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Progress in Iodine Deficiency Disorders (IDD) Control and Elimination in Europe and Central Asia Region (ECAR) in 2010–2020 2010-2020年欧洲和中亚区域(ECAR)碘缺乏症(IDD)控制和消除进展
Pub Date : 2021-12-29 DOI: 10.14341/ket12713
Г. А. Герасимов, И. Парванта, Lilia Turcan, G. Gerasimov
Йодирование соли в странах региона Европы и Центральной Азии (ЕЦАР) имеет долгую историю. Стратегии всеобщего йодирования соли (ВЙС) были повторно введены в странах ЕЦАР в середине 1990-х гг. и получили мощный импульс в течение десятилетия 2000–2009 гг.: к концу 2009 г. доступ населения в ЕЦАР к адекватно йодированной соли увеличился до 55%. Это было качественным скачком по сравнению с предыдущим десятилетием, но все еще ниже целевого показателя в 90%. Целью этого обзора было задокументировать достижения и проблемы ВЙС в 18 странах ЕЦАР за десятилетие 2010–2020 гг. и разработать рекомендации по устойчивому поддержанию ВЙС. Обзор проводился на основе анализа информации, полученной из различных источников, включая офисы ЮНИСЕФ и национальных координаторов глобальной сети по йоду (ГСЙ), а также общедоступных онлайн-ресурсов и публикаций. Исходя из имеющейся информации, страны ЕЦАР делятся на 3 группы. Группа 1. Йодный дефицит устойчиво устранен: 11 стран (Армения, Азербайджан, Босния и Герцеговина, Косово, Северная Македония, Черногория, Сербия, Туркменистан, Казахстан, Кыргызстан и Грузия) успешно сохранили достигнутый ранее адекватный йодный статус. Эта группа стран должна сосредоточиться на поддержании ВЙС, обеспечить включение цели ВЙС по использованию йодированной соли в домашних хозяйствах и пищевой и хлебопекарной промышленности в соответствующие национальные программы. Группа 2. Йодный дефицит устранен, но есть риск отката назад: 3 страны (Албания, Молдова и Кыргызстан) сохранили адекватный йодный статус населения, но потребление адекватно йодированной соли в домохозяйствах остается низким, а использование йодированной соли в промышленно обработанных пищевых продуктах (ПОПП) — неоднородным, тогда как слабая система мониторинга надзора ставит под угрозу устойчивость ВЙС. Этим странам даны рекомендации по обеспечению строгого мониторинга и соблюдения национальных стандартов йодированной соли для обеспечения постоянного и высокого (>90%) использования йодированной соли на уровне домашних хозяйств, а также при производстве основных солесодержащих ПОПП (в основном хлеба). Группа 3. Устранение йодного дефицита требует дополнительных усилий: в 4 странах (Россия, Таджикистан, Украина и Узбекистан) население в целом и наиболее уязвимые группы в частности сохраняют неадекватный йодный статус. Этой группе стран необходимо усилить внедрение ВЙС путем более тесного взаимодействия с производителями соли и частным сектором и выявления ресурсов для улучшения мониторинга. Принятие законодательства по ВЙС имеет первостепенное значение для достижения высокого охвата йодированной солью и оптимального йодного статуса населения в России и Украине. Материалы настоящего обзора подтверждают, что стратегия ВЙС успешно поддерживается в большинстве стран ЕЦАР. Опыт, накопленный в этом регионе, дополняет растущее количество свидетельств того, что ВЙС является эффективной стратегией снижения йодной недостаточности у населения, и поддерживает точку зрения о том, что глоба
欧洲和中亚国家(ezar)的盐碘化历史悠久。20世纪90年代中期,ezar国家重新引入了普遍碘盐政策,并在2000 - 2009年十年中获得了强大的动力:到2009年底,ezar的居民获得足够碘盐的机会增加到55%。与上一个十年相比,这是一个很好的反弹,但仍低于90%的目标。这次审查的目的是记录2010 - 2020年10月18日在ezar 18个国家的wise的成就和问题,并制定可持续维护wis的建议。审查是基于来自各种来源的信息,包括联合国儿童基金会办公室和全球尤达网络国家协调员,以及公共的在线资源和出版物。据我们所知,ezar国家分为3组。第一组。约德赤字持续消除:11个国家(亚美尼亚、阿塞拜疆、波斯尼亚和黑塞哥维那、科索沃、马其顿北部、黑山、塞尔维亚、土库曼斯坦、哈萨克斯坦、吉尔吉斯斯坦和格鲁吉亚)成功地维持了先前充分的约德地位。这一组国家应集中精力维护wis,确保wis将在家庭和食品和面包工业中使用碘盐的目标纳入有关国家方案。第二组。碘缺乏病消除赤字,但是有倒退的风险:三个国家(阿尔巴尼亚、摩尔多瓦共和国和吉尔吉斯斯坦人口)保护充分性碘缺乏病地位,但家庭充分碘盐消费量仍然很低,平均工业使用碘盐加工食品(poppy),异质性弱监督监测系统则危及可持续ВЙС。这些国家被建议严格监测和遵守本国的碘盐标准,以确保在家庭一级持续和高(>90%)使用碘盐,并生产主要盐(主要是面包)。第三组。消除一个赤字需要额外的努力:在四个国家(俄罗斯、塔吉克斯坦、乌克兰和乌兹别克斯坦),人口和最脆弱的群体特别是保持不充分的yoda地位。这一组国家需要通过与盐生产商和私营部门更密切的合作和资源识别来加强对wis的实施,以改善监测。在俄罗斯和乌克兰实现高盐覆盖和最佳的人口地位方面,通过vice立法至关重要。本审查报告证实,在大多数ezar国家,wis战略得到了成功支持。该地区的经验补充了越来越多的证据表明,wise是有效的减小全球失衡的战略,并支持这样一种观点:通过将食品盐标准化来实现全球成功。
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引用次数: 1
Macro-TSH in patients with primary hypothyroidism due to autoimmune thyroiditis 自身免疫性甲状腺炎所致原发性甲状腺功能减退患者的巨量tsh
Pub Date : 2021-11-29 DOI: 10.14341/ket12710
Г. Сарибекян, Д. А. Петренко, Д.А. Трухина, А. Г. Кузьмин, Л. К. Дзеранова, Л. В. Никанкина, Г. С. Колесникова, Anna G. Saribekian, D. Petrenko, D. Trukhina, A. Kuzmin, Dzeranova, L. V. Nikankina, Galina S. Kolesnikova
Thyroid stimulating hormone (TSH) is one of the key indicators in the diagnosis of the thyroid gland functional disorders. Minor changes in TSH concentration make it possible to suspect thyroid dysfunction even before clinical manifestations, which increases the value of correct and timely measurement of it. In the clinical practice, an endocrinologist often encounter the well-known phenomenon of macroprolactinemia; a much less common phenomenon is macrotyrotropinemia (macro-TSH). The presence of macro-TSH complexes can be suspected when the serum detects atypically high TSH values with reference values of FT4 without any signs of hypothyroidism. Since the phenomenon is based on an autoimmune mechanism, macro-TSH can often be detected in patients with autoimmune thyroiditis (AIT). This article presents clinical cases of patients with a combination of the macro-TSH phenomenon and primary hypothyroidism due to AIT.
促甲状腺激素(TSH)是诊断甲状腺功能障碍的关键指标之一。TSH浓度的微小变化可以在临床表现之前就怀疑甲状腺功能障碍,这增加了正确及时测量TSH的价值。在临床实践中,内分泌学家经常会遇到众所周知的巨催乳素血症现象;一种不太常见的现象是大酪蛋白血症(大tsh)。当血清检测到非典型的高TSH值,FT4参考值,而没有甲状腺功能减退的迹象时,可以怀疑存在大TSH复合物。由于这种现象是基于自身免疫机制,因此在自身免疫性甲状腺炎(AIT)患者中经常可以检测到巨量tsh。本文介绍了由AIT引起的大促甲状腺激素现象和原发性甲状腺功能减退合并的临床病例。
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引用次数: 0
By an anniversary of the birth of Johann Peter Müller — 220 years 在约翰·彼得·迈勒诞辰220周年之际
Pub Date : 2021-11-29 DOI: 10.14341/ket12567
U. V. Buyvalenko, A. R. Levshina
July 14, 2021 marks the 220th anniversary of an outstanding scientist and physician — Johann Peter Müller. It is thanks to his works that we know what the «endocrine gland» is, understand the taxonomy of the animal world and the essence of ontogenesis. Professor, researcher, wonderful teacher, director of the anatomical and physiological museum of the University of Berlin — he succeeded in any role in life. Mueller’s discoveries were recognized during his lifetime, textbooks were published under his leadership, and scientific articles were published. The value of the professor’s work is high to this day, which once again proves the colossal contribution of Johann Müller in the formation of world science.
2021年7月14日是杰出科学家和医生约翰·彼得·迈勒诞辰220周年。正是由于他的工作,我们知道了什么是“内分泌腺”,了解了动物世界的分类学和个体发生的本质。教授、研究员、优秀的教师、柏林大学解剖学和生理学博物馆馆长——他在生活中的任何角色都取得了成功。穆勒的发现在他的一生中得到了认可,教科书在他的领导下出版,科学文章也发表了。直到今天,这位教授的工作仍然具有很高的价值,这再次证明了约翰·米勒对世界科学的形成所作的巨大贡献。
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引用次数: 0
From physics to medicine, fundamentalist Leonidas D. Marinelli 从物理学到医学,原教旨主义者列奥尼达斯·d·马里内利
Pub Date : 2021-11-29 DOI: 10.14341/ket12547
D. Yudakov, S. P. Bondarenko, A. Trukhin
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引用次数: 0
Thyrotoxicosis treatment with lithium corbanate. Cases reported 公司酸锂治疗甲状腺毒症。病例报道
Pub Date : 2021-11-25 DOI: 10.14341/ket12709
I. A. Matsueva, A. Dalmatova, T. V. Andreychenko, E. Grineva
Treatment of thyrotoxicosis caused by Graves’ disease or multinodular toxic goiter, is not difficult, in most cases, since the prescription of thionamides allows to normalize the level of thyroid hormones quickly and safety. But in a number of cases this therapy might be associated with serious side effects (agranulocytosis, toxic hepatitis, cholestasis), severe allergic reactions and also individual intolerance on thionamides. In such cases lithium carbonate is used, especially in severe thyrotoxic syndrome. It is known, that lithium can accumulate in the thyroid gland at a concentration 3–4 times higher than in the plasma. Perhaps, lithium uses Na+/I- ions. It can inhibit the synthesis and secretion thyroid hormones of thyroid gland. The article presents the cases reported the use of lithium carbonate in thyrotoxicosis treatment before thyroidectomy. Administering low doses of carbonate lithium (900 mg/ per day) renders significant decrease or normalization of thyroid hormones concentration within 7–14 days, thus it let perform thyroidectomy on the patients. No side effects have been identified with such a short course of lithium carbonate treatment.
在大多数情况下,治疗由格雷夫斯病或多结节性中毒性甲状腺肿引起的甲状腺毒症并不困难,因为硫胺的处方可以快速安全地使甲状腺激素水平正常化。但在一些情况下,这种疗法可能与严重的副作用(粒细胞缺乏症、中毒性肝炎、胆汁淤积)、严重的过敏反应以及个体对硫胺的不耐受有关。在这种情况下使用碳酸锂,特别是在严重的甲状腺毒性综合征。众所周知,锂在甲状腺中的蓄积浓度比在血浆中的蓄积浓度高3-4倍。也许,锂使用Na+/I-离子。能抑制甲状腺甲状腺激素的合成和分泌。本文报道了在甲状腺切除术前应用碳酸锂治疗甲状腺毒症的病例。低剂量碳酸锂(900 mg/ d)治疗后7 ~ 14天甲状腺激素浓度明显下降或恢复正常,可行甲状腺切除术。如此短疗程的碳酸锂治疗没有发现任何副作用。
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引用次数: 1
Clinical guidelines «Thyroiditis in children» 临床指南«儿童甲状腺炎»
Pub Date : 2021-11-25 DOI: 10.14341/ket12711
А. Петеркова, О. Б. Безлепкина, В. Нагаева, Т. Ю. Ширяева, О. А. Чикулаева, Т. А. Вадина, Е. В. Шрёдер, Таранушенко, Елена Ефимовна Петряйкина, Олег Артурович Малиевский, А. В. Кияев, И. Б. Кострова, Е. Б. Башнина, Евгения Геннадьевна Михайлова, Гирш, Елена Борисовна Храмова, И. Л. Алимова, Любовь Николаевна Самсонова, Н. В. Болотова, Ф. Войно-Ясенецкого, Красноярск, Россия, Москва И. Пирогова, Россия Уфа, М. Н. Кураева, Россия Санкт-Петербург, Самара им. Н. Н. Ивановой, Россия Сургут, V. A. Peterkova, Olga B. Bezlepkina, E. V. Nagaeva, T. Y. Shiryaeva, Оlga А. Chikulaeva, Vadina, Ekaterina V. Shreder, Tatiana E. Taranushenko, Elena E. Petryaykina, O. Malievskiy, Kiyaev, Irina B. Kostrova, Elena B. Bashnina, Evgeniya G. Mikhailova, Yana V. Girsh, Elena B. Khramova, Alimova, Lubov Samsonova, N. V. Bolotova
The thyroiditis in children are urgent problem of pediatric endocrinology due to the widespread occurrence and characterized by clinical and pathogenetic heterogeneity. The developed clinical guidelines are the main working tool of the practitioner. They briefly and structurally present the main information about the epidemiology and modern classification of thyroiditis, methods of their diagnosis and treatment based on the principles of evidence-based medicine.
小儿甲状腺炎发病率普遍,且具有临床和发病异质性,是儿科内分泌学亟待解决的问题。制定的临床指南是医生的主要工作工具。本文简要介绍了甲状腺炎的流行病学、现代分类、基于循证医学原则的诊断和治疗方法。
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引用次数: 3
On the 180th anniversary of Emil Theodor Kocher, a Swiss thyroid surgeon 在瑞士甲状腺外科医生埃米尔·西奥多·科赫诞辰180周年之际
Pub Date : 2021-11-25 DOI: 10.14341/ket12579
М. Демина, Andrey А. Tulsky, Elena M. Demina
August 25, 2021 marks the 180th anniversary of the birth of the renowned physician Emil Theodor Kocher. He was a man whose talent has manifested itself in various fields of medicine. Nowadays it is impossible to imagine a doctor who does not know the name of Kocher, because he is the author of many surgical methods and techniques that are still valid, despite advances in modern medicine. Furthermore, some of the instruments designed by Kocher are still used in surgery. In addition to the biography of Kocher, this article considers information about his work in the field of thyroidology, for which he received the Nobel Prize in 1909. Kocher has performed more than 5,000 thyroidectomies during his career. Thanks to the technique he developed, the mortality rate of that surgery decreased at least fortyfold. In those days there were not researches on functions of the thyroid gland, but Kocher noticed that total thyroidectomy leads to serious consequences. Therefore he refused to do such surgeries without invariable indications.
2021年8月25日是著名医生埃米尔·西奥多·科赫诞辰180周年。他是一个在医学的各个领域都表现出才华的人。今天,很难想象一个医生不知道科克的名字,因为他是许多外科手术方法和技术的作者,尽管现代医学取得了进步,但这些方法和技术仍然有效。此外,Kocher设计的一些器械仍在手术中使用。除了Kocher的传记外,本文还考虑了他在甲状腺学领域的工作信息,他因此获得了1909年的诺贝尔奖。在他的职业生涯中,Kocher已经做了5000多例甲状腺切除术。多亏了他发明的技术,那个手术的死亡率降低了至少四十倍。当时还没有关于甲状腺功能的研究,但Kocher注意到甲状腺全切除术会导致严重的后果。因此,他拒绝在没有固定指征的情况下进行此类手术。
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引用次数: 2
To the 225th Anniversary of the Birth of Robert James Graves 纪念罗伯特·詹姆斯·格雷夫斯诞辰225周年
Pub Date : 2021-09-08 DOI: 10.14341/ket12557
A. L. Kurchakov, I. A. Likhova
Robert James Graves is an eminent medical practitioner who has made significant contributions to this field. The main path of the scientist began by no means with medical practice, but with extensive travels that prompted him to start and fruitfully carry out scientific activity in the future. The scientific activity carried out by Robert James Graves throughout his life formed special preconditions for the development of medical education and entire fields of medicine. The practice of students, according to his teaching model, was not typical, but many experts in this field spoke about it quite positively, for example, such as T.J. McKenn and Armand Trousseau. He made history 180 years ago by discovering an autoimmune disease, which causes hyperthyroidism, he was known as a physician whose contribution covered the entire field of endocrinology, cardiology, infectious diseases and neurology.
罗伯特·詹姆斯·格雷夫斯是一位杰出的医生,他对这一领域做出了重大贡献。科学家的主要道路绝不是从医学实践开始的,而是从广泛的旅行开始的,这些旅行促使他开始并在未来富有成效地开展科学活动。罗伯特·詹姆斯·格雷夫斯一生从事的科学活动为医学教育和整个医学领域的发展形成了特殊的先决条件。根据他的教学模式,学生的实践并不典型,但这一领域的许多专家都非常积极地评价了这一模式,例如T.J.麦肯恩和阿曼德·特鲁索。180年前,他发现了一种导致甲状腺机能亢进的自身免疫性疾病,创造了历史。他被称为一名贡献涵盖内分泌学、心脏病学、传染病和神经学整个领域的医生。
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引用次数: 0
Consensus guidelines of congenital hypothyroidism by the European Society for pediatric endocrinology and the European Society for Endocrinology: key points and comments 欧洲儿科内分泌学会和欧洲内分泌学会的先天性甲状腺功能减退共识指南:要点和评论
Pub Date : 2021-09-08 DOI: 10.14341/ket12703
E. Shreder, T. Shiryaeva, E. Nagaeva, O. Bezlepkina
Congenital hypothyroidism is an actual clinical problem in pediatric practice. Previous clinical guidelines were published in 2014. The presented clinical recommendations are based on articles published from January 2013 to early 2020. The consensus guidelines include such sections as results of neonatal screening, diagnostics and criteria for treatment, lifelong follow-up, genetics of congenital hypothyroidism, family genetic counselling. The key points of new congenital hypothyroidism guidelines were commented by pediatric endocrinologists of Russians.
先天性甲状腺功能减退症是儿科实践中的一个实际临床问题。之前的临床指南发布于2014年。提出的临床建议基于2013年1月至2020年初发表的文章。共识指南包括新生儿筛查结果、诊断和治疗标准、终身随访、先天性甲状腺功能减退的遗传学、家庭遗传咨询等部分。俄罗斯儿科内分泌专家对新先天性甲状腺功能减退指南要点进行了点评。
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引用次数: 1
Life and Heritage of Hakaru Hashimoto 桥本光的生平与遗产
Pub Date : 2021-09-08 DOI: 10.14341/ket12562
E. A. Lygina, V. V. Latyi
In May 2021, the 140th anniversary of his birth is celebrated by Japanese doctor Hakaru Hashimoto. Did not receive recognition during his lifetime, this amazing scientist discovered a new disease of the thyroid gland, which later became the eponym. For a long time, his name was forgotten, but the main work of his life was decades ahead of the development of science. Without it, the study of autoimmune pathologies, the incidence of which currently continues to increase, would be impossible. It was on patients with Hashimoto’s thyroiditis that a study was conducted for the first time, demonstrating not only the uniqueness of the pathogenesis of thyroiditis, but also the existence of autoimmune reactivity of the body as a whole.
2021年5月,日本医生桥本光将庆祝他诞辰140周年。在他的一生中没有得到认可,这位了不起的科学家发现了一种新的甲状腺疾病,后来成为了这个名字的名字。在很长一段时间里,他的名字被遗忘了,但他一生的主要工作比科学的发展领先了几十年。如果没有它,对自身免疫性疾病的研究将是不可能的,而目前这种疾病的发病率仍在不断增加。首次对桥本甲状腺炎患者进行了研究,不仅证明了甲状腺炎发病机制的独特性,而且证明了机体整体自身免疫反应性的存在。
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引用次数: 0
期刊
Clinical and experimental thyroidology
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