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.

The Global Burden of Disease Study 2021 (GBD 2021) analyzed 371 diseases and injuries using 100,983 data sources, estimating years lived with disability, years of life lost, disability-adjusted life years, and healthy life expectancy. From 1990 to 2019, the annual rate of change in global all-cause mortality ranged from -0.9% to 2.4%, while deaths increased by 10.8% and 7.5% in 2020 and 2021 respectively due to COVID-19. In 2021, COVID-19 was the second lea-ding cause of death globally, with a mortality rate of 94.0 per 100 000. The mortality rates of other major causes, such as ischemic heart disease and stroke were 108.7 and 87.4 per 100 000, respectively. Global life expectancy rose from 65.5 years in 1990 to 73.3 years in 2019 but dropped to 71.7 years in 2021 due to COVID-19, which reduced life expectancy by 2.2 years, significantly impacting the trend of health improvement. In China, GBD 2021 data shows a significant increase in life expectancy from 1990 to 2021: from 69.9 to 80.7 years for women and from 65.7 to 74.9 years for men. However, non-communicable diseases such as cardiovascular diseases, cancers, and chronic respiratory diseases remain major health threats. In 2021, these diseases had the highest burden among the top ten causes in China, with rising incidence and morta-lity rates. Major health risk factors in China include tobacco, hypertension, and dietary risks. This paper, through the systematic analysis of GBD 2021 data, reveals current trends in disease burden globally and in China, and proposes public health strategy recommendations. China should enhance chronic disease management, improve public health emergency responses, address health inequalities, and promote basic research and international cooperation to improve overall health levels.

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.

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.

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.

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.

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.

In China, the clinical prevalence of hyperthyroidism is 0.78%, subclinical hyperthyroidism is 0.44%, and Graves' disease hyperthyroidism is 0.53%. Untreated hyperthyroidism and subclinical hyperthyroidism may increase the risk of atrial fibrillation, stroke, and other cardiovascular events, as well as osteoporosis and fractures. In special populations (such as pregnant women and the elderly), both the diagnosis and treatment of hyperthyroidism require special conside-rations. Although China has made some progress in the standardized diagnosis and treatment of hyperthyroidism, challenges remain. Despite established guidelines for diagnosis and differential diagnosis, clinical practice faces obstacles, notably due to limited access to thyroid radionuclide imaging and 131 iodine uptake rate in some hospitals. Additionally, the peak systolic velocity (PSV) in the thyroid obtained by thyroid ultrasound is not widely adopted. While clinical treatment methods align with international standards in China, there is a lack of specific guidelines on the initial dose and dose adjustment during the reduction period of antithyroid drugs (ATD). Currently, most clinicians follow the initial dose regimen re-commended by the guidelines established by the American Thyroid Association. Furthermore, indicators in both domestic and international guidelines for predicting adverse reactions to ATD remain unclear. During the ATD treatment of hyperthyroidism, the incidence of transient neutropenia is 1%-5%, and follow-up of baseline blood routine and liver function is ne-cessary. At present, there is a lack of monitoring frequency regulations and high-quality evidence-based medical support for above indice, and clinical practice has not yet established feasible indicators for predicting ATD adverse reactions. ATD-induced agranulocytosis is related to genetic susceptibility, age, drug type and dosage. HLA-B*27:05, HLA-B*38:02 and HLA-DRB1*08:03 on chromosome 6 in Chinese Han population may be susceptibility genes. Progress has been made in the diagnosis and treatment of thyroid associated ophthalmopathy (TAO) in China, with 36.7% of doctors adopting a multidisciplinary approach. Due to accessibility issues, less than 10% of patients receive biological agents to treat TAO, which is significantly lower than that in Western countries. Given these current status and challenges in China, further measures are necessary to improve the diagnosis and treatment of hyperthyroidism.

Breast cancer is one of the most common cancers affecting women globally. With the advent of digital pathology slide scanners and the continuous evolution of deep learning algorithms, there has been a significant advancement in the application of artificial intelligence (AI) in the diagnosis and treatment of breast cancer. This article provided an overview of the current research and application status of AI in breast cancer pathological diagnosis, and summarized the challenges encountered as well as future directions in this field.

Diabetes is a common chronic disease, which has caused a significant health and economic burden worldwide. Diabetes is highly heterogeneous. Accurate diagnosis and classification are the premises to achieve standardized and accurate treatment of diabetes and improve the clinical outcomes of patients. Recently, the American Diabetes Association (ADA) issued the 2024 Standards of Medical Care in Diabetes. In the chapter on diabetes diagnosis and classification, the latest developments have been taken into account, with recommended approaches for the differential diagnosis of atypical diabetes, screening, diagnosis, and follow-up processes of different types of diabetes. This article interprets this section of the guidelines to provide a reference for healthcare professionals in the endocrine field in China for the accurate diagnosis, classification, and individualized treatment of diabetes.

The global incidence of type 1 diabetes mellitus (T1DM) in children and adolescents aged 0-19 years is about 1 211.9/10 million, with an incidence rate of 149.5/1 million person-years. In China, the incidence of T1DM in children and adolescents aged 0-19 years is about 56/1 million, with an incidence rate of 6.1/1 million person-years. The incidence of type 2 diabetes mellitus (T2DM) in children and adolescents has been rising annually. Epidemiological data shows that the incidence of T2DM among adolescents in the United States increased from 34/100 000 in 2001 to 46/100 000 in 2009 and to 67/100 000 in 2017. In China, the incidence of pediatric T2DM has also shown a significant upward trend, rising from 4.1/100 000 in 1995 to 10.0/100 000 in 2010. The diagnostic criteria for pediatric diabetes in China follow the standards set by the World Health Organization in 2019. Diabetes subtypes related to children include T1DM, T2DM, mixed-type diabetes, and other specific types of diabetes. The typical clinical manifestations of adult diabetes are polydipsia, polyuria, polyphagia, and weight loss (the ‘three P’s and one less’). However, in children with T1DM, these symptoms are more pronounced, while T2DM may present more subtly. Traditional treatment for T1DM primarily involves insulin therapy, but it cannot fundamentally address the issue of impaired pancreatic function. Preventing or delaying β-cell damage and protecting the remaining pancreatic function have become new research directions in T1DM treatment. In addition to traditional insulin therapy and lifestyle interventions, new treatments such as immunotherapy, artificial pancreas, and stem cell transplantation have shown promising clinical results. These advances not only provide new directions for the future treatment of diabetes but also have the potential to transform diabetes from an incurable disease into a treatable one.

Objective Screen autophagy related genes of Alzheimer disease(AD) based on microarray analysis, conduct pathway analysis and identify key genes in order to explore potential pathogenesis and therapeutic targets. Methods The GSE33000 dataset was downloaded from GEO Database, and the differentially expressed genes of AD were obtained by R software limma package. Autophagy-related genes were downloaded from Human Autophagy Database, Human Autophagy Modulator Database and GeneCard Database, respectively, and the autophagy-related gene set was obtained. The AD autophagy-related genes were obtained through intersecting the differentially expressed genes with the autophagy-related gene set. The R software packages such as org.Hs.eg.db and clusterProfiler were used to perform gene ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis, the online software Search Tool for the Retrieval of Interacting Genes (STRING) was used to conduct protein-protein interaction network analysis, and the key genes were predicted based on MCC algorithm. Results A total of 66 autophagy related genes were obtained, of which 41 genes were up-regulated and 25 genes were down-regulated. Gene enrichment analysis showed that cellular components in GO analysis were mainly enriched in phagocytic vesicle membrane, secretory granule membrane, membrane microdomain, late endosome, etc., and molecular functions were mainly enriched in Toll-like receptor binding, ubiquitin-like protein ligase binding, etc., and biological processes were enriched in regulation of autophagy, positive regulation of cellular catabolic process, response to lipopolysaccharide, regulation of inflammatory response, cellular response to external stimulus, etc. In KEGG enrichment analysis, the differentially expressed autophagy-related genes were mainly concentrated in NOD-like receptor signaling pathway, lipid and atherosclerosis, forkhead box protein O(FoxO) signaling pathway, etc. Our research completed the construction of protein-protein interaction (PPI), identified 10 key genes, and screened out that interleukin-6(IL-6) and signal transducer and activator of transcription 3(STAT3) were closely related to AD. Conclusions Ten key autophagy-related genes were obtained in this study, among which IL-6 and STAT3 are more closely related to AD.

Thyroid storm is a rare, life-threatening endocrine emergency characterized by severe clinical manifestations of thyrotoxicosis. Studies in the United States and Japan show that the annual incidence rates of hyperthyroid storm are (0.57-0.76) per 100 000 people and 0.2/100 000 people, respectively, accounting for 0.22% of all hyperthyroid patients and 5.4% of hospitalized hyperthyroid patients. Even with timely treatment, the mortality rate of patients with hyperthyroidism storm is still as high as 10%-30%; If left untreated, the mortality rate of patients may reach 90%. The misdiagnosis and missed diagnosis rate of hyperthyroidism storm in the Emergency Department is as high as 43.48%. It may be precipitated by abrupt discontinuation of antithyroid drugs or by an acute event such as infection, trauma, thyroid or nonthyroidal surgery, an acute iodine load, or parturition and other rare causes. There are currently no recognized standards or validated clinical tools for diagnosing thyroid storm. The diagnosis of thyroid storm is based upon the presence of biochemical evidence of hyperthyroidism (elevation of free T₄ and/or T₃ and suppression of TSH), and severe and life-threatening symptoms (hyperpyrexia, cardiovascular dysfunction, and altered mentation). BWPS has been widely used for the identification of thyroid storm for nearly 30 years. The main treatments for thyroid storm consist of symptomatic treatment and specific treatment for the thyroid gland, including removing the cause and treating complications cuse of thionamide, iodine, glucocorticoids and beta-blockers to inhibit new hormone synthesis, block the peripheral conversion of T₄ to T₃, inhibition of the release of thyroid hormone. If the above treatment do not improve the condition, blood purification therapy (plasmapheresis) can be tried. In addition to specific therapy directed against the thyroid, supportive therapy is essential. After active treatment, most of the status of patients with thyroid storm are improved within 1 to 2 days. After a successful rescue of thyroid storm, hyperthyroidism should be treated by radical treatment.

Thyroid nodules (TNs) exhibit a high prevalence rate of 36.9% in China, with a marked preponderance in females over males, and regional variations observed. Ultrasonography (US), due to its non-invasiveness, convenience, and high sensitivity, has emerged as the primary diagnostic tool for TNs. In recent years, advancements in US diagnostic techniques have flourished, including the Thyroid Imaging Reporting and Data System (TIRADS), multimodal US, fine-needle aspiration (FNA) coupled with molecular testing, and artificial intelligence (AI). Notably, the 2020 edition of the Chinese-specific C-TIRADS system has improved diagnostic accuracy by tailoring to China's healthcare landscape. Multimodal US assessment, integrating various US techniques, has significantly enhanced diagnostic efficacy, reducing unnecessary biopsies. Molecular testing and AI-assisted diagnosis have further improved diagnostic precision; however, the generalization capabilities of AI models and their long-term clinical application efficacy remain to be validated. Ultrasound-guided interventional therapies occupy a pivotal position in TN management, including chemical ablation and thermal ablation techniques. Chemical ablation is primarily utilized for cystic-predominant nodules, whereas thermal ablation is suitable for both cystic-solid and solid nodules, with their combined application yielding optimal results. Although the application of thermal ablation in thyroid micropapillary carcinoma remains controversial, preliminary studies have demonstrated its efficacy and safety. Despite the remarkable progress in US technologies for TN diagnosis and treatment, challenges persist, including inconsistent diagnostic criteria, disparities in equipment and technical expertise across regions and hospitals, and the absence of large-scale studies on the long-term efficacy and safety of thermal ablation. Future directions encompass refining risk stratification systems, intensifying research on multimodal US assessment, enhancing the generalization capabilities of AI models, standardizing the application of molecular testing, exploring indications for ablation therapy, and establishing standardized efficacy assessments.

Cardiovascular disease is still one of the most common causes of death in the world. In the past, timely reperfusion treatment has greatly reduced the death rate of the disease while promoting blood recovery and cardiomyocyte recovery. Ischemia reperfusion (IR) injury is an inevitable pathological process in many clinical practices. The mechanisms of myocardial IR injury include a variety of pathological processes such as mitochondrial autophagy and apoptosis, and these signaling pathways are interrelated and act on each other. Among them, mitochondrial autophagy has attracted wide attention as a selective autophagy. Mitochondrial autophagy maintains the normal operation of cardiomyocytes by regulating the quality and quantity of mitochondria. However, as stimulated by oxidative stress, ischemia and hypoxia, excessive mitochondrial autophagy or insufficient mitochondrial autophagy can affect the function of cardiomyocytes and even lead to the death of cardiomyocytes. Therefore, the activation degree of mitochondrial autophagy in cardiomyocytes should be strictly controlled. This article reviews the mechanism and progress of mitochondrial autophagy in myocardial IR injury, aiming to provide some assistance in the study of myocardial IR injury.

Objective To investigate correlation of levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and IL-8 in cerebrospinal fluid with the severity of the disease in patients with intracerebral hemorrhage, and to analyze the value of the cytokines for predicting prognosis of the patients. Methods A total of 40 patients with new-onset intracerebral hemorrhage, admitted to the Department of Neurosurgery of the General Hospital of Xinjiang Military Region, were collected from March 2023 to December 2023. Forty patients who underwent cerebrospinal fluid examination at the hospital due to the presence of clinical symptoms, but whose central nervous system disease was eventually excluded, served as the control group. Within 24 h of the onset of illness, the patient's cerebrospinal fluid was collected,as well as the laboratory test results. The levels of inflammatory cytokines TNF-α, IL-6, and IL-8 were measured both in serum and cerebrospinal fluid samples. Patients were divided into the mild-moderate group (GCS 9-15, n=14) and severe group (GCS 3-8, n=26) accor-ding to the Glasgow coma scale (GCS) on admission, and also were divided into ≥30mL group (n=21) and <30mL group (n=19) according to the hemorrhage volume. At 90 days after discharge, the patients with intracerebral hemorrhage were divided into a good prognosis group (GOS 4-5 points, n=18) and a poor prognosis group (GOS 1-3 points, n=22) according to the Glasgow out-come scale (GOS). Spearman correlation coefficient and Receiver operating characteristic curve (ROC) was used to analyze the value of inflammatory cytokines in serum and cerebrospinal fluid for predicting the prognosis in patients with intracerebral hemorrhage. Results Compared with the control group, TNF-α, IL-6 and IL-8 levels in serum and cerebrospinal fluid were significantly increased in the intracerebral hemorrhage (P<0.001). The levels of TNF-α, IL-6 and IL-8 in serum and cerebrospinal fluid were higher in the severe intracerebral hemorrhage group than those in the mild-moderate group (P<0.01), and all of them were negatively correlated with the GCS score (r=-0.397, P<0.05; r=-0.587, P<0.01; r=-0.615, P<0.01; r=-0.696, P<0.01; r=-0.671, P<0.01; r=-0.510, P<0.01). Compared with patients in the group of hemorrhage volume <30mL, TNF-α, IL-6 and IL-8 levels in cerebrospinal fluid of patients in the ≥30 mL group were elevated (P<0.05), and in serum only IL-6 levels were elevated (P<0.05). The levels of TNF-α, IL-6 and IL-8 in serum and cerebrospinal fluid were elevated in the poor prognosis group compared with the good prognosis group (P<0.01). The area under the curve (AUC) of single and combined detection of TNF-α, IL-6 and IL-8 in the cerebrospinal fluid of patients with cerebral hemorrhage for the first time on admission to the hospital for predicting the prognosis of patients with cerebral hemorrhage were 0.836, 0.773, 0.849, and 0.917, respectively. The AUC of single and combined tests of serum TNF-α, IL-6 and IL-8 in patients within 24 h admission for predicting the prognosis were 0.692, 0.808, 0.721 and 0.843, respectively. Conclusions TNF-α, IL-6 and IL-8 levels are elevated in the cerebrospinal fluid of patients with intracerebral hemorrhage, and they correlated with the severity of the patient's condition. In addition, the levels of these indicators in the cerebrospinal fluid detected for the first time on admission may be used to predict the prognosis 90 days after discharge.

In recent years, minimally invasive surgical techniques represented by endoscopic techniques and robotic surgical systems have become a new trend in the development of surgical treatment. With the advantages of precision, minimally invasive and aesthetics, robotic surgery has been more and more widely used in the field of breast surgery. By analysing literature, this paper reviewed the application of robotic surgery in breast cancer treatment in recent years, including the development of the technology, feasibility and safety of the surgery, etc., so as to provide a theoretical basis for the application of robotic surgical systems in breast cancer treatment.

Thyroid nodules, a common endocrine tumor, have shown a significant increase in incidence globally. The total incidence rate of thyroid nodules worldwide is about 25% from 2000 to 2022, of which the incidence of malignant thyroid nodules is 4.0% to 6.5%. In recent years, the application of thermal ablation technology in the treatment of thyroid nodules has been steadily increasing, with broader indications and fewer contraindications. Thermal ablation techniques have been widely applied in the treatment of benign thyroid nodules. Studies have demonstrated that radiofrequency ablation (RFA) and microwave ablation (MWA) significantly reduce nodule volume and alleviate symptoms. For retrosternal thyroid nodules, the post-treatment volume reduction rate exceeds 90%. For calcified benign nodules, a five-year follow-up showed an average volume reduction rate of 92.95%. Studies on follicular tumors indicated that more than half of the nodules achieved a 90%-volume reduction one year after thermal ablation, with a low incidence of complications in the treatment group. In the treatment of malignant thyroid tumors, thermal ablation has shown promising results in T_1aN₀M₀ solitary low-risk papillary thyroid microcarcinoma (PTMC), with a disease progression rate as low as 3.6%. For T_1bN₀M₀-T₂N₀M₀ primary solitary papillary thyroid carcinoma (PTC), the prognosis following thermal ablation is comparable to surgery, with a lower incidence of complications. In patients with multifocal PTC, the success rate of thermal ablation was 100%, with a low rate of local tumor progression during follow-up. For PTMC located in the isthmus, adjacent to the trachea, or close to the thyroid capsule, thermal ablation demonstrated similar efficacy to surgery, with lower rates of complications and recurrence. This review summarizes the current indications of thermal ablation technology in the treatment of thyroid nodules and provides a reference for clinical applications.

Hereditary breast cancer-related gene mutations significantly increase the risk of breast cancer in women. In this regard, the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Genetic/Familial High-Risk Assessment was developed to guide genetic assessment and counseling in mutation carriers of breast cancer risk genes, providing crucial information for the prevention, screening and treatment of breast cancer. This article provided an interpretation of the NCCN Clinical Practice Guidelines in Genetic/Familial High-Risk Assessment, integrating the clinical practice experience of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine.

In December 2023, the Chinese Center for Disease Control and Prevention published National and subnational trends in cancer burden in China, 2005-2020: an analysis of national mortality surveillance data.on Lancet Public Health, covering the mortality rate and average years of life lost from 23 specific tumor sites in people in 31 provinces and cities across the country. The analysis suggests that in 2020, the number of deaths from cancer in China was 2.3978 million, with a mortality rate of 170.80/100 000. The top 10 tumor deaths cases are as follows: lung cancer 761,000, liver cancer 367,700, stomach cancer 291,200, colorectal cancer 182,400, esophageal cancer 173,300, pancreatic cancer 100,400, breast cancer 57,100, leukemia 54,900, cranial nerve cancer 54,200, cervical cancer 44,800, accounting for 32.0%, 15.3%, 12.1%, 7.6%, 7.2%, 4.2%, 2.4%, 2.3%, 2.3%, 1.9% of the total number of deaths due to tumors, respectively. The mortality rates were 54.57/100 000, 26.19/100 000, 20.74/100 000, 13.00/100 000, 12.34/100 000, 7.15/100 000, 4.06/100 000, 3.91/100 000, 3.86/100 000 and 3.19/100 000, respectively. In 2020, the average years of life lost (AYLL) due to cancer in China was 23.60 years, which was 3.74 years lower than that in 2015. Among them, leukemia caused an AYLL of 37.35 years, with a decrease of 13.36 years from the AYLL of 50.71 years caused by leukemia in 2005, but it was still the tumor that caused the most life loss. Prostate cancer was the tumor that caused the least AYLL. The composition of China’s cancer spectrum is changing to those in developed countries. Lung cancer, breast cancer and colorectal cancer, which are highly prevalent in developed countries, are showing an increasing disease burden trend in China. In 2020, the mortality rates of lung cancer, breast cancer and colorectal cancer all increased during this period, increasing by 78.98%, 19.41% and 47.56% respectively compared with those in 2005. GLOBOCAN2022 suggests that the top 10 cancer incidence rates in China in 2020 are lung cancer (40.8/100 000), breast cancer (33.0/100 000), thyroid cancer (24.6/100 000), liver cancer (20.1/100 000), cervical cancer (15.0/100 000), gastric cancer (13.8/100 000), prostate cancer (13.7/100 000), esophageal cancer (9.7/100 000), uterine cancer (8.7/100 000) and ovarian cancer (6.8/100 000). Five of the top 10 common cancer in China and the United States overlap, and lung cancer is the leading cause of death in both countries. Changes in the spectrum of tumor diseases have made the promotion and implementation of proven tumor prevention and control measures more urgent.