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JPT2 in subclinical hypothyroidism-related miscarriage as a transcription co-factor: involvement of LEPR/STAT3 activation. 亚临床甲状腺功能减退症相关流产中作为转录辅助因子的 JPT2:参与 LEPR/STAT3 激活。
IF 5.4 2区 医学 Q1 Medicine Pub Date : 2024-10-01 Epub Date: 2024-06-22 DOI: 10.1007/s40618-024-02343-0
Y-Y Zhou, S-Y Zhao, F-J Huang, L-J Zhang, Y-L Liu, J Wang, X-J Ma

Background and purpose: Subclinical hypothyroidism (SCH) has been identified to be associated with implantation failure, in which the dysfunction of trophoblast cells is involved. In this study, the transcriptomics of aborted placenta from SCH rats were analyzed. Jupiter microtubule-associated homolog 2 (JPT2) was downregulated in the aborted placenta. This study aims to investigate its role in SCH-associated miscarriage.

Methods: Spontaneous abortion was observed in SCH rats generated by thyroidectomy combined with levothyroxine administration. The transcriptomics analysis was performed using aborted placenta. Afterward, the effects of JPT2 on trophoblast cells were explored using gain-and loss-of-function experiments.

Results: Transcriptomics analysis showed 1286 downregulated genes and 2300 upregulated genes in the aborted placenta, and JPT2 was significantly downregulated in the aborted placenta from SCH rats. Afterward, gain-and loss-of-function experiments exhibited that overexpression of JPT2 promoted the proliferation, migration, invasion, spheroid formation of HTR-8/SVneo trophoblast cells and their attachment to endometrial stromal cells, while these biological behaviors were suppressed by JPT2 knockdown. Furthermore, JPT2 accelerated the transcription of leptin receptor (LEPR), and activated signal transducer and activator of transcription 3 (STAT3) signal in a transcription factor AP-2γ-dependent manner. In addition, silencing of LEPR abolished the role of JPT2.

Conclusion: Our results revealed that JPT2, which was downregulated in the aborted placenta from SCH rats, promoted proliferation, migration, invasion, spheroid formation, and attachment of trophoblast cells via regulating LEPR/STAT3 axis as a transcription co-factor. It is indicated that low expression of JPT2 may contribute to the abortion in individuals with SCH.

背景和目的:亚临床甲状腺功能减退症(SCH)已被确认与植入失败有关,滋养层细胞的功能障碍与植入失败有关。本研究分析了 SCH 大鼠流产胎盘的转录组学。在流产胎盘中,木星微管相关同源物 2(JPT2)出现下调。本研究旨在探讨其在SCH相关流产中的作用:方法:在甲状腺切除术联合左甲状腺素给药的 SCH 大鼠中观察自然流产。采用流产胎盘进行转录组学分析。随后,利用功能增益和功能缺失实验探讨了 JPT2 对滋养层细胞的影响:结果:转录组学分析显示,流产胎盘中有1286个基因下调,2300个基因上调,JPT2在SCH大鼠流产胎盘中显著下调。随后的功能增益和功能缺失实验表明,JPT2的过表达促进了HTR-8/SVneo滋养层细胞的增殖、迁移、侵袭、球形形成及其与子宫内膜基质细胞的附着,而JPT2的敲除则抑制了这些生物学行为。此外,JPT2还能加速瘦素受体(LEPR)的转录,并以转录因子AP-2γ依赖的方式激活信号转导和激活转录3(STAT3)信号。此外,沉默 LEPR 可消除 JPT2 的作用:我们的研究结果表明,在 SCH 大鼠流产胎盘中下调的 JPT2 作为转录辅助因子,通过调节 LEPR/STAT3 轴促进滋养层细胞的增殖、迁移、侵袭、球形体形成和附着。这表明,JPT2的低表达可能是导致SCH患者流产的原因之一。
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引用次数: 0
Relationship between diabetic peripheral neuropathy and adherence to the Mediterranean diet in patients with type 2 diabetes mellitus: an observational study. 2 型糖尿病患者糖尿病周围神经病变与坚持地中海饮食之间的关系:一项观察性研究。
IF 5.4 2区 医学 Q1 Medicine Pub Date : 2024-10-01 Epub Date: 2024-03-18 DOI: 10.1007/s40618-024-02341-2
S Zúnica-García, J J Blanquer-Gregori, R Sánchez-Ortiga, M I Jiménez-Trujillo, E Chicharro-Luna

Purpose: The main study goal is to assess the relationship between adherence to the mediterranean diet (MD) and the presence of diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes mellitus (T2DM).

Methods: Observational pilot study of 174 patients diagnosed with T2DM. Sociodemographic and anthropometric variables, physical activity, smoking habits, blood biochemical parameters and comorbidities were recorded. The presence of alterations in sensitivity to pressure, pain, thermal and vibration was explored. Good MD adherence was a score  ≥  9 the 14-point MD adherence questionnaire (MEDAS-14).

Results: The study population consisted of 174 patients (61.5% men and 38.5% women), with a mean age of 69.56 ± 8.86 years; 19% of these patients adhered to the MD. The score obtained in the MEDAS-14 was higher in patients who did not present alterations in sensitivity to pressure (p = 0.047) or vibration (p = 0.021). The patients without diabetic peripheral neuropathy were more likely to comply with the MD and had a higher score on the MEDAS-14 (p = 0.047). However, multivariate analysis showed that only altered sensitivity to pressure was associated with adherence to the MD (altered sensitivity OR = 2.9; 95%CI 1.02-8.22; p = 0.045).

Conclusions: Although the patients with DPN had lower scores on the MEDAS questionnaire and therefore poorer adherence to the mediterranean diet, the only parameter significantly associated with the MD was that of sensitivity to pressure (monofilament test).

目的:研究的主要目的是评估地中海饮食(Mediterranean diet,MD)的坚持与 2 型糖尿病(T2DM)患者出现糖尿病周围神经病变(DPN)之间的关系:方法:对 174 名确诊为 T2DM 的患者进行观察试验研究。记录了社会人口学和人体测量变量、体力活动、吸烟习惯、血液生化指标和合并症。研究还探讨了患者对压力、疼痛、热和振动的敏感性是否发生改变。14点MD依从性问卷(MEDAS-14)得分≥9分为MD依从性良好:研究对象包括 174 名患者(61.5% 为男性,38.5% 为女性),平均年龄(69.56 ± 8.86)岁;其中 19% 的患者坚持使用 MD。对压力(p = 0.047)或振动(p = 0.021)的敏感性没有改变的患者在 MEDAS-14 中的得分更高。无糖尿病周围神经病变的患者更有可能遵守 MD,其 MEDAS-14 得分也更高(p = 0.047)。然而,多变量分析表明,只有对压力的敏感性改变与坚持 MD 相关(敏感性改变 OR = 2.9; 95%CI 1.02-8.22; p = 0.045):结论:虽然 DPN 患者的 MEDAS 问卷得分较低,因此对地中海饮食的依从性较差,但唯一与地中海饮食显著相关的参数是对压力的敏感性(单纤丝测试)。
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引用次数: 0
Who and how to screen for endogenous hypercortisolism in type 2 diabetes mellitus or obesity. 谁以及如何筛查 2 型糖尿病或肥胖症患者的内源性皮质醇增多症。
IF 5.4 2区 医学 Q1 Medicine Pub Date : 2024-10-01 DOI: 10.1007/s40618-024-02455-7
Valentina Guarnotta, Carla Giordano, Giuseppe Reimondo

Purpose: The current review aims to summarize and discuss the prevalence of confirmed hypercortisolism in patients with diabetes mellitus or obesity, analysing the screening tests used and their accuracy, in order to better identify whether patients with diabetes mellitus and obesity should be screened for Cushing's syndrome (CS) and how.

Methods: A narrative review was performed including publications focusing on the current knowledge on prevalence of confirmed hypercortisolism in patients with type 2 diabetes mellitus (T2DM) or obesity and on screening tests used to detect CS.

Results: The studies reviewed suggest that the prevalence of CS in patients with T2DM is variable, ranging from 0.6 to 9.3%. The most used screening test is the overnight cortisol after 1 mg of dexamethasone suppression test (DST), with a false positive rate ranging from 3.7 to 21%. The prevalence of CS among obese patients is generally about 1%, except for two studies which reported higher prevalence. For obese patients, 1 mg DST and late-night salivary cortisol are the most accurate screening tests for CS.

Conclusions: Clinical expertise remains the mainstay to identify which subjects should be screened for CS. The evaluation of the clinical stigmata of CS and the combination with clinical comorbidities typical of CS are the stronger predictors of CS. In addition, we could hypothesize that in patients with T2DM, overnight 1 mg DST is the more accurate screening test for CS. By contrast, in patients with obesity both LNSC and overnight 1 mg DST could be equally used for the screening of hypercortisolism.

目的:本综述旨在总结和讨论糖尿病或肥胖症患者确诊皮质醇增多症的患病率,分析所使用的筛查测试及其准确性,以便更好地确定糖尿病和肥胖症患者是否应筛查库欣综合征(CS)以及如何筛查:方法:我们对相关出版物进行了叙述性综述,内容主要涉及目前对2型糖尿病(T2DM)或肥胖症患者确诊皮质醇过多症患病率的了解,以及用于检测库欣综合征的筛查试验:综述的研究表明,T2DM 患者中 CS 的患病率各不相同,从 0.6% 到 9.3% 不等。最常用的筛查试验是 1 毫克地塞米松抑制试验(DST)后的过夜皮质醇,假阳性率为 3.7% 至 21%。肥胖患者的 CS 患病率一般约为 1%,只有两项研究报告了更高的患病率。对于肥胖患者,1 毫克 DST 和深夜唾液皮质醇是最准确的 CS 筛查测试:结论:临床专业知识仍是确定哪些受试者应接受 CS 筛查的主要依据。结论:临床专业知识仍是确定哪些受试者应接受 CS 筛查的主要依据,而对 CS 临床症状的评估以及与 CS 典型临床合并症的结合则是预测 CS 的更有力因素。此外,我们还可以假设,在 T2DM 患者中,隔夜 1 毫克 DST 是更准确的 CS 筛查试验。相比之下,在肥胖症患者中,LNSC 和过夜 1 毫克 DST 同样可用于筛查皮质醇过多症。
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引用次数: 0
Measurement of PDE5 concentration in human serum: proof-of-concept and validation of methodology in control and prostate cancer patients. 人体血清中 PDE5 浓度的测量:对照组和前列腺癌患者的概念验证和方法验证。
IF 5.4 2区 医学 Q1 Medicine Pub Date : 2024-10-01 DOI: 10.1007/s40618-024-02428-w
Giovanni Luca Gravina, Eugenia Guida, Maria Dri, Renato Massoud, Savino M Di Stasi, Giorgio Fucci, Andrea Sansone, Susanna Dolci, Emmanuele A Jannini

Purpose: We aimed to investigate if the type 5 phosphodiesterase (PDE5), an enzyme with cardinal biological functions in sexual and cardiovascular health, can be detected and quantited in human serum.

Methods: Blood samples were collected from control male and female subjects. PDE5 levels were measured by a specific ELISA kit. ROC curves weighted for age and serum levels of PSA (male subjects), or age (female subjects) were used to identify the predictive ability in the detection of PCa. Sensitivity, specificity, PPV and NPV values were determined for cut-off value determined during ROC curve analysis.

Results: 41 control male subjects, 18 control female subjects, and 55 consecutive subjects, of which 25 were affected by benign prostatic hypertrophy (BPH) and 30 with histologically confirmed prostate cancer (PCa), were studied. PDE5 serum levels were detectable in all subjects (range: 5 to 65 ng/ml). Analysis by MANCOVA identified a significant difference in serum PDE5 between control subjects or hyperplasia patients and PCa patients. Marginal means of serum PDE5 concentrations showed a significant difference (p < 0.001). The ROC curve demonstrated that PDE5 serum levels can predict men with or without PCa, with 0.806 AUC value (p < 0.0001). Using a 12.705 ng/ml PDE5 serum cut-off yielded sensitivity, specificity, PPV, and NPV of 83.3%, 77.27%, 62.5%, and 91.1% in detecting men with histologically proven PCa, respectively.

Conclusions: We demonstrated, for the first time, that PDE5 levels can be detected in human sera and that PCa patients have significantly higher PDE5 concentration compared to BPH patients or male and female controls. While serum PDE5 level measurement may open new research avenues, the clinical relevance of PDE5 levels in PCa patients deserves further investigation.

目的:我们的目的是研究能否在人体血清中检测和定量 5 型磷酸二酯酶(PDE5):方法:采集对照组男女受试者的血样。方法:采集对照组男性和女性受试者的血样,用特定的酶联免疫吸附试剂盒检测 PDE5 的水平。采用年龄和血清中 PSA(男性受试者)或年龄(女性受试者)水平加权的 ROC 曲线来确定检测 PCa 的预测能力。根据 ROC 曲线分析中确定的临界值,确定敏感性、特异性、PPV 和 NPV 值:研究对象包括41名对照组男性受试者、18名对照组女性受试者和55名连续受试者,其中25人患有良性前列腺肥大(BPH),30人经组织学证实患有前列腺癌(PCa)。所有受试者的血清中均可检测到 PDE5 水平(范围:5 至 65 纳克/毫升)。通过 MANCOVA 分析发现,对照组或增生患者与 PCa 患者的血清 PDE5 存在显著差异。血清 PDE5 浓度的边际均值显示出显著差异(p 结论:PDE5 浓度的边际均值与 PCa 患者血清 PDE5 浓度的边际均值存在显著差异:我们首次证明,人体血清中可检测到 PDE5 水平,而且 PCa 患者的 PDE5 浓度明显高于良性前列腺增生患者或男女对照组。虽然血清中 PDE5 水平的测量可能会开辟新的研究途径,但 PCa 患者体内 PDE5 水平的临床意义值得进一步研究。
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引用次数: 0
Who and how to screen for endogenous hypercortisolism in a high-risk population: a special issue of the journal of endocrinological investigations. 在高危人群中筛查内源性皮质醇过多症的对象和方法:《内分泌学调查》杂志特刊。
IF 5.4 2区 医学 Q1 Medicine Pub Date : 2024-10-01 DOI: 10.1007/s40618-024-02449-5
Filippo Ceccato, Massimo Terzolo, Carla Scaroni
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引用次数: 0
Unusual infections and thrombotic events in Cushing's syndrome. 库欣综合征的异常感染和血栓事件。
IF 5.4 2区 医学 Q1 Medicine Pub Date : 2024-10-01 DOI: 10.1007/s40618-024-02454-8
Mattia Barbot, Martina Lazzara, Pierluigi Mazzeo, Francesca Pecori Giraldi

The diagnosis of Cushing's syndrome requires a high degree of suspicion, especially in patients in whom typical features are overshadowed by other ailments. These include, among others, widespread opportunistic infections or sepsis and venous or arterial thromboembolism.This Review will summarize available data on patients presenting with severe infections or thrombotic events and the best approach to diagnosis.

库欣综合征的诊断需要高度怀疑,尤其是那些被其他疾病掩盖了典型特征的患者。本综述将总结出现严重感染或血栓事件的患者的现有数据以及最佳诊断方法。
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引用次数: 0
ACROMORFO study: gait analysis in a cohort of acromegalic patients. ACROMORFO 研究:一组肢端肥大症患者的步态分析。
IF 5.4 2区 医学 Q1 Medicine Pub Date : 2024-10-01 Epub Date: 2024-02-28 DOI: 10.1007/s40618-024-02340-3
V Cimolin, C Premoli, G Bernardelli, E Amenta, M Galli, L Donno, D Lucini, L M Fatti, B Cangiano, L Persani, G Vitale

Purpose: In acromegaly, skeletal complications resulted to be associated with low quality of life (QoL) and high risk of falls. The aim of the present study was to perform a quantitative assessment of movement through gait analysis technique in patients with acromegaly.

Study population: Thirty-three acromegalic patients [9 with active disease (AD), 14 with controlled disease (CD) and 10 with disease remission (RD)] and 20 healthy subjects were enrolled for the study.

Measurements: Kinetic and kinematic data were collected with 3D-gait analysis. Kinematic data were processed to compute the Gait Profile Score (GPS), a parameter that summarizes the overall deviation of kinematic gait data relative to unaffected population.

Results: The acromegalic group showed longer stance phase duration (p < 0.0001) compared to controls. The GPS and several gait variable scores resulted to be statistically higher in the acromegalic group compared to healthy controls. GPS values were significantly higher in AD compared to CD (p < 0.05) and RD groups (p = 0.001). The AD group presented significantly higher values in terms of hip rotation and ankle dorsiflexion compared to CD and RD groups and with regard to the foot progression compared to RD. Interestingly, patients with RD exhibited a more physiological gait pattern.

Conclusion: Acromegalic patients showed quantitative alterations of gait pattern, suggesting instability and increased risk of falls. Arthropathy, along with its associated abnormal joint loading, proprioceptive impairment and hyperkyphosis could be contributing factors. Disease control and remission appear to improve postural balance. A better knowledge on walking performance in acromegaly would help to develop specific rehabilitation programmes to reduce falls' risk and improve QoL.

目的:肢端肥大症患者的骨骼并发症与低生活质量(QoL)和高跌倒风险有关。本研究旨在通过步态分析技术对肢端肥大症患者的运动情况进行定量评估:研究对象:33 名肢端肥大症患者(9 名活动期患者(AD)、14 名控制期患者(CD)和 10 名疾病缓解期患者(RD))和 20 名健康受试者:通过三维步态分析收集动力学和运动学数据。对运动数据进行处理,计算步态轮廓评分(GPS),该参数概括了运动步态数据相对于未受影响人群的总体偏差:肢端肥大症组的步态阶段持续时间更长(p 结论:肢端肥大症组的步态阶段持续时间更长(p):肢端肥大症患者的步态模式发生了定量改变,表明其步态不稳定,跌倒风险增加。关节病及其相关的异常关节负荷、本体感觉障碍和肌张力过高可能是诱因。疾病控制和缓解似乎能改善姿势平衡。如果能更好地了解肢端肥大症患者的行走表现,将有助于制定特定的康复计划,以降低跌倒风险并提高生活质量。
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引用次数: 0
Rachel score: a nomogram model for predicting the prognosis of lung neuroendocrine tumors. 雷切尔评分:预测肺部神经内分泌肿瘤预后的提名图模型。
IF 5.4 2区 医学 Q1 Medicine Pub Date : 2024-10-01 Epub Date: 2024-03-23 DOI: 10.1007/s40618-024-02346-x
A La Salvia, B Marcozzi, C Manai, R Mazzilli, L Landi, M Pallocca, G Ciliberto, F Cappuzzo, A Faggiano

Background: Lung NET, classified in typical carcinoids (TC) and atypical carcinoids (AC), are highly heterogeneous in their biology and prognosis. The histological subtype and TNM stage are well-established prognostic factors for lung NET. In a previous work by our group, we demonstrated a significant impact of laterality on lung NET survival outcomes.

Materials and methods: We developed a nomogram that integrates relevant prognostic factors to predict lung NET outcomes. By adding the scores for each of the variables included in the model, it was possible to obtain a prognostic score (Rachel score). Wilcoxon non-parametric statistical test was applied among parameters and Harrell's concordance index was used to measure the models' predictive power. To test the discriminatory power and the predictive accuracy of the model, we calculated Gonen and Heller concordance index. Time-dependent ROC curves and their area under the curve (AUC) were used to evaluate the models' predictive performance.

Results: By applying Rachel score, we were able to identify three prognostic groups (specifically, high, medium and low risk). These three groups were associate to well-defined ranges of points according to the obtained nomogram (I: 0-90, II: 91-130; III: > 130 points), providing a useful tool for prognostic stratification. The overall survival (OS) and progression free survival (PFS) Kaplan-Meier curves confirmed significant differences (p < 0.0001) among the three groups identified by Rachel score.

Conclusions: A prognostic nomogram was developed, incorporating variables with significant impact on lung NET survival. The nomogram showed a satisfactory and stable ability to predict OS and PFS in this population, confirming the heterogeneity beyond the histopathological diagnosis of TC vs AC.

背景:肺癌分为典型类癌(TC)和不典型类癌(AC),其生物学特性和预后具有高度异质性。组织学亚型和 TNM 分期是公认的肺癌预后因素。在我们小组之前的一项工作中,我们证实了侧位对肺NET生存结果的显著影响:我们开发了一种整合了相关预后因素的提名图来预测肺 NET 的预后。通过将模型中每个变量的得分相加,可以得到一个预后评分(Rachel 评分)。各参数之间采用 Wilcoxon 非参数统计检验,并使用 Harrell 一致性指数来衡量模型的预测能力。为了检验模型的鉴别力和预测准确性,我们计算了 Gonen 和 Heller 一致性指数。与时间相关的 ROC 曲线及其曲线下面积(AUC)用于评估模型的预测性能:通过应用 Rachel 评分,我们确定了三个预后组(具体为高、中、低风险)。根据所得到的提名图,这三个组与定义明确的分数范围相关联(I:0-90;II:91-130;III:>130 分),为预后分层提供了有用的工具。总生存期(OS)和无进展生存期(PFS)Kaplan-Meier曲线证实,Rachel评分确定的三个组别之间存在显著差异(P < 0.0001):结论:结合对肺NET生存有重大影响的变量,制定了预后提名图。该提名图在预测该人群的OS和PFS方面显示出令人满意且稳定的能力,证实了组织病理学诊断TC vs AC之外的异质性。
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引用次数: 0
Analysis of the finasteride treatment and its withdrawal in the rat hypothalamus and hippocampus at whole-transcriptome level. 从全转录组水平分析大鼠下丘脑和海马的非那雄胺治疗和停药情况。
IF 5.4 2区 医学 Q1 Medicine Pub Date : 2024-10-01 Epub Date: 2024-03-17 DOI: 10.1007/s40618-024-02345-y
S Giatti, L Cioffi, S Diviccaro, R Piazza, R C Melcangi

Purpose: As reported in patients treated for androgenetic alopecia with finasteride (i.e., a blocker of the enzyme 5 alpha-reductase) and in an animal model, side effects affecting sexual, psychiatric, neurological, and physical domains, may occur during the treatment and persist with drug suspension. The etiopathogenesis of these side effects has been poorly explored. Therefore, we performed a genome-wide analysis of finasteride effects in the brain of adult male rat.

Methods: Animals were treated (i.e., for 20 days) with finasteride (1mg/rat/day). 24 h after the last treatment and 1 month after drug suspension, RNA sequencing analysis was performed in hypothalamus and hippocampus. Data were analyzed by differential expression analysis and Gene-Set Enrichment Analyses (GSEA).

Results: Data obtained after finasteride treatment showed that 186 genes (i.e., 171 up- and 15 downregulated) and 19 (i.e., 17 up- and 2 downregulated) were differentially expressed in the hypothalamus and hippocampus, respectively. Differential expression analysis at the drug withdrawal failed to identify dysregulated genes. Several gene-sets were enriched in these brain areas at both time points.

Conclusion: Some of the genes reported to be differentially expressed (i.e., TTR, DIO2, CLDN1, CLDN2, SLC4A5, KCNE2, CROT, HCRT, MARCKSL1, VGF, IRF2BPL) and GSEA, suggest a potential link with specific side effects previously observed in patients and in the animal model, such as depression, anxiety, disturbance in memory and attention, and sleep disturbance. These data may provide an important background for future experiments aimed at confirming the pathological role of these genes.

目的:据报道,在使用非那雄胺(即 5 α-还原酶的阻断剂)治疗雄激素性脱发的患者中以及在动物模型中,可能会在治疗期间出现影响性、精神、神经和身体领域的副作用,并且在停药后仍会持续。对这些副作用的病因尚未进行深入研究。因此,我们对非那雄胺对成年雄性大鼠大脑的影响进行了全基因组分析:方法:用非那雄胺(1 毫克/只/天)对动物进行治疗(即 20 天)。在最后一次治疗 24 小时后和停药 1 个月后,对下丘脑和海马进行 RNA 测序分析。数据通过差异表达分析和基因组富集分析(Gene-Set Enrichment Analyses,GSEA)进行分析:结果:非那雄胺治疗后获得的数据显示,186个基因(即171个上调,15个下调)和19个基因(即17个上调,2个下调)分别在下丘脑和海马中差异表达。停药时的差异表达分析未能发现失调基因。在这两个时间点,这些脑区都富集了几个基因集:结论:报告的一些差异表达基因(即 TTR、DIO2、CLDN1、CLDN2、SLC4A5、KCNE2、CROT、HCRT、MARCKSL1、VGF、IRF2BPL)和 GSEA 表明,这些基因与之前在患者和动物模型中观察到的特定副作用(如抑郁、焦虑、记忆和注意力障碍以及睡眠障碍)存在潜在联系。这些数据可为今后旨在证实这些基因的病理作用的实验提供重要背景。
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引用次数: 0
The need for the GREAT+ score to predict relapse in Graves' disease: a questionnaire among patients and internal medicine specialists. 用 GREAT+ 评分预测巴塞杜氏病复发的必要性:患者和内科专家问卷调查。
IF 5.4 2区 医学 Q1 Medicine Pub Date : 2024-10-01 Epub Date: 2024-03-25 DOI: 10.1007/s40618-024-02358-7
H I Jansen, C Heuveling van Beek, P H Bisschop, A C Heijboer, E Bruinstroop, A Boelen

Purpose: Graves' disease (GD) is an auto-immune cause of hyperthyroidism. First-line treatment often consists of a 12-18 month course of antithyroid drugs (ATD). After discontinuation of ATD, GD relapses in approximately 50% of patients. The 'Graves recurrent event after therapy+ ' (GREAT+) score may predict individual relapse chances after ATD discontinuation more accurately based on clinical and laboratory parameters at diagnosis. We investigated the need for the GREAT+ score through an online questionnaire among GD patients and physicians treating GD.

Methods: An anonymous online questionnaire was distributed to patients and physicians between June 2022 and August 2023.

Results: The questionnaire was completed by 532 patients and 44 physicians. Results showed that 94% of patients were interested in knowing their GREAT+ score at the start of treatment. 55% would consider definite treatment (radioiodine/thyroidectomy) as first-line treatment in case of a high relapse chance. 98% of the physicians indicated the GREAT + score would support patient counseling. 84% may change their advice for first-line treatment if a patient has a high relapse chance based on the score.

Conclusion: Patients and physicians considered the GREAT+ score as a valuable addition to the current available information which could change treatment decisions. Therefore, external validation of the GREAT+ score is justified to implement this score in clinical practice.

目的:巴塞杜氏病(GD)是导致甲状腺功能亢进的自身免疫性疾病。一线治疗通常包括为期12-18个月的抗甲状腺药物(ATD)疗程。停用抗甲状腺药物后,约有50%的患者会复发。根据诊断时的临床和实验室参数,"治疗后巴塞杜氏复发事件+"(GREAT+)评分可以更准确地预测停用ATD后的复发几率。我们通过在线问卷调查了 GD 患者和治疗 GD 的医生对 GREAT+ 评分的需求:方法:我们在 2022 年 6 月至 2023 年 8 月期间向患者和医生发放了一份匿名在线问卷:共有 532 名患者和 44 名医生填写了问卷。结果显示,94% 的患者有兴趣在治疗开始时了解自己的 GREAT+ 分数。55%的患者在复发几率较高的情况下会考虑将明确治疗(放射性碘/甲状腺切除术)作为一线治疗。98% 的医生表示,GREAT + 分数将有助于为患者提供咨询。如果患者的复发几率很高,84%的医生可能会根据评分改变他们的一线治疗建议:患者和医生认为 GREAT+ 评分是对现有信息的宝贵补充,可改变治疗决策。因此,有必要对 GREAT+ 评分进行外部验证,以便在临床实践中使用该评分。
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引用次数: 0
期刊
Journal of Endocrinological Investigation
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