Application Value of NT-proBNP Combined with NLR in Evaluation of Major Adverse Cardiac Events in Elderly Patients with Chronic Heart Failure.

Objective: To explore the application value of N-terminal pro-B type natriuretic peptide (NT-proBNP) combined with neutrophil-to-lymphocyte ratio (NLR) in evaluation of major adverse cardiac events (MACEs) in elderly patients with chronic heart failure (CHF). Methods: 50 CHF patients admitted to the Department of Cardiovascular Medicine of our hospital from January 2021 to December 2021 were selected as the observation group. Another 50 non-CHF patients of our hospital were selected as the control group. Clinical data were collected from subjects who met the inclusion criteria, including general information, personal disease history, and laboratory test indicators. Patients with CHF were followed up for 6 months. Patients with CHF were divided into two groups, MACE group and non-MACE group. Results: The levels of WBC, NEU, NLR, and NT-proBNP in observation group were higher than those in control group, but the level of LYM was the opposite (P < 0.05). The age, WBC, NEU, LYM, PLT, blood glucose, NLR, and NT-proBNP of MACE group and non-MACE group were significantly different (P < 0.05). The increased levels of NEU, NLR, NT-proBNP and the decreased levels of LYM and PLT are all independent risk factors for MACE in elderly patients with CHF (P < 0.05). The AUC of NLR in evaluating the occurrence of MACE in elderly CHF patients was 0.841. When the Youden index was 0.7692, the sensitivity was 76.92% and the specificity was 100.00%. The AUC of NT-proBNP in evaluating the occurrence of MACE in elderly CHF patients was 0.705. When the Youden index was 0.5260, the sensitivity was 76.92% and the specificity was 75.68%. The AUC of NT-proBNP combined with NLR in evaluating the occurrence of MACE in elderly CHF patients was 0.954. When the Youden index was 0.8420, the sensitivity was 92.31% and the specificity was 91.89%. Conclusion: NT-proBNP combined with NLR has high value in the evaluation of MACE in elderly CHF patients and can be used as an auxiliary predictive index in clinic.

Intractable hiccups as a rare gastrointestinal manifestation in severe endocrine and metabolic crisis: case report and review of the literature.

Diabetic ketoacidosis (DKA) and thyroid storm (TS) are severe metabolic and endocrine disorders. Both usually manifest with multiple systemic clinical signs and symptoms, and digestive symptoms, such as nausea and vomiting, are most common in these patients. Moreover, the presence of a concurrent severe or rare complication may worsen the condition or even cause death due to misdiagnosis, delayed diagnosis, or inappropriate treatment. The identification of these symptoms is usually closely related to the severity and prognosis of the disease. Although clinical prognosis might be improved by prompt diagnosis and aggressive treatment, some rare and insidious metabolic complications are difficult to identify early. Moreover, life-threatening gastrointestinal symptoms are very rare in patients with DKA and TS. Here, we report an inpatient diagnosed with DKA and Graves' disease who developed life-threatening intractable hiccups resulting in TS and respiratory failure during the treatment of DKA. In addition, we review the literature to discuss the possible underlying mechanism of intractable hiccups in the development of TS.

IQGAP1 modulates the proliferation and invasion of thyroid cancer cells in response to estrogen.

Thyroid cancer is an endocrine malignancy with a high incidence rate, which is affected by female hormones, particularly estrogens, in its growth and progression. IQ-domain GTPase-activating protein 1 (IQGAP1) is overexpressed in a range of types of cancer and is reported to interact with estrogen receptor α (ERα) in breast cancer cells. However, the association between IQGAP1 and ERα in thyroid cancer cells remains to be elucidated. In this study, the role of IQGAP1 in thyroid cancer cells was examined. The expression of IQGAP1 (190 kDa) was analyzed using western blot analysis, which indicated that IQGAP1 was overexpressed in thyroid cancer tissues and FTC133 cells. However, IQGAP1 knockdown in the FTC133 cells led to a significant downregulation in ERα transcriptional activity, cell proliferation, cell adhesion and cell invasion under 17ß-estradiol (E2) conditions. Furthermore, ERα knockdown inhibited the enhanced protein expression levels of phosphorylated ERK1/2 and cyclin D1, which were induced by the overexpression of IQGAP1. Co-immunoprecipitation was also performed in thyroid cancer cells and the results suggested that IQGAP1 directly interacted with ERα in the FTC133 cells and the co-transfected COS-7 cells. Taken together, these findings revealed that IQGAP1 may directly interact with ERα and serve as a signal integrator, mediating ERα transcriptional activity, cell proliferation and cell invasion during the progression of thyroid cancer.

Chinese herbal medicines for benign thyroid nodules in adults.

BACKGROUND: A thyroid nodule is a discrete lesion within the thyroid gland that might be palpable and is ultrasonographically distinct from the surrounding thyroid parenchyma. Thyroid nodules are more common as age increases and occur more frequently in women. Benign thyroid nodules often cause pressure symptoms and cosmetic complaints. In China and many other countries, doctors use Chinese herbal medicines (CHM) to treat thyroid nodules. OBJECTIVES: To assess the effects of Chinese herbal medicines in the treatment of benign thyroid nodules in adults. SEARCH METHODS: Review authors searched the following electronic databases: The Cochrane Library, MEDLINE, EMBASE, the Chinese Biomedical Literature Database (CBM), the China National Knowledge Infrastructure (CNKI), VIP information (a Chinese database), WANFANG Data (a Chinese database), the Chinese Conference Papers Database and the Chinese Dissertation Database (all searched up to April 2013). SELECTION CRITERIA: Randomised controlled trials comparing CHM or CHM plus levothyroxine versus levothyroxine, placebo or no treatment in adults with benign thyroid nodules. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data, assessed studies for risk of bias and evaluated overall study quality according to GRADE (Grading of Recommendations Assessment, Development and Evaluation), with differences resolved by consensus. MAIN RESULTS: We included one randomised trial involving 152 participants with a randomisation ratio of 2:1 (CHM vs no treatment). The trial applied adequate sequence generation; however, allocation concealment was unclear. Duration of treatment was three months, and follow-up six months. Our a priori defined outcomes of interest (i.e. nodule volume reduction ≥ 50%; pressure symptoms, cosmetic complaints or both; health-related quality of life; all-cause mortality; cancer occurrence; changes in number and size of thyroid nodules; changes in thyroid volume; and socioeconomic effects) were not investigated in the included study. Thyrotropin (TSH), thyroxine (T4) and tri-iodothyronine (T3) serum levels were normal in both groups before and after the trial was conducted. No adverse events were reported (low quality evidence). AUTHORS' CONCLUSIONS: Firm evidence cannot be found to support or refute the use of Chinese herbal medicines for benign thyroid nodules in adults.

[Clinical analysis of hypoparathyroidism with altered serum muscle enzymes: report of 41 cases].

OBJECTIVE: To examine the clinical features of hypoparathyroidism (HP) with altered serum muscle enzymes and explore the correlations with age, gender, disease duration, serum total calcium, serum total phosphorus and parathyroid hormone (PTH). METHODS: From January 2005 to October 2011, a total of 41 HP patients at our hospital were retrospectively analyzed. RESULTS: There were 16 patients with elevated serum muscle enzymes and 25 with normal serum muscle enzymes. The former group included 11 patients of idiopathic hypoparathyroidism (IHP) and 5 of pseudohypoparathyroidism (PHP); serum calcium was (1.53 ± 0.25) mmol/L and serum phosphorus (2.1 ± 0.6) mmol/L; medians of creatine kinase (CK), lactic dehydrogenase (LDH), aspartate amino transfer enzymes (AST) were 309 (126 - 10 046), 279 (131 - 741) and 27 (17 - 467) U/L in HP patients respectively. And the latter group included 20 IHP patients and 5 PHP ones; serum calcium was (1.64 ± 0.29) mmol/L and serum phosphorus (2.2 ± 0.6) mmol/L. The levels of serum muscle enzyme were compared before and after treatment in the former group. And they significantly declined with the rising serum level of calcium after treatment. The serum levels of CK (r = -0.82), LDH (r = -0.55) and AST (r = -0.56) in HP patients with elevated serum muscle enzymes had a negative correlation with the serum level of calcium (all P < 0.05). And there was no correlation with age, gender, disease duration or serum total phosphorus (P > 0.05). CONCLUSION: Elevated serum muscle enzymes in HP patients have a negative correlation with serum level of calcium and there is no correlation with age, gender, disease duration, serum total phosphorus or parathyroid hormone. And elevated serum muscle enzymes are gradually restored with the normalized serum level of calcium.

DKK3 is a potential tumor suppressor gene in papillary thyroid carcinoma.

The expression of the Dickkopf homolog 3 (DKK3) gene is downregulated in some human cancers, suggesting a possible tumor suppressor role of this gene. The role and regulation of DKK3 in thyroid cancer have not been examined. In this study, we explored the relationship of promoter methylation with the inactivation of DKK3 and tumor behaviors in papillary thyroid carcinoma (PTC). We used methylation-specific PCR and RT-PCR to examine the promoter methylation and expression of DKK3 and tumor characteristics. We found mRNA expression of DKK3 in 44.9% of the PTC tissue samples vs 100% of the matched normal thyroid tissue samples (P<0.01). In contrast, an opposite distribution pattern of DKK3 gene methylation was observed; specifically, 38.8% of the PTC tissue samples vs 0% of the matched normal thyroid tissue samples harbored DKK3 methylation. An inverse correlation between the promoter methylation and mRNA expression of DKK3 in PTC tissue samples was also observed. Moreover, we also found an inverse correlation between DKK3 expression and some aggressive pathological characteristics of PTC, including high TNM stages and lymph node metastasis, but a positive correlation between DKK3 promoter hypermethylation and pathological aggressiveness of the tumor. Treatment of the PTC cell line TPC-1 with the demethylating agent 5-azaC reduced DKK3 promoter methylation and enhanced its expression, establishing functionally the impact of DKK3 methylation on its expression. Our data thus for the first time demonstrate that the DKK3 gene is a potential tumor suppressor gene in thyroid cancer and that aberrant promoter methylation is an important mechanism for its downregulation, which may play a role in the tumorigenesis and aggressiveness of PTC.

Analysis of misdiagnosis of 4 cases of tuberculosis of thyroid and literature review.

Objective. To investigate the cause of misdiagnosis and the diagnosis and treatment of tuberculosis of thyroid. Methods. Four cases of tuberculosis of thyroid were reported and the related literature was reviewed, as well as the causes of misdiagnosis and the diagnosis and treatment were discussed. Results. Two cases were misdiagnosis as thyroid adenoma and one case as thyroid carcinoma, while one case as missed diagnosis. Part of resection, local excision, and lobectomy was performed, respectively, with all the patients who were treated with antituberculosis drugs and recovered. Conclusion. The atypical manifestation of tuberculosis of thyroid suggested that it is important to reinforce the knowledge of this disease. Cytological examination by fine-needle aspirate biopsy was helpful to the diagnosis. The first choice was treatment with anti-tuberculosis drugs.