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).

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.

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.

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.

Physicians often encounter patients with both hyperthyroidism and pregnancy in clinical practice. Proper treatment will help a lot for both mother and fetus. However, whether propranolol could be applied routinely in the medical therapy other than antithyroid drugs is not regularly mentioned in text book, because there were few literatures reporting its side effects including miscarrage, intrauterine growth retardation, bradycardia, respiratory depression, hypoglycemia, and hyperbilirubinemia. Animal experiments revealed bradycardia after propranolol administration, and respiratory depression after birth due to blockage of β receptors in the lungs. Nevertheless, this drug has been considered safe in pregnant hyperthyroid women according to long-term experience, as no malformation has been demonstrated in the offsprings, and it helps a lot in hyperemesis gravidarum as well. Specialists also recommend short-term use like a few weeks before antithyroid drugs set in action and during thyroid storm, in order to avoid potential side effects. It is suggested that less than routine-dose of the drug be administered before labor, as the plasma drug concentration in the neonate would elevate after birth. As for lactating mother, it's safe to take regular dose of the drug because only extremely low dose will be taken by the neonate through milk.

In the tumor microenvironment, inflammatory cells regulate intracellular signaling transduction mediated by the corresponding nuclear transcription factor by releasing inflammatory factors ,which leads to transformation of epithelial cells to mesenchymalcellsand eventually promote tumor metastasis. Because of the intimate relationship between inflammation and tumor metastasis , it would be helpful for further enhancement of effectiveness of tumor therapy if we could better understand both the biological character of tumor and the related inflammatory factors.

Objective To investigate the association between thyroid autoimmunity (TAI) and miscarriage.Methods A systematic review of both case-control and cohort studies on the association between TAI and miscarriage published before March 2009 was performed.All the literatures were abstracted based on the defined selection criteria by two independent investigators.Publication bias was tested by funnel plot.The odd ratios of case-control studies and relative risks of cohort studies were pooled respectively,depending on the result of heterogeneity test among the individual studies.The software Review Manager (version 4.3.1) was used for meta analysis.Results Electronic search yielded 23 articles,4 of which were reviews and were excluded.The remaining 19 clinical studies met the selection criteria,of which 7 were case-control studies and 12 cohort studies.A clear association between the presence of thyroid autoantibodies (TA) and miscarriage was found with a pooled odds ratio of 2.72 (95% CI 1.27-5.80,P = 0.01) in 7 case-control studies,and a pooled relative risk of 2.41 (95% CI 1.96-2.96,P＜0.01) in 12 cohort studies.Women with TA were found to have slightly older age (age difference,1.29 years,95% CI 0.43-2.16,P = 0.003) and raised TSH levels (TSH difference,0.61 mIU/L,95% CI 0.51-0.71,P＜0.01) compared with those without TA.Conclusion TAI is significantly associated with miscarriage,which can be interpreted as the direct involvement of TA.Alternatively,the association can be partially explained by the slightly older age in women with TA compared with those without.A third possibility is mild thyroid failure,as TSH levels in TA-positive but euthyroid women are higher than in TA-negative women.

Caloric restriction has been practiced over 500 years as a method for increasing both the length and quality of life.Experimental work confirming the success of this approac h in animals has accumulated in the last 100 years.Since 2000,emerging evidence in humans has shown that caloric restriction can delay the onset of age related diseases including reduced risk of obesity,diabetes,cardiovascular disease,cancer,and neurodegenerative disorders.The mechanisms and clinical applications have been extensively studied.

Objective Diabetic cardiomyopathy is a heart disease that excludes coronary heart disease,hypertensive heart disease and other heart diseases,and patients with diabetes mellitus prone to cardiac structural and functional changes.Echocardiography is often the first choice of examination methods,and nuclear magnetic resonance and nuclear magnetic resonance imaging is a new method to observe the changes of myocardial fibrosis and myocardial metabolism.In the treatment,need to a variety of methods to intervene,such as blood glucose control,using statin lipid -lowering drugs,angiotensin converting enzyme inhibitor,angiotensin receptor blocking agent,beta blockers,antioxidants,and traditional Chinese medicine etc.