Clinical management of hyperthyroidism complicated with liver failure / 中华内分泌代谢杂志

Clinical data from 11 previously diagnosed and treated patients with hyperthyroidism(Graves′ disease) complicated by liver failure were collected. Among them, 4 cases were drug-induced liver injury leading to liver failure, 1 case had a history of schistosomal liver cirrhosis combined with hyperthyroidism, and 6 cases had hyperthyroidism-induced liver injury(HILI) leading to liver failure. During hospitalization, all patients received supportive therapy and symptomatic treatment with β-blockers. Nine patients were treated with glucocorticoids and artificial liver support therapy. Among the 11 patients, 2 died, 8 patients achieved normal thyroid and liver function within 1-12 months after treatment, and 1 patient with liver cirrhosis had stable liver function in the later stage. After improvement in liver function, 7 patients received isotope therapy, 1 patient underwent total thyroidectomy, and 1 patient received medication. These results indicate that the clinical characteristics differ for drug-induced liver injury and HILI-related liver failure. Early initiation of artificial liver support therapy, in addition to β-blockers and glucocorticoids, is important in alleviating thyroid toxicity and liver damage, thus creating an opportunity for subsequent radioactive iodine or surgical treatment.

Clinical and metabolic characteristics in 165 patients with common COVID-19 / 中华内分泌代谢杂志

Objective:To retrospectively analyze the clinical and serological characteristics in rehabilitated patients with common novel coronavirus pneumonia(COVID-19).Methods:A total of 165 patients with common COVID-19 were enrolled in this retrospective study, in which clinical data was collected from February 23 to March 15, 2020 in Leishenshan Hospital(Wuhan, China). The patients with COVID-19 were divided into elderly group and non-elderly group according to their age, and the differences in the clinical and serological metabolic characteristics between these two groups were analyzed.Results:49.7% patients were over 60 years old. The most common clinical symptoms were fever, cough, and fatigue, followed by muscle soreness. Expectoration and digestive tract symptoms were rare. Dyspnea occurred more frequently in the elderly group than in non-elderly group(47.56% vs 25.30%, P<0.01). Hypertension was the most common concomitant disease(accounting for 29.1%)followed by diabetes. Hypertension was more common in the elderly group than in non-elderly group(41.46% vs 16.86%, P<0.01), but without significant difference in diabetes between the two groups. The counts of leukocytes and lymphocytes in all patients were in the normal range, and no difference was observed between the groups. The comparison of serological indicators showed that serum creatinine in the elderly group was higher than that in the non-elderly group( P<0.01)while serum albumin, glomerular filtration rate, and serum calcium were lower in the elderly group. After serum albumin correction, the levels of albumin corrected calcium in all patients were in the normal range, without significant difference between these two groups. There was no significant difference between the two groups when the length of hospital stay was taken as the index of outcome [(34.01±10.24) vs(30.97±10.51)d, P>0.05]. Conclusion:Fever, cough, and fatigue are the most common clinical symptoms in patients with ordinary COVID-19. The elderly are more likely to develop dyspnea. The blood routine and metabolic characteristics in patients with common COVID-19 are normal, but serum albumin level is more likely to decrease in elderly patients with COVID-19.

Study of human leucine-rich amelogenin peptide and its regulation of mineralization by cryogenic transmission electron microscopy / 华西口腔医学杂志

<p><b>OBJECTIVE</b>Recombinant human leucine-rich amelogenin peptide (LRAP) was studied by cryogenic transmission electron microscopy (TEM); evaluation focused on its self-assembly and crystal growth in vitro.</p><p><b>METHODS</b>Human LRAP was recombined through prokaryotic expression vector pCold-SUMO and transformed into Escherichia coli BL21plys to acquire purified proteins. Cryogen TEM recorded assembly and self-assembling of LRAP from pH 3.5 to pH 8.0, and the hydroxyapatite crystal growth in the mixture of LRAP protein solution and artificial saliva was observed using TEM and selected area electron diffraction.</p><p><b>RESULTS</b>More than 90% purity LRAP was expressed, purified and identified as described in methods. LRAP linked into oligomers, nanospheres, nanochains, and microribbons, whereas pH value increased from 3.5 to 8.0. Mature hydroxyapatite crystal growth was guided in artificial saliva filled with calcium phosphate.</p><p><b>CONCLUSIONS</b>LRAP is simplified amelogenin functional domain and conserved the basic characters of amelogenin such as self-assembling and inducing crystallization along c axis. In the area of acellular synthesis of hydroxyapatite using extracellular enamel matrix protein, LRAP is one of candidate repair materials for irregular hard tissue defection.
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Comparative analysis of clinical manifestations of syphilis cerebrovascular infarction and atherosclerotic cerebrovascular infarction / 中华神经医学杂志

Objective To search the clinical methods for identification of syphilis cerebrovascular infarction from atherosclerotic cerebrovascular infarction. Methods The clinical manifestations, laboratory examination results, MRI results and DSA characteristics of 20 patients with cerebrovascular infarction (syphilis group) and 80 patients with atherosclerotic cerebrovascular infarction (atherosclerosis group), admitted to our hospital from February 2008 to August 2014, were retrospectively analyzed and compared. Results As compared with patients of the atherosclerosis group, the patients of syphilis group had significantly younger onset age ([47.4±11.3] y vs. [62.7±11.0]y), higher male proportion (9:1 vs. 4:1), higher proportion of farmers and individual workers (70%vs. 21.2%, P<0.05). Dizziness (35%) and headache (20%) were more common as the first symptom, and memory loss (15%) and walking instability (15%) were more common as first symptoms in patients of syphilis group, while limb weakness (75%) and unclear speech (35%) were more common as first symptoms in patients of atherosclerosis group; significant differences were noted between the two groups (P<0.05). In MRI, lesions in lobes of the brain (45.0%) were more common in syphilis group, and lesions in the basal ganglia were (67.5%)more common in atherosclerosis group; significant difference was noted between the two groups (P<0.05);lesions involved more than two sites (38.8%) or even three sites lesions (45.0%) were more common in patients of syphilis group. In DSA, middle cerebral artery stenosis (65%), internal carotid artery stenosis (38.8%) were more frequently found in patients of syphilis group, and more than two (75.0%) or even three (55.0%) vascular involvements were more common in syphilis group;significant difference was noted between the two groups (P<0.05). Conclusion The clinical features and imaging features of the syphilis cerebrovascular infarction are different from atherosclerotic cerebrovascular infarction; DSA is important in the diagnosis and treatment of syphilis cerebrovascular infarction.