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Chronic disease management is a challenging issue in China. To address the needs of talents and mature innovation ecosystem related to chronic disease management, The First Affiliated Hospital of Sun Yat-sen University(FAH-SYSU) actively responds to the national strategy to promote the high-quality development of the hospital through strengthening strategic planning, top-level design, and systematic consideration. Precise management of chronic diseases was taken as key measure for the construction of a national medical center. With continuous exploration in establishing talent pool, innovation center and application platform, and chronic disease management system that focuses on core elements of talent and innovation, the FAH-SYSU Model for the precise management of chronic diseases has been initially formed.
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Thyroid cancer is the most common endocrine gland malignanct tumor. Numerous studies have found that the content of peripheral blood circulating RNA in various cancer types is aberrantly expressed, which could be a potential biological diagnostic marker and therapeutic target. Tissue-speciifc messenger RNA has a dysregulated expression and may be used for the diagnosis and residual/metastatic detection of thyroid cancer. Recent studies have showed that non-coding RNA (ncRNA) could act as oncogene or tumor suppressor gene in bacteria, fungi and mam-mals. It plays a regulatory role in occurrence and development of tumors and stably exists in peripheral blood. It is hopeful that it will become a new marker for diagnosis of tumors. This review introduces some latest research progress on circulating RNA associated with thyroid cancer; and emphatically discuss the role of mRNA, microRNA (miRNA), long non-coding RNA (lncRNA) and circular RNA (circRNA) in thyroid tumorigenesis and metastasis.
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The endocrine system with the normal aging is characterized by a progressive loss of reserve capacity,resulting in a decreased ability to adapt to environmental demands.This loss of homeostatic regulation reflects important alterations in hormonal synthesis,metabolism,and action.However,these changes may have no significant clinical manifestations,especially under non-stress conditions.This review discusses the endocrine system in the elderly in general.
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This paper elaborates on the importance and necessity of implementing information technology in medical education,the application of information technology in the whole process of medical education,the conceptual construction of medical students' life-long education,the construction of practical teaching resources and the cultivation of information capacity both in teachers and students,etc.In the meantime,this paper introduces the basic framework of medical network and remote education center of Sun Yat-sen University under construction.
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Objective A previously reported female diagnosed with type A insulin resistance syndrome bearing a heterozygous missense mutation of R1174W in the insulin receptor gene was followed for 7 years since the age of 16 years. Methods Five-hour oral glucose tolerance tests (OGTT) were done on baseline, the 3rd, 6th and 7th year respectively, with serum insulin and C-peptide measured at the same time points. Areas under of curve (AUC) of glucose, insulin and C-peptide were compared between the years.Acute insulin response (AIR) was determined at baseline and the 7th year. The dose response were insulin secretion rates at each time point during OGTT being plotted over the corresponding glucose levels, and the slopes of which quantified the insulin secretion responding to glucose. Results The follow up data showed that the glucose metabolism of the subject did not deteriorate over time with yearly glycosylated hemoglobin A1c (HbAlc) being normal (4.6%-5.5%), and hyperinsulinemic hypoglycemia was a persistent phenomenon observed at 4-5 hours post-load. The fasting and AUCs of serum insulin and C-peptide tended to decline without simultaneously increase of those of plasma glucose. The AIR decreased by 56% as compared to baseline. The dose response curves shifted downward as years went by. Conclusions It supports that with the alleviation of physiological insulin resistance after puberty, the gross hyperinsulinemia tends to ameliorate, and β-cell secretion does not deteriorate over time as glucose homeostasis maintains.
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Objective To study clinical characteristics,causes of misdignosis and diagnostic and therapeutic methods for primary hyperparathyroidism (PHPT).Methods Retrospective analysis was done for 51 patients of PHPT,47 confirmed by biopsy after surgical operation and 4 without operation diagnosed based on their serum levels of calcium,alkaline phosphatase ( ALP),intact parathyroid hormone ( iPTH ),and computed tomography (CT) or 99mtechnetium sestamibi (99mTcMIB1) imaging at the First Affiliated Hospital of Sun Yat-sen University,Guangzhou during June 1997 to November 2010.Results Bone-related complications were the most common clinical manifestation,accounting for 51％ (26/51 ) of the cases,and adenoma,a benign,enlarged and hyperactive parathyroid gland,in 34 of 47 cases ( 72％ ).In orthotopic lesions,the right inferior was affected in 19 of 46 cases (41％),followed by the left inferior in 13 cases (28％),while 5 of 51 cases (10％) with ectopic parathyroid gland.PHPT was easily misdiagnosed as urolithiasis,rheumatic disease,primary osteoporosis,etc,accounting for 92％ of the cases in our study.Preoperative serum levels of calcium,ALP and iPTH in the patients varied with their clinical type and pathological classification,the highest in patients with urolithiasis-bone-related complications [ (3.22 ±0.35) mmol/L,(1455 ± 1091 ) U/L and (1669 ± 515 ) ng/L,respectively ] and in patients with parathyroid carcinoma [ (3.46 ± 0.40) mmol/L,( 1410 ± 426) U/L and ( 1861 ± 768) ng/L,respectively ].Sensibility of preoperative localization diagnosis using ultrasonography,CT and 99mTcMIBI was 88％ (35/40),97％ (30/31) and 97％ (31/32),respectively.Conclusions PHPT is frequently misdiagnosed as other diseases.Measurement of serum calcium should be included in routine physical examinations,supplemented with measurement of serum ALP and iPTH,as well as medical imaging,which can help avoid misdiagnosis.CT combined with 99mTcMIBI imaging can improve accuracy of preoperative localization diagnosis.
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Objective To study the effect of smoking on resting energy expenditure ( REE ) and the relationships among REE, smoking , inflammation and oxidative stress in patients with diabetic kidney disease. Methods A case control study of 31 smokers and 40 non-smokers with early stage of diabetic kidney disease( stage Ⅲ ) were performed to evaluate the chronic effect of smoking on REE. REE/fat free mass( FFM ), biomarkers of oxidative stress malondialdehyde ( MDA ), superoxide dismutase ( SOD ) and inflammation high-sensitivity C-reactive protein (hs-CRP), adiponectin, TNFα were also measured in these subjects. Data were analyzed by Pearson correlation analysis. Results Compared with non-smokers, REE/FFM in smokers group was significantly increased by 15.96% ( P =0.001 ). Pearson analysis showed that smoking was significantly correlated with REE/FFM ( t = 0.395, P = 0.001 ). There were significantly different between smokers and non-smokers in MDA, SOD and hs-CRP ( P＜0.05 ). But no difference between two groups in adiponectin and TNFα ( P ＞ 0.05 ). No significant relationships between REE/FFM and MDA, SOD, hs-CRP, adiponectin, TNFα was found ( P ＞ 0.05 ). Conclusion Chronic smoking can lead to increased REE, arouse oxidative stress and inflammatory in patients with early stage of diabetic kidney disease. However, there is no relationship between increased REE due to smoking and oxidative stress and inflammatory.
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Metabolic syndrome is on the rise in China. An improved understanding of the criteria for the diagnosis of this syndrome will lead to important questions for the population in China. The progression of this syndrome to type 2 diabetes mellitus(DM) is a dreaded outcome that may be prevented. Once DM is established,knowledge of the current therapeutic approaches is required.
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We analyzed the minus of present medical education,basing on questionnaires of 1773 medical students,including the students' participation rates in lectures of multiple fields and their demands on future lectures.We gave some pieces of advice to solve the problems as well as some references to boost our lectures.
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Concurrent Graves' disease and primary hyperparathyroidism in the same patient is rare, probably accounts for hypercalcemia in no more than 1 percent of thyrotoxic patients. Hypercalcemia may be noted during the course of hyperthyroidism in as many as 22 percent of cases. The cause of hypercalcemia in a thyrotoxic patient might be due to the activation of osteoclastic bone resorption by the excess thyroid hormone, as the severity of hyperthyroidism correlates positively with osteoclastic activity in trabecular and cortical bone. In 1936, Noble JF et al reported the first case in the world. To our knowledge, only 49 such cases have been described in the literature until the year of 1989. No case has been reported again afterward. The occurrence of hypercalcemia in a patient with hyperthyroidism may present a challenging diagnostic problem. In this communication, we described the first case in mainland of China with hypercalcemia caused by concurrent hyperthyroidism and primary hyperparathyroidism, and the clinical and laboratory characteristics were studied before and after therapy with anti-thyroid medication.
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Femenino , Humanos , Persona de Mediana Edad , Enfermedad de Graves , Patología , Hiperparatiroidismo , PatologíaRESUMEN
Objective In order to select appropriate size of embolizing granules and to achieve complete embolization and good therapeutic effect, the diameters of thyroid arteries in Graves disease was measured. Methods Multiple slides of embolized thyroid tissues from superior pole, body and inferior pole of resected thyroid glands were made. After being embeded and stained, diameters of arteries in various parts of thyroid glands were measured with microscope calipers (Olympus). Results Average diameter capillary network of the thyroid body gland adjacent to superior, infreior artery was 0. 12-0. 25 mm, and the smallest one was 0. 04-0. 11 mm. The diameter of isthmus was 0. 130. 15 mm. The average diameter of superior and inferior artery was 2- 5. 5 mm and 3. 0- 3. 75 mm measured by using interventional angiography Conclusion According to the diameters of arteries which were measured, complete embolization and good therapeutic effect can be achieved.
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Objective To investigate the potential association among urinary albumin excretion rate(U_(AER)), 24h ambulatory blood pressure(ABP) and erythrocyte sodium-lithium countertransport(SLC) in non-insulin dependent diabetes mellitus (NIDDM). Methods U_(AER), SLC were determined with radioimmunoassay and modified method of Canessa respectively, and 24h ABP profiles were recorded in 69 NIDDM subjects. Results NIDDM patients with increased U_(AER) had higher prevalence of hypertension and higher prevalence of abnormal circadian rhythm of blood pressure. Blood pressure(BP), particularly nighttime systolic BP was also significantly increased. U_(AER) was positively correlated to mean nighttime BP, mean daytime and 24h systolic BP, while inversely related to day-night dip in systolic BP. However, there was no significant difference in SLC between NIDDM subjects with and without increased U_(AER). Futhermore, neither U_(AER) nor all ABP indices were correlated to SLC. Conclusion Close association exists among diabetic nephropathy and increased BP and abnormal diumal BP rhythm, while either SLC and U_(AER) or SLC and BP is significantly correleted. Increased rate of SLC is not likely a marker for diabetic nephropathy in NIDDM, and it seems not to be involved in the pathogenesis of diabetic hypertension.
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Objective To study the pathological morphology of thyroid specimen after thyroid arteries embolization. In order to select appropriate size of embolizing granules, the diameters of thyroid arteries in Graves' disease were measured. Methods Multiple slides of embolized thyroid tissues from superior pole, body and inferior pole of the resected thyroid glands were made. After being embedded and stained, pathological morphology was observed and diameters of arteries in various parts of thyroid glands were measured under microscopy. Results Pathological examination of thyroid glands showed that superior and inferior thyroid arteries and most of their branches were embolized with ischemic necrosis and fibrosis in the embolized thyroid tissue. Follicular epithelium appeared as flat or cubic shapes with colloid reduction. Average diameter of main branches of superior artery was 440～550?m and that of inferior artery was 300～375?m. The diameters of capillary network in the thyroid body was 120～250?m, and the non embolized ones was 40～110?m. The diameter of isthmus was 130～150?m. Conclusions Pathological morphology of Graves' disease after thyroid arteries embolization showed that the excretion of thyroid glands would be decreased and equivalents to subtotal thyroidectomy.