Hashimoto thyroiditis (HT) is one of the most common autoimmune thyroid disease, and its pathogenesis has not been fully clarified at present. Most people believe that it is induced by mental stress, overwork, infection, stress, environmental pollution, unreasonable diet structure (such as high iodine diet) and other factors on the basis of genetic defects and genetic susceptibility. Vitamin D is a steroid hormone that maintains the balance of calcium and phosphorus metabolism in the body, regulating bone and mineral salt metabolism. Monocyte chemoattractant protein-1 (MCP-1) is a member of the chemokine CC family. It binds to chemokine receptor (CCR) and participates in immune inflammatory response. In recent years, more and more studies have found that vitamin D and MCP-1 are involved in the occurrence and development of many immune diseases, including Hashimoto thyroiditis. This article reviews the new research progress of the role of vitamin D and MCP-1 in Hashimoto thyroiditis.

Sleep disorders commonly exist and are the earliest clinical symptoms in Alzheimer's disease (AD). At present, the molecular mechanism of AD caused by sleep disorders is not clear. Recent studies have found that sleep disorders can promote the accumulation of beta amyloid (Aβ) in the brain to form amyloid plaques with toxic effects. The increased Aβ inhibits the synaptic transmission pathway and induces abnormal phosphorylation of tau protein, which eventually leads to synaptic dysfunction. In addition, the inflammatory and stress response induced by Aβ are also associated with AD. Therefore, the improvement of sleep disorders may be a new pathway for the treatment of AD, in which light therapy is proved to be particularly effective. This article reviewes the latest progresses in the influences of sleep disorders in pathogenesis and treatment of AD in recent years.

Objective:To investigate the peripheral blood levels of vitamin D and monocyte chemotactic protein 1 (MCP-1) in patients with Hashimoto thyroiditis (HT) and their clinical significance.Methods:Adopting a prospective research approach, 100 patients with HT from October 2022 to April 2023 in Jining First People′s Hospital were selected. Among them, the normal thyroid function was in 50 cases (HT normal thyroid function group), and the hypothyroidism was in 50 cases (HT hypothyroidism group). Another 50 cases of physical examination in the same period were selected as healthy control group. The general data were recorded. The levels of free triiodothyronine (FT 3), free thyroxine (FT 4), thyroid stimulating hormone (TSH), thyroglobulin antibody (TgAb), thyroid peroxidase antibody (TPOAb), vitamin D and MCP-1 were measured. Correlation analysis was performed using Pearson method or Spearman method. Binary Logistic regression analysis was used to analyze the risk factors leading to the development of HT, and the receiver operating characteristic (ROC) was used to assess the diagnostic value of vitamin D and MCP-1 for HT. Results:The FT 3 and FT 4 in HT hypothyroidism group were significantly lower than those in healthy control group and HT normal thyroid function group: (3.48 ± 1.00) pmol/L vs. (4.48 ± 0.49) and (4.28 ± 0.47) pmol/L, 12.40 (10.01, 14.23) pmol/L vs. 15.70 (14.30, 17.33) and 15.00 (13.10, 16.00) pmol/L, the TSH was significantly higher than that in healthy control group and HT normal thyroid function group: 8.60 (5.56, 27.13) mU/L vs. 1.97 (1.23, 2.89) and 3.06 (2.34, 3.42) mU/L, and there were statistical differences ( P<0.01); there were no statistical differences in FT 3, FT 4 and TSH between healthy control group and HT normal thyroid function group ( P>0.05). The TPOAb, TgAb and MCP-1 in HT normal thyroid function group and HT hypothyroidism group were significantly higher than those in healthy control group: 367.90 (151.60, 547.30) and 426.00 (175.30, 600.00) kU/L vs. 9.00 (9.00, 9.30) kU/L, 410.00 (222.00, 1 218.00) and 1 061.00 (427.30, 1 604.00) kU/L vs. 13.20 (12.08, 15.03) kU/L, 66.20 (54.43, 105.3) and 79.47 (41.57, 114.1) ng/L vs. 21.78 (15.23, 45.83) ng/L, the vitamin D was significantly lower than that in healthy control group: 14.32 (11.24, 16.99) and 12.73 (10.87, 15.36) μg/L vs. 18.12 (15.49, 21.92) μg/L, and there were statistical differences ( P<0.01); there were no statistical difference in TPOAb, TgAb, MCP-1 and vitamin D between HT normal thyroid function group and HT hypothyroidism group ( P>0.05). In healthy control group, there were no correlation between vitamin D, MCP-1 and FT 3, FT 4, TSH, TPOAb, TgAb ( P>0.05). In HT normal thyroid function group, vitamin D was positively correlated with FT 4 ( r = 0.376, P<0.01), negatively correlated with TPOAb ( r = - 0.400, P<0.01), and not correlated with FT 3, TSH and TgAb ( P>0.05); MCP-1 was positively correlated with TgAb ( r = 0.579, P<0.01), and not correlated with FT 3, FT 4, TSH, TPOAb ( P>0.05). In HT hypothyroidism group, vitamin D was positively correlated with FT 3 and FT 4 ( r = 0.522 and 0.567, P<0.01), negatively correlated with TSH, TPOAb and TgAb ( r = - 0.568, - 0.404 and - 0.328; P<0.01 or <0.05); MCP-1 was negatively correlated with FT 3 and FT 4 ( r = - 0.351 and - 0.469, P<0.05 or <0.01), positively correlated with TSH, TPOAb and TgAb ( r = 0.508, 0.431 and 0.522; P<0.01). In healthy control group, MCP-1 was not correlated with vitamin D ( P>0.05); in HT normal thyroid function group and HT hypothyroidism group, MCP-1 was negatively correlated with vitamin D ( r = - 0.457 and - 0.533, P<0.01). Binary Logistic regression analysis result showed that female, family history of thyroid disease, reduced vitamin D and elevated MCP-1were independent risk factors for the development of HT ( OR = 3.619, 3.675, 0.730 and 1.050; 95% CI 1.140 to 12.590, 1.174 to 16.220, 0.637 to 0.818 and 1.033 to 1.070; P<0.05 or <0.01). ROC curve analysis result showed that vitamin D, MCP-1 and vitamin D combined with MCP-1 had moderate diagnostic value for HT (area under the curve was 0.808, 0.858 and 0.886), and the combined diagnostic value was higher than that of the single index. Conclusions:In patients with HT, the serum vitamin D levels decrease and MCP-1 levels increase, which are related to thyroid function and antibodies. Insufficient vitamin D and increased MCP-1 can both increase the risk of HT.

Objective:To develop a list of basic and expanded medical laboratory tests in community health service centers in Shanghai.Methods:The status quo of human and equipment resource allocation, the test items and quality control currently performed, the perspectives of various stakeholders, the capacity building of community clinical laboratory in community health service centers in Shanghai were investigated by quantitative survey and qualitative interview; and the rating scores of each test item were assessed by expert consultation using Delphi method. The expert focus discussion was conducted, and each test item was rated and classified. Finally a list of the basic tests and expanded tests in clinical laboratories of community health service center was developed.Results:A total of 247 questionnaires were distributed and 192 (77.7%) were answered. A list of 94 laboratory test items was screened out based on the questionnaire survey of the laboratories of the community health centers. Thirty one experts in the relevant areas were invited to rate the test items, the average authority coefficient of experts was 0.90, with which the weighted average of the expert ratings was made. There were 45 (47.9%) items scored 7 or higher, 38 (40.4%) scored between 5 and 7, and 11 (11.7%) scored less than 5. Based on the results of the expert focus discussion, 48 items were recommended as the basic tests and 46 items as the extended tests.Conclusion:In this study a list of tests recommended to clinical laboratories in Shanghai community health service centers has been developed, which contains 48 basic tests and 46 extended tests.