[Summary] The theory of fetal origins of adult disease (FOAD) is now widely accepted by researchers who hold the opinion that adult degenerative and metabolism diseases have close relationship with the environment of fetal development inside and outside the womb. Some studies have proved that maternal hypothyroidism can negatively affect the glucose metabolism of their offsprings. However, the whole mechanism is not clear yet. Insufficient thyroid hormone during pregnancy was proved to slow down the formation of fetal pancreatic cytoskeleton, to decrease the proinsulin gene transcription, and to modulate series of cytokines and enzymes which are related to glucose dependent insulin secretion. Thyroid hormone receptor is also considered to be partially responsible for the relation between low thyroid hormone and β cell insufficiency. However, more studies in vivo should be carried out to prove this hypothesis. Epidemiologic studies have suggested that type 2 diabetes and low birth weight can be different phenotypes of the same genotype. The definite mechanism of maternal hypothyroidism in influencing fetal β-cell function should be studied by further investigation.

Thyroid diseases during pregnancy are highlighted in recent decade by both endocrinologists and gynaecologists.Hyper-and hypothyroidism accompanied with pregnancy may cause side effects on maternal and fetal health,increase the incidence of obstetric complications and impair the development of the fetal nervous system.It is widely accepted that subclinical thyroid dysfunction such as subclinical hypothyroidism,hypothyroxinemia,and thyroid autoimmunity may result in adverse obstetric outcomes.A very crucial work is going on to set up trimester special reference of thyroid function in each clinical laboratory.

Objective To study the prevalence of thyroid disease in pregnant women living in both excess and sufficient water iodine area of in Jiangsu Province,and to establish an epidemiological database of thyroid disorders among pregnant women in different water iodine area in Jiangsu Province in order to guide our clinical practise.Methods Fengxian and Suining of Xuzhou were selected as excess and sufficient water iodine region.All the 439 pregnant women within the first trimester were enrolled in our study.The name,age,and previous history were recorded on questionnaire.The samples of fasting blood were obtained.Serum parameters such as free triiodothyronine ( FT3 ),free thyroxine ( FT4 ),total thyroxine ( TT4 ),thyrotropic stimulating hormone ( TSH ),and thyroid peroxidase (TPOAb) were measured by electrochemiluminescence assay.The data of the eligible 396 subjects were stored and analyzed by Epidata after excluding subjects with previous thyroid dysfuncion,renal disease,heart disease,and pregnancy-induced hypertension syndrome.Results Among the 396 subjects,197 women ( 49.7％ ) had thyroid disorders. The prevalence of hyperthyroidism, subclinical hyperthyroidism, hypothyroidism, subclinical hypothyroidism,hypothyroxinaemia,and thyroid autoimmunity were 0.5％,6.3％,3.3％,29.3％,9.3％,and 1.0％,respectively.The prevalence of subclinical hypothyroidism was significantly higher in excess water iodine region (32.4％) than that in sufficient water iodine area ( 19.6％ ),while the prevalence of other types of thyroid diseases such as subclinical hyperthyroidism,hyperthyroidism,hypothyroidism,hypothyroxinaemia,and TPOAbpositive cases in either excess or sufficient water iodine regions was not different.Conclusions Subclinical hyperthyridism,hypothyroxinaemia,and subclinical hypothyroidism are the main thyroid disorders in pregnant women in both excess and sufficient water iodine area.The prevalence of subclinical hypothyroidism increases obviously in excess water iodine region,indicating the relationship between thyroid disease and high iodine intake.

BACKGROUND:The limb ischemia model in rats has been widely applied in China to study the pathological process and treatment method of limb ischemia, but there are some controversies on the model construction and evaluation, so a reliable, convenient and economical disease model is needed for the related research. OBJECTIVE:To compare limb ischemia degree, duration and changing rule of acute hind limb ischemia models prepared by different ways in Sprague-Dawley rats, and find a method to prepare models that have moderate and stable limb ischemia and maintain a longer time. METHODS: 72 Sprague-Dawley rats were randomly divided into four groups, with 18 rats in each group. Group A: sham operation group, abdominal aorta below renal artery and iliolumbar artery, right superficial femoral artery, popliteal artery, saphenous artery were separated. Group B: the right superficial femoral artery, popliteal artery, saphenous artery were cut off, and the right femoral artery was resected to establish acute hind limb ischemic model. Group C: abdominal aorta and bilateral abdominal perineal artery were ligated to establish acute hind limb ischemic model. Group D: abdominal aorta, iliolumbar artery and lumbar artery were ligated to establish acute hind limb ischemic model. RESULTS AND CONCLUSION:Right hind limb muscle strengths of rats in groups B, C, D were weaker than that in group A at weeks 2, 4, 6 after operation; muscle strengths in group D was weaker than that in groups B, C at week 4 after operation; muscle strengths in groups B, D was stil weaker than that in group C at week 6 after operation. The partial venous oxygen pressure of right hind limbs in groups B, C, D was lower than that in group A at weeks 2, 4, 6 after operation; the partial venous oxygen pressure in group D was lower than that in groups B and C at weeks 2, 4 after operation; and group D was stil lower than group C at week 6 after operation. At weeks 2, 4 after operation, some muscle cels in the right hind limb muscle tissue were disrupted, fibrous connective tissue hyperplasia and capilary hyperplasia were detected, inflammatory cels infiltrated in the groups B, C, D. These pathological findings were more apparent in group D. Fiber connective tissue hyperplasia was attenuated, capilary hyperplasia, expansion and congestion were found in each group at week 6 postoperatively. The method of ligating abdominal aorta, iliolumbar artery and lumbar artery below renal artery for hind limb ischemia model can obtain moderate and stable ischemia conditions, maintain a long time, and is convenient to prepare.

[Summary] To determine how endocrinologists in China access and treat patients with Graves' orbitopathy (GO) and gain insight on how to make the management of this disease more uniform and standardized in the context that management of GO continues to be challenging.Based on the questionnaire used in the European survey on GO,a questionnaire in Chinese was drafted and circulated to the members of Chinese Society of Endocrinology (CSE).There were a total of 124 valid responders.The majority (94.4％) of the responders believe that a muhidisciplinary approaches for GO management is valuable.Over 80％ of the participants advocated the evaluation of exophthalmometry,vision,visual fields by perimetry,eye movements,fundoscopy,TSH receptor antibodies,thyroid function,and ultrasound.Steroids were preferred as the first-line therapy by 92.7％ of responders,among them,59.7％ choose intravenous route.The treatment strategy for GO with intravenous glucocorticoids therapy still remains debated.Antithyroid drugs were the most common choice (72.6％) for first-line therapy of thyrotoxicosis.Treatment options for GO were very similar among Chinese,Latin-American,and European responders,though radioactive iodine and surgical treatment were more often indicated in China.The appropriate treatment of the patient with GO is controversial even amongst thyroid specialists.Further training of clinicians,easier access of patients to specialist multidisciplinary centres,and the publication of practice guidelines may help improving the management of this condition in China.

Objective To explore the dynamic changes and clinical significance of relative pituitary hormones in children after craniocerebral injury.Methods The quantitative analysis and dynamic observation were performed in 125 children after craniocerebral injury and 20 voluntary healthy children of relative pituitary hormones including serum prolactin(PRL),cortisol(PTC),three free triiodothyronine (FT3),free thyroxine (FT4),thyroid stimulating hormone (TSH),growth hormone (GH) by applying electrochemical luminescence method.Tbe hormone variational characteristics were analyzed according to posttraumatic time,Glasgow Coma Scale(GCS) scores on admission and Glasgow Outcome Scale (GOS) scores on discharge,and the relationship between hormone variational characteristics of 58 cases was followed up over 2 years and the activities of daily living (ADL) were also investigated.Results The serum PRL was significantly increased on the first,third and fifth day compared with the healthy control group (P =0.000 0,0.000 0,0.006 7),respectively.There was significant difference between mild,moderate and severe groups within 30 days after suffering from craniocerebral injury (P ＜ 0.05).PTC was heavily increased within 3 days,and significant difference existed among mild and moderate groups mild and severe groups (all P ＜ 0.05) ; TSH,FT3,FT4 decreased slightly after injury and gradually rose in later;GH change wasn't significant;and the larger variation of relative pituitary hormones was responsible for lower GCS scores;FT3,FT4,TSH,and GH decreased in different degrees,which were found in parts of children with craniocerebral injury,and the significant difference of serum PRL existed between GOS scores 4-5 and GOS scores 1-3 groups (P =0.000 1).Conclusions The changes of relative pituitary hormones were associated with the posttraumatic time and the severity of craniocerebral injury.The PRL in serum can aid in prediction of outcome for the children with craniocerebral injury.

Objective To investigate changes of relative pituitary hormones in adults with traumatic brain injury (TBI) and the related clinical significance.Methods Quantitative analysis and dynamic observation of relative pituitary hormones were performed in 158 TBI patients by electrochemical luminescence method.Measured indices included plasma total cortisol (PTC),free triiodothyronine (lT3),free thyroxine (FT4),thyrotropin (TSH),growth hormone,follicle stimulating hormone (FSH),luteinizing hormone (LH),estradiol,testosterone,and prolactin.Results Prolactin and PTC increased in the acute phase,but gradually reduced three days after trauma.TSH,FT3,and FT4 slightly decreased after trauma,followed by a gradual return.While there were no significant changes in FSH,LH,estradiol,testosterone,and growth hormone after trauma.Changes in relative pituitary hormones were more profound in patients with a lower GCS.Some patients presented different degree of reduced hormones in recovery period and needed hormone replacement therapy.Among the patients with poor activity of daily living (ADL),lvothyroxine replacement therapy was applied in 2 patients (2/6),prednisone acetate in 1 (1/6),and eleven acid testosterone in 2 (2/6).Among patients with mild ADL,levothyroxine replacement therapy was applied in 2 patients (11％),prednisone acetate in 1 (6％),and eleven acid testosterone in 3 (17％).Among patients with good ADL,levothyroxine replacement therapy was applied in 2 patients (4％) and eleven acid testosterone in 3 (6％).Persistent prolactin elevation was found in patients with poor outcome.Conclusions Changes of relative pituitary hormones in adult patients with TBI are associated with severity and duration of trauma.Abnormal prolactin level can affect outcome of the patients.

Objective To compare oral with intravenous Prednisolone after hepatoportoenterostomy in improving biliary drainage and survival with the native liver.Methods Forty-nine cases of biliary atresia were conducted from January to December in 2012.Participants were randomized to receive oral Prednisolone (group A) or intravenous Prednisolone (group B) on the fifth day of posthepatoportoenterostomy (the other treatments were same,including intravenous injection of Cefoperazone for 2 weeks, choleretic treatment, etc.).The initial dose was 4 mg/(kg · d), and it was reduced by half per 3 days, until 1 mg/(kg · d).Then Prednisolone was administered orally with 1 mg/(kg · d)for 3 months.The primary end points were the total bilirubin level(TBIL) and the percentage of cholangitis in 6 months of posthepatoportoenterostomy.Secondary outcome was survival with native liver in 24 months after hepatoportoenterostomy.Results The ages of group A and group B were(98 ±33) d and(105 ±36) d,TBIL of them were (158.36 ± 55.22) μmol/L and (160.11 ±43.12) μmol/L,and there were no statistical differences between the 2 groups before surgery (t =-0.663,-0.123, all P ＞ 0.05).In the first 2 months after operation, the mean TBIL value of group A was higher than that of group B (in the first month after surgery ,the TBIL quartiles P25 ,P50 ,P75 of group A were 105 μmol/L, 152 μmol/L, 236 μmol/L, and the quartiles of group B were 40 μmol/L, 74 μmol/L, 99 μmol/L.In the second month after surgery,the TBIL quartiles of group A were 67 μmol/L, 103 μmol/L, 144 μmol/L,and the quartiles of group B were 39 μmol/L,64 μmol/L, 196 μmol/L) (all P ＜ 0.05).The morbidity of cholangitis which occurred in group A(56.0％ ,60.0％) was higher than that in group B (25.0％, 29.2％) (x2 =4.871,4.705, all P ＜ 0.05).However,from the 3rd to 6th months,there was no statistical difference between group A and group B(all P ＞ 0.05).Transplant-free survival was 44.0％ in group A and 47.7％ in group B 24 months after operation, and there was no statistical difference(x2 =1.007 ,P ＞ 0.05).Conclusions Therapy of intravenous Prednisolone following portoenterostomy may be more beneficial in bile drainage than oral method,but it's of no use to improve survival.

OBJECTIVETo explore early clinical effect of acetabular cup in total hip replacement for the treatment of Crowe II developmental dysplasia of hip.

METHODSEighteen patients (18 hips) with Crowe type II developmental dysplasia of hip were treated with total hip replacement from September 2001 to July 2013. Among them,including 13 males and 5 females aged from 42 to 60 years old with an average of 47.6 years old; the courses of diseases ranged from 9 to 22 years with an average of 13.5 years. All the patients had hip joint pain, limb shortening and limited hip function before operation. Harris score of hip joint were used to evaluate recovery of function at 1 day and 12 months after operation. Prosthetic coverage of acetabular cup at 1 week after operation was observed by using radiography.

RESULTSEighteen patients (18 hips) were followed up from 12 to 24 months with an average 17 months. All incisions were healed at stage I. No deep vein thrombosis, hip dislocation, periprosthetic joint infection and prosthesis loosening were occurred. No revision surgery during follow-up period. Prosthetic coverage of acetabular cup was more than 80% at 1 week after operation. Harris score were increased from 42.67 ± 5.06 before operation to 94.79 ± 3.27 at 12 months after operation (t = -45.269, P < 0.001).

CONCLUSIONFor type Crowe II developmental dysplasia of hip patients, 15° face-changing acetabular cups in THR could obtain higher actebular component coverage rate and satisfactory early clinical effects.

Acetabulum ; surgery ; Adult ; Arthroplasty, Replacement, Hip ; instrumentation ; Female ; Follow-Up Studies ; Hip Dislocation, Congenital ; surgery ; Hip Joint ; surgery ; Hip Prosthesis ; Humans ; Male ; Middle Aged

OBJECTIVETo investigate effects of the variation of immune function in high humidity environment in different time, and lay a foundation for further study of the related mechanism.

METHODThirty SD rats were divided into 3 groups (n = 10): 20 day group, 40 day group in 90% relative humidity chamber and control group in normal relative humidity. Peripheral blood and spleens were collected to detect the levels of T lymphocyte subsets by Flow Cytometery.

RESULTSIn peripheral blood of the 20 day group rats, the CD3+ %, CD4+ %, CD8+ % and CD4+/CD8+ were 52.91 +/- 6.27, 37.80 +/- 4.11, 14.85 +/- 3.73 and 2.72 +/- 0.82 separately. Expect CD3+ %, they all had significant differences (P < 0.05). In addition, the data of the 40 day group rats showed no diversity in statistics. In spleen, CD8+ % of the 20 day group rats was 6.23 +/- 2.87 with significant differences (P < 0.05) and IgG, IgA and IgM did not change a lot in blood serum of the high humidity groups except C3 of the 20 days group (P < 0.05).

CONCLUSIONIn high humidity environment, the immune function of the rats increased in the initial stage. As time went on, the immune function gradually went to normal level through the self adjustment.

Acclimatization ; Animals ; Humidity ; Rats ; Rats, Sprague-Dawley ; Spleen ; immunology ; T-Lymphocyte Subsets ; immunology