Hasil untuk "Diseases of the endocrine glands. Clinical endocrinology"

Hirokazu Takahashi, Seiho Nagafuchi, Keiichiro Mine et al.

, Gerry Rayman, Ketan Dhatariya et al.

Introduction Hyperosmolar hyperglycemic state (HHS) is a life-threatening metabolic emergency with high mortality rate. Yet, there is no national system in the UK to monitor clinical practice or outcomes. To address this, we implemented and evaluated a multicenter surveillance system for HHS, assessing interhospital variations in management, outcomes, and barriers to guideline implementation.Research design and methods This mixed-methods observational study was conducted across 12 NHS hospitals between 2021 and 2024. A standardized data collection tool was developed, capturing demographics, biochemistry, treatment, and outcomes of HHS care. Adults meeting the Joint British Diabetes Societies criteria for HHS were included. Quantitative analyses were conducted to investigate care variations compared with guidelines among centers and identify predictors of HHS outcomes. In parallel, stakeholder interviews were analyzed thematically to explore implementation experiences. The Reach, Effectiveness, Adoption, Implementation, Maintenance framework guided evaluation.Results In our cohort, a total of 218 HHS episodes were included. Median patient age was 77 years; 84.4% had type 2 diabetes, with a high comorbidity burden. The median hospital stay was 10.3 days, and the mortality rate was 16.1%. Significant interhospital variation was observed in insulin dosing, glucose monitoring, and time to discharge. Multivariate analysis identified older age and elevated sodium as independent predictors of mortality. The Digital Evaluation of Ketosis and Other Diabetes Emergencies (DEKODE)-HHS model demonstrated feasibility, high user engagement, and potential for integration into routine quality improvement structures. Qualitative findings revealed barriers, including diagnostic misclassification and resource constraints, to the adoption of the DEKODE-HHS model. However, they also highlighted the educational impact and system usability once the model was adopted.Conclusions The DEKODE-HHS model represents the first UK multicenter surveillance initiative for HHS. It identifies variation in practice and outcome predictors while highlighting systemic barriers to guideline adherence. This model provides a scalable framework for continuous quality improvement in HHS management and may inform future updates to national guidance.

Laura Fugazzola, Maurilio Deandrea, Stefano Borgato et al.

Background: Radiofrequency ablation (RFA) is effective in the treatment of thyroid nodules, leading to a 50–90% reduction with respect to baseline. Current guidelines indicate the need for a benign cytology prior to RFA, though, on the other side, this procedure is also successfully used for the treatment of papillary microcarcinomas. No specific indications are available for nodules with an indeterminate cytology (Bethesda III/IV). Aim: To evaluate the efficacy of RFA in Bethesda III nodules without genetic alterations as verified by means of a custom panel. Methods: We have treated 33 patients (mean delivered energy 1069 ± 1201 J/mL of basal volume) with Bethesda III cytology, EU-TIRADS 3-4, and negative genetic panel. The mean basal nodular volume was 17.3 ± 10.7 mL. Results: Considering the whole series, the mean volume reduction rate (VRR) was 36.8 ± 16.5% at 1 month, 59.9 ± 15.5% at 6 months, and 62 ± 15.7% at 1-year follow-up. The sub-analysis done in patients with 1 and 2 years follow-up data available (n = 20 and n = 5, respectively) confirmed a progressive nodular volume decrease. At all-time points, the rate of reduction was statistically significant (P < 0.0001), without significant correlation between the VRR and the basal volume. Neither cytological changes nor complications were observed after the procedure. Conclusion: RFA is effective in Bethesda III, oncogene-negative nodules, with reduction rates similar to those obtained in confirmed benign lesions. This procedure represents a good alternative to surgery or active surveillance in this particular class of nodules, regardless of their initial volume. A longer follow-up will allow to evaluate further reduction or possible regrowth.

Xiping Duan, Tianchi Zhang, Ke Wang

BackgroundMetabolic disorders are significant risk factors for peripheral neuropathy (PN) diseases. However, current clinical observational studies cannot fully determine the causal relationships between hypothyroidism (HT) and PN diseases.MethodsWe performed univariate Mendelian randomization (MR) analyses using single nucleotide polymorphisms (SNPs) associated with hypothyroidism and two diseases clinically presented as HT (autoimmune thyroid disease and benign neoplasm of the pituitary gland and craniopharyngeal duct) as instrumental variables. We selected eight peripheral neuropathy diseases (diabetic neuropathy, nerve root/plexus disorder, carpal tunnel syndrome, polyneuropathies, sciatica with lumbago, trigeminal neuralgia, postherpetic neuralgia, small fiber neuropathy) as outcomes. Genetic data were sourced from authoritative genome-wide association study (GWAS) datasets. We primarily used the inverse variance-weighted (IVW) method and conducted a comprehensive sensitivity analysis to ensure robustness.ResultsThe IVW results indicated that HT was significantly associated with an increased risk of diabetic peripheral neuropathy (OR = 1.22, p = 6.49E-05). HT was also significantly linked to nerve root/plexus disorder (OR = 1.04, p = 6.43E-06) and carpal tunnel syndrome (OR = 1.04, p = 0.004), but appeared to be a potential protective factor for polyneuropathies (OR = 0.93, p = 0.0009). Additionally, autoimmune thyroid disease (AITD) was identified as a potential risk factor for carpal tunnel syndrome (OR = 13.79, p = 0.006) and a protective factor for polyneuropathies (OR = 0.0011; p = 4.44E-5).ConclusionsThis study provides genetic evidence supporting potential causal links between hypothyroidism and various peripheral neuropathy diseases.

Shaun Wen Huey Lee, Simon Bell, Chun Wie Chong et al.

The prevalence of pre-diabetes is increasing globally, affecting an estimated 552 million people by 2030. While lifestyle interventions are the first line of defense against progression toward diabetes, information on barriers toward pre-diabetes management and how to overcome these barriers are scarce. This systematic review describes the publics’ and healthcare professionals’ knowledge, attitude and practice (KAP) toward pre-diabetes and determines the barriers toward pre-diabetes management. A systematic search for studies examining KAP towards pre-diabetes was conducted in six databases from inception to September 2022. Studies that quantitatively assessed at least two KAP elements using questionnaires were included. The quality of studies was assessed using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Barriers and enablers were identified and mapped onto the Capability, Motivation, and Behaviour model to identify factors that influence behavior change. Twenty-one articles that surveyed 8876 participants were included in this review. Most of the reviews (n=13) were directed to healthcare professionals. Overall, positive attitudes toward diabetes prevention efforts were observed, although there were still knowledge deficits and poor behavior toward pre-diabetes management. Barriers and enablers were detected at patients (eg, goals and intention), healthcare professionals (eg, clinical judgement) and system (eg, access and resources) levels. The use of different survey instruments to assess KAP prevented a head-to-head comparison between studies. Most studies conducted among patients were from middle-income countries, while among healthcare professionals (HCPs) were from high-income countries, which may produce some biasness. Nevertheless, the development of pre-diabetes intervention should focus on: (1) increasing knowledge on pre-diabetes and its management; (2) imparting practical skills to manage pre-diabetes; (3) providing resources for lifestyle management; (4) improving the accessibility of lifestyle management programs; and (5) other HCPs and human support to pre-diabetes management.

Jianglin Zhang, Yue Qiu, Li Peng et al.

BackgroundDiabetes mellitus (DM) is a chronic disease with hyperglycemia. If not treated in time, it may lead to lower limb amputation. At the initial stage, the detection of diabetes-related foot ulcer (DFU) is very difficult. Deep learning has demonstrated state-of-the-art performance in various fields and has been used to analyze images of DFUs.ObjectiveThis article reviewed current applications of deep learning to the early detection of DFU to avoid limb amputation or infection.MethodsRelevant literature on deep learning models, including in the classification, object detection, and semantic segmentation for images of DFU, published during the past 10 years, were analyzed.ResultsCurrently, the primary uses of deep learning in early DFU detection are related to different algorithms. For classification tasks, improved classification models were all based on convolutional neural networks (CNNs). The model with parallel convolutional layers based on GoogLeNet and the ensemble model outperformed the other models in classification accuracy. For object detection tasks, the models were based on architectures such as faster R-CNN, You-Only-Look-Once (YOLO) v3, YOLO v5, or EfficientDet. The refinements on YOLO v3 models achieved an accuracy of 91.95% and the model with an adaptive faster R-CNN architecture achieved a mean average precision (mAP) of 91.4%, which outperformed the other models. For semantic segmentation tasks, the models were based on architectures such as fully convolutional networks (FCNs), U-Net, V-Net, or SegNet. The model with U-Net outperformed the other models with an accuracy of 94.96%. Taking segmentation tasks as an example, the models were based on architectures such as mask R-CNN. The model with mask R-CNN obtained a precision value of 0.8632 and a mAP of 0.5084.ConclusionAlthough current research is promising in the ability of deep learning to improve a patient’s quality of life, further research is required to better understand the mechanisms of deep learning for DFUs.

Guy S. Taylor, Andy Shaw, Jadine H. Scragg et al.

BackgroundMany individuals with type 1 diabetes retain residual beta-cell function. Sustained endogenous insulin and C-peptide secretion is associated with reduced diabetes related complications, but underlying mechanisms remain unclear. Lower circulating numbers of endothelial and hematopoietic progenitor cells (EPCs and HPCs), and the inability to increase the count of these cells in response to exercise, are also associated with increased diabetes complications and cardiovascular disease. It is unknown whether residual beta-cell function influences HPCs and EPCs. Thus, this study examined the influence of residual beta-cell function in type 1 diabetes upon exercise-induced changes in haematopoietic (HPCs) and endothelial progenitor cells (EPCs).MethodsParticipants with undetectable stimulated C-peptide (n=11; Cpepund), 10 high C-peptide (Cpephigh; &gt;200 pmol/L), and 11 non-diabetes controls took part in this observational exercise study, completing 45 minutes of intensive walking at 60% V˙O2peak. Clinically significant HPCs (CD34+) and EPCs (CD34+VEGFR2+) phenotypes for predicting future adverse cardiovascular outcomes, and subsequent cell surface expression of chemokine receptor 4 (CXCR4) and 7 (CXCR7), were enumerated at rest and immediately post-exercise by flow cytometry.ResultsExercise increased HPCs and EPCs phenotypes similarly in the Cpephigh and control groups (+34-121% across phenotypes, p&lt;0.04); but Cpepund group did not significantly increase from rest, even after controlling for diabetes duration. Strikingly, the post-exercise Cpepund counts were still lower than Cpephigh at rest.ConclusionsResidual beta-cell function is associated with an intact exercise-induced HPCs and EPCs mobilisation. As key characteristics (age, fitness, HbA1c) were similar between groups, the mechanisms underpinning the absent mobilisation within those with negative C-peptide, and the vascular implications, require further investigation.

Jinghong Yuan, Zhi Du, Zhiwen Wu et al.

ObjectiveIdiopathic short stature (ISS), an endocrine-related disease, is difficult to diagnose. Previous studies have shown that many children with some inflammation-related diseases often have short stature, but whether inflammation is the underlying mechanism of ISS has not been studied. Here, we attempt to explore the role of inflammation in the occurrence and development of ISS and to demonstrate an available clinical diagnostic model of ISS.MethodsFrozen serum samples were collected from ISS patients (n = 4) and control individuals (n = 4). Isobaric tags for relative and absolute quantitation (iTRAQ) combined with LC-MS/MS analysis were applied to quantitative proteomics analysis. To assess clusters of potentially interacting proteins, functional enrichment (GO and KEGG) and protein-protein interaction network analyses were performed, and the crucial proteins were detected by Molecular Complex Detection (MCODE). Furthermore, serum levels of two selected proteins were measured by ELISA between ISS patients (n = 80) and controls (n = 80). In addition, experiments in vitro were used to further explore the effects of crucial proteins on endochondral ossification.ResultsA total of 437 proteins were quantified, and 84 DEPs (60 upregulated and 24 downregulated) were identified between patients with ISS and controls. Functional enrichment analysis showed that the DEPs were primarily enriched in blood microparticle, acute inflammatory response, protein activation cascade, collagen-containing extracellular matrix, platelet degranulation, etc. According to the results of top 10 fold change DEPs and MCODE analysis, C1QA and C1QB were selected to further experiment. The expression levels of C1QA and C1QB were validated in serum samples. Based on the logistic regression analysis and ROC curve analysis, we constructed a novel diagnostic model by serum levels of C1QA and C1QB with a specificity of 91.2% and a sensitivity of 75% (AUC = 0.900, p &lt;0.001). Finally, the western blotting analysis confirmed the expression levels of OCN, OPN, RUNX2, and Collagen X were downregulated in chondrocytes, and the outcome of Collagen II was upregulated.ConclusionOur study is the first to demonstrate the significant role of inflammation in the development of ISS. In addition, we identify C1QA and C1QB as novel serum biomarkers for the diagnosis of ISS.

Hye Rim Chung, Joon Ho Moon, Jung Sub Lim et al.

Background The effect of intrauterine hyperglycemia on fat mass and regional fat proportion of the offspring of mothers with gestational diabetes mellitus (OGDM) remains to be determined. Methods The body composition of OGDM (n=25) and offspring of normoglycemic mothers (n=49) was compared using dualenergy X-ray absorptiometry at age 5 years. The relationship between maternal glucose concentration during a 100 g oral glucose tolerance test (OGTT) and regional fat mass or proportion was analyzed after adjusting for maternal prepregnancy body mass index (BMI). Results BMI was comparable between OGDM and control (median, 16.0 kg/m2 vs. 16.1 kg/m2). Total, truncal, and leg fat mass were higher in OGDM compared with control (3,769 g vs. 2,245 g, P=0.004; 1,289 g vs. 870 g, P=0.017; 1,638 g vs. 961 g, P=0.002, respectively), whereas total lean mass was lower in OGDM (15,688 g vs. 16,941 g, P=0.001). Among OGDM, total and truncal fat mass were correlated with fasting and 3-hour glucose concentrations of maternal 100 g OGTT during pregnancy (total fat mass, r=0.49, P=0.018 [fasting], r=0.473, P=0.023 [3-hour]; truncal fat mass, r=0.571, P=0.004 [fasting], r=0.558, P=0.006 [3-hour]), but there was no correlation between OGDM leg fat mass and maternal OGTT during pregnancy. Regional fat indices were not correlated with concurrent maternal 75 g OGTT values. Conclusion Intrauterine hyperglycemia is associated with increased fat mass, especially truncal fat, in OGDM aged 5 years.

Alejandro Ayala, Emiliano Corpas, Álvaro Larrad-Jiménez et al.

Christoph Reiners, Rita Schneider, Tamara Platonova et al.

Published studies on the risk of radiation-induced second primary malignancy (SPM) after radioiodine treatment (RAI) of differentiated thyroid cancer (DTC) refer mainly to patients treated as middle-aged or older adults and are not easily generalizable to those treated at a younger age. Here we review available literature on the risk of breast cancer as an SPM after RAI of DTC with a focus on females undergoing such treatment in childhood, adolescence, or young adulthood. Additionally, we report the results of a preliminary international survey of patient registries from academic tertiary referral centers specializing in pediatric DTC. The survey sought to evaluate the availability of sufficient patient data for a potential international multicenter observational case–control study of females with DTC given RAI at an early age. Our literature review identified a bi-directional association of DTC and breast cancer. The general breast cancer risk in adult DTC survivors is low, ~2%, slightly higher in females than in males, but presumably lower, not higher, in those diagnosed as children or adolescents than in those diagnosed at older ages. RAI presumably does not substantially influence breast cancer risk after DTC. However, data from patients given RAI at young ages are sparse and insufficient to make definitive conclusions regarding age dependence of the risk of breast cancer as a SPM after RAI of DTC. The preliminary analysis of data from 10 thyroid cancer registries worldwide, including altogether 6,449 patients given RAI for DTC and 1,116 controls, i.e., patients not given RAI, did not show a significant increase of breast cancer incidence after RAI. However, the numbers of cases and controls were insufficient to draw statistically reliable conclusions, and the proportion of those receiving RAI at the earliest ages was too low.In conclusion, a potential international multicenter study of female patients undergoing RAI of DTC as children, adolescents, or young adults, with a sufficient sample size, is feasible. However, breast cancer screening of a larger cohort of DTC patients is not unproblematic for ethical reasons, due to the likely, at most slightly, increased risk of breast cancer post-RAI and the expected ~10% false-positivity rate which potentially produced substantial “misdiagnosis.”

Xi Shen, Hui Long, Wenya Guo et al.

Background: To investigate the optimal ovulation trigger–oocyte pickup (OPU) interval of a progestin-primed ovarian stimulation (PPOS) protocol.Method: Patients with normal ovarian reserve in their first PPOS OPU cycle were enrolled in this retrospective cohort study between July 2013 and April 2018. This retrospective cohort study included two parts. In part I, we studied the regression trend of mature oocyte rate, implantation rate, and live birth rate within the whole ovulation trigger–OPU interval of 7,258 patients. To homogenize some clinical characters that were key regulators of OPU time, in part II, we used propensity score matching to auto-select patients among trigger–OPU interval group 1 (35.6–36.4 h), group 2 (36.4–37.1 h), and group 3 (37.1–37.8 h) and analyzed clinical outcomes.Results: Study part I showed that the whole ovulation trigger–OPU interval (33–39.5 h) of PPOS protocol had a trend of a high mature oocyte rate (&gt;80%), increasing implantation rate, and high live birth rate. Propensity score matching of patients with homogeneous clinical characteristics further indicated that the trigger–OPU interval within groups 2 and 3 (36.4–37.8 h) had significantly higher mature oocyte rates (84.54% vs. 84.60% vs. 82.34%, P = 0.002) and implantation rates (34.17% vs. 34.37% vs. 29.61%, P &lt; 0.05) than group 1. The same tend was observed in the live birth rate.Conclusions: The ovulation trigger–OPU interval of 36.4–37.8 h is optimal for most patients using a PPOS protocol.

Baldeep K. Mann, Janpreet S. Bhandohal, Jungrak Hong

This review summarizes the vast literature describing the long-term epidemiological studies with emphasis on postprandial glucose as a stronger predictor of cardiovascular complications as compared to fasting glucose and HbA1c. Many molecular studies also supported this fact by illustrating that postchallenge hyperglycemia is associated with elevated biomarkers of systemic inflammation in the plasma and thus increasing the chances of vascular damage. Large-scale studies have proved that vascular stiffness, brachial-ankle pulse-wave velocity, carotid intima thickness, and left ventricular hypertrophy have been associated with postprandial glucose as compared to fasting glucose or glycosylated hemoglobin.

Asociación Colombiana de Endocrinología Diabetes y Metabolismo

Listado • Póster El Estado República de Colombia cuenta con precedente constitucional jurisprudencial T-622 de 2014, sentencia que reafirma la importancia del diagnóstico certero de los pacientes INTERSEXUALES y actualiza cómo mira el Estado a estos pacientes.  S. Chahin, F. Mejía • Póster Caso emblemático “XXXX” estado intersexual demanda efectiva prevalencia “regla jurisprudencial constitucional pro infancia” por ausencia de asertivo reconocimiento gonadal civil, “REGOCI”. S. Chahin, F. Mejia. • Póster Utilidad de la plasmaféresis en pancreatitis aguda por hipertrigliceridemia: a propósito de un caso.  Concha Mejía Alejandro, Montaño Padilla Gina Sofía, Rincón Reinaldo, Rodríguez Ruiz Karen • Póster Correlation between androgen receptor / estrogen receptor ratio and A 5-Genes proliferation signature in estrogen receptorpositive breast cancer patients.  Rangel N, Rondon-Lagos M, Annaratone L, Cassoni P, Sapino A, Castellano I. • Póster Hipogonadismo obesogénico y respuesta a la terapia de remplazo hormonal: presentación de una serie de casos.  Palacio JI, Jaramillo A, Rosero RJ. • Póster Terapia con lutecio en pacientes con tumores neuroendocrinos bien diferenciados en progresión. Clínica las américas 2012-2018, Medellín, Colombia. Reporte de casos.  Vásquez M., Aristizábal N., Torres JL., Quintero FM. • Póster Cirugía mínimamente invasiva video-asistida para corazón carcinoide.  Velásquez-Uribe OA, Muñoz E, Morales S, Gandara J, Román-González A . • Póster Histopatología testicular de ratas BIOU: Wistar expuestas a malatión.  Serrano RA, Hernández GA, Hung S, Lozano R, Paoli M, Gómez Pérez R. • Póster Posible efecto de la altitud en la aparición de paragangliomas.  Oscar Arcos, Viviana Fuentes, María Fernanda Zambrano, Jackeline Munier, Alex Valenzuela, Miguel Omehara, Fernando Lizcano. • Póster Infecciones asociadas a la atención en salud en pacientes endocrinológicos en unidades de cuidados intensivos, Cartagena de Indias, Colombia. Ochoa Díaz MM, Gómez Camargo D.

I.А. Zoriy, N.V. Pashkovska

The article presents data of the literature review and own observations on studying the role of genetic factors in the risk of development and progression of severe complications of diabetic distal symmetric polyneuropathy. It was found that in patients with non-insulin-dependent (type 2) diabetes mellitus complicated by distal symmetric polyneuropathy, there is an association between the homozygous ТТ genotype of endothelial nitric oxide synthase gene G894T polymorphism and significant subjective symptoms, the presence of axonal lesion of motor nerves according to electroneuromyography, with an increase in the level of glycated hemoglobin, and also in the content of lipid peroxidation products.

Salvatore De Rosa, Biagio Arcidiacono, Eusebio Chiefari et al.

Type 2 diabetes mellitus (DM) is a common metabolic disorder predisposing to diabetic cardiomyopathy and atherosclerotic cardiovascular disease (CVD), which could lead to heart failure through a variety of mechanisms, including myocardial infarction and chronic pressure overload. Pathogenetic mechanisms, mainly linked to hyperglycemia and chronic sustained hyperinsulinemia, include changes in metabolic profiles, intracellular signaling pathways, energy production, redox status, increased susceptibility to ischemia, and extracellular matrix remodeling. The close relationship between type 2 DM and CVD has led to the common soil hypothesis, postulating that both conditions share common genetic and environmental factors influencing this association. However, although the common risk factors of both CVD and type 2 DM, such as obesity, insulin resistance, dyslipidemia, inflammation, and thrombophilia, can be identified in the majority of affected patients, less is known about how these factors influence both conditions, so that efforts are still needed for a more comprehensive understanding of this relationship. The genetic, epigenetic, and environmental backgrounds of both type 2 DM and CVD have been more recently studied and updated. However, the underlying pathogenetic mechanisms have seldom been investigated within the broader shared background, but rather studied in the specific context of type 2 DM or CVD, separately. As the precise pathophysiological links between type 2 DM and CVD are not entirely understood and many aspects still require elucidation, an integrated description of the genetic, epigenetic, and environmental influences involved in the concomitant development of both diseases is of paramount importance to shed new light on the interlinks between type 2 DM and CVD. This review addresses the current knowledge of overlapping genetic and epigenetic aspects in type 2 DM and CVD, including microRNAs and long non-coding RNAs, whose abnormal regulation has been implicated in both disease conditions, either etiologically or as cause for their progression. Understanding the links between these disorders may help to drive future research toward an integrated pathophysiological approach and to provide future directions in the field.

Carlos Marin, Carlos Marin, Carlos Marin et al.

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease known by the presence of elevated blood glucose levels. Nowadays, it is perceived as a worldwide epidemic, with a very high socioeconomic impact on public health. Many are the complications caused by this chronic disorder, including a negative impact on the cardiovascular system, kidneys, eyes, muscle, blood vessels, and nervous system. Recently, there has been increasing evidence suggesting that T2DM also adversely affects the skeletal system, causing detrimental bone effects such as bone quality deterioration, loss of bone strength, increased fracture risk, and impaired bone healing. Nevertheless, the precise mechanisms by which T2DM causes detrimental effects on bone tissue are still elusive and remain poorly studied. The aim of this review was to synthesize current knowledge on the different factors influencing the impairment of bone fracture healing under T2DM conditions. Here, we discuss new approaches used in recent studies to unveil the mechanisms and fill the existing gaps in the scientific understanding of the relationship between T2DM, bone tissue, and bone fracture healing.

Salvatore Ulisse, Daniela Bosco, Francesco Nardi et al.

The new Italian cytological classification (2014) of thyroid nodules replaced the TIR3 category of the old classification (2007) with two subclasses, TIR3A and TIR3B, with the aim of reducing the rate of surgery for benign diseases. Moreover, thyroid imaging reporting and data system (TI-RADS) score appears to ameliorate the stratification of the malignancy risk. We evaluated whether the new Italian classification has improved diagnostic accuracy and whether its association with TI-RADS score could improve malignancy prediction. We retrospectively analyzed 70 nodules from 70 patients classified as TIR3 according to the old Italian classification who underwent surgery for histological diagnosis. Of these, 51 were available for cytological revision according to the new Italian cytological classification. Risk of malignancy was determined for TIR3A and TIR3B, TI-RADS score, and their combination. A different rate of malignancy (p=0.0286) between TIR3A (13.04%) and TIR3B (44.44%) was observed. Also TI-RADS score is significantly (p=0.003) associated with malignancy. By combining cytology and TI-RADS score, patients could be divided into three groups with low (8.3%), intermediate (21.4%), and high (80%) risk of malignancy. In conclusion, the new Italian cytological classification has an improved diagnostic accuracy. Interestingly, the combination of cytology and TI-RADS score offers a better stratification of the malignancy risk.

N. P Lyamina, E. S Karpova, E. V Kotel'nikova et al.

Основной целью использования контролируемых физических тренировок (КФТ) на этапе реабилитации у больных после чрескожного коронарного вмешательства (ЧКВ) является получение максимального долговременного кардиопротективного эффекта. Оценить эффективность проводимых реабилитационных программ можно с помощью функциональных маркеров, в то же время использование молекулярных маркеров может значительно повысить уровень индикации кардиопротективного эффекта ФТ в программах кардиореабилитации. Цель. Оценить динамику уровня молекулярных и функциональных маркеров при проведении комбинированных КФТ (интенсивностью 60 и 80%) и КФТ интенсивности (60%) на стационарном и постстационарном этапах у пациентов с неполной реваскуляризацией миокарда после ЧКВ и миокардиальной дисфункции. Материал и методы. В открытое проспективное исследование были включены 122 пациента с ишемической болезнью сердца (ИБС) после ЧКВ с частичной реваскуляризацией и положительными результатами парного стресс-теста с физической нагрузкой. Пациенты 1-й группы (n=71) на фоне стандартной медикаментозной терапии выполняли короткий курс (10 КФТ) ежедневных КФТ интенсивностью 80% в условиях реабилитационного стационара с последующим 12-недельным курсом умеренных КФТ в амбулаторных условиях. Пациенты 2-й группы (n=51) выполняли КФТ только интенсивности 60% на стационарном и амбулаторном этапах аналогичной продолжительности. В оценке кардиопротективного эффекта КФТ использовались как функциональные маркеры (максимальная депрессия сегмента ST, число отведений с депрессией сегмента ST≥1 мм, время восстановления сегмента ST до исходного уровня, эктопическая активность), так и молекулярные (ишемия-модифицированный альбумин - ИМА, свободные жирные кислоты - СЖК, мозговой натрийуретический пептид - N-про-МНП). Результаты. После 10-дневного курса КФТ в 1-й группе отмечались снижение уровня депрессии сегмента ST на 18,6% , во 2-й - на 14,7%; в 1-й группе уменьшение продолжительности восстановления сегмента ST на 15,7%, в группе сравнения - на 13,2% , снижение эктопической активности в 1,5 раза, в группе сравнения - в 1,1 раза. Это сопровождалось снижением уровня ИМА на 8,6% (127,2±23 нг/мл, исходно 139,6±12 нг/мл); в группе сравнения - на 7,07% (126,2±19 нг/мл, исходно 135,6±11,3 нг/мл). В 1-й группе уровень СЖК снизился на 13,5% (0,89 ммоль/л, исходно 1,03 ммоль/л), в группе сравнения - на 12,5% (0,98 ммоль/л, исходно 1,12%). Аналогично уровень N-про-МНП в 1-й группе снизился на 5,7% (45,7 пг/мл, исходно 48,48 пг/мл); в группе сравнения - на 4,1% (43,8 пг/мл, исходно 45,7 пг/мл). После 12-недельного курса умеренных КФТ в амбулаторных условиях у пациентов 1 и 2-й групп при сравнении по уровню прироста функциональных маркеров достоверно значимых изменений не выявлялось, в то же время уровень молекулярных маркеров ишемии достоверно снизился в 1-й группе. Заключение. Таким образом, комбинированные ФТ (интенсивностью 80 и 60%) и КФТ интенсивности (60%) на стационарном и постстационарном этапах у больных ИБС с частичной реваскуляризацией миокарда являются сравнимыми между собой по безопасности, но более эффективными в формировании кардиопротективного эффекта. Для оценки эффективности физической реабилитации у больных ИБС с частичной реваскуляризацией миокарда как на стационарном, так и на постстационарном этапе наблюдения целесообразно использовать аддитивный подход в оценке функциональных и молекулярных маркеров.

Xi Mei, Yao Li, Ping Qiu et al.

We report a case of drug-induced lupus (DIL) on a Chinese woman caused by methimazole (MMI). This report discusses DIL associated with MMI and briefly reviewed the literature concerning to anti-thyroid DIL.