Pub Date : 2024-03-03DOI: 10.22141/2224-0721.20.1.2024.1353
S. Tkach, V.I. Pankiv, Z.H. Krushinska
Background. Metabolic-associated fatty liver disease (MAFLD) is the most common chronic liver disease in which the main pathogenic processes originate from metabolic dysfunction. In recent years, MAFLD has acquired the nature of an epidemic, which is closely related to the epidemic of obesity, type diabetes mellitus (T2DM) and a significant increase in the risk of cardiovascular diseases. Along with the known pathogenetic factors outlined in the “multiple parallel hits” hypothesis, in the context of the COVID-19 pandemic and the russian military aggression in Ukraine, an additional powerful pathogenetic factor that can affect the course of many diseases, including MAFLD, is chronic stress. The aim of the study is to identify the clinical and biochemical features of MAFLD against the background of T2DM under the conditions of military stress in Ukraine. Materials and methods. We conducted a comparative study on the features of the course of MAFLD in 64 participants with T2DM: the first group — 44 individuals who were constantly under martial law in Ukraine, and controls — 20 patients who returned to Ukraine after a long (over 12 months) stay abroad. Results. The research shows that patients with MAFLD, who were affected by the negative consequences of military actions, had a statistically significant increase in the level of fasting glucose and markers of insulin resistance, an increase in the activity of liver transaminases and the level of markers of systemic inflammation compared to the pre-war period. The negative impact of wartime stress factors causes diabetic distress and a more severe course of MAFLD, which can subsequently lead to rapid progression of the disease. Most patients of the first group reported significant changes in the psycho-emotional state. The most common were low mood (81.8 %), feeling of anxiety/fear (79.5 %), sleep disturbances (81.8 %), general weakness and quick fatigue (63.3 %), which occurred much more often and were more pronounced than in the control group. Conclusions. During active military operations, epigenetic factors such as changes in the regime and quality of nutrition, psycho-emotional disorders in the form of astheno-neurotic and anxiety-depressive disorders, post-traumatic stress disorders, war-related unemployment and other negative factors become of great importance. Therefore, in these patients, control of optimal levels of glycemia, indicators of liver tests and lipid spectrum, as well as the state of mental health, are very significant.
{"title":"Features of type 2 diabetes combined with metabolic dysfunction-associated fatty liver disease under conditions of chronic stress","authors":"S. Tkach, V.I. Pankiv, Z.H. Krushinska","doi":"10.22141/2224-0721.20.1.2024.1353","DOIUrl":"https://doi.org/10.22141/2224-0721.20.1.2024.1353","url":null,"abstract":"Background. Metabolic-associated fatty liver disease (MAFLD) is the most common chronic liver disease in which the main pathogenic processes originate from metabolic dysfunction. In recent years, MAFLD has acquired the nature of an epidemic, which is closely related to the epidemic of obesity, type diabetes mellitus (T2DM) and a significant increase in the risk of cardiovascular diseases. Along with the known pathogenetic factors outlined in the “multiple parallel hits” hypothesis, in the context of the COVID-19 pandemic and the russian military aggression in Ukraine, an additional powerful pathogenetic factor that can affect the course of many diseases, including MAFLD, is chronic stress. The aim of the study is to identify the clinical and biochemical features of MAFLD against the background of T2DM under the conditions of military stress in Ukraine. Materials and methods. We conducted a comparative study on the features of the course of MAFLD in 64 participants with T2DM: the first group — 44 individuals who were constantly under martial law in Ukraine, and controls — 20 patients who returned to Ukraine after a long (over 12 months) stay abroad. Results. The research shows that patients with MAFLD, who were affected by the negative consequences of military actions, had a statistically significant increase in the level of fasting glucose and markers of insulin resistance, an increase in the activity of liver transaminases and the level of markers of systemic inflammation compared to the pre-war period. The negative impact of wartime stress factors causes diabetic distress and a more severe course of MAFLD, which can subsequently lead to rapid progression of the disease. Most patients of the first group reported significant changes in the psycho-emotional state. The most common were low mood (81.8 %), feeling of anxiety/fear (79.5 %), sleep disturbances (81.8 %), general weakness and quick fatigue (63.3 %), which occurred much more often and were more pronounced than in the control group. Conclusions. During active military operations, epigenetic factors such as changes in the regime and quality of nutrition, psycho-emotional disorders in the form of astheno-neurotic and anxiety-depressive disorders, post-traumatic stress disorders, war-related unemployment and other negative factors become of great importance. Therefore, in these patients, control of optimal levels of glycemia, indicators of liver tests and lipid spectrum, as well as the state of mental health, are very significant.","PeriodicalId":13962,"journal":{"name":"INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine)","volume":"31 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140081184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-03DOI: 10.22141/2224-0721.20.1.2024.1356
H. Semenyna, M.I. Hrytsko, M. Doroshenko-Kravchyk, O. Korytko, T. Fartushok
Background. Genital endometriosis is one of the most urgent problems of modern gynecology. Considering oxidative stress as a pathogenetic link of endometriosis, we believe it reasonable to use a combined drug containing superoxide dismutase, resveratrol, and zinc. The purpose of the work was to evaluate the effectiveness of the treatment for genital endometriosis supplemented with the use of superoxide dismutase, resveratrol, and zinc, taking into account the leading pathophysiological links of the pathology. Materials and methods. Thirty-seven women of reproductive age with genital endometriosis were under observation. Treatment in the first group was carried out in accordance with the Guideline Development Group recommendations. Thirty-nine women of the second group additionally received a drug containing superoxide dismutase, resveratrol, and zinc. The control group included 30 healthy women. The state of lipid peroxidation processes was assessed by the level of diene conjugates and malondialdehyde in the blood serum and the antioxidant defense system by the content of superoxide dismutase and glutathione peroxidase. To monitor the patients’ quality of life, pain syndrome was studied using the Visual Analogue Scale. Statistical processing of the obtained data was carried out by means of the standard StatSoft Statistica for Windows 13.0 program package. Results. The assessment of the pain syndrome in the second group showed that it completely disappeared in women with the first stage of the disease. Among patients with the second stage, pain disappeared in 8 cases, 3 patients had a decrease from severe to mild pain. At the third stage, pain disappeared completely in 5 women, in 4 cases, it decreased from severe to mild, and in one woman, the pain decreased from unbearable to mild. All patients of the second group noted a decrease in pain during intercourse, and in the first stage — its absence, an increase in work capacity (r = 0.64, p < 0.01), a decrease in irritability and anxiety in the perimenstrual period (r = –0.59, p < 0.05) and overall satisfaction with the treatment result. Side effects were not noted in any of the patients. Conclusions. Improving treatment for genital endometriosis by supplementing therapy with superoxide dismutase, resveratrol, and zinc is pathogenetically justified, as it has a significant positive effect on the lipid peroxidation and antioxidant defense system, compared to the traditional treatment regimen.
{"title":"New opportunities for correction of hormonal disorders and oxidative stress in women with genital endometriosis","authors":"H. Semenyna, M.I. Hrytsko, M. Doroshenko-Kravchyk, O. Korytko, T. Fartushok","doi":"10.22141/2224-0721.20.1.2024.1356","DOIUrl":"https://doi.org/10.22141/2224-0721.20.1.2024.1356","url":null,"abstract":"Background. Genital endometriosis is one of the most urgent problems of modern gynecology. Considering oxidative stress as a pathogenetic link of endometriosis, we believe it reasonable to use a combined drug containing superoxide dismutase, resveratrol, and zinc. The purpose of the work was to evaluate the effectiveness of the treatment for genital endometriosis supplemented with the use of superoxide dismutase, resveratrol, and zinc, taking into account the leading pathophysiological links of the pathology. Materials and methods. Thirty-seven women of reproductive age with genital endometriosis were under observation. Treatment in the first group was carried out in accordance with the Guideline Development Group recommendations. Thirty-nine women of the second group additionally received a drug containing superoxide dismutase, resveratrol, and zinc. The control group included 30 healthy women. The state of lipid peroxidation processes was assessed by the level of diene conjugates and malondialdehyde in the blood serum and the antioxidant defense system by the content of superoxide dismutase and glutathione peroxidase. To monitor the patients’ quality of life, pain syndrome was studied using the Visual Analogue Scale. Statistical processing of the obtained data was carried out by means of the standard StatSoft Statistica for Windows 13.0 program package. Results. The assessment of the pain syndrome in the second group showed that it completely disappeared in women with the first stage of the disease. Among patients with the second stage, pain disappeared in 8 cases, 3 patients had a decrease from severe to mild pain. At the third stage, pain disappeared completely in 5 women, in 4 cases, it decreased from severe to mild, and in one woman, the pain decreased from unbearable to mild. All patients of the second group noted a decrease in pain during intercourse, and in the first stage — its absence, an increase in work capacity (r = 0.64, p < 0.01), a decrease in irritability and anxiety in the perimenstrual period (r = –0.59, p < 0.05) and overall satisfaction with the treatment result. Side effects were not noted in any of the patients. Conclusions. Improving treatment for genital endometriosis by supplementing therapy with superoxide dismutase, resveratrol, and zinc is pathogenetically justified, as it has a significant positive effect on the lipid peroxidation and antioxidant defense system, compared to the traditional treatment regimen.","PeriodicalId":13962,"journal":{"name":"INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine)","volume":"10 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140081257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-03DOI: 10.22141/2224-0721.20.1.2024.1350
Z. Kotsiubiichuk, A. Antoniv, L.V. Kanovska, O. Mandryk
Background. Non-alcoholic fatty liver disease and chronic kidney disease are public health concerns worldwide due to their increasing prevalence, adverse prognosis, and health care burden. The purpose of the study was to determine the probable effect of a combination of metformin, rosuvastatin, essential phospholipids and quercetin on the blood lipids, endothelial function, fibrinolysis system and platelet hemostasis, which are factors for the progression of nonalcoholic steatohepatitis. Materials and methods. Studies were performed on the dynamics of treatment in 60 patients with non-alcoholic fatty liver disease, type 2 diabetes mellitus and diabetic kidney disease (stage I–III). Depending on the prescribed treatment at random, the examined patients were divided into 2 groups. Twenty-eight persons of the first group received a low-calorie diet with dietary restrictions, essential phospholipids, metformin hydrochloride, rosuvastatin. Thirty-two patients from the second group received quercetin in addition to similar dietary recommendations, essential phospholipids, hypoglycemic and hypolipidemic therapy. The mean age of patients was 53.80 ± 3.52 years. The comparison group consisted of 30 healthy individuals of the corresponding age. Results. To evaluate the degree of endothelial-protective effect of quercetin on the background of the recommended protocol therapy, markers of endothelial dysfunction, fibrinolysis and platelet hemostasis were studied. NO content significantly reduced (1.7 times) in patients of group 2 before treatment, increased by 1.5 times (p < 0.05). This can be explained by the effect of quercetin, as well as the use of metformin, which reduces the degree of insulin resistance and the level of hyperlipidemia. Conclusions. The effectiveness of a combination therapy for non-alcoholic steatohepatitis and type 2 diabetes mellitus with diabetic kidney disease using essential phospholipids, statins and metformin with the addition of quercetin is higher than that of traditional therapy, as it significantly restores the functional state of the endothelium, eliminates the phenomena of hypercoagulation syndrome without the additional prescription of antiplatelet agents.
{"title":"Correction of endothelial dysfunction in patients with type 2 diabetes mellitus, diabetic kidney disease and non-alcoholic steatohepatitis","authors":"Z. Kotsiubiichuk, A. Antoniv, L.V. Kanovska, O. Mandryk","doi":"10.22141/2224-0721.20.1.2024.1350","DOIUrl":"https://doi.org/10.22141/2224-0721.20.1.2024.1350","url":null,"abstract":"Background. Non-alcoholic fatty liver disease and chronic kidney disease are public health concerns worldwide due to their increasing prevalence, adverse prognosis, and health care burden. The purpose of the study was to determine the probable effect of a combination of metformin, rosuvastatin, essential phospholipids and quercetin on the blood lipids, endothelial function, fibrinolysis system and platelet hemostasis, which are factors for the progression of nonalcoholic steatohepatitis. Materials and methods. Studies were performed on the dynamics of treatment in 60 patients with non-alcoholic fatty liver disease, type 2 diabetes mellitus and diabetic kidney disease (stage I–III). Depending on the prescribed treatment at random, the examined patients were divided into 2 groups. Twenty-eight persons of the first group received a low-calorie diet with dietary restrictions, essential phospholipids, metformin hydrochloride, rosuvastatin. Thirty-two patients from the second group received quercetin in addition to similar dietary recommendations, essential phospholipids, hypoglycemic and hypolipidemic therapy. The mean age of patients was 53.80 ± 3.52 years. The comparison group consisted of 30 healthy individuals of the corresponding age. Results. To evaluate the degree of endothelial-protective effect of quercetin on the background of the recommended protocol therapy, markers of endothelial dysfunction, fibrinolysis and platelet hemostasis were studied. NO content significantly reduced (1.7 times) in patients of group 2 before treatment, increased by 1.5 times (p < 0.05). This can be explained by the effect of quercetin, as well as the use of metformin, which reduces the degree of insulin resistance and the level of hyperlipidemia. Conclusions. The effectiveness of a combination therapy for non-alcoholic steatohepatitis and type 2 diabetes mellitus with diabetic kidney disease using essential phospholipids, statins and metformin with the addition of quercetin is higher than that of traditional therapy, as it significantly restores the functional state of the endothelium, eliminates the phenomena of hypercoagulation syndrome without the additional prescription of antiplatelet agents.","PeriodicalId":13962,"journal":{"name":"INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine)","volume":"6 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140080905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-09DOI: 10.22141/2224-0721.19.8.2023.1344
E.V. Luchytskyi, V. Luchytskyi, G.A. Zubkova, V. Rybalchenko, I.I. Skladanna
Background. Based on the results of epidemiological studies, it was found that coronavirus disease 2019 (COVID-19) affects men more often than women. Among COVID-19 complications, erectile dysfunction is considered a marker of endothelial dysfunction and one of the main factors for the development of cardiovascular diseases. Lower total and free testosterone levels are predictors of adverse prognosis in males with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Testosterone deficiency syndrome is considered an independent risk factor of cardiometabolic disorders. The purpose of the study is to investigate the state of erectile function in men who suffered from COVID-19 six months after recovery. Materials and methods. Seventy-two men suffering from COVID-19 and being treated in an infectious disease hospital were examined 6.90 ± 0.29 months after recovery. Their average age was 45.23 ± 3.01 years. The control group included 18 conditionally healthy men aged 43.18 ± 2.90 years. The state of erectile function was assessed using the International Index of Erectile Function (IIEF). The concentration of testosterone was determined by the enzyme-linked immunosorbent assay with DRG (Germany) and DiaMetra (Italy) kits. All measurements were performed on the Stat Fax 3200 analyzer. Statistical comparison of the obtained results between groups was performed according to the Student’s test. A value of p < 0.05 was considered to be significant. Results. In addition to erectile dysfunction, as evidenced by a reduced corresponding integrative indicator “erectile function” of IIEF-15 in men with COVID-19, a decrease in sexual desire was found, as well as a deterioration of sensations in the form of a decrease in ejaculation frequency and orgasmic sensations during sex contacts. The average serum level of total testosterone was 10.9 nmol/l and was significantly reduced compared to that in the control group. Analysis of individual indicators showed that testosterone level was decreased in 10 patients and was within the normal range in 13 men with COVID-19. The average serum concentration of total testosterone in the examined men after the disease was 10.73 ± 1.07 nmol/l and was significantly reduced compared to that of the control group. Conclusions. There was an erectile dysfunction in men who suffered COVID-19, it was confirmed by a probable decrease in IIEF-15 score and integrative indicators of erectile function. A significant decrease in the blood concentration of total testosterone was detected in the examined men, which may be one of the causes of erectile dysfunction. Large-scale prospective, randomized, controlled trials in patients infected with SARS-CoV-2 are needed to provide an understanding of the molecular mechanisms that cause erectile dysfunction.
{"title":"Erectile function in men with COVID-19 six months after recovery","authors":"E.V. Luchytskyi, V. Luchytskyi, G.A. Zubkova, V. Rybalchenko, I.I. Skladanna","doi":"10.22141/2224-0721.19.8.2023.1344","DOIUrl":"https://doi.org/10.22141/2224-0721.19.8.2023.1344","url":null,"abstract":"Background. Based on the results of epidemiological studies, it was found that coronavirus disease 2019 (COVID-19) affects men more often than women. Among COVID-19 complications, erectile dysfunction is considered a marker of endothelial dysfunction and one of the main factors for the development of cardiovascular diseases. Lower total and free testosterone levels are predictors of adverse prognosis in males with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Testosterone deficiency syndrome is considered an independent risk factor of cardiometabolic disorders. The purpose of the study is to investigate the state of erectile function in men who suffered from COVID-19 six months after recovery. Materials and methods. Seventy-two men suffering from COVID-19 and being treated in an infectious disease hospital were examined 6.90 ± 0.29 months after recovery. Their average age was 45.23 ± 3.01 years. The control group included 18 conditionally healthy men aged 43.18 ± 2.90 years. The state of erectile function was assessed using the International Index of Erectile Function (IIEF). The concentration of testosterone was determined by the enzyme-linked immunosorbent assay with DRG (Germany) and DiaMetra (Italy) kits. All measurements were performed on the Stat Fax 3200 analyzer. Statistical comparison of the obtained results between groups was performed according to the Student’s test. A value of p < 0.05 was considered to be significant. Results. In addition to erectile dysfunction, as evidenced by a reduced corresponding integrative indicator “erectile function” of IIEF-15 in men with COVID-19, a decrease in sexual desire was found, as well as a deterioration of sensations in the form of a decrease in ejaculation frequency and orgasmic sensations during sex contacts. The average serum level of total testosterone was 10.9 nmol/l and was significantly reduced compared to that in the control group. Analysis of individual indicators showed that testosterone level was decreased in 10 patients and was within the normal range in 13 men with COVID-19. The average serum concentration of total testosterone in the examined men after the disease was 10.73 ± 1.07 nmol/l and was significantly reduced compared to that of the control group. Conclusions. There was an erectile dysfunction in men who suffered COVID-19, it was confirmed by a probable decrease in IIEF-15 score and integrative indicators of erectile function. A significant decrease in the blood concentration of total testosterone was detected in the examined men, which may be one of the causes of erectile dysfunction. Large-scale prospective, randomized, controlled trials in patients infected with SARS-CoV-2 are needed to provide an understanding of the molecular mechanisms that cause erectile dysfunction.","PeriodicalId":13962,"journal":{"name":"INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine)","volume":"32 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139442825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-09DOI: 10.22141/2224-0721.19.8.2023.1338
N. Kulaiets, V.M. Kulaiets, O.O. Tkachuk-Hryhorchuk, N. Nyshchuk-Oliinyk
Background. Cardiovascular diseases, including heart failure (HF) and heart failure with preserved ejection fraction (HFpEF), pose a global health challenge. HFpEF is on the rise, especially among the elderly and those with conditions like diabetes, obesity, and hypertension. Type 2 diabetes mellitus (T2DM) often coexists with HFpEF, and atrial fibrillation (AF) further complicates matters due to shared risk factors. The purpose of this study is to comprehensively investigate the influence of type 2 diabetes mellitus on cardiac function and biomarker profiles in patients with heart failure with preserved ejection fraction in the presence or absence of atrial fibrillation. Materials and methods. This was a cohort, single-center study. Four hundred and forty-eight patients with HFpEF were examined. They were divided into 4 groups: group 1 — 189 patients with HFpEF alone; group 2 — 39 patients with HFpEF and T2DM; group 3 — 176 patients with HFpEF and atrial fibrillation; group 4 — 44 patients with HFpEF, AF, T2DM. Results. T2DM may contribute to a slightly older patient population in HFpEF, but age alone is not a primary discriminator. T2DM alone does not substantially impact left ventricular mass index but, when combined with AF, it does. T2DM is associated with an increased left atrial volume index, and AF intensifies this effect. T2DM influences diastolic function, with AF exacerbating it. T2DM affects left ventricular filling pressure, and AF worsens this in HFpEF. T2DM also influences left ventricular systolic function, further compromised when combined with AF in HFpEF patients. Galectin-3 levels are elevated in HFpEF patients with T2DM, further exacerbated with AF. NT-proBNP levels are influenced by T2DM and worsened with the combination of AF in HFpEF. SST2 levels are elevated in HFpEF patients with T2DM, further increased with AF, indicating myocardial fibrosis and adverse remodeling. Conclusions. The interaction between T2DM and AF in HFpEF patients creates a synergistic effect, resulting in significant cardiac structural and functional alterations. Novel biomarkers such as galectin-3, NT-proBNP, and sST2 emerge as valuable diagnostic tools, reflecting the complex pathophysiological processes in HFpEF.
{"title":"Impact of type 2 diabetes mellitus on heart failure with preserved ejection fraction depending on the presence of atrial fibrillation","authors":"N. Kulaiets, V.M. Kulaiets, O.O. Tkachuk-Hryhorchuk, N. Nyshchuk-Oliinyk","doi":"10.22141/2224-0721.19.8.2023.1338","DOIUrl":"https://doi.org/10.22141/2224-0721.19.8.2023.1338","url":null,"abstract":"Background. Cardiovascular diseases, including heart failure (HF) and heart failure with preserved ejection fraction (HFpEF), pose a global health challenge. HFpEF is on the rise, especially among the elderly and those with conditions like diabetes, obesity, and hypertension. Type 2 diabetes mellitus (T2DM) often coexists with HFpEF, and atrial fibrillation (AF) further complicates matters due to shared risk factors. The purpose of this study is to comprehensively investigate the influence of type 2 diabetes mellitus on cardiac function and biomarker profiles in patients with heart failure with preserved ejection fraction in the presence or absence of atrial fibrillation. Materials and methods. This was a cohort, single-center study. Four hundred and forty-eight patients with HFpEF were examined. They were divided into 4 groups: group 1 — 189 patients with HFpEF alone; group 2 — 39 patients with HFpEF and T2DM; group 3 — 176 patients with HFpEF and atrial fibrillation; group 4 — 44 patients with HFpEF, AF, T2DM. Results. T2DM may contribute to a slightly older patient population in HFpEF, but age alone is not a primary discriminator. T2DM alone does not substantially impact left ventricular mass index but, when combined with AF, it does. T2DM is associated with an increased left atrial volume index, and AF intensifies this effect. T2DM influences diastolic function, with AF exacerbating it. T2DM affects left ventricular filling pressure, and AF worsens this in HFpEF. T2DM also influences left ventricular systolic function, further compromised when combined with AF in HFpEF patients. Galectin-3 levels are elevated in HFpEF patients with T2DM, further exacerbated with AF. NT-proBNP levels are influenced by T2DM and worsened with the combination of AF in HFpEF. SST2 levels are elevated in HFpEF patients with T2DM, further increased with AF, indicating myocardial fibrosis and adverse remodeling. Conclusions. The interaction between T2DM and AF in HFpEF patients creates a synergistic effect, resulting in significant cardiac structural and functional alterations. Novel biomarkers such as galectin-3, NT-proBNP, and sST2 emerge as valuable diagnostic tools, reflecting the complex pathophysiological processes in HFpEF.","PeriodicalId":13962,"journal":{"name":"INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine)","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139443886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-09DOI: 10.22141/2224-0721.19.8.2023.1336
O. Tovkai, V. Palamarchuk, Y. Kozachuk, L. Stotska, N. Belemets
Background. Laser interstitial thermal therapy (LITT) is one of the most effective and economically justified methods, which is recommended as the first-line treatment for patients with compression syndrome, a significant cosmetic defect, and those who categorically refuse surgery or have contraindications to it. The purpose of the study was to analyze the short-term outcomes of LITT in patients with euthyroid nodular goiter. Materials and methods. The results of LITT were analyzed in 20 patients with euthyroid nodular goiter, Bethesda category II, and solid echostructure for 2021–2023. The average volume of nodules was 0.67 (0.16; 1.39) cm3. Medical GaAlAs diode laser VELAS II-30F was used. The response of the nodules was classified as positive effect if volume reduction rate (VRR) was above 70 %, absent with VRR 69–0 %, negative effect with VRR < 0 %. The total follow-up ranged from 1 to 24 months. Results. A linear regression analysis revealed that shrinkage of the final nodule volume after the first session (0.37 (0.06; 0.9) cm3) statistically significantly depended on the initial volume (0.67 (0.16; 1.39) cm3), R2 = 0.955, p < 0.001. A positive effect was observed only in nodules up to 1.0 cm3 (average of 0.16 (0.085; 0.31) cm3). Statistically significant correlation was not found after the first session between the effect and the initial nodule volume (r = –0.163, p = 0.49). A linear regression analysis showed the absence of statistically significant correlation between the final nodule volume, final VRR, and laser characteristics (p > 0.05). The final nodule volume after the second session decreased statistically significantly vs. initial one (p = 0.007) and vs. the final volume after the first session (p = 0.028). There was no statistically significant difference between the frequency of effect in patients after single LITT and in those with two sessions (χ2 = 2.14, p = 0.34). A linear regression analysis did not show statistically significant causal relationship between these indicators (R2 = 0.27, p = 0.12). Conclusions. Laser interstitial thermal therapy is a safe method of organ-preserving treatment in patients with the euthyroid nodular goiter, which can be performed on an outpatient basis and does not lead to thyroid dysfunction. LITT is the most effective with a volume nodule of up to 1.0 cm3. The use of LITT in nodules larger than 1.0 cm3 does not meet the criteria of technical “success” but this does not necessarily indicate the overall ineffectiveness since the sample volume was insufficient. For greater validity, a study should be conducted on a larger sample of patients, which will allow reliably assessing the effectiveness of the method and determining clear criteria of selecting patients for this intervention. The study is still in progress.
{"title":"Application of laser interstitial thermal therapy in the treatment of patients with euthyroid nodular goiter: aingle-center prospective study","authors":"O. Tovkai, V. Palamarchuk, Y. Kozachuk, L. Stotska, N. Belemets","doi":"10.22141/2224-0721.19.8.2023.1336","DOIUrl":"https://doi.org/10.22141/2224-0721.19.8.2023.1336","url":null,"abstract":"Background. Laser interstitial thermal therapy (LITT) is one of the most effective and economically justified methods, which is recommended as the first-line treatment for patients with compression syndrome, a significant cosmetic defect, and those who categorically refuse surgery or have contraindications to it. The purpose of the study was to analyze the short-term outcomes of LITT in patients with euthyroid nodular goiter. Materials and methods. The results of LITT were analyzed in 20 patients with euthyroid nodular goiter, Bethesda category II, and solid echostructure for 2021–2023. The average volume of nodules was 0.67 (0.16; 1.39) cm3. Medical GaAlAs diode laser VELAS II-30F was used. The response of the nodules was classified as positive effect if volume reduction rate (VRR) was above 70 %, absent with VRR 69–0 %, negative effect with VRR < 0 %. The total follow-up ranged from 1 to 24 months. Results. A linear regression analysis revealed that shrinkage of the final nodule volume after the first session (0.37 (0.06; 0.9) cm3) statistically significantly depended on the initial volume (0.67 (0.16; 1.39) cm3), R2 = 0.955, p < 0.001. A positive effect was observed only in nodules up to 1.0 cm3 (average of 0.16 (0.085; 0.31) cm3). Statistically significant correlation was not found after the first session between the effect and the initial nodule volume (r = –0.163, p = 0.49). A linear regression analysis showed the absence of statistically significant correlation between the final nodule volume, final VRR, and laser characteristics (p > 0.05). The final nodule volume after the second session decreased statistically significantly vs. initial one (p = 0.007) and vs. the final volume after the first session (p = 0.028). There was no statistically significant difference between the frequency of effect in patients after single LITT and in those with two sessions (χ2 = 2.14, p = 0.34). A linear regression analysis did not show statistically significant causal relationship between these indicators (R2 = 0.27, p = 0.12). Conclusions. Laser interstitial thermal therapy is a safe method of organ-preserving treatment in patients with the euthyroid nodular goiter, which can be performed on an outpatient basis and does not lead to thyroid dysfunction. LITT is the most effective with a volume nodule of up to 1.0 cm3. The use of LITT in nodules larger than 1.0 cm3 does not meet the criteria of technical “success” but this does not necessarily indicate the overall ineffectiveness since the sample volume was insufficient. For greater validity, a study should be conducted on a larger sample of patients, which will allow reliably assessing the effectiveness of the method and determining clear criteria of selecting patients for this intervention. The study is still in progress.","PeriodicalId":13962,"journal":{"name":"INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine)","volume":"117 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139444719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-09DOI: 10.22141/2224-0721.19.8.2023.1346
I. Chernyavska, N. Skrypnyk, V.I. Pankiv
Chronic adrenal insufficiency is an endocrine disease caused by insufficient secretion of adrenal hormones due to dysfunction of one or more links of the hypothalamic-pituitary-adrenal axis. The highest prevalence has been documented in Scandinavian countries: 15–22 people per 100,000 population, while other European countries report 10 cases per 100,000 population. Autoimmune adrenalitis is the most common cause of primary adrenal insufficiency in adults, and it can be either alone (40 %) or a component of autoimmune polyglandular syndromes (60 %). The etiologic factors of primary adrenal insufficiency include tuberculosis or AIDS. These causes of adrenal cortical insufficiency are particularly relevant in Ukraine. The article describes a clinical case of a patient with both primary adrenal insufficiency and Werlhof’s disease. The prevalence of adrenal insufficiency and etiologic factors of primary adrenal insufficiency are highlighted. A detailed differential diagnosis of primary adrenal insufficiency with other diseases that could cause clinical symptoms such as hypoglycemic states, severe weight loss, hypotension, severe muscle weakness, hyponatremia, hyperkalemia is performed. The basic principles of diagnosis, treatment, and prognosis in primary adrenal insufficiency are discussed. Despite typical, specific manifestations of adrenal insufficiency, diagnosis in real clinical practice is difficult. Awareness and vigilance of doctors regarding the symptoms of adrenal insufficiency is necessary. Late detection of chronic adrenal insufficiency can lead to complications. Timely diagnosis and treatment of chronic adrenal insufficiency improves disease prognosis and quality of life.
{"title":"Long-diagnosed primary adrenal insufficiency in the setting of Werlhof’s disease. A clinical case report","authors":"I. Chernyavska, N. Skrypnyk, V.I. Pankiv","doi":"10.22141/2224-0721.19.8.2023.1346","DOIUrl":"https://doi.org/10.22141/2224-0721.19.8.2023.1346","url":null,"abstract":"Chronic adrenal insufficiency is an endocrine disease caused by insufficient secretion of adrenal hormones due to dysfunction of one or more links of the hypothalamic-pituitary-adrenal axis. The highest prevalence has been documented in Scandinavian countries: 15–22 people per 100,000 population, while other European countries report 10 cases per 100,000 population. Autoimmune adrenalitis is the most common cause of primary adrenal insufficiency in adults, and it can be either alone (40 %) or a component of autoimmune polyglandular syndromes (60 %). The etiologic factors of primary adrenal insufficiency include tuberculosis or AIDS. These causes of adrenal cortical insufficiency are particularly relevant in Ukraine. The article describes a clinical case of a patient with both primary adrenal insufficiency and Werlhof’s disease. The prevalence of adrenal insufficiency and etiologic factors of primary adrenal insufficiency are highlighted. A detailed differential diagnosis of primary adrenal insufficiency with other diseases that could cause clinical symptoms such as hypoglycemic states, severe weight loss, hypotension, severe muscle weakness, hyponatremia, hyperkalemia is performed. The basic principles of diagnosis, treatment, and prognosis in primary adrenal insufficiency are discussed. Despite typical, specific manifestations of adrenal insufficiency, diagnosis in real clinical practice is difficult. Awareness and vigilance of doctors regarding the symptoms of adrenal insufficiency is necessary. Late detection of chronic adrenal insufficiency can lead to complications. Timely diagnosis and treatment of chronic adrenal insufficiency improves disease prognosis and quality of life.","PeriodicalId":13962,"journal":{"name":"INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine)","volume":"16 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139443143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-09DOI: 10.22141/2224-0721.19.8.2023.1341
Viktoriia Yerokhovych, Y. Komisarenko, O.V. Karpenko, V.I. Pankiv, N.M. Kobyliak, M. Bobryk, D.V. Kyriienko, K. Gurska, A.A. Kaplina, V.L. Vasiuk
Background. Given the proven excessive activation of the renin-angiotensin-aldosterone system and the clinical manifestations of hypertension, mostly of renal origin, there is a need to optimize antihypertensive therapy aimed at an active nephroprotection. The purpose of the study is to carry out a comprehensive assessment of kidney and heart risk factors in patients with type 2 diabetes mellitus and chronic kidney disease (CKD) and to justify the administration of non-steroidal mineralocorticoid receptor antagonists to these patients. Materials and methods. In a prospective cohort study, 88 patients with type 2 diabetes were examined: group 1 — estimated glomerular filtration rate (eGFR) < 60 ml/min/m2, group 2 — eGFR ≥ 60 ml/min/m2. eGFR was evaluated according to the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) formula based on serum creatinine. GFR category was defined according to the KDIGO (Kidney Disease: Improving Global Outcomes) criteria. The albumin-creatinine ratio was calculated. The level of glycated hemoglobin (HbA1c) was assessed by the method of high-performance liquid chromatography. Aldosterone was evaluated by immunoenzymatic method. Results. In patients with eGFR < 60 ml/min/m2, the albumin-creatinine ratio in daily urine is statistically significantly higher compared to group 2. Patients with eGFR < 60 ml/min/m2 had an average uric acid level of 410.3 ± 98.8 μmol/l, which is statistically significantly higher than in those with eGFR ≥ 60 ml/min/m2 — 321.10 ± 74.54 μmol/l. A statistically significant correlation between the level of uric acid and markers of renal dysfunction was found only in patients with eGFR < 60 ml/min/m2. Aldosterone levels were higher in the first group. No statistical difference was found between the average value of HbA1c in the studied groups. Conclusions. Numerous factors of unfavorable prognosis regarding kidney and heart risks have been identified: hypertension, increased albumin-creatinine ratio and cholesterol, unsatisfactory compensation of diabetes, obesity. There is an increase in the frequency of resistant hypertension, hyperuricemia, and hyperaldosteronism in patients with decreased eGFR. In patients with diabetic kidney damage on the background of type 2 diabetes, the administration of finerenone, a non-steroidal mineralocorticoid receptor antagonist, at a dose of 10–20 mg/day is pathogenetically justified.
{"title":"Assessment of renal and cardiovascular risks in patients with type 2 diabetes when using non-steroidal mineralocorticoid receptor antagonists","authors":"Viktoriia Yerokhovych, Y. Komisarenko, O.V. Karpenko, V.I. Pankiv, N.M. Kobyliak, M. Bobryk, D.V. Kyriienko, K. Gurska, A.A. Kaplina, V.L. Vasiuk","doi":"10.22141/2224-0721.19.8.2023.1341","DOIUrl":"https://doi.org/10.22141/2224-0721.19.8.2023.1341","url":null,"abstract":"Background. Given the proven excessive activation of the renin-angiotensin-aldosterone system and the clinical manifestations of hypertension, mostly of renal origin, there is a need to optimize antihypertensive therapy aimed at an active nephroprotection. The purpose of the study is to carry out a comprehensive assessment of kidney and heart risk factors in patients with type 2 diabetes mellitus and chronic kidney disease (CKD) and to justify the administration of non-steroidal mineralocorticoid receptor antagonists to these patients. Materials and methods. In a prospective cohort study, 88 patients with type 2 diabetes were examined: group 1 — estimated glomerular filtration rate (eGFR) < 60 ml/min/m2, group 2 — eGFR ≥ 60 ml/min/m2. eGFR was evaluated according to the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) formula based on serum creatinine. GFR category was defined according to the KDIGO (Kidney Disease: Improving Global Outcomes) criteria. The albumin-creatinine ratio was calculated. The level of glycated hemoglobin (HbA1c) was assessed by the method of high-performance liquid chromatography. Aldosterone was evaluated by immunoenzymatic method. Results. In patients with eGFR < 60 ml/min/m2, the albumin-creatinine ratio in daily urine is statistically significantly higher compared to group 2. Patients with eGFR < 60 ml/min/m2 had an average uric acid level of 410.3 ± 98.8 μmol/l, which is statistically significantly higher than in those with eGFR ≥ 60 ml/min/m2 — 321.10 ± 74.54 μmol/l. A statistically significant correlation between the level of uric acid and markers of renal dysfunction was found only in patients with eGFR < 60 ml/min/m2. Aldosterone levels were higher in the first group. No statistical difference was found between the average value of HbA1c in the studied groups. Conclusions. Numerous factors of unfavorable prognosis regarding kidney and heart risks have been identified: hypertension, increased albumin-creatinine ratio and cholesterol, unsatisfactory compensation of diabetes, obesity. There is an increase in the frequency of resistant hypertension, hyperuricemia, and hyperaldosteronism in patients with decreased eGFR. In patients with diabetic kidney damage on the background of type 2 diabetes, the administration of finerenone, a non-steroidal mineralocorticoid receptor antagonist, at a dose of 10–20 mg/day is pathogenetically justified.","PeriodicalId":13962,"journal":{"name":"INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine)","volume":"17 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139443103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-09DOI: 10.22141/2224-0721.19.8.2023.1337
V.V. Popova, K.P. Zak, M. Tronko
Background. In patients with newly diagnosed type 2 diabetes mellitus (T2DM), a small but statistically significant decrease in absolute number of natural killer (NK) cells (CD56+) in the peripheral blood (PB) was found, especially pronounced with concomitant obesity. In connection with the above, one of the main aims of the present report was to further study the role of NK cells in patients with newly diagnosed T2DM, including those with obesity. For this purpose, a combination of flow cytometry methods with scanning and transmission electron microscopy was used to determine the number and function of CD56+ cells in the PB of patients with T2DM. Materials and methods. We examined 144 patients of both sexes with newly diagnosed T2DM aged 40–70 years who had no other acute or chronic diseases and had not previously taken any hypoglycemic drugs. The control group consisted of 50 healthy individuals with normoglycemia aged 40–65 years who had not COVID-19 disease. Results. Our studies have found that in untreated patients with newly diagnosed T2DM compared to healthy controls, there is a very small statistically significant decrease in the absolute number of CD56+ cells in the PB. When combining flow cytometry (FACS method), transmission and scanning electron microscopy in patients with T2DM, a significant change in the ultrastructure of CD56+ cells was revealed, indicating a decrease in their function (an increase in the number of cells with a smoother surface of the cell membrane, a sharp decrease in the number of azurophilic granules in the cytoplasm considered the main producer of cytokines and perforins, the appearance of parallel tubular structures, biomarkers of decreased cell function, a disruption of the Golgi apparatus structure, granular endoplasmic reticulum, etc.). The data obtained indicate that at the initial stage of T2DM development in humans, there is a pronounced weakening in the function of NK cells and, consequently, the natural immune defense of the body and explain the increased susceptibility of diabetics to various viruses and infections, including COVID-19, and also more severe clinical course and increased mortality. Conclusions. The conducted studies show that in patients with T2DM who are at the initial stage of T2DM, there is a sharp disturbance in the submicroscopic organization of CD56+ cells, the most important cellular element of natural immunity, which suggests a weakening of the function of natural immune defense. It is the main cause of increased sensitivity of diabetic patients to infection with various pathogens, including the SARS-CoV-2, as well as more severe clinical course and increased mortality rate.
{"title":"Content and ultrastructure of natural killer cells in the blood of patients with newly diagnosed type 2 diabetes mellitus","authors":"V.V. Popova, K.P. Zak, M. Tronko","doi":"10.22141/2224-0721.19.8.2023.1337","DOIUrl":"https://doi.org/10.22141/2224-0721.19.8.2023.1337","url":null,"abstract":"Background. In patients with newly diagnosed type 2 diabetes mellitus (T2DM), a small but statistically significant decrease in absolute number of natural killer (NK) cells (CD56+) in the peripheral blood (PB) was found, especially pronounced with concomitant obesity. In connection with the above, one of the main aims of the present report was to further study the role of NK cells in patients with newly diagnosed T2DM, including those with obesity. For this purpose, a combination of flow cytometry methods with scanning and transmission electron microscopy was used to determine the number and function of CD56+ cells in the PB of patients with T2DM. Materials and methods. We examined 144 patients of both sexes with newly diagnosed T2DM aged 40–70 years who had no other acute or chronic diseases and had not previously taken any hypoglycemic drugs. The control group consisted of 50 healthy individuals with normoglycemia aged 40–65 years who had not COVID-19 disease. Results. Our studies have found that in untreated patients with newly diagnosed T2DM compared to healthy controls, there is a very small statistically significant decrease in the absolute number of CD56+ cells in the PB. When combining flow cytometry (FACS method), transmission and scanning electron microscopy in patients with T2DM, a significant change in the ultrastructure of CD56+ cells was revealed, indicating a decrease in their function (an increase in the number of cells with a smoother surface of the cell membrane, a sharp decrease in the number of azurophilic granules in the cytoplasm considered the main producer of cytokines and perforins, the appearance of parallel tubular structures, biomarkers of decreased cell function, a disruption of the Golgi apparatus structure, granular endoplasmic reticulum, etc.). The data obtained indicate that at the initial stage of T2DM development in humans, there is a pronounced weakening in the function of NK cells and, consequently, the natural immune defense of the body and explain the increased susceptibility of diabetics to various viruses and infections, including COVID-19, and also more severe clinical course and increased mortality. Conclusions. The conducted studies show that in patients with T2DM who are at the initial stage of T2DM, there is a sharp disturbance in the submicroscopic organization of CD56+ cells, the most important cellular element of natural immunity, which suggests a weakening of the function of natural immune defense. It is the main cause of increased sensitivity of diabetic patients to infection with various pathogens, including the SARS-CoV-2, as well as more severe clinical course and increased mortality rate.","PeriodicalId":13962,"journal":{"name":"INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine)","volume":"51 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139441854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-09DOI: 10.22141/2224-0721.19.8.2023.1335
S.M. Cherenko
No abstract
无摘要
{"title":"Review of the 2023 World Congress on Thyroid Cancer (WCTC 2023, London): is there light at the end of the tunnel for patients with neglected cancer?","authors":"S.M. Cherenko","doi":"10.22141/2224-0721.19.8.2023.1335","DOIUrl":"https://doi.org/10.22141/2224-0721.19.8.2023.1335","url":null,"abstract":"No abstract","PeriodicalId":13962,"journal":{"name":"INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine)","volume":"47 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139442596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：