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High-quality development is the primary task of building a socialist modern country in an all-round way. Organ donation and transplantation in China are evolving from high-speed growth to high-quality development, which put forward new requirements for the safe, stable and healthy operation of Organ Procurement Organization (OPO). Safety is the foundation and prerequisite for achieving the goal of high-quality development. As an independent and comprehensive department, internal audit should create new achievements in the new era. The department should include OPO and organ donation into the scope of internal audit, shift the emphasis upon the overall development of organ donation. Besides, it should fully consider the actual situation in different places, conduct all-round, objective and fair evaluation, provide evaluation and consulting services for OPO to properly implement organ donation, and give full play to the supervision and prevention role of internal audit.
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Léri-Weill dyschondrosteosis (LWD) has typical triad: short middle limbs, short stature, Madelung deformity of wrist, and increased body mass index. Short stature and high body mass index are risk factors for metabolic syndrome, type 2 diabetes, cardiovascular diseases, and autoimmune thyroid diseases. However, metabolic disorders and thyroid diseases in adult LWD patients have not been elucidated. This paper reports two adult patients with LWD presented to the Department of Endocrinology and metabolism. By introducing clinical characteristics, genetic variations, and diagnostic methods, physicians can deepen their understanding of LWD, improve diagnosis, and be aware of the comorbid metabolic diseases and thyroid disorders with a view of early prevention and treatment.
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With the reform of organ donation and transplantation in China, the establishment of Organ Procurement Organization (OPO) will become more centralized and enlarged in scale, evolving into the united OPO development stage coordinated by multiple hospitals. How to enhance the operation management and scientific development planning of united OPO has become an urgent and novel issue facing the administrators at all levels. At present, certain constraint factors of united OPO still exist in the integrated management, cost control, service homogenization, cultural integration and discipline layout. To give full play to the large-scale benefits and expand the supply of high-quality organ donation services, the development principle of putting connotation construction first and the appropriate direction of public welfare should be upheld. Leading and driving the development of organ donation services of our province are the responsibility, and discipline construction and talent training serve as the core. The overall development plan should be determined in a scientific pattern and homogeneous management should be implemented according to local conditions, aiming to provide successful experience for establishing a provincial unified OPO.
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Quality assurance is the responsibility of Organ Procurement Organization (OPO). The establishment of OPO quality management system is a novel task for implementing high-quality human organ donation. At present, the quality management of OPO still has certain problems, such as lack of comprehensive management organization, standardized management process, scientific evaluation index, qualified professionals and strong safety culture atmosphere, etc. It is necessary to deliver top-level design from three perspectives of ideological concept change, quality management system construction and process implementation management in combination with the actual situation of OPO and reference to the criteria of international general quality management system. More importantly, the managers of OPO should play a leading role in ensuring the efficient operation of OPO in the persistent improvement of quality management system.
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In recent years, the fields of donation after citizen's death and organ transplantation in China have developed rapidly with remarkable achievements and revolutionary changes in the source of transplant organs.How to transform the development of organ donation and transplantation from high-speed to high-quality growth mode?It is extremely urgent to establish the expenditure and management system of organ donation and transplantation.In this article, the establishment and management of clinical use price of organs from donation after citizen's death were investigated from the perspectives of policy basis, accounting items, accounting methods, price formation and price management, aiming to provide reference for resolving the problem of cost accounting and price determination of clinical use of donated organs.
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This article reported a patient with familial dysalbuminemic hyperthyroxinemia (FDH). A 38-year-old male occasionally found to have increased FT 4 level with normal FT 3 and TSH on routine physical examination was admitted to our hospital. Thyroid function was rechecked and found that the levels of TT 4, FT 4, rT 3 were increased, while TT 3, FT 3, TSH, TRAb, TPOAb and TGAb were normal. The patient had no other symptoms of thyrotoxicosis except occasional diarrhea. Gene sequencing revealed a heterozygous mutation of c. 653G>A (p.R218H) in exon 7 of albumin (ALB) gene, therefore the patient was confirmed as a case of FDH.
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Graves′ ophthalmopathy is a complex autoimmune disease characterized by inflammation and the orbital connective/adipose tissue with infiltration. About 3% to 7% of patients with Graves′ ophthalmopathy can have severe or very severe course of disease. In severe forms of Graves′ ophthalmopathy, there might occur considerable exophthalmos complicated in some cases with corneal ulceration due to incomplete closure of the eyelids and (or) pressure on optic nerve leading to neuropathy (dysthyroid optic neuropathy). The patient′s visual acuity and the color perception decreased sharply , which seriously affected the patients quality of life. In this paper, we explore effective therapies by compared the effects of high-dose intravenous steroids for the treatment of sight-threatening Graves′ ophthalmopathy in 2 cases.
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Graves' ophthalmopathy is a complex autoimmune disease characterized by inflammation and the orbital connective/adipose tissue with infiltration. About 3％to 7％of patients with Graves' ophthalmopathy can have severe or very severe course of disease. In severe forms of Graves' ophthalmopathy, there might occur considerable exophthalmos complicated in some cases with corneal ulceration due to incomplete closure of the eyelids and ( or ) pressure on optic nerve leading to neuropathy ( dysthyroid optic neuropathy) . The patient's visual acuity and the color perception decreased sharply , which seriously affected the patients quality of life. In this paper, we explore effective therapies by compared the effects of high-dose intravenous steroids for the treatment of sight-threatening Graves' ophthalmopathy in 2 cases.
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Objective To study the relationship between the health?related quality of life and Graves′ophthalmopathy quality of life(GO?QOL)in Graves′ophthalmopathy(GO)patients. Methods A total of 44 GO patients were recruited for the study and investigated with SF?36 and GO?QOL questionnaires. In addition,the thyroid function and related antibodies were also detected. Results The scores of SF?36 and GO?QOL were higher in the patients over 45 years than those under 45 years(P<0.05). GO?QOL score was lower in the patients with thyroid stimulating hormone recep?tor antibody higher than 10 IU/mL(P<0.05). The scores of SF?36 and GO?QOL were obviously higher in the patients who had a clinical activity score above 3(P<0.01). Conclusion GO?QOL is a better and more specific questionnaire for GO patients.
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Objective To investigate the association of serum leptin (LEP) levels during the first postpartum year with the occurrence of postpartum thyroiditis (PPT).Methods Fifty-seven PPT patients consisted of 34 with overt PPT and 23 subclinical PPT.37 healthy postpartum women were used as controls.Serum samples were obtained at 4 postpartum date points,i.e.3-days and 3,6,12-months postpartum.LEP level was determined by radioimmunoassav.Results Compared with control women,PPT patients were maintaining significantly higher levels of LEP and LEP/body mass index (BMI) ratio during the first postpartum year.There was no significant difference in serum LEP level or LEP/BMI ratio between overt PPT and subclinical PPT groups.In PPT patients,LEP and LEP/BMI ratio were negatively correlated with serum TSH,and positively correlated with serum FT4 and FT3.Conclusion Sustained high levels of serum LEP after delivery may favor the occurrence of PPT.Further studies are needed to clarify the specific role played by LEP in PPT.
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ObjectiveTo investigate the cumulative incidence of persistent hypothyroidism in patients who were diagnosed as postpartum thyroiditis ( PPT),and to determine the factors associated with the development of persistent hypothyroidism in those patients.MethodsThe present study was performed as the continuous study followed by the former epidemiological survey on PPT,in which 58 patients with PPT (35 overt PPT and 23 subclinical PPT) were diagnosed.The 58 patients were followed up at 12th month postpartum,and then for every 6 months until 24 months postpartum.Fasting blood samples were taken for testing serum TSH,thyroid peroxidase antibody ( TPOAb),and thyroglobulin antibody ( TgAb ).Free T3 ( FT3 ),free T4 ( FT4 ),and TSH receptor antibody ( TRAh ) were detected if TSH was abnormal.50 healthy postpartum women were used as control group.ResultsOf the total 58 PPT patients,91,4％ ( n =53 ) were successfully followed.Five patients with overt PPT and 6 patients with subclinical PPT developed persistent hypothyroidism,and the cumulative incidence of persistent hypothyroidism in the studied PPT patients was 20.8％.Among 15 PPT patients who had a classical biphasic course (a thyrotoxic phase followed by a hypothyroid phase),persistent hypothyroidism was seen in 26.7％ (n =4 ).Among 11 PPT patients with hypothyroidism only,persistent hypothyroidism was seen in 63.6％ ( n =7).On the contrary,none of the patients with thyrotoxicosis only had persistent hypothyroidism.All of the patients who developed persistent hypothyrodism had a higher TSH levels than 4.8 mU/L at 6th month postpartum.Before delivery,TSH levels of the patients developed persistent hypothyroidism were significantly higher than those of the patients with transient hypothyroidism,and this was the case at the 12th month postpartum ( all P＜0.01 ).PPT patients maintained a relatively higher rate of thyroid autoantibodies.The positive rate of TPOAb at the 12th,18th,and 24th month postpartum was 56.6％,50.9％,and 52.8％,respectively; and the positive rate of TgAb being 35.8％,30.2％,and 30.2％,respectively.Both the positive rate and titer of TPOAb in patients with overt PPT were higher than those in patients with subclinical PPT at the 18th and 24th month postpartum (P＜0.05).Conclusions 20.8％ patients with PPT developed persistent hypothyroidism at the 24th month postpartum.Whether a patient with PPT would develop persistent hypothyroidism depends on his clinical feature and TSH level.
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To explore the dose- and time- dependent relationship between the chronic iodine excess and thyroid structure, ultrastructure, and thyroid function in autoimmune-prone NOD. H-2h4 mice. Chronic iodine excess leads to iodine-induced goiter with an ultrastructure of follicle epithelial cells injury in a dose and time dependent way.
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A total of 1 870 patients who had undergone thyroidectomy were investigated.The mean TSH level in patients with differentiated thyroid cancer (DTC) was significantly higher than that in patients with benign thyroid nodules[(1.95±1.69 vs 1.40±1.98)mIU/L,P＜0.01].DTC patients who had lymphatic metastasis or the diameter of tumor more than 10 mm had higher serum TSH level.Serum thyrotropin is an independent risk predictor for DTC.
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Objective To assess the effects of maternal subclinical hypothyroidism (SCH) during the first trimester on neuropsychological development of the offspring by 20-30 months. Methods In this study, 1 761 pregnant women from 10 hospitals with about 8 weeks of gestation were enrolled. Urinary iodine excretion and serum thyrotropin ( TSH ), free thyroxine ( FT4 ), and thyroid peroxidase antibody ( TPOAb ) levels were determined in all subjects. Pregnant women with SCH (TSH≥2.5 mIU/L) were divided into two subgroups using trimester-specific thyroid function reference: group A (2.5 mIU/L≤TSH＜3.93 mIU/L, 18 cases), and group B (TSH ≥3.93 mIU/L, 20 eases). Thirty euthyroid and TPOAb-negative women from the same cohort were selected as controls. Intellectual and motor development score evaluations were performed in the children by 20-30 months of age. Results Children of women with SCH and subgroups A and B had lower mean intelligence scores 6.55,3.39, and 9.40 points compared with those of the control group (P=0. 001, P=0. 125, and P＜0. 001 ); the respective mean motor scores were 6.31,4.35, and 8.07 points being lower than that of the control ( P=0. 003,P=0. 070, and P=0. 001 ). Intelligence scores and motor scores were negatively correlated with TSH levels (r=-0.425, P＜0. 001 and r=-0. 394, P=0. 001 ). Multiple group comparisons revealed that differences of TSH affected intelligence and motor scores (F=9. 277, P＜0. 001 and F=5. 909, P=0. 004). Ordinal logistic regression analysis showed that possibilities for the reduction of filial mental development index ( MDI ) and psychomotor development index ( PDI ) scores in SCH with maternal TSH levels≥3.93 mIU/L were 8.66 and 6.27 times that of controls ( OR = 8.66,95% CI 2.72-27.57, OR =6.27,95% CI 2.03-19.34 ). Conclusion Maternal elevated TSH levels diagnosed by trimester-specific reference during early gestation are independently associated with lowered filial neurodevelopment scores by 20-30 months.
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Objective To clarify the effect of iodine intake on serum thyroglobulin (Tg). Methods A 5-year prospective study was conducted in the 3 different iodine intake areas in China [Panshan (miht deficiency) ,Zhangwu (more than adequate) and Huanghua (excess)]. A total of 3 099 people with normal serum levels of Tg in 1999 were followed and 2 448 of these participants were feasible to be observed in 2004 and included in the present study. The serum levels of Tg, thyraglobulin antibody(TgAb), thyroid peroxidase antibody(TPOAb) and TSH, thyroid volume, family and personal histories of thyroid diseases were measured and inquried. The general linear model (GLM) was used to explore the determinants of Tg. Results Among the study population at baseline, serum Tg were significantly different in three areas [7.5 (4.4-13. 1) μg/L at Panshan, 6.8 (3.6-11.2)μg/L at Huanghua, 5.9 (3.2-10.7) μg/L at Zhangwu, P<0.01]. They were associated with age, sex and the rate of positive TgAb, abnormal thyroid volume, abnormal TSH and positive personal history of thyroid diseases, in order to control the effects of confounding factors, the data from 1856 subjects with thyroid-related indexes all in normal range and without personal history of thyroid diseases were analyzed to clarify the effect of iodine intake on Tg. The serum Tg among three areas were significantly different in both 1999 and 2004, they were all increased in 5 years with significant augment (△ Tg) among the three areas[3.1 (-0.2-8.0) μg/L at Panshan, 3.5 (0.5-9.0)μg/L at Huanghua vs 2. 5(0.3-6.1) μg/L at Zhangwu,P<0.01]. The GLM analysis revealed that age, Tg and TSH levels at baseline were the determinants of △Tg in addition to iodine intake. Conclusion Iodine intake is a dominant determinant of serum Tg. Age and TSH should also be considered while indicating iodine intake by serum Tg.
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Thyrocytes expressing MHC class Ⅱ molecules were separated from transgenic mice and were co-cultured with autologous spleen T lymphocytes. T cells did not proliferate and were not activated, but CD4+ T cells were promoted into apoptosis.
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Objective To investigate the epidemiological characteristics of non-toxic goiter and non-toxic thyroid nodules in the regions with different iodine intakes and the factors influencing the occurrence, development and outcome of goiter and thyroid nodules. Methods 3 385 subjects, who had taken part in the previous survey in 1999 with the ultrasonic examination of thyroid, were composed of individuals in Panshan with chronic mild iodine deficiency,in Zhangwu with more than adequate iodine "after iodine supplementation and in Huanghua with excessive iodine. These 3 groups of subjects were followed up in 2004. Results (1) The cumulative incidences of diffuse goiter in Panshan ,Zhangwu and Huanghua were 7.1% ,4.4% and 6.9% ,respectively ,being the lowest in Zhangwu (P<0.01) and those of nodular goiter were 5.0% ,2. 4% and 0.8%, respectively, being the highest in Panshan (P<0.01). (2) The incidences of single nodule were 4.0% ,5.7% and 5.6%, respectively, and those of multiple nodules 0.4%, 1.2% and 1.0%, respectively. (3)The result of logistic analysis showed that iodine deficiency,iodine excess and positive thyroid autoantibodies (TAA) were the independent risk factors for the occurrence of goiter. (4)In Zhangwu ,the incidence of non-toxic goiter in the group with positive TAA was higher than that in the group with negative TAA(P<0.01) ,while there were no such differences in Panshan and Huanghua. (5)In these three regions, the rates of positive TAA in the individuals with diffuse non-toxic goiter were higher than those in the healthy subjects (P<0.05). And in Huanghua,the rate of positive TAA in subjects with non-toxic nodular goiter was also higher than that in the healthy individuals (P<0.05). Conclusion Iodine deficiency and iodine excess may both induce the raising incidence of goiter. Nodular goiter is prevalent in iodine deficient district and diffuse goiter is the predominant form in places with iodine excess. Thyroid autoimmunity is associated with occurrence and maintenance of goiter, and this phenomenon is more obvious in the community with previous iodine deficiency followed then by treatment with more than adequate iodine.
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Objective To determine the factors that influence the development of abnormal thyrotropin (TSH) level in an euthyroid population.Methods We conducted a follow-up study in 3 communities with different iodine status.Of the 3403 euthyroid subjects at baseline screened in 1999,80.1% ( n = 2727 ) was visited and sampled in 2004 for measuring TSH,thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb).Results Iodine status in the 3 communities were stable.Decreased TSH level( <0.3 mU/L) developed in 2.5% (n =68) of sampled subjects,while raised TSH level( > 4.8 mU/L) in 2.4% (n = 64).A logistic analysis showed that risk factors for developing decreased TSH level included positive conversion of TPOAb (OR = 5.5 ),positive TPOAb both in 1999 and in 2004 ( OR = 4.0),positive TgAb in 2004 ( OR = 3.7) and TSH < 1.0 mU/L in 1999 ( OR = 2.6).Risk factors involved in developing raised TSH level included iodine status of Zhangwu community ( OR = 4.1 ),iodine status of Huanghua community ( OR = 3.9),positive TgAb in 2004 ( OR = 3.7 ),positive TPOAb both in 1999 and 2004 (OR =3.6),positive conversion of TPOAb (OR =2.7) and TSH > 1.9 mU/L in 1999 (OR = 2.6 ).Conclusions Exposure to long-term iodine excess imposes danger of developing hypothyroidism.The risk will be even higher when exposing to iodine adequacy after correction of iodine deficiency.An interval between 1.0 and 1.9 mU/L of TSH level was optimul with the least probability of developing abnormal TSH level.
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Objective To explore the correlation between anti-thyroid autoantibodies and hepatitis C virus (HCV) infection. Methods Four hundred and sixty-two samples with positive thyroid peroxidase antibody (TPOAb) and (or) thyroglobulin antibody (TgAb) were collected. Three hundred and eighty age and gender matched subjects with negative TPOAb and TgAb were selected as controls. The anti-HCV antibody was examined in all the cases using the third-generation enzyme-linked immunosorbent assay (ELISA), HCV RNA qualitative examination was examined further in those who had positive anti-HCV antibody. Meanwhile, 195 subjects with hepatitis C, 150 healthy subjects and 150 subjects with hepatitis B were tested for thyroid-related markers. The data were analyzed by independent-sample t test and chi square test. Results The HCV infection rate in 462 thyroid autoantibodies positive subjects was 1.30% and 0.53% in 380 thyroid autoantibodies negative subjects. There was no significant difference of the HCV infection rate between two groups (X2=1.322, P>0.05). In the subjects with hepatitis C, 30.8% were TPOAb positive, 30.8% were TgAb positive, which were significantly different from those of healthy subjects and subjects with hepatitis B (X2=21.496,X2=30.454;P<0.01). Conclusions HCV infection rate does not increase in subjects with abnormal thyroid autoimmunity. However, positive rate of thyroid autoantibodies increases in subjects with hepatitis C, which suggests that thyroid-related markers should be examined in hepatitis C patients.
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Objective To study the effect of maternal subclinical thyroid abnormalities [including subclinical hypothyroidism, hypothyroxinemia and positive anti-thyroid peroxidase antibody (TPOAb) with normal thyroid function] in women during 16-20 weeks of gestation on offspfing's intellectual development and motor function. Methods Sera from 1 268 women during 16-20 weeks of gestation (collected 2 years ago) were obtained and thyroid stimulating hormone (TSH), total thyroxine (TT4), free thyroxine (FT4) and TPOAb levels were measured. Pregnant specific thyroid function reference ranges were used to screen for subclinical hypothyroidism (18 cases), hypothyroxinemia (19 cases) and positive TPOAb (34 cases). From the same cohort, a total of 142 pregnant women who were euthyroid with negative TPOAb were selected as controls (a case: control ratio of 1 : 2). Intellectual and motor development score evaluations were performed in their children at 25-30 months of age. Results In the group of pregnant women with subclinical hypothyroidism, the offspring' s intelligence score was (109.89±13.81) points, which was 8.88 points lower than in the control group (P < 0.01). Similarly, the motor score of the offspring was (108.11±9.93) points, which was 9.98 points lower than in the control group (P < 0.01). In the pregnant women with hypothyroxinemia, the offspring's intelligence score was (112.32±15.10) points, 9.30 points lower than in the control group (P <0.01); the motor score was (112.21±12.26) points, 7.57 points lower than in the control group (P < 0.01). In the pregnant women with positive TPOAb and euthyroid function, the offspring's intelligence score was (112.70±20.64) points, 10.56 points lower than in the control group (P < 0.01); the motor score was (110.64±12.49) points, 9.03 points lower than in the control group (P < 0.01). Conclusion Maternal subclinical thyroid abnormality between 16-20 weeks of gestation adversely may affect offspring intellectual and motor development, suggesting the necessity for screening and treatment of maternal subclinical thyroid abnormality in the early stages of pregnancy.