The second part of (2008 edition)includes iodine deficiency disease,thyroditis and thyroid nodule.This guideline reaffirms the epidemic characteristics,the prevention and the management of iodine deficiency disease.It identifies the measurement of iodine nutritional status and the necessity of iodinized salt.It emphasizes the regular diagnosis and treatment of subacute and chronic thyroiditis,and also mentions the advancement on differential diagnosis and rational therapy of thyroid nodules.In addition,it gives some advices on the management of thyroid nodules in two special groups(pregnant women and children).

Severe aplastic anaemia is a marrow failure syndrome characterized by pancytopenia and hypocellular bone marrow.Immunosuppressive therapy(IST)consisting of antithymocyte or antilymphocyte globulin (ATG) and cyclosporine has been recommended for children lacking HLA-matched sibling donor.For children unresponsive to initial immunosuppressive therapy or those who relapsed after first immunosuppressive therapy,they can choose repeat course of immunosuppressive therapy,allogeneic hernatopoietic stem cell transplantation,new drugs or clinical trials.And the prognosis has been greatly improved in recent years,dueing to the development of allogeneic hematopoietic stem cell transplantation and the application of new drugs such as eltrombopag.This article reviews researches advance in different therapies for children with relapsed or refractory severe aplastic anaemia,aimed at guaiding treatment methods.

Thyroid-associated ophthalmopathy(TAO)is an organ specific autoimmune disorder affecting the life quality of patients.Glucocorticoids have been applied for many years in the treatment of TAO,though the side effects are the major concern.Recently,intravenous methylprednisolone pulse therapy is a novel and effective method for TAO treatment.Nevertheless this new strategy needs to be modified,and attention should be paid to the indications and contraindications in order to prevent liver damage when high dose methylprednisolone is applied.

Objective To introduce the surgical technique and results of total mesorectal excision (TME) for rectal cancer. Methods　Reviews.Results　As a result of TME, local recurrence rates have declined from 20%-30% to 3%-8%, 5-year survival rate have risen to 75%, and the rates of sphincter preservation have risen too.Conclusion　Total mesorectal excision reduces the local recurrence rates and raise the survival figures after excision of rectal cancer. Patients have a high quality of life.

Taking the characteristics of Indian students into account,teaching quality can be improved by these means:thorough preparation before class,various application for teaching,mutual and interactive communication and inspiration.

Chronic atrophic gastritis (CAG) is the disease with the pathological features of gastric mucosa inherent glands atrophy, mucous membrane thinning, muscularis mucosa thickening, gastric acid secretion decreasing, or along with intestinal metaplasia or pseudopyloric metaplasia. TCM differential treatment has obvious advantages. Through the summary of the literature on CAG, the authors summarize the aspects of etiology and pathogenesis, syndrome differentiation characteristic and their relations with gastroscopic image, pathology, and Helicobacter pylori infection, with a purpose to provide references for TCM clinic.

Objective To investigate the relationship of hypoxia inducible factor-1 α(HIF-1α),tumor necrosis factor-α (TNF-α),hepatocyte growth factor (HGF) and cerebral infarction.Method Two hundred and twelve cases with acute cerebral infarction in the Fourth People's Hospital of Langfang from Jun.to Dec.2013 were divided into progressive cerebral infarction(PCI) group(n =105) and the stability of cerebral infarction (SCI) group (n =107).Meanwhile 100 healthy people were served as control group.Enzyme-linked immunosorbent assay(ELISA) was applied to detect the levels of HIF-1 α,TNF-α and HGF.The PCI group were divided into small groups according to nerve function or infarction lesion size,and the levels of HIF-1 α,TNF-α and HGF of each group.Result The levels of HIF-1 α,TNF-α,HGF in PCI group were (2.3 ± 1.3) ng/L,(4.0 ± 0.5) mg/L and (1.4 ± 0.3) μg/L,significantly higher than those in SCI group ((1.1 ± 0.5) ng/L,(3.1 ±1.3) mg/L and (0.7 ±0.4) μg/L;F=5.42) and control group((0.5 ±0.1) ng/L,(1.8 ±0.4) mg/L and (0.4 ±0.1) μg/L;F =3.14).Meanwhile,the levels of HIF-1 α,TNF-α,HGF in SCI group was significantly higher than that of the control group (F =1.32,P ＜ 0.05).The levels of HIF-1α,TNF-α,HGF in mild PCI group were significantly lower than those in moderate group and severe group,and those in moderate group was lower than those in severe group (F =0.93,4.32,2.31 ; P ＜ 0.01).The levels of HIF-1 α,TNF-α,HGF in small infarction group were (0.6 ± 0.4) ng/L,(2.7 ± 0.4) mg/L,(0.7 ± 0.4) μg/L,significantly lower than those in infarction group ((1.1 ± 0.5) ng/L,(4.4 ± 0.5) mg/L,(1.1 ± 0.2) μg/L; F =4.71,P＜0.05) and large infarction group((1.4 ± 0.6) ng/L,(4.8 ± 0.6) mg/L,(1.9 ± 0.5) μg/L; F =2.09,P＜0.05).The levels of HIF-1α,TNF-α,HGF in focal infarction group was significantly lower than that in large infarction group and the difference is statistically significant(F =2.45,P ＜0.05).Conclusion HIF-1 α,TNF-α and HGF serum levels in progressive cerebral infarction are significantly increased,which is related to the function defect and size of infarction.

[Summary] Epidemiologic evidence favors strong correlations between low thyrotropin(TSH) and high bone turnover, low bone mineral density ( BMD), and high fracture risk in hyperthyroid patients. Even subclinical hyperthyroidism, in which TSH is low and thyroid hormones are normal, is associated with osteopenia and osteoporosis. These evidences indicate that action of TSH on bone metabolism is independent of thyroid hormones and thus support the theory of the pituitary-bone axis. TSH plays its osteoprotective effect by binding TSH receptor on osteoclasts and inhibiting TNF-α expression. Physicians should screen the BMD in patients with overt and subclinical hyperthyroidism, especially the elderly, and make early diagnosis and better management for the underlying osteopenia and osteoporosis.

[Summary] Thyroid nodules are a common clinical problem, the majority of which are regarded as benign nodules by initial fine-needle aspiration biopsy(FNAB) or ultrasound characteristics. Given the low false negative rate of ultrasound-guided FNAB cytology and the higher yield of missed malignancies based upon nodule sonographic pattern, a routine sonographic surveillance is recommended to the thyroid nodules with benign cytology. If there are any sonographic evidence of growth or development of new suspicious sonographic features, the FNAB could be repeated. Treatment for benign thyroid nodules includes medications, percutaneous ethanol injection, thermal ablation and surgery. In order to avoid over-treatment, the potential harm and benefits of any intervention should be assessed.

[Summary] Transplantation of human cell, tissue or organ is an effective means to cure completely the disease. Animal experiments and clinical studies have demonstrated that the efficacies of transplantation are obvious in the treatment of hypothyroidism. In recent years, thyroid stem cell transplantation has drawn much attention, embryonic stem cells, bone marrow mesenchymal stem cells and adult stem cells had also made progress in clinical investigations. Especially the embryonic stem cell transplantation has been used successfully in animal experiments. It provided a new perspective for clinical thyroid transplantation, but it also faces many problems to solve.