infants with adenoviral conjunctivitis were examined in this study. Thirty-five eyes of 35 infants who had detailed ophthalmological examination and clinical scoring were included. The conjunctiva of 15 infants (Group 1) were irrigated with povidone iodine 2.5% solution and then treated with preservative-free artificial tears and preservative-free antibiotic drops. Twenty infants (Group 2) were treated only with the same drops with the same posology, without conjunctival irrigation with povidone iodine. Patients were examined two times a week until the complete recovery. Lid edema, conjunctival chemosis, fragility of conjunctival vasculature, pseudomembrane formation, and corneal involvement were scored clinically.

Results: Twenty patients (57%) were female and 15 patients (43%) were male and mean age was 3.1 months (ranged from 1 to 4 months). No relation was found between gender and clinical scores. Statistically significant lower clinical scores were obtained from Group 1. The median recovery time was earlier in Group 1 (7?d) than Group 2 (12?d) (p?=?0.001).

Conclusion: Conjunctival irrigation with 2.5% povidone iodine is effective in the treatment of adenoviral conjunctivitis in infants.     

Diagnosis and Treatment of Patients with Thyroid Cancer

Background

Thyroid cancer is the most common malignancy of the endocrine system, representing 3.8% of all new cancer cases in the United States and is the ninth most common cancer overall. The American Cancer Society estimates that 62,450 people in the United States will be diagnosed with thyroid cancer in 2015, and 1950 deaths will result from the disease.

Objective

To review the current approach to the diagnosis and treatment of patients with thyroid cancer.

Discussion

Over the past 3 decades, there has been a dramatic increase in the number of people diagnosed with thyroid cancer, which may be attributable to the wide use of imaging studies, including ultrasounds, computed tomography, magnetic resonance imaging, and positron emission tomography scans that incidentally detect thyroid nodules. Thyroid cancer is divided into several main types, with papillary thyroid cancer being the most common. The treatment options for patients with thyroid cancer include the surgical removal of the entire thyroid gland (total thyroidectomy), radioactive iodine therapy, and molecular-targeted therapies with tyrosine kinase inhibitors. This article summarizes the diagnosis and treatment of thyroid cancer, with recommendations from the American Thyroid Association regarding thyroid nodules and differentiated thyroid cancer. Recently approved drugs and treatment trends are also explored.

Conclusion

The prognosis and treatment of thyroid cancer depend on the tumor type and its stage at the time of diagnosis. Many thyroid cancers remain stable, microscopic, and indolent. The increasing treatment options for patients with thyroid cancer, including therapies that were recently approved by the US Food and Drug Administration, have kept the mortality rate from this malignancy low, despite the increase in its incidence. Early diagnosis and appropriate treatment can improve prognosis and reduce mortality.