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Abstract:Thyroid disease is one of the most common and frequently-occurring endocrinological diseases. About 30% of young and middle-aged people and 50% of elderly suffer from this disease. Generally speaking, the influencing factors for the increasing incidence of the disease include self-susceptibility (as inherited disease), immune-dysfunction (autoimmune thyroid disorders), aging and gender (female). Changes in thyroid function and morphology are the major pathological changes in thyroid disease. However, only 50% of all the patients need treatments. In past 30 years when edible iodine supplementation is used to prevent goiter, much evidence indicated the role of edible iodine in the occurrence and development of thyroid disease. Insufficient or excessive intake of edible iodine both may lead to increased onset of thyroid disease. Therefore, it is of vital importance to implement and do more research on iodine supplementation at appropriate doses.

Abstract:In elderly people, the thyroid shows distinct alteration in histology, biochemistry and function. With age increasing, the serum levels of thyroid hormones display aging related changes. Serum levels of T3 and T4 are decreased with aging, which is significant for T3, while mild or even no change for T4. But serum level of rT3 is significantly increased with aging, and thyroid-stimulation hormone is faintly elevated. For the patients with thyroid dysfunction, they have a high detection of hypothyroidism when people grow older. But the detection rate of hyperthyroidism has no age difference. For the patients with subclinical thyroid dysfunction, individual treatment should be carried out in combination with the incidences of relative complications. Besides, the prevalence of thyroid nodules is of extremely high incidence by ultrasonography in elderly people, and becomes even higher with the increase of aging. The incidence of thyroid nodule (especially multiple nodules and larger nodule) is increased with age, and solid nodules are the most common form. For ultrasonography-identified calcification, comprehensive analysis should be performed in combination with other features in ultrasonographic image, so as to make a definite diagnosis of the nature of nodules. Attention should be paid to the prevention and treatment of thyroid disorders in elderly people. In order to diagnose and treat as early as possible, ultrasonography of thyroid and evaluation of thyroid function should be carried out in general physical examination.

Abstract:Hypothyroidism is a systemic metabolic disorder resulting from inadequate production of thyroid hormone (TH) or inadequate action of TH to target tissues. Primary hypothyroidism, as the principal type, is mainly caused by Hashimoto￠s thyroiditis, while, other causes include central deficiency of thyrotropin-releasing hormone or thyroid-stimulating hormone (TSH), or the outcome after the thyroid surgery or radioiodine therapy for hyperthyroidism. It is difficult to diagnose thyroid diseases based only on symptoms, but manifestation of these symptoms could be an indicator for thyroid function evaluation. Evaluations of TSH and free thyroxine (FT4) is used to diagnose overt hypothyroidism (high TSH with low FT4 levels) and subclinical hypothyroidism (high TSH with normal FT4 levels). The goal to treat hypothyroidism is to relieve symptoms and avoid progression to myxedema. Hypothyroidism is usually treated with synthetic levothyroxine. Although the diagnosis and treatment of hypothyroidism is often considered simple, there are large numbers of people with hypothyroidism who are suboptimally treated. Even in those people with biochemically euthyroid on levothyroxine replacement, there is a significant proportion who report poorer quality of life. This review summarized etiology and types of hypothyroidism, including subclinical disease, and diagnosis and current treatment for hypothyroidism. The reasons for suboptimal treatment and potential solutions were also discussed.

Abstract:The guidelines of management of hyperthyroidism has been published by American Thyroid Association (ATA) and American Association of Clinical Endocrinologists (AACE) in 2011. This article introduced its key points related to 131I therapy for hyperthyroidism, and the advances of 131I in the treatment of hyperthyroidism at home and abroad in recent years. Our clinical experiences on 131I in the treatment of refractory severe hyperthyroidism without antithyroid drug pretreatment in China were highlighted particularly.

Abstract:Thyroiditis includes acute suppurative thyroiditis (a rare disease), subacute thyroiditis (5% of patients with thyroid disease) and chronic lymphocytic thyroiditis (prevalence of 10%-12%), the incidence of which increased with aging and in female gender. Major pathogeneses of thyroiditis include infection with bacteria or virus and autoimmune dysfunction. Excessive iodine intake could increase thyroiditis incidence. The major treatments for thyroiditis include lifestyle changes, appropriate iodine intake from food, and immunoregulation for inflammation suppression. Acute inflammation process could be controlled; however, it is prone to recurrence and occurrence of hypothyroidism after treatment.

Abstract:Thyroid nodule is a common clinical disease. In recent years, the detection rate of thyroid nodule, as well as the incidence of thyroid cancer, presents higher and higher in China. Thyroid nodule is confirmed with a prevalence of ultrasonic inspection of 20% to 76%, while, the incidence of thyroid cancer detected from thyroid nodule reaches 5% to 15%. Therefore, identifying benign or malignancy of the nodule, and the damage of surrounding tissue is of particularly importance. Risk factors of thyroid cancer developing from thyroid nodules could be evaluated by collecting complete medical history. This might do great help to arrange reasonable diagnosis and treatment. High resolution ultrasound evaluation is the preferred approach for thyroid nodule. Biopsy has the highest accuracy (83%) and specificity (92%) in assessing benign or malignancy of thyroid nodule. Other laboratory and imaging examination can play a supplementary role. Surgery, postoperative 131I therapy and thyroid stimulating hormone suppression therapy are most common treatments for thyroid cancer. Follow-up schedule of thyroid nodules and thyroid carcinoma should be arranged according to each specific situation. Though the prevalence of thyroid nodule is higher in the elderly than in young subjects, the incidence of thyroid carcinoma in the elderly is relatively lower. The therapeutic management for the elderly is the same as that for the young.

Abstract:The pathogenesis of hyperthyroidism is relatively complicated. In clinical practice, diffuse toxic goiter accompanied with hyperthyroidism (as known as Graves￠ disease) is more common. The pharmaceutical treatment of Graves￠ disease includes antithyroid drugs (ATD), iodine, β-blocker, glucocorticoids and lithium carbonate. ATD are the main treatment for hyperthyroidism, and Methimazole (MMI) and propylthiouracil (PTU) are the two drugs which are most commonly used currently. Generally, ATD are safe and effective, though their clinical adverse reactions are also relatively common. These reactions are usually reversible and disappeared spontaneously when the drug is discontinued. However, the serious rare side effects also occur sometimes. MMI is usually preferred over PTU because it has significantly fewer adverse reactions in a dose-dependent fashion. MMI is the first choice for treating mild and moderate hyperthyroidism. Iodine is mainly used in hyperthyroidism crisis and before operation. Glucocorticoids are mainly used for Graves￠ ophthalmopathy and hyperthyroidism crisis. β-blocker is used to control the symptoms at initial treatment. Lithium carbonate is not commonly used, and only suitable for short-term treatment. The clinicians should evaluate comprehensively and individually to choose appropriate agents for better outcome, and closely monitor their efficiency and side effects.

Abstract:正确处理妊娠期间甲状腺疾病是优生优育的重要内容之一。本文结合2011年颁布的“妊娠和产后甲状腺疾病诊治指南”，对妊娠期间甲状腺功能的生理变化，妊娠期甲状腺功能评定，控制存在的甲状腺功能异常避免给胎儿和妊娠过程造成的不良影响做一概述。对于妊娠期Graves病的诊断，要特别强调与妊娠甲状腺功能亢进综合征相鉴别，抗甲状腺药物的选择早期为丙硫氧嘧啶，中晚期改为甲巯咪唑。妊娠期一旦确诊甲状腺功能减退，应立即选择左甲状腺素（L-T4）治疗，并尽早使得血清促甲状腺激素（TSH）水平达标，即孕早期0.1～2.5mU/L，孕中期0.2～3.0mU/L，孕晚期0.3～3.0mU/L。由于妊娠期分化型甲状腺癌的预后和非妊娠期相似，因此手术可推迟至产后施行，并给予L-T4抑制治疗，将血清TSH控制在0.1～1.5mU/L。对于孕期的良性甲状腺结节，不建议补充L-T4治疗。

Abstract:Objective To investigate the risk factors and in-hospital outcomes of recurrent acute myocardial infarction (AMI). Methods A total of 1447 consecutive AMI patients admitted to our hospital from January 2006 to December 2010 were recruited. Their clinical background, angiographic findings, heart function, infarction types, serum indices within 24 h after hospitalization and in-hospital prognosis were retrospectively compared between patients with first AMI (n＝1268) and those with recurrent AMI (n＝179). Logistic regression analysis was used to study the risk factors of recurrent AMI. Results Patients with a recurrent AMI were older and had a higher prevalence of diabetes mellitus (DM) than those with first AMI. In addition, they also had worse heart function at admission and more severe coronary lesions. Logistic regression analysis indicated that the independent risk factors of recurrent AMI included age (OR, 1.03; 95% CI∶1.01–1.04, P＜0.01), DM (OR, 2.10; 95% CI: 1.51–2.91, P＜0.01), smoking (OR, 1.76; 95% CI: 1.20–2.57, P＜0.01), and serum creatinine (OR, 1.003; 95% CI∶1.001–1.004, P＜0.01). Recurrent AMI had an increasing trend in in-hospital all-cause death as well as cardiac-related death compared with a first AMI, though with no significant difference between the 2 groups. Conclusion Age, DM, smoking and serum creatinine are independent risk factors for the recurrence of AMI. Recurrent AMI has no effect on in-hospital death.

Abstract:Objective To evaluate the efficacy of antiplatelet aggregation drugs (aspirin and clopridogrel) in in-stent restenosis (ISR) after percutaneous transluminal angioplasty and stenting (PTAS) by using thromboelastography (TEG) to assess the inhibitory rates of platelet aggregation. Methods Clinical data of 49 patients who were rehospitalizated in 6 to 12 months after PTAS for conventional re-evaluation by digital subtraction angiography (DSA) and TEG, and 6 patients with recurrent ischemic stroke (infarction or transient) after intra-or extra-cerebral stent placement in Jinling Hospital in November 2010 to May 2012 were collected. All patients were assessed the inhibitory rates of arachidonic acid (AA) pathway and adenosine diphosphate (ADP) receptor pathway in platelets by TEG. DSA confirmed 14 ISR among 64 lesion vessels treated with stents (ISR group). Potential variables for restenosis and the inhibitory rates of AA pathway and ADP receptor pathway in platelets were analyzed for any predictive power for the ISR with SPSS version 15.0. Results (1) There was significant difference in male-to-female ratio between recurrent stroke group (male/female∶1/5) and non-recurrence group (male/female: 39/4; P＜0.01). The serum concentrations of high-sensitivity C reactive protein (hs-CRP) in patients with recurrent stroke were higher than those without recurrence [(8.9±11.0) vs (2.9±4.1) mg/L, P＜0.05)]. The differences of other variables between recurrent and non-recurrent groups were not significant (P＞0.05). (2) Compared with non-ISR (control) group, variables in ISR group including age [(58.0±12.8) vs (64.6±9.8) years], the ratio of diabetes, and the ratio of lesion distributions in intra-and extra-cranial vessels (6/14 vs 7/14, 7/50 vs 43/50) were all significantly different (P＜0.05). Moreover, the serum concentration of hs-CRP was remarkably higher in ISR group than in non-ISR group [(6.1±7.6) vs (2.1±2.1) mg/L, P＝0.028]. Additionally, inhibitory rates of AA pathway and ADP receptor in patients with ISR were (58.0±43.8)% and (28.1±26.1)% whereas those in patients without ISR were (83.4±23.1)% and (52.8±29.5)% respectively, with significant difference (P＜0.01). (3) Logistic regression analysis showed that the inhibitory rate of ADP receptor or efficacy of clopidogrel (HR＝0.959; 95% CI 0.921～0.998; P＝0.039) was the only independent negative predictor for ISR after adjustment of the influence of other variables. Conclusion Despite the differences of several variables are significant including age, diabetes, distribution of lesion location, serum concentration of hs-CRP, and efficacy of aspirin and clopidogrel between ISR and non-ISR groups, only the inhibitory rate of ADP receptor in platelets or efficacy of clopidogrel is associated with decreased risk of ISR.

Abstract:Objective To determine the roles of the frequency of CD4+CD28null T lymphocytes and the serum level of C-reactive protein (CRP) in diabetes and non-diabetes coronary patients. Methods A total of 51 patients with acute coronary syndrome (ACS) in the Department of Cardiology from our hospital during March 2010 to June 2011 were enrolled in this study. They were further divided into diabetes (n=21) and non-diabetes (n=30) group, according to the diagnostic standards of type 2 diabetes mellitus. Frequency of CD4+CD28null T lymphocytes was analyzed by multiple-color flow cytometry, and serum level of CRP was measured by ELISA. Their clinical data and results of coronary arteriography were recorded and analyzed. Results Compared to the non-diabetes ACS patients, the frequency of CD4+CD28null T lymphocytes was higher in peripheral blood of diabetes ACS patients [(4.66±4.24)% vs (8.89±6.45)%, P＜0.05]. But there was no significant difference in serum level of CRP between the two groups [(1.97±1.05) vs (2.22±1.14)mg/L, P＞0.05]. Coronary angiography suggested that the rate of complete obstruction and diffuse pathogenic changes were more severe in diabetes ACS patients (7 vs 11, P＜0.05; 6 vs 12, P＜0.01). Conclusion Coronary pathogenic changes are more severe in diabetes ACS patients than those without diabetes. Costimulatory molecule may be involved in the immune-modulation disturbance of patients with diabetes and ACS.

Abstract:Objective To investigate the on-set features of maternally inherited essential hypertension (MIEH) in central district of Jiangsu Province in China, in order to provide consideration for the prevention and treatment of the disease. Methods A total of 1000 cases with essential hypertension (EH) who met the diagnostic standard of WHO Hypertension Guideline in Subei People￠s Hospital were subjected in this study. Their general data (sex, age, onset age, and family history) were collected. Among them, 276 cases with MIEH were taken as the indicative cases and the other 276 healthy adults who took physical examination during same period served as normal controls. A comparative analysis was carried out on waist circumference, abdominal circumference, body mass index (BMI), blood biochemical parameters between the indicative and control cases. Results MIEH patients developed hypertension at earlier ages than those who were paternally inherited or had no family history of hypertension (P＜0.05), with obvious familial aggregation. The values of waist circumference, abdominal circumference, BMI, serum triglyceride, blood low density lipoprotein cholesterol (LDL-C), blood glucose, serum creatinine, blood urea nitrogen and uric acid were significantly higher in MIEH patients than in normal controls (P<0.05). There were significant correlations of MIEH with obesity, blood LDL-C, blood glucose, serum creatinine, blood urea nitrogen and uric acid. Conclusions MIEH develops hypertension at earlier ages, and has a tendency of familial aggregation and more target organ damage. MIEH is associated with obesity, blood LDL-C, blood glucose, serum creatinine, blood urea nitrogen and uric acid in central district of Jiangsu Province in China.

Abstract:Objective To analyze the distribution, sensitivity and resistance pattern of pathogen isolated from patients with stroke-associated pneumonia (SAP) in ICU. Methods From March 2010 to March 2012, 129 patients with brain stroke who had been admitted to ICU of our hospital were enrolled in this study. Their sputum cultivation and drug sensitivity were retrospectively analyzed. Results Of all the 129 patients, 64 cases were found having SAP, among which 41 cases were positive for sputum cultivation, with a positivity rate of 64.06%. There were totally 69 strains of bacteria isolated. And 46 strains (66.67%) were Gram negative bacilli, dominantly with 23 strains of Acinetobacter baumannii (33.33%). Eleven strains (15.94%) were Gram positive cocci, mainly Methicillin resistant Staphylococcus aureus (9 strains, 13.04%). And the left 12 strains were fungi (17.40%), with 4 strains of Candida albicans (5.80%) and 4 strains of Candida glabrata (5.80%) covering the main part. Acinetobacter baumannii was drug resistant but especially sensitive to Cefoperazone/Sulbactam, with a rate of 30.43%. Pseudomonas aeruginosa was highly sensitive to Imipenem, with a rate of 88.33%. Methicillin resistant Staphylococcus aureus had a very high sensitivity to Vancomycin, Teicoplanin and Linezolid. The isolated fungi were sensitive to Fluconazol, Itraconazole, Voriconazole, Caspofungin, as well as Amphotericin. Conclusion The major pathogenic bacteria causing SAP in ICU are Gram negative, and resistant to a range of antibiotics, both widely and strongly. Regularly monitoring the distribution and drug resistance of pathogens, and rationally using antibiotics will certainly increase the cure rate of SAP.

Abstract:Objective To investigate the dynamic changes of complement regulatory protein CD46 expression and discuss its possible mechanisms cerebral ischemia-reperfusion injury. Methods The middle cerebral artery occlusion (MACO) model was induced through filament method. Brain pathological injury was recorded. Immuno?uorescence and real time RT-PCR method were used to detect complement regulatory protein CD46 expression. Results Brain pathological injury was the most serious at 24h after reperfusion. The complement regulatory protein CD46 expression decreased gradually after local cerebral ischemia-reperfusion injury, to the lowest at 24h after reperfusion, and returned to normal at 96h after reperfusion. complement regulatory protein CD46 expression was negatively correlated with brain pathological injury. Conclusions The complement regulatory protein CD46 has a significant change after cerebral ischemia-reperfusion. It is speculated that it participates in the injury after ischemia-reperfusion. So regulation of complement regulatory protein CD46 is likely to be a new important method of treatment for ischemia-reperfusion injury.

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Abstract:As the incidence of diabetes mellitus continues to rise in recent years, more and more attention has been paid to diabetic cardiomyopathy. However, the underlying molecular mechanism of cardiomyocyte dysfunction after diabetes remains unclear. The pathogenesis of diabetic cardiomyopathy is multifactorial, including impaired calcium homeostasis, up-regulated renin-angiotensin system, increased oxidative stress, altered myocardial substrate metabolism and mitochondrial dysfunction. This article reviewed how impaired energy metabolism contributes to diabetic cardiomyopathy.

Abstract:yncope usually includes neurally mediated syncope, orthostatic hypotension syncope, cardiogenic syncope, and cerebrovascular syncope. Among them, neurally mediated syncope is the most common one, including vasovagal syncope, situational syncope, carotid sinus syncope, carotid sinus syncope, and psychiatric syncope. In this article, we reviewed the etiology, pathogenesis and treatment of neurally mediated syncope.