Zhonghua yi xue za zhi最新文献

Objective: To compare the diagnostic and therapeutic preferences for Graves' disease (GD) between Chinese and international endocrinologists. Methods: A secondary analysis was conducted on the results of a global questionnaire survey on the management preferences for GD from May 1 to August 31, 2023. The questionnaire consisted of 31 items covering the diagnosis and treatment of GD, as well as the management of patients under different clinical scenarios, including those with pregnancy plans or concurrent pregnancy, and those with recurrent GD. Differences in responses between endocrinologists in China and those in other countries were compared. Results: A total of 991 questionnaire responses from interviewed endocrinologists were deemed valid data, including 380 males, 604 females, and 7 physicians who declined to answer. Among them, there were 108 Chinese endocrinologists and 883 foreign endocrinologists. The age of Chinese endocrinologists was mainly concentrated in the 36-45 age group (43.5%, 47/108), while foreign endocrinologists were mostly over 45 years old (56.9%, 502/883). For the diagnosis of GD, both Chinese and foreign endocrinologists selected thyrotropin receptor antibody (TRAb), thyroid peroxidase antibody (TPOAb), free triiodothyronine (FT3), and thyroid-stimulating hormone re-examination as diagnostic indicators. The proportion of Chinese endocrinologists choosing TRAb [98.1% (106/108) vs 75.4% (666/883)], TPOAb [84.3% (91/108) vs 40.8% (360/883)], thyroglobulin antibody (TgAb) [82.4% (89/108) vs 24.7% (218/883)], and FT3 [58.3% (63/108) vs 28.1% (248/883)] was higher than that of foreign endocrinologists (all P<0.001). For GD treatment, antithyroid drugs (ATD) were selected as the preferred treatment method by both Chinese and foreign endocrinologists [95.4% (103/108) vs 94.2% (832/883), P=0.637]. When treating GD patients with pregnancy plans or concurrent pregnancy, Chinese endocrinologists were more likely to choose ATD or radioactive iodine therapy compared to foreign endocrinologists (both P<0.05). For patients with recurrent GD, Chinese endocrinologists had a significantly higher proportion of selecting long-term (≥24 months) ATD treatment compared to foreign endocrinologists (P<0.001). Conclusions: Chinese endocrinologists generally share similar core diagnostic and therapeutic strategy preferences (in terms of diagnostic items and first-choice medications) with their foreign counterparts for GD. However, they exhibit a higher selection rate for certain examination items and demonstrate differences from foreign endocrinologists in terms of treatment approaches and duration preferences for special GD patients.

Objective: To explore the correlation between obesity and ultrasonic malignant features of papillary thyroid carcinoma (PTC). Methods: A retrospective analysis was conducted on 8 483 patients who underwent thyroid surgery and were postoperatively diagnosed with PTC at China-Japan Union Hospital of Jilin University between January 2008 and December 2017. The cohort included 1 580 males and 6 903 females, with the age [M(Q₁,Q₃)] of 42.0(36.0,49.0) years. Patients were divided into the non-obese group and the obese group based on whether their body mass index was≥28 kg/m². Propensity score matching (PSM) was employed to conduct 1∶1 matching for variables such as gender and history of diabetes. Core ultrasound features and thyroid imaging reporting and data system (TIRADS) scores were compared between the two groups. Subgroup analyses were performed based on gender. A multivariate logistic regression model was employed to analyze the correlation between obesity and malignant ultrasonic features of PTC. Results: After PSM, each group consisted of 1 762 patients, and there were no statistically significant differences between the two groups in terms of gender, diabetes history, family history of thyroid cancer, the maximum tumor diameter was>1 cm, multifocality, extraglandular invasion, lymph node metastasis, and Hashimoto's thyroiditis (all P>0.05). The proportion of punctate hyperechoic foci (microcalcifications) in the obese group was lower than that in the non-obese group [33.1% (584/1 762) vs 37.9% (668/1 762), P=0.009]. Subgroup analysis by gender revealed that among obese males, the proportions of markedly hypoechoic nodules [4.9% (34/692) vs 2.7% (19/694)] and coarse calcifications [25.0% (173/692) vs 19.3% (134/694)] were higher than those in the non-obese group, while the proportion of punctate hyperechoic foci was lower [35.6% (246/692) vs 42.4% (294/694)] (all P<0.05). Among females, there were no statistically significant differences in any ultrasound features between the obese and non-obese groups (all P>0.05). There was no statistically significant difference in the overall distribution of TIRADS risk categories in thyroid nodules between the obese and non-obese groups (P=0.054). The multivariate logistic regression analysis revealed that obesity was a significant factor associated with the presence of peripheral calcification or punctate hyperechoic foci in thyroid ultrasound findings (OR=0.80, 95%CI: 0.70-0.93). Conclusions: Obesity is associated with a decreased display rate of a key malignant ultrasound feature in PTC -- punctate hyperechoic foci. The incidence of this feature is lower in obese males compared to non-obese males.

A retrospective study was conducted on the patients with hematological disease who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) at Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine between February 2023 and July 2024. The patients were divided into the luspatercept group and the control group according to whether luspatercept was administered after allo-HSCT. The luspatercept group was further subdivided into the matched group and the mismatched group according to ABO blood group compatibility between the donor and recipient, to compare the recovery of hematopoietic function before and after treatment in each group.The luspatercept group included 39 patients [18 males and 21 females; aged (47±13) years], and the control group included 94 patients [53 males and 41 females; aged (44±13) years]. In the luspatercept group, the hemoglobin (Hb) rose from (54.0±10.2) g/L at baseline to (95.8±19.7) g/L 21 days later, with 84.6% (33/39) of patients achieving an erythroid response (Hb increase≥20 g/L). Among luspatercept-treated patients, 17 were ABO-matched and 22 were ABO-mismatched. The baseline and day-21 Hb levels did not differ significantly between both groups (both P>0.05). Although the baseline Hb level was higher in the control group than that in the luspatercept group [(75.2±13.4) vs (54.0±10.2) g/L, P<0.001], there was no statistically significant difference in Hb levels between the two groups after 21 days of treatment (P=0.392). One-year overall survival and disease-free survival in the luspatercept group were 84.1% and 81.5%, respectively, while those in the control group were 92.9% and 88.6%. The differences in one-year overall survival and disease-free survival were not statistically significant (both P>0.05). Adverse events in the luspatercept group were predominantly grade 1-2, inclued diarrhea, nausea, and hypertension. Early administration of luspatercept after allo-HSCT can safely accelerate erythroid recovery.

Objective: To determinate the effective axial compression yield loads of different types of femoral fracture fixed by bridge system with mixed-rod and double-rod to select the internal fixation method. Methods: A total of 32 polyformaldehyde mixed-rod and double-rod models of long oblique, long spiral, wedge-shaped with large fragment and supracondylar fractures were made. Among them, there were 4 mixed-rod models and 4 double-rod models for each type of fractures. Axial compression test was conducted on all fracture models using the microcomputer-controlled electronic universal testing machine. When the compression displacement was 2.0 mm, the axial compression yield loads, which were the maximum effective loads, and the average load was calculated and compared with the reference value of 2 475 N. When the compression displacement was less than 2.0 mm, if there was an obvious break point in the load-displacement curve, the maximum load was invalid. Results: The average loads of models for different types of femoral fractures were as follows: the load of long oblique fracture with mixed-rod and double-rod models was (7 603.5±471.7) N and (4 117.5±29.2) N, respectively; the load of long spiral fractures was (2 890.1±139.4) N and(2 500.6±74.5)N, respectively; the load of wedge-shaped fracture with larger fragment was (5 110.2±489.0) N and(4 234.3±256.0)N, respectively; and the load of supracondylar fracture was (9 071.3±1 444.3) N and(9 403.1±1 649.6)N, respectively. The average loads of all the mixed-rod and double-rod models of femoral fractures were greater than the reference value. Conclusion: For long oblique, long spiral, wedge-shaped with large fragment and supracondylar fractures of the femur, the double-rod of bridge system can meet the fixation requirements, and it is recommended to use the double-rod of bridge system in terms of open reduction and internal fixation.

Central neck compartment metastases are most commonly found in papillary thyroid cancer(PTC) patients. Central neck dissection (CND), encompassing lymph node levels Ⅵ and Ⅶ, remains controversial when performed prophylactically CND (pCND) in clinically node-negative (cN0) PTC patients. Current guidelines, consensus statements, and literatures lack a unified, objective criterion for determining cN0 status. The reasons for the controversy surrounding pCND lie in the varying oncological benefits and complication rates of pCND reported in different studies for cN0 PTC patients, as well as the inconsistent research conclusions drawn by scholars from China and the West. Currently, there is insufficient evidence from large-sample, long-term follow-up randomized controlled trials to support the oncologic benefits of pCND. Therefore, the application of non-long-term follow-up study results regarding pCND in cN0 PTC should be interpreted and approached with caution. Furthermore, there is no established quality control indicators for CND. Anatomic landmark-guided standardized CND is crucial for ensuring the quality control of pCND.

A retrospective analysis of clinicopathological features was conducted on 10 cases of thyroid tumors with PTEN mutations from Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Fujian Provincial Hospital, and the Affiliated Hospital of Qingdao University from 2020 to 2024. Histomorphological features were quantified using the Thyroid Histomorphological PTEN Hamartoma Syndrome (PHTS) scoring system(THiPS), immunophenotypic profiling and genetic features were examined via immunohistochemical staining and next-generation sequencing respectively. The cohort included 3 males and 7 females, with the age [M(Q₁,Q₃)] of 68.0(53.0, 74.0) years. Those 10 cases included papillary thyroid carcinomas (3 cases), oncocytic carcinoma of the thyroid (2 cases), follicular thyroid carcinoma (1 case), differentiated high-grade thyroid carcinoma (1 case), and thyroid low risk neoplasm (3 cases). The cases in this study had low THiPS scores [(1.0±1.15) scores], and all lacked the characteristic morphological features of PHTS. Immunohistochemical staining showed that loss of PTEN expression was confirmed in 7 cases, positive expression was found in 3 cases with non-sense PTEN mutation. Molecular analysis revealed co-mutations with PTEN in 80% of cases (8/10), including BRAF^V600E(3 cases), TERT promoter (4 cases), and TP53 mutations (2 cases), while 2 cases harbored PTEN-only mutations. Follow-up data were obtained for 6 cases, with a follow-up period of 15.0 (9.0, 20.0) months. Among them, 1 case was initially diagnosed with OCT pulmonary metastasis, while the remaining 5 cases showed no recurrence or metastatic lesions during the follow-up period. The THiPS score has limited diagnostic value for thyroid tumors with PTEN alteration. Negative PTEN immunohistochemical staining may suggest a PTEN mutation, but positive staining does not exclude a genetic alteration. PTEN gene mutations can be combined with BRAF, TERT, and TP53 alteration.

Objective: Comparison of the epidemiological profile, clinical characteristics, and disease-related factors in vitiligo patients between 2001-2011 and 2022-2024. Methods: Clinical data from the inital visits of patients diagnosed with vitiligo at the Dermatology Department of Xijing Hospital were retrospectively collected during the periods of 2001-2011 and 2022-2024. The distribution of demographic and clinical characteristics, including age at the first visit, onset age, and disease duration, were compared between the 2001-2011 group and the 2022-2024 group. Results: The 2001-2011 group included 8 053 patients (4 284 males and 3 769 females), while the 2022-2024 group included 1 041 patients (581 males and 460 females). No significant difference was found in the gender distribution between the two groups (P=0.119). Compared to the 2001-2011 group, the 2022-2024 group was significantly older at the first visit [median 29 (IQR 16-39) years vs 21 (11-31) years] and at onset [22 (11-33) years vs 17 (9-26) years], with a higher proportion of patients with disease onset at ≥50 years of age [7.5% (78/1 041) vs 3.8% (305/8 053)]. The proportion of mild cases was significantly increased in 2022-2024 group [73.8% (768/1 041) vs 66.3% (5 341/8 053)], while the proportion of extremely severe cases was lower [0.4% (4/1 041) vs 1.9% (157/8 053)] (all P<0.05). Additionally, the 2022-2024 group showed a higher proportion of cases with onset in winter [14.2% (148/1 041) vs 4.4% (353/8 053)] and a lower proportion with onset in summer [15.3% (159/1 041) vs 18.6% (1 495/8 053)] (all P<0.05). Conclusion: Compared with the 2001-2011 period, patients in the 2022-2024 period exhibit important shifts in disease characteristics, including an older age at onset and a higher propensity for onset in winter.

Objective: To explore the value of model based on the stress hyperglycemia ratio (SHR) in predicting acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). Methods: This was a retrospective cross-sectional study. Patients diagnosed with AMI from the MIMIC-Ⅳ 3.0 database in the United States between 2008 and 2022 were included and randomly divided into a training set (1 861 cases) and an internal validation set (799 cases) at a 7∶3 ratio. Additionally, eligible AMI patients from Qingdao Municipal Hospital between January 1, 2021, and February 1, 2025, were included as an external test set (316 cases). Key factors were screened using the Least Absolute Shrinkage and Selection Operator (LASSO) regression. Univariate and multivariate logistic regression models were used to identify factors influencing the occurrence of CS in AMI patients, and a nomogram prediction model based on SHR was established. The predictive performance of the model was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC), calibration curve, and decision analysis (DCA) curve. Results: In the training set, patients had a median age of 69 (61, 77) years, with 1 293 males, and 16.7% (310/1 861) had concurrent CS. In the internal validation set, patients had a median age of 69 (61, 77) years, with 550 males, and 18.3% (146/799) had concurrent CS. In the external test set, patients had a median age of 72 (64, 80) years, with 199 males, and 11.1% (35/316) had concurrent CS. Multivariate logistic regression analysis indicated that systolic blood pressure (SBP), SHR, white blood cell (WBC) count, hematocrit (HCT), aspartate aminotransferase (AST), anion gap (AG), activated partial thromboplastin time (APTT), heart failure (HF), and acute kidney injury (AKI) were all influencing factors for the occurrence of CS in AMI patients (all P<0.05). A nomogram model based on these nine variables demonstrated an AUC of 0.82 (95%CI: 0.80-0.84), a sensitivity of 0.68 and a specificity of 0.82 in the training set for predicting CS in AMI patients; an AUC of 0.79 (95%CI: 0.75-0.83), a sensitivity of 0.64 and a specificity of 0.77 in the internal validation set; and an AUC of 0.84 (95%CI: 0.77-0.92), a sensitivity of 0.77 and a specificity of 0.80 in the external test set. Calibration curves indicated good consistency across all datasets, and DCA curve demonstrated that the nomogram model had excellent clinical applicability. Conclusions: SHR is an influencing factor for CS in AMI patients. The nomogram model developed using SBP, SHR, WBC, HCT, AST, AG, APTT, HF and AKI provides a more intuitive method for identifying the risk of CS in AMI patients.

Amid frequent global population mobility, rapid socioeconomic development, accelerated climate change and population aging process, the coexistence of multiple infectious disease threats and the complex interplay of various health determinants have made the co-circulation of multiple infectious diseases a new challenge for public health. Multi-disease prevention targets infectious diseases that share commonalities in clinical manifestations, modes of transmission, risk factors, as well as prevention and control strategies and measures. It integrates the planning, surveillance, testing, prevention, control, and management of such diseases to enhance the quality and efficiency of public health responses. The feasibility of multi-disease prevention lies in its scientific approach to identifying common patterns in the epidemiological characteristics, transmission mechanisms, and control logic of various infectious diseases, thereby enabling highly coordinated and efficient prevention and control efforts. Multi-disease prevention is an urgent practical response to the co-circulation of multiple diseases, a vital means of optimizing resource allocation and improving control efficiency, and an inevitable pathway toward modernizing the public health system. It is recommended to improve the institutional mechanisms for multi-disease prevention. Guided by the principle of"integrated planning, integrated surveillance, integrated testing, integrated prevention and control, and integrated assessment", scientific approaches should be adopted to advance multi-disease prevention efforts.

Objective: To analyze the molecular epidemiological features of the mcr-1 gene among intestinal Escherichia coli (E. coli) isolates from healthy individuals during 2016 and 2024. Methods: This cross-sectional study included 362 mcr-1-positive E. coli isolates recovered from the intestinal flora of healthy individuals across six provinces (6 475 participants) in 2016, 2019, 2022, and 2024. Strain identification was conducted using MALDI-TOF/MS, and mcr-1 gene was screened by PCR. Antibiotic susceptibility testing was performed to determine the resistance phenotypes of the strains. Whole-genome sequencing was employed to analyze the genetic environment of mcr-1 and the phylogenetic relationships of the host strains. Differences in the epidemiological patterns, resistance phenotypes, and genetic characteristics of mcr-1-positive E. coli isolates were analyzed across sampling years. Results: Among 362 participants, the mean age was (49±20) years; 194 were male. The carriage rate of the mcr-1 in E. coli showed a significant downgrade trend, decreasing from 13.3% (91/684) in 2016 to 0.4% (5/1 250) in 2024 (P=0.029). Among mcr-1-positive isolates, resistance was highest to cefotaxime (51.9%, 118/362), followed by ciprofloxacin (46.9%, 170/362) and aztreonam (31.2%, 113/362), while high susceptibility was retained to amikacin, cefoperazone/sulbactam, carbapenems, and tigecycline. Compared to 2016, the resistance of mcr-1-positive isolates to aztreonam, cefotaxime and ciprofloxacin all increased in 2019 (all P<0.05). Compared to 2022, the resistance to seven antimicrobial agents showed varying degrees of decline in 2024 (except for ciprofloxacin and meropenem, all P<0.05). Plasmid analysis identified nine plasmid incompatibility types among mcr-1-positive isolates, with IncI2 being most frequent (40.1%, 145/362), followed by IncX4 (15.5%, 56/362), IncHI2 (6.4%, 23/362), IncHI2A (2.8%, 10/362), IncP (2.2%, 8/362), IncF (1.4%, 5/362), and IncY (1.1%, 4/362). The genetic environment analysis of the mcr-1 gene showed that the IncI2 plasmid retained the mcr-1-pap2 structure of transposon Tn6330 during evolution. Conclusions: The plasmids carrying mcr-1 were more concentrated, with IncI2 plasmids becoming the dominant plasmid.