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    Research progress of Hashimoto thyroiditis
    TIAN Limin, FENG Jing
    Journal of Internal Medicine Concepts & Practice    2024, 19 (04): 217-223.   DOI: 10.16138/j.1673-6087.2024.04.01
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    Hashimoto thyroiditis (HT) is a very common organic autoimmune thyroid disease, and its incidence is increasing year by year. It not only causes hypothyroidism in clinical practice, but also has many connections with a variety of immune diseases, endocrine diseases, rheumatic diseases and thyroid cancer. Although the exact etiology of HT has not been fully clarified, the mainstream treatment is still based on management and alternative treatment of hypothyroidism. However, as the research further deepens, more clinical variants have been gradually discovered, more and more factors have been found to be related to the onset of HT, and new discoveries have been made in treatment methods. This article reviews the research progress on clinical manifestations, pathological features, diagnosis, pathogenesis, relationship with other diseases and treatment of HT.

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    Research progress on agranulocytosis caused by antithyroid drugs
    TIAN Ruochen, LI Jing
    Journal of Internal Medicine Concepts & Practice    2024, 19 (04): 264-268.   DOI: 10.16138/j.1673-6087.2024.04.09
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    In China, antithyroid drugs are the first choice of treatment for hyperthyroidism. However, their side effects may result in agranulocytosis, which has an insidious onset and requires urgent treatment. Up to date,the mechanisms of agranulocytosis caused by antithyroid drugs is still unclear. Herein, the article reviewed the direct toxic activities, the immune effects, and the genetic susceptibility of antithyroid drugs, which may be helpful to provide better clinical treatment options and improve the prognosis of agranulocytosis caused by the drugs.

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    Journal of Internal Medicine Concepts & Practice    2022, 17 (02): 123-126.   DOI: 10.16138/j.1673-6087.2022.02.005
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    Study on efficacy and safety of Dioscorea bublifera L. in treatment of Graves disease
    CUI Yifan, ZHANG Ruixiang, WEI Xiao, LIU Chao
    Journal of Internal Medicine Concepts & Practice    2024, 19 (04): 273-277.   DOI: 10.16138/j.1673-6087.2024.04.11
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    Hyperthyroidism is most common in Graves disease (GD), and traditional antithyroid medicine are often difficult to achieve satisfactory efficacy, and high recurrence rate and long course of treatment are the most prominent problems. Huangyaozi(Dioscorea bublifera L.), a traditional Chinese medicine, has the effect of “Xiao Ying” and has been widely used in the treatment of GD in recent years, but long-term use may cause liver and kidney damage. Therefore, more research on the efficacy and safety of Huangyaozi need to be done in the treatment of GD.

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    Recent advances in diagnosis and treatment of subacute thyroiditis
    LI Yajie, CUI Dai
    Journal of Internal Medicine Concepts & Practice    2024, 19 (04): 259-263.   DOI: 10.16138/j.1673-6087.2024.04.08
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    Subacute thyroiditis (SAT) is a common thyroid inflammatory disease that is frequently prone to misdiagnosis or underdiagnosis, which impact the quality of life for patients adversely. In this review, we summarize the pathogenesis, clinical manifestations, diagnosis, and treatment of SAT, aiming to improve clinician’s understanding of the disease.

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    Ultrasound features and clinical manifestations of two cases of thyroid metastatic cancer: pay attention to abnormal thyroid ultrasound spectrum
    LI Yuanyuan, DING Wenbo, JIANG Ziyu, CHEN Xi, LIU Binbin, CHEN Guofang, LIU Chao
    Journal of Internal Medicine Concepts & Practice    2024, 19 (04): 254-258.   DOI: 10.16138/j.1673-6087.2024.04.07
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    Ultrasonography plays an important role in early screening of thyroid cancer. This article introduced two cases of thyroid metastatic carcinoma secondary to renal clear cell carcinoma and cervical squamous cell carcinoma respectively, analyzed their clinical diagnosis and treatment process, ultrasound characteristics, and prognosis, as well as reviewed the related literature. As atypical thyroid lesions were detected through the ultrasound spectrum in patients with a history of malignant tumors, it should be alert to the possibility of metastatic cancer. Ultrasound-guided core-needle biopsy combined with immunohistochemical testing can help early diagnosis and timely treatment.

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    Expert consensus on diagnosing and evaluating sacroiliitis using magnetic resonance imaging
    DAI Shengming, BAO Chunde, ZOU Hejian, et al
    Journal of Internal Medicine Concepts & Practice    2023, 18 (02): 65-69.   DOI: 10.16138/j.1673-6087.2023.02.001
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    Research progress on pathogenesis of diabetic nephropathy
    BI Liming, WANG Zhaohui
    Journal of Internal Medicine Concepts & Practice    2023, 18 (03): 201-205.   DOI: 10.16138/j.1673-6087.2023.03.014
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    Impact of maternal hyperthyroidism during pregnancy on neurological and psychiatric development of offspring
    YANG Ao, ZHANG Peiheng, ZHANG Yang, GAO Ying
    Journal of Internal Medicine Concepts & Practice    2024, 19 (04): 269-272.   DOI: 10.16138/j.1673-6087.2024.04.10
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    Gestational hyperthyroidism can significantly increase health risks to both mother and fetal. However, there are few reports on its impact on the neuropsychological development of offspring. This article reviews the literature related to the effect of hyperthyroidism during pregnancy on brain structure, intelligence quotient (IQ) and neuropsychiatric disorders of offsprings. It was found that hyperthyroidism during pregnancy may be associated with reduced brain volume and cortical gray matter volume, lower IQ, and increase the risk of depression in offspring. However, its’ relationship with other mental and emotional well-being disorder of the offspring is unclear.

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    Journal of Internal Medicine Concepts & Practice    2022, 17 (03): 258-261.   DOI: 10.16138/j.1673-6087.2022.03.017
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    Journal of Internal Medicine Concepts & Practice    2024, 19 (03): 166-166.  
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    An update on complement targeted treatment of IgA nephropathy
    ZHANG Huijian, LI Guisen
    Journal of Internal Medicine Concepts & Practice    2023, 18 (03): 197-200.   DOI: 10.16138/j.1673-6087.2023.03.013
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    Investigation of serum uric acid level in adult patients and analysis of related influencing factors
    LUO Yadan, YUAN Liying, LU Yide, WANG Ziqiu, WANG Zhaohui
    Journal of Internal Medicine Concepts & Practice    2023, 18 (03): 141-145.   DOI: 10.16138/j.1673-6087.2023.03.002
    Abstract659)   HTML17)    PDF(pc) (567KB)(323)       Save

    Objective To investigate the distribution characteristics of hyperuricemia(HUA) and related influencing factors among the adult patients in Ruijin Hospital, and provide the clinical reference for prevention and treatment of HUA. Methods A retrospective study of serum uric acid was carried out on 47 100 people in Ruijin Hospital in June 2018, who were over 18 years old. Among them, 27 091 were males and 20 009 were females. The value of serum uric acid and distribution in different gender, age groups and clinical departments were studied. Results The total detection rate of HUA was 20.26%; it was 22.82% in male, and it was 16.88% in females. The serum uric acid level was negatively correlated with age in males, and females (≤50 years) (P<0.05), while it was positively correlated with female over 50 years (P<0.05). The high incidence age groups were 18-30 years in male, and in women over 71 years(P<0.05). Three departments with the highest HUA detection rate were the departments of nephrology, cardiac surgery outpatient and hypertension outpatient. Conclusions The detection rate of HUA in the study was high. The overall blood uric acid level in men was higher than that in women. The blood uric acid level in men gradually decreased with age, and the blood uric acid level in women showed a trend of decreasing and then increasing. Learning the distribution characteristics of uric acid in population could give help in strengthening education and prevention work in the susceptible population.

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    Journal of Internal Medicine Concepts & Practice    2024, 19 (03): 158-158.  
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    Value of serum N-terminal pro-brain natriuretic peptide levels in primary screening peritoneal dialysis patients with volume overload
    LI Hua, HUANG Xiaomin, ZHANG Chunyan, DU Lu, REN Hong, XU Tian
    Journal of Internal Medicine Concepts & Practice    2023, 18 (03): 157-164.   DOI: 10.16138/j.1673-6087.2023.03.005
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    Objective To explore the relationship between serum N-terminal pro-brain natriuretic peptide (NT-proBNP) level and hydration status and cardiac function indexes in the patients receiving peritoneal dialysis(PD) treatment,and to further analyze the factors affecting the level of NT-proBNP. Methods A total of 111 patients with PD who were followed up in the PD Center of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from May 2019 to January 2022 were enrolled and the data was analyzed retrospectively. According to the results of multi-frequency bioelectrical impedance body composition monitor (BCM), relative hydration status (DHS), the ratio obtained through dividing extracellular water (ECW) by overhydration (OH), the patients were divided into normal volume group (OH/ECW≤15%) and overhydration group (OH/ECW>15%). The relationship between serum NT-proBNP level and hydration status in two groups was compared, and the related factors affecting the level of NT-proBNP were further analyzed and discussed. Using BCM result as the“gold standard”, the receiver operator characteristic curve(ROC curve) determined the optimal threshold of NT-proBNP as the capacity was overloaded. The patients were divided into two groups according to NT-proBNP and their clinical data were compared. Results The indexes including systolic blood pressure, urine volume, urea clearance index (Kt/V), creatinine clearance rate(CCr), dialysate to plasma ratio for urea at 4 hours(4hD/PCr), types of antihypertensive drugs, type of diuretic, hemoglobin, serum albumin, log2(NT-proBNP), interventricular septal thickness (IVST), left ventricular posterior wall thickness(LVPWT), left atrial diameter(LAD), OH, TBW, ECW, OH/TBW, ECW/TBW and ECW/ICW were detected in volume overload group and normal volume group, and showed statistically significant (all P<0.05). log2(NT-proBNP) level was correlated with systolic blood pressure, dialysis duration, ultrafiltration volume, dialysis dose, antihypertensive drug group, IVST, LVPWT, LAD, left ventricular end-systolic dimension (LVESD), left ventricular end-diastolic dimension (LVEDD), OH, OH/ECW were positively correlated (all P<0.05). It was negatively correlated with urine volume, Kt/V, CCr, normalized protein catabolic rate (nPCR), hemoglobin, serum albumin and LVEF (all P<0.05). NT-proBNP 4 896 ng/L could be used as the critical value of initial screening capacity overload and was applied to divide the patients into two groups, and the systolic blood pressure, urine volume, ultrafiltration volume, Kt/V, CCr, IVST, LVPWT, OH/ECW indicators showed significant differences (all P<0.05) in two groups. Conclusions The level of NT-proBNP in PD patients is generally increased, and it indicates volume overload as its value is greater than 4 896 ng/L, which can be used as a simple monitoring index for the preliminary judgment of volume overload in PD patients.

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    Interpretation of Chinese expert consensus on understanding and management of renal anemia in diabetic kidney disease
    WANG Weiming
    Journal of Internal Medicine Concepts & Practice    2023, 18 (03): 137-140.   DOI: 10.16138/j.1673-6087.2023.03.001
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    Journal of Internal Medicine Concepts & Practice    2022, 17 (01): 48-52.   DOI: 10.16138/j.1673-6087.2022.01.009
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    Molecular study of benign and malignant thyroid nodules
    LI Haorong, HAN Rulai, YU Danyan, YE Lei
    Journal of Internal Medicine Concepts & Practice    2023, 18 (04): 266-269.   DOI: 10.16138/j.1673-6087.2023.04.011
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    Objective To establish a next-generation sequencing panel for the molecular diagnosis of thyroid nodules. Methods The panel, named ThyNod Panel, was designed to detect single nucleotide variant(SNV), indel, fusion, copy number variant (CNV) and RNA expression levels in 112 thyroid nodules associated genes, including benign and malignant molecular markers, thyroid differentiation or function genes and cell identity marker genes. Results The ThyNod Panel was successfully constructed and applied, and 856 benign or malignant thyroid nodules were completed sequencing. Totally 676 (79.0%) thyroid nodules were detected mutations. In 627 thyroid nodules with definite pathological diagnosis, 17.6% were benign nodules and 82.4% were malignant ones, in which malignant pathological types included classical papillary carcinoma, follicular variant papillary carcinoma, and medullary carcinoma. The most common mutant genes detected were BRAF (n=426), followed by RET (n=68), RET/PTC fusion (n=68), DICER1 (n=35), telomerase reverse transcriptase (TERT) (n=35), HRAS (n=24), NRAS (n=23), neurotrophin receptor kinase (NTRK3) fusion (n=19), and eukaryotic translation initiation factor 1A, X-chromosomal (EIF1AX) (n=11). The malignant percentage was counted for the detected mutations, and the malignant related variants such as BRAF V600E and RET fusion were higher than 90.0%, while the overall malignant percentage of RAS-like variants was only 18.9%. Conclusions ThyNod Panel can efficiently identify genetic characteristics in thyroid nodules and be applied in the molecular diagnosis of thyroid nodules.

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    Journal of Internal Medicine Concepts & Practice    2024, 19 (03): 179-179.  
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    Contrast study on efficacy of ultrasound-guided transversus abdominis plane block combined with rectus sheath block in peritoneal dialysis catheterization
    WANG Chaojun, YU Ling, WANG Hengjie, REN Hong, SHI Manman, ZHENG Hong, MA Yuhua, XU Tian
    Journal of Internal Medicine Concepts & Practice    2023, 18 (03): 152-156.   DOI: 10.16138/j.1673-6087.2023.03.004
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    Objective To compare the effects of ultrasound-guided transversus abdominis plane block(TAPB) combined with rectus sheath block(RSB), TAPB and local infiltration anesthesia in peritoneal dialysis catheterization,and to explore and promote the ideal anesthesia method for peritoneal dialysis catheterization. Methods A total of 46 patients who underwent peritoneal dialysis catheterization in our hospital from May 2016 to June 2021 were enrolled and randomly divided into three groups according to the random number method: ultrasound-guided TAPB combined with RSB (group A),ultrasound-guided TAPB (group B) and local infiltration anesthesia group (group C). The mean arterial pressure (MAP), heart rate, visual analogue scale (VAS) score at different time points during the operation [anesthesia (T0), skin incision (T1), separation of rectus abdominis (T2), establishment of subcutaneous tunnel (T3), and skin suture (T4)], overall operation duration, number of additional anesthetics, number of intraoperative and postoperative adverse reactions and postoperative complications were compared and analyzed among three groups. Results There was no statistically significant difference in MAP and heart rate (all P>0.05) in group A and group B, while both MAP and heart rate in group C showed significant difference (P<0.05) during the operation time (T0, T1, T2, T3 and T4). Compared with group A, additional anesthetics during operation in group B and group C was more frequently used (P<0.05). Compared with group A, the VAS scores of group B at T2, and the VAS scores of group C at T1, T2, T3 and T4 were significantly higher (P<0.05). The operation time of group A was significantly shorter than that of group B and group C (P<0.05). The postoperative complications in group A were significantly less than those in group B and group C (P<0.05). Conclusions Compared with ultrasound-guided TAPB and local infiltration anesthesia, the ultrasound-guided TAPB combined with RSB is a relatively ideal anesthesia method for peritoneal dialysis catheterization, which shows the advantages of safe anesthesia, stable hemodynamics, better comfort and fewer postoperative complications.

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