A makro-TSH diagnosztikus és terápiás jelentősége Hashimoto-thyreoiditises betegekben | Diagnostic and therapeutical significance of macro-TSH in patients with Hashimoto’s thyroiditis

Absztrakt: Bevezetés: A makro-TSH szerkezete, incidenciája és klinikai szerepe pajzsmirigybetegekben nem tisztázott. Célkitűzés: A makro-TSH előfordulási gyakoriságának, tulajdonságainak meghatározása Hashimoto-thyreoiditises betegek savójában. Módszer: A Hashimoto-thyreoiditises betegek vérmintáiban a makro-TSH-t meghatározták polietilén-glikol precipitációs módszerrel és protein G agaróz abszorpciós, illetve gélfiltrációs kromatográfiával. A makro-TSH biológiai aktivitását TSH-receptorral transzfektált CHO bioassay módszerével mérték. A betegek L-tiroxin-kezelésben részesültek (átlagosan 66,5 µg/nap), a betegek fele pedig szelént is kapott (átlagosan 60 µg/nap). Eredmények: 880 Hashimoto-thyreoiditises beteget (728 nő, átlagéletkor 44,8 év) vontak be a vizsgálatba. A makro-TSH-t 41 betegben (4,6%) mutatták ki, az átlagos TSH-szint a PEG-precipitáció előtt 185,4 ± 35 IU/l volt, a precipitáció után pedig 5,55 ± 1,8 IU/l. Az anti-TPO-szint 445 ± 51 IU/l volt és fokozatosan csökkent 212 ± 51 IU/l-re egyéves tiroxin- és szelénkezelés után. Mind a PEG-precipitációs, mind a protein G abszorpciós módszerrel, illetve gélkromatográfiás eljárással a TSH elleni antitest jelenlétét mutatták ki a makro-TSH-immunkomplexben. A makro-TSH biológialag inaktívnak bizonyult, mivel a CHO-sejteket nem stimulálta. A makro-TSH a szelénnel nem kezelt csoportban 18 ± 3,2 hónapig, a szelénnel kezeltben 12 ± 1,9 hónapig volt kimutatható. Következtetés: A TSH elleni antitestek fő komponensei a makro-TSH-nak és diagnosztikus, illetve terápiás nehézségeket okozhatnak. A PEG-precipitációs eljárás alkalmas szűrőmódszer a makro-TSH bizonyítására. A szelén képes nemcsak az anti-TPO-, hanem a makro-TSH-szint csökkentésére egyaránt. Amikor a TSH-szint 40,0 IU/l feletti a hypothyreosis jelei nélkül, gondolnunk kell a makro-TSH jelenlétére. Orv Hetil. 2017; 158(34): 1346–1350. | Abstract: Introduction: Structure, importance and incidence and clinical role of macro-TSH not clarified in thyroid diseases. Aim: This study was undertaken to determine the incidence and biological role of macro-TSH in patients with Hashimoto’s thyroiditis. Method: Blood samples taken from patients with Hashimoto’s thyroiditis were screened for the presence of macro-TSH with the polyethylene glycol method and confirmed with protein G agarose absorption test and gel filtration chromatography. Stimulatory capacity of macro-TSH was measured by CHO cells bio-assay. Patients were treated with L-thyroxine (mean 66.5 µg/day) and half of them with selenium (mean 60 µg/day), respectively. Results: 880 patients (728 female, aged 44.8 yr) with Hashimoto’s thyroiditis was involved in the study. Macro-TSH was found in the serum of 41 patients (4.6%), the mean TSH 185.4 ± 35 IU/l was before PEG precipitations and after 5.55 ± 1.8 IU/l. Titre of anti-TPO proved to be 445 ± 51 IU/l and gradulally decreased to 212 ± 51 IU/l after one year therapy. Both the precipitation, protein G absorption and gel chromatography supported the presence of anti-TSH antibody in the macro-TSH complex. Stimulatory capacity of macro-TSH on CHO bio-assay was not proved. The macro-TSH was detected in the selenium not treated group for 18 ± 3.2 months, selenium-treated for 12 ± 1.9 months. Conclusion: It is concluded that anti-human TSH autoantibodies are a major components of macro-TSH and may cause diagnostic and therapeutical difficulties. The PEG precipitation is a suitable screening method for detection of macro-TSH. Selenium is able to decrease of anti-TPO antibodies and macro-TSH, respectively. When the TSH level is greater than 40.0 IU/l, without the signs of hypothyroidism, the presence of macro-TSH is to be considered. Orv Hetil. 2017; 158(34): 1346–1350

Clinical characteristics of included NSCLC patients.

<p>Data are reported as mean ± SD with minimum and maximum in parentheses.</p

Schematic illustration of analysis.

<p>We first constructed functional connectivity network (step A–D) within the CBG motor network (A) at voxel-wise scale (B), and optimal sparsity threshold was estimated and applied (D). Once network was constructed, efficiency for each node was computed and efficiency map for each subject was generated (E).</p

Correlation between abnormal network properties and UPDRS motor scores.

<p>SPG.L: the left superior parietal gyrus.</p

Alteration of Brain Functional Networks in Early-Stage Parkinson’s Disease: A Resting-State fMRI Study

<div><p>Although alterations of topological organization have previously been reported in the brain functional network of Parkinson’s disease (PD) patients, the topological properties of the brain network in early-stage PD patients who received antiparkinson treatment are largely unknown. This study sought to determine the topological characteristics of the large-scale functional network in early-stage PD patients. First, 26early-stage PD patients (Hoehn and Yahr stage:1-2) and 30 age-matched normal controls were scanned using resting-state functional MRI. Subsequently, graph theoretical analysis was employed to investigate the abnormal topological configuration of the brain network in early-stage PD patients. We found that both the PD patient and control groups showed small-world properties in their functional brain networks. However, compared with the controls, the early-stage PD patients exhibited abnormal global properties, characterized by lower global efficiency. Moreover, the modular structure and the hub distribution were markedly altered in early-stage PD patients. Furthermore, PD patients exhibited increased nodal centrality, primarily in the bilateral pallidum, the inferior parietal lobule, and the medial superior frontal gyrus, and decreased nodal centrality in the caudate nucleus, the supplementary motor areas, the precentral gyrus, and the middle frontal gyrus. There were significant negative correlations between the Unified Parkinson Disease Rating Scale motor scores and nodal centralities of superior parietal gyrus. These results suggest that the topological organization of the brain functional network was altered in early-stage PD patients who received antiparkinson treatment, and we speculated that the antiparkinson treatment may affect the efficiency of the brain network to effectively relieve clinical symptoms of PD.</p></div

Demographic and clinical characteristics of the PD and HC groups.

a<p>The p value was calculated using two-tail two-sample t test.</p>b<p>The p value was calculated using chi-squared test.</p><p>PD, Parkinson's disease; HC, healthy control; R, right.</p><p>Demographic and clinical characteristics of the PD and HC groups.</p

Methodological quality of the 28 studies.

<p>Methodological quality of the 28 studies.</p

Correlation between the SWI phase values and R2* values in vivo.

<p>The Spearman correlation between the SWI phase values and R2* values in 87 cirrhotic patients (<i>r</i> = −0.742, <i>P</i><0.001) (a) and in 37 healthy subjects (<i>r = </i>0.096, <i>P</i> = 0.576) (b).</p

Relationship between Apparent Diffusion Coefficient and Tumour Cellularity in Lung Cancer

<div><p>Background and objective</p><p>To prospectively investigate the relationship between the apparent diffusion coefficient (ADC) and cellularity in lung cancer.</p><p>Methods</p><p>Sixty patients histopathologically confirmed with lung cancer (41 men, 19 women) underwent diffusion-weighted magnetic resonance imaging of the chest (with <i>b values</i> of 50 and 1000 s/mm²). The median mean ADC (ADCmean) value and median minimum ADC (ADCmin) value within each primary tumour were calculated and compared with the median nucleo-cytoplasmic ratio (NCR), which was selected to represent the cellularity. The correlation between the NCR and ADCmean/ADCmin was calculated with SPSS 18.0 software.</p><p>Results</p><p>The mean ADCmean values, ADCmin values and median NCR were (1.07±0.12)×10⁻³ mm²/s, (0.86±0.14)×10⁻³ mm²/s, and (14.9±2.6) %, respectively, in adenocarcinoma; (0.88±0.10)×10⁻³ mm²/s, (0.73±0.12)×10⁻³ mm²/s, and (20.6±4.4) %, respectively, in squamous cell carcinoma; and (0.89±0.13)×10⁻³ mm²/s, (0.67±0.13)×10⁻³ mm²/s, and (18.3±3.5) %, respectively in small cell lung cancer. The NCR of squamous cell carcinoma and small cell lung cancer is greater than that of adenocarcinoma (P<0.01 and P = 0.002, respectively). There was an inverse relationship between ADCmean/NCR and ADCmin/NCR (r = −0.60, P = 0.001 and r = −0.47, P<0.001, respectively).</p><p>Conclusion</p><p>There is a significant inverse relationship between tumour cellularity and ADC in lung cancer. However, tumour cellularity most likely is not the sole determinant of the ADC.</p></div

Brain regions with blue color indicated significant (FDR multiple comparison correction, p<0.05) decreases of efficiency map in PD relative to healthy control using two-tailed two sample t test with age, gender and frame-wise displacement as covariance.

<p>Those regions were presented in axial view. HC, healthy control; PD, Parkinson's disease.</p