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Glucocorticoid Sensitivity Among Young Survivors of Childhood Acute Lymphoblastic Leukemia: What Does It Matter? 儿童急性淋巴细胞白血病年轻幸存者的糖皮质激素敏感性:这有什么关系?
IF 2 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-10-01 Epub Date: 2024-08-05 DOI: 10.1055/a-2363-4823
Adriana Aparecida Siviero-Miachon, Ana Virgínia Lopes de Sousa, Bruno Moreira Simião, Elisangela Oliveira Araújo, Renato Alvarenga, Angela Maria Spinola-Castro, Carlos Alberto Longui

The aim of the study was to assess glucocorticoid sensitivity in survivors of childhood acute lymphoblastic leukemia using in vivo and in vitro tests. Thirty leukemia survivors of both sexes aged ≥18 years participated in the study and at least two years after therapy withdrawal. In vivo tests comprised: a) a very low dose intravenous dexamethasone suppression test for measurement of serum cortisol before, after, and % suppression, compared with 32 age-matched controls; and b) 0.25 mg overnight oral dexamethasone suppression test for assessment of salivary cortisol before, after, and % suppression. In vitro methods comprised: c) glucocorticoid receptor polymorphisms: BcI1-NR3C1 and A3669G; and d) splicing variant of glucocorticoid receptor GR-α mRNA by real-time quantitative polymerase chain reaction, compared with 32 controls. There was a reduction in salivary cortisol, and 73.3% of leukemia survivors showed high sensitivity according to % suppression after oral dexamethasone (p<0.05). Serum cortisol at baseline, after the test, % suppression after intravenous dexamethasone, and the percentage of high sensitivity were reduced in the leukemia group (%F=36.7; p<0.05). The BcI1-NR3C1 and A3669G polymorphisms were present in 11/30 (36.7%) and 5/30 (16.7%) patients, respectively. GR-α mRNA levels were lower in the leukemia group than in the controls (p<0.05). Survivors of acute lymphoblastic leukemia presented with reduced glucocorticoid sensitivity. Glucocorticoid sensitivity allows individualized treatment to avoid adverse effects and may be involved in cardiovascular disease risk among this particular group of cancer survivors.

这项研究旨在通过体内和体外测试评估儿童急性淋巴细胞白血病幸存者对糖皮质激素的敏感性。30名年龄≥18岁的男女白血病幸存者参加了这项研究,并在停止治疗至少两年后参加了这项研究。体内试验包括:a)极低剂量静脉注射地塞米松抑制试验,用于测量血清皮质醇抑制前、抑制后和抑制百分比,并与 32 名年龄匹配的对照组进行比较;b)0.25 毫克隔夜口服地塞米松抑制试验,用于评估唾液皮质醇抑制前、抑制后和抑制百分比。体外方法包括:c) 糖皮质激素受体多态性:BcI1-NR3C1 和 A3669G;以及 d) 通过实时定量聚合酶链反应检测糖皮质激素受体 GR-α mRNA 的剪接变异。唾液皮质醇有所下降,根据口服地塞米松后的抑制率,73.3% 的白血病幸存者表现出高度敏感性(p
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引用次数: 0
Meta-Analysis and Network Analysis Differentially Detect Various Pro-Inflammatory Mediators and Risk Factors for Type 2 Diabetes in the Elderly. 元分析和网络分析可差异化检测各种促炎介质和老年人 2 型糖尿病的风险因素。
IF 2 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-10-01 Epub Date: 2024-01-09 DOI: 10.1055/a-2241-5281
Linlin Gu, Yue Du, Fang Liang

Type 2 diabetes (T2D) has a pathophysiological component that includes inflammation. Inflammation-sensitive marker measurement may be helpful in determining the risk of complications for both older T2D patients and the public. This study aimed to investigate the association between blood pro-inflammatory mediators and the characteristics of elderly patients with T2D using meta and network analyses. The Web of Science, Scopus, PubMed, and Cochrane Library databases were selected as study methodology. The Quality in Prognosis Studies (QUIPS) tool in the meta-analysis assessed the studies' methodological quality. The selected studies were statistically analyzed using the META-MAR tool based on the standardized mean difference (SMD). The selected studies included nine examinations involving 6399 old people [+>+55 years old, 65.9+±+4.09 (mean+±+SD)]. The meta-analysis showed that pro-inflammatory mediators (SMD 0.82) and patient-related variables [risk factors (SMD 0.71)] were significantly associated with T2D (p+<+0.05). Subgroup analysis revealed that tumor necrosis factor alpha (TNF-α; SMD 1.08), body mass index (SMD 0.64), high-density lipoprotein (HDL; SMD -0.61), body weight (SMD 0.50), and blood pressure (SMD 1.11) were factors significantly associated with T2D (p+<+0.05). Network analysis revealed that among patient characteristics, diastolic blood pressure and, among inflammatory mediators, leptin were the most closely associated factors with T2D in older adults. Moreover, network analysis showed that TNF-α and systolic blood pressure were most closely associated with leptin. Overall, alternate techniques, such as meta-analysis and network analysis, might identify different markers for T2D in older people. A therapeutic decision-making process needs to consider these differences in advance.

2 型糖尿病(T2D)的病理生理因素包括炎症。对炎症敏感的标记物测量可能有助于确定老年 T2D 患者和公众的并发症风险。本研究旨在通过 Meta 和网络分析,研究血液中的促炎介质与老年 T2D 患者特征之间的关联。研究方法选择了 Web of Science、Scopus、PubMed 和 Cochrane Library 数据库。荟萃分析中的预后研究质量(QUIPS)工具评估了研究的方法学质量。根据标准化平均差(SMD),使用 META-MAR 工具对所选研究进行统计分析。所选研究包括 9 项检查,涉及 6399 名老年人[年龄大于 55 岁,65.9±4.09(平均值±SD)]。荟萃分析表明,促炎介质(SMD 0.82)和患者相关变量[风险因素(SMD 0.71)]与 T2D 显著相关(p
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引用次数: 0
Cross-Talk Between Thyroid Disorders and Nonalcoholic Fatty Liver Disease: From Pathophysiology to Therapeutics. 甲状腺疾病与非酒精性脂肪肝之间的交叉对话:从病理生理学到治疗学。
IF 2 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-10-01 Epub Date: 2024-02-26 DOI: 10.1055/a-2276-7973
Yan Yang, Jiyuan Xiao, Wen Qiu, Luxia Jiang

The medical community acknowledges the presence of thyroid disorders and nonalcoholic fatty liver disease (NAFLD). Nevertheless, the interconnection between these two circumstances is complex. Thyroid hormones (THs), including triiodothyronine (T3) and thyroxine (T4), and thyroid-stimulating hormone (TSH), are essential for maintaining metabolic balance and controlling the metabolism of lipids and carbohydrates. The therapeutic potential of THs, especially those that target the TRβ receptor isoform, is generating increasing interest. The review explores the pathophysiology of these disorders, specifically examining the impact of THs on the metabolism of lipids in the liver. The purpose of this review is to offer a thorough analysis of the correlation between thyroid disorders and NAFLD, as well as suggest potential therapeutic approaches for the future.

医学界承认甲状腺疾病和非酒精性脂肪肝(NAFLD)的存在。然而,这两种情况之间的相互联系十分复杂。甲状腺激素(THs),包括三碘甲状腺原氨酸(T3)、甲状腺素(T4)和促甲状腺激素(TSH),对于维持代谢平衡以及控制脂类和碳水化合物的代谢至关重要。THs的治疗潜力,尤其是以TRβ受体同工酶为靶点的THs,正引起越来越多的关注。本综述探讨了这些疾病的病理生理学,特别研究了 THs 对肝脏中脂类代谢的影响。本综述旨在全面分析甲状腺疾病与非酒精性脂肪肝之间的相关性,并提出未来可能的治疗方法。
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引用次数: 0
Effect of Low Dose Glucocorticoid Inhalation on Bronchopulmonary Dysplasia in Premature Infants. 小剂量糖皮质激素吸入对早产儿支气管肺发育不良的影响
IF 2 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-09-30 DOI: 10.1055/a-2414-3061
Xiaohua Li, Heng Liu

The aim of the study was to explore the effect of low dose glucocorticoid on bronchopulmonary dysplasia in premature infants, to provide new ideas for clinical prevention and cure of bronchopulmonary dysplasia in premature infants. The 144 cases of premature infants were divided into 72 each: control group and experimental group. Control group received routine clinical prevention and cure, while experimental group was received low dose glucocorticoid on the basis of control group. The serum interleukin-10 (IL-10) , interleukin-8 (IL-8), and transforming growth factor-1 (TGF-β1) before and after treatment were compared between two groups. The incidence and severity of bronchopulmonary dysplasia was compared between two groups. The mechanical ventilation time, oxygen inhalation time and hospitalization time in two groups were recorded, and the body mass, head circumference and body length at 30 days after birth were assessed in both groups. After treatment, the serum IL-10 level in experimental group was increased and IL-8, TGF-β1 levels were decreased compared with control group (p <0.05). The incidence rate of bronchopulmonary dysplasia in experimental group was 13.89% and the disease severity in experimental group was significantly reduced (p<0.05). Both groups exhibited no notable adverse reactions (p>0.05). Low-dose glucocorticoids have a significant preventive and therapeutic effect on bronchopulmonary dysplasia in preterm infants, and have a high safety, showing high clinical application value for bronchopulmonary dysplasia in preterm infants.

该研究旨在探讨小剂量糖皮质激素对早产儿支气管肺发育不良的影响,为临床防治早产儿支气管肺发育不良提供新思路。将 144 例早产儿分为对照组和实验组各 72 例。对照组接受常规临床防治,实验组在对照组基础上接受小剂量糖皮质激素治疗。比较两组治疗前后的血清白细胞介素-10(IL-10)、白细胞介素-8(IL-8)和转化生长因子-1(TGF-β1)。比较两组支气管肺发育不良的发生率和严重程度。记录两组的机械通气时间、氧气吸入时间和住院时间,评估两组出生后30天的体重、头围和身长。与对照组相比,实验组治疗后血清IL-10水平升高,IL-8、TGF-β1水平降低(P 0.05)。小剂量糖皮质激素对早产儿支气管肺发育不良有明显的预防和治疗作用,安全性高,对早产儿支气管肺发育不良有较高的临床应用价值。
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引用次数: 0
Retraction Note: Clinical Application of Thyrotropin Receptor Antibodies. 促甲状腺激素受体抗体的临床应用。
IF 2 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-09-15 DOI: 10.1055/a-2415-5376
Yang Yang, Huang Weipeng

This article has been retracted by Thieme and the Editor in Chief. This article was published in error and this retraction is thus not the result of any fault or action of the authors. The Publisher and Editor apologise for this mistake and any inconvenience caused by this error.

促甲状腺激素受体抗体(TRAb)是巴塞杜氏病(GD)的特异性抗体,在GD的发病机制中起着至关重要的作用。最近,TRAb检测方法有了很大改进。本综述讨论了 TRAb 在甲状腺功能亢进症的鉴别诊断、GD 的预后、妊娠期和儿科 GD 以及 GD 相关眼病(GO)中的临床应用。除了经典的竞争检测和生物检测外,TRAb检测还出现了一种新的桥接检测方法。TRAb 是 GD 甲状腺功能亢进症的主要致病机制。治疗后的 GD 仍有很高的复发率,甚至会出现 TRAb 短期激增,导致 GO 迅速恶化。胎儿甲状腺肿可能与妊娠期母体TRAb升高有关,过度治疗可能导致胎儿甲状腺功能减退。小儿甲状腺肿大患者的TRAb较高,治疗缓解率低,而GO的表现不明显。TRAb与GO的活性和严重程度密切相关。目前,TRAb检测具有较高的特异性和灵敏度,可直接用于确定甲状腺功能亢进的病因。TRAb可用于预测药物治疗后GD的复发或RAI治疗后GO的进展。应定期测量妊娠期GD的TRAb,以指导抗甲状腺药物治疗,避免胎儿甲亢或甲减。监测小儿GD的TRAb有助于控制GO的进展。TRAb检测是治疗GO的重要指导。
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引用次数: 0
Triglyceride Glucose Index and the Risk of Diabetic Nephropathy in Patients with Type 2 Diabetes: A Meta-Analysis. 甘油三酯血糖指数与 2 型糖尿病患者罹患糖尿病肾病的风险:一项 Meta 分析。
IF 2 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-09-05 DOI: 10.1055/a-2376-6044
Sheng Deng, Ling Peng

Diabetic nephropathy (DN) is a leading cause of end-stage renal disease in patients with type 2 diabetes mellitus (T2DM). This meta-analysis aims to evaluate the association between the triglyceride glucose (TyG) index, a novel marker reflecting insulin resistance, and the risk of developing DN in patients with T2DM. We conducted a comprehensive literature search in PubMed, Embase, and Web of Science databases up to May 12, 2024. Studies assessing the TyG index in relation to DN risk among T2DM patients were included. The pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. A total of eight longitudinal follow-up studies encompassing 15 889 patients with T2DM were included. The pooled analysis revealed a significant association between a higher TyG index and an increased risk of DN in patients with T2DM (RR=1.53, 95% CI: 1.37-1.71, p<0.001; I2=35%). The results of meta-regression analysis suggested that the cutoff of TyG index was positively associated with the RR for the association between TyG index and DN. Subgroup analyses demonstrated that the association was stronger in studies with cutoff of TyG index ≥9.5 as compared to those with the cutoff <9.5 (RR: 1.73 vs. 1.40, p for subgroup difference <0.05). The association was not significantly affected by study design, mean age of the patients, proportion of men, or follow-up durations. In conclusion, higher TyG index is significantly associated with an increased risk of DN in patients with T2DM.

糖尿病肾病(DN)是 2 型糖尿病(T2DM)患者终末期肾病的主要病因。本荟萃分析旨在评估反映胰岛素抵抗的新型标志物甘油三酯葡萄糖(TyG)指数与 T2DM 患者罹患糖尿病肾病风险之间的关联。截至 2024 年 5 月 12 日,我们在 PubMed、Embase 和 Web of Science 数据库中进行了全面的文献检索。纳入了评估TyG指数与T2DM患者DN风险关系的研究。采用随机效应模型计算了汇总的相对风险(RRs)和 95% 置信区间(CIs)。共纳入了 8 项纵向随访研究,涉及 15 889 名 T2DM 患者。汇总分析显示,TyG 指数越高,T2DM 患者罹患 DN 的风险越高(RR=1.53,95% CI:1.37-1.71,P2=35%)。元回归分析结果表明,TyG指数的临界值与TyG指数和DN之间相关性的RR呈正相关。亚组分析表明,与TyG指数分界点≥9.5的研究相比,TyG指数分界点≥9.5的研究与DN的相关性更强。
{"title":"Triglyceride Glucose Index and the Risk of Diabetic Nephropathy in Patients with Type 2 Diabetes: A Meta-Analysis.","authors":"Sheng Deng, Ling Peng","doi":"10.1055/a-2376-6044","DOIUrl":"https://doi.org/10.1055/a-2376-6044","url":null,"abstract":"<p><p>Diabetic nephropathy (DN) is a leading cause of end-stage renal disease in patients with type 2 diabetes mellitus (T2DM). This meta-analysis aims to evaluate the association between the triglyceride glucose (TyG) index, a novel marker reflecting insulin resistance, and the risk of developing DN in patients with T2DM. We conducted a comprehensive literature search in PubMed, Embase, and Web of Science databases up to May 12, 2024. Studies assessing the TyG index in relation to DN risk among T2DM patients were included. The pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. A total of eight longitudinal follow-up studies encompassing 15 889 patients with T2DM were included. The pooled analysis revealed a significant association between a higher TyG index and an increased risk of DN in patients with T2DM (RR=1.53, 95% CI: 1.37-1.71, p<0.001; I<sup>2</sup>=35%). The results of meta-regression analysis suggested that the cutoff of TyG index was positively associated with the RR for the association between TyG index and DN. Subgroup analyses demonstrated that the association was stronger in studies with cutoff of TyG index ≥9.5 as compared to those with the cutoff <9.5 (RR: 1.73 vs. 1.40, p for subgroup difference <0.05). The association was not significantly affected by study design, mean age of the patients, proportion of men, or follow-up durations. In conclusion, higher TyG index is significantly associated with an increased risk of DN in patients with T2DM.</p>","PeriodicalId":12999,"journal":{"name":"Hormone and Metabolic Research","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
HINT2 may be One Clinical Significance Target for Patient with Diabetes Mellitus and Reduced ROS-Induced Oxidative Stress and Ferroptosis by MCU. HINT2可能是糖尿病患者的一个临床意义靶点,MCU可减少ROS诱导的氧化应激和铁氧化。
IF 2 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-09-01 Epub Date: 2024-01-29 DOI: 10.1055/a-2238-2689
Mei Bai, Wei Lu, Jun Tan, Xin Mei

The World Health Organization (WHO) predicted that patients with diabetes around the world will increase to 600 million by 2040, of which about 1/3 will develop diabetic nephropathy (DN). Therefore, the present study aimed to uncover therapeutic effect of HINT2 and determined its possible mechanisms. Patients with diabetes mellitus and normal volunteers were enrolled at our hospital. Male C57BL/6 mice were fed with a high fat diet and injected intraperitoneally with STZ for once (100 mg/kg body weight). Mouse podocytes (MPC5) cells were induced with 20 mmol/l D-glucose. Inhibition of HINT2 mRNA expression levels in patients with DN was observed, compared with normal group. The serum of HINT2 mRNA expression was negative in correlation with blood sugar, tubulo-interstitial damage, glomerular damage score or urine protein level in patients with DN. HINT2 expression in kidney tissue of mice with DN were downregulated. HINT2 presented reduced DN and inflammation and ROS-induced oxidative stress in model of DN. HINT2 promoted ferroptosis in model of DN by mitochondrial membrane potential. HINT2 suppressed MCU expression in model of DN. HINT2 protein combined with MCU protein increased MCU protein ubiquitination. HINT2 triggers mitochondrial Ca2+ influx to increase ROS production level by MCU. Taken together, these findings demonstrated that HINT2 reduced ROS-induced Oxidative stress and ferroptosis by MCU, suggesting that HINT2 may be a feasible strategy to treat DN.

世界卫生组织(WHO)预测,到2040年,全球糖尿病患者将增至6亿,其中约1/3将罹患糖尿病肾病(DN)。因此,本研究旨在揭示 HINT2 的治疗作用并确定其可能的机制。本院招募了糖尿病患者和正常志愿者。雄性 C57BL/6 小鼠以高脂肪饮食喂养,腹腔注射 STZ 一次(100 毫克/千克体重)。用 20 毫摩尔/升 D-葡萄糖诱导小鼠荚膜细胞(MPC5)。与正常组相比,DN 患者的 HINT2 mRNA 表达水平受到抑制。血清中 HINT2 mRNA 的表达与 DN 患者的血糖、肾小管间质损伤、肾小球损伤评分或尿蛋白水平呈负相关。DN 小鼠肾组织中的 HINT2 表达下调。在 DN 模型中,HINT2 减少了 DN 和炎症以及 ROS 引起的氧化应激。HINT2 通过线粒体膜电位促进了 DN 模型中的铁变态反应。HINT2抑制了MCU在DN模型中的表达。HINT2 蛋白与 MCU 蛋白结合可增加 MCU 蛋白的泛素化。HINT2 触发线粒体 Ca2+ 流入,增加 MCU 产生的 ROS 水平。综上所述,这些研究结果表明,HINT2能减少ROS诱导的氧化应激和MCU的铁变态反应,这表明HINT2可能是治疗DN的一种可行策略。
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引用次数: 0
Elevated Levels of Interleukin-18 are Associated with Lymph Node Metastasis in Papillary Thyroid Carcinoma. 白细胞介素-18水平升高与甲状腺乳头状癌淋巴结转移有关
IF 2 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-09-01 Epub Date: 2024-02-14 DOI: 10.1055/a-2255-5718
Wang Chun, Meiyin Lu, Jiakang Chen, Jian Li

Interleukin-18 (IL-18) is a proinflammatory cytokine that primarily stimulates the Th1 immune response. IL-18 exhibits anticancer activity and has been evaluated in clinical trials as a potential cancer treatment. However, evidence suggests that it may also facilitate the development and progression of some cancers. So far, the impact of IL-18 on papillary thyroid cancer (PTC) has not been investigated. In this study, we found that the expression of IL-18 was significantly increased in PTC compared to normal thyroid tissue. Elevated IL-18 expression was closely associated with lymphovascular invasion and lymph node metastases. Furthermore, compared to PTC patients with no nodal metastasis, serum IL-18 levels were slightly increased in patients with 1-4 nodal metastases and significantly elevated in patients with 5 or more nodal metastases. The pro-metastatic effect of IL-18 may be attributed to the simultaneous increase in the expression of S100A10, a known factor that is linked to nodal metastasis in PTC. In addition, the activation of several pathways, such as the intestinal immune network for lgA production and Staphylococcus aureus infection, may be involved in the metastasis process. Taken together, IL-18 may trigger pro-metastatic activity in PTC. Therefore, suppressing the function of IL-18 rather than enhancing it appears to be a reasonable strategy for treating aggressive PTC.

白细胞介素-18(IL-18)是一种促炎细胞因子,主要刺激 Th1 免疫反应。IL-18 具有抗癌活性,已在临床试验中被评估为一种潜在的癌症治疗药物。然而,有证据表明,它也可能促进某些癌症的发展和恶化。迄今为止,尚未研究过 IL-18 对甲状腺乳头状癌(PTC)的影响。本研究发现,与正常甲状腺组织相比,IL-18 在 PTC 中的表达明显增加。IL-18表达的升高与淋巴管侵犯和淋巴结转移密切相关。此外,与无结节转移的PTC患者相比,有1-4个结节转移的患者血清IL-18水平略有升高,而有5个或5个以上结节转移的患者血清IL-18水平则明显升高。IL-18 的促转移作用可能是由于 S100A10 的表达同时增加所致,而 S100A10 是已知的与 PTC 结节转移有关的因子。此外,肠道免疫网络产生 lgA 和金黄色葡萄球菌感染等多个途径的激活也可能参与了转移过程。综上所述,IL-18 可能会引发 PTC 的促转移活性。因此,抑制而非增强 IL-18 的功能似乎是治疗侵袭性 PTC 的合理策略。
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引用次数: 0
Recent Advances in Molecular Pathways and Therapeutic Implications for Peptic Ulcer Management: A Comprehensive Review. 分子途径的最新进展及其对消化性溃疡治疗的影响:全面回顾。
IF 2 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-09-01 Epub Date: 2024-03-11 DOI: 10.1055/a-2256-6592
Deepak Chandra Joshi, Nirmal Joshi, Ajeet Kumar, Shubhrat Maheshwari

Peptic ulcers, recognized for their erosive impact on the gastrointestinal mucosa, present a considerable challenge in gastroenterology. Epidemiological insights underscore the global prevalence of peptic ulcers, affecting 5-10+% of individuals, with a yearly incidence of 0.3 to 1.9 cases per thousand. Recent decades have witnessed a decline in complications, attributed to improved diagnostics and therapeutic advancements. The review deepens into H. pylori-associated and NSAID-induced ulcers, emphasizing their distinct prevalence in developing and industrialized nations, respectively. Despite advancements, managing peptic ulcers remains challenging, notably in H. pylori-infected individuals facing recurrence and the rise of antibiotic resistance. The pathophysiology unravels the delicate balance between protective and destructive factors, including the intricate molecular mechanisms involving inflammatory mediators such as TNF-α, ILs, and prostaglandins. Genetic and ethnic factors, rare contributors, and recent molecular insights further enhance our understanding of peptic ulcer development. Diagnostic approaches are pivotal, with upper gastrointestinal endoscopy standing as the gold standard. Current treatment strategies focus on H. pylori eradication, NSAID discontinuation, and proton pump inhibitors. Surgical options become imperative for refractory cases, emphasizing a comprehensive approach. Advances include tailored H. pylori regimens, the emergence of vonoprazan, and ongoing vaccine development. Challenges persist, primarily in antibiotic resistance, side effects of acid suppressants, and translating natural compounds into standardized therapies. Promising avenues include the potential H. pylori vaccine and the exploration of natural compounds, with monoterpenes showing therapeutic promise. This review serves as a compass, guiding healthcare professionals, researchers, and policymakers through the intricate landscape of peptic ulcer management.

消化性溃疡因其对胃肠道粘膜的侵蚀性影响而被公认,是消化内科面临的巨大挑战。流行病学研究表明,消化性溃疡在全球的发病率为 5-10+%,年发病率为 0.3-1.9 例/千人。近几十年来,由于诊断和治疗技术的进步,并发症有所减少。本综述深入探讨了幽门螺杆菌相关性溃疡和非甾体抗炎药引起的溃疡,强调了它们分别在发展中国家和工业化国家的不同发病率。尽管取得了进步,但消化性溃疡的治疗仍然充满挑战,尤其是幽门螺杆菌感染者面临复发和抗生素耐药性上升的问题。病理生理学揭示了保护性因素和破坏性因素之间的微妙平衡,包括涉及 TNF-α、ILs 和前列腺素等炎症介质的复杂分子机制。遗传和种族因素、罕见的致病因素以及最新的分子研究成果进一步加深了我们对消化性溃疡发病机制的了解。诊断方法至关重要,上消化道内窥镜检查是金标准。目前的治疗策略主要是根除幽门螺杆菌、停用非甾体抗炎药和质子泵抑制剂。对于难治性病例,手术治疗成为当务之急,强调综合治疗。目前取得的进展包括为幽门螺杆菌量身定制的治疗方案、vonoprazan 的出现以及正在进行的疫苗研发。挑战依然存在,主要是抗生素耐药性、抑酸剂的副作用以及将天然化合物转化为标准化疗法。前景看好的途径包括潜在的幽门螺杆菌疫苗和天然化合物的开发,其中单萜类化合物显示出治疗前景。本综述可作为指南针,指导医疗保健专业人员、研究人员和政策制定者了解消化性溃疡治疗的复杂情况。
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引用次数: 0
Utility of Simple and Non-Invasive Strategies Alternative to Inferior Petrosal Sinus Sampling and Peripheral CRH Stimulation in Differential Diagnosis of ACTH-Dependent Cushing Syndrome. 在鉴别诊断促肾上腺皮质激素依赖性库欣综合征时,替代下上颌窦取样和外周 CRH 刺激的简单非侵入性策略的实用性。
IF 2 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-09-01 Epub Date: 2023-12-28 DOI: 10.1055/a-2236-0864
Bhawna Attri, Alpesh Goyal, Mani Kalaivani, Devasenathipathy Kandasamy, Yashdeep Gupta, Shipra Agarwal, Shamim A Shamim, Nishikant Damle, Mehar Chand Sharma, Viveka P Jyotsna, Ashish Suri, Nikhil Tandon

We aimed to evaluate the utility of simple, cost-effective, and non-invasive strategies alternative to BIPSS and peripheral CRH stimulation in differential diagnosis of ACTH-dependent CS. First, we performed ROC analysis to evaluate the performance of various tests for differential diagnosis of ACTH-dependent CS in our cohort (CD, n=76 and EAS, n=23) and derived their optimal cut-offs. Subsequently, combining various demographic (gender), clinical (hypokalemia), biochemical (plasma ACTH, HDDST, peripheral CRH stimulation) and imaging (MRI pituitary) parameters, we derived non-invasive models with 100% PPV for CD. Patients with pituitary macroadenoma (n=14) were excluded from the analysis involving non-invasive models. Relative percent ACTH (AUC: 0.933) and cortisol (AUC: 0.975) increase on peripheral CRH stimulation demonstrated excellent accuracy in discriminating CD from EAS. Best cut-offs for CD were plasma ACTH<97.3 pg/ml, HDDST≥57% cortisol suppression, CRH stimulation≥77% ACTH increase and≥11% cortisol increase. We derived six models that provided 100% PPV for CD and precluded the need for BIPPS in 35/85 (41.2%) patients with ACTH-dependent CS and no macroadenoma (in whom BIPSS would have otherwise been recommended). The first three models included basic parameters and avoided both peripheral CRH stimulation and BIPSS in 19 (22.4%) patients, while the next three models included peripheral CRH stimulation and avoided BIPSS in another 16 (18.8%) patients. Using simple and non-invasive alternative strategies, BIPSS can be avoided in 41% and peripheral CRH stimulation in 22% of patients with ACTH-dependent CS and no macroadenoma; such patients can be directly referred for a pituitary surgery.

我们的目的是评估替代 BIPSS 和外周 CRH 刺激的简单、经济、无创策略在鉴别诊断 ACTH 依赖性 CS 中的效用。我们在队列(CD,76 人;EAS,23 人)中进行了 ROC 分析,以评估各种检测方法在鉴别诊断促肾上腺皮质激素依赖性 CS 中的性能,并得出其最佳临界值。随后,结合各种人口统计学(性别)、临床(低钾血症)、生化(血浆促肾上腺皮质激素、HDDST、外周 CRH 刺激)和影像学(核磁共振垂体成像)参数,我们得出了对 CD 的 PPV 值为 100% 的无创模型。垂体大腺瘤患者(14 人)不包括在无创模型分析中。在外周 CRH 刺激下,ACTH(AUC:0.933)和皮质醇(AUC:0.975)增加的相对百分比显示了区分 CD 和 EAS 的极佳准确性。CD 的最佳临界值是血浆 ACTH
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Hormone and Metabolic Research
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