Objective To measure the burden of chronic obstructive pulmonary disease (COPD) in a rural area of Kunming. Methods Shilin County was selected as the study region. Disability adjusted life years (DALY) was used to measure the burden to COPD. Results The overall prevalence of COPD was 6.68% , and males had higher prevalence of COPD than females. Females accounted for higher YLL rate and DALY rate due to COPD than males, whereas males had higher YLD rate due to COPD than females. People aged 60 years and over were responsible for higher YLL rate, YLD rate and DALY rate due to COPD compared to other age group. Conclusion COPD does harm to males' quality of life whereas threatens females' death in the study region. The region should focus on further prevention and control of COPD.

Hypothyroidism is a common endocrine disease.Its treatment depends on thyroid hormone replacement therapy.Currently,levothyroxine (L-T4) is the preparation recommended by many guidelines.However,there are some L-T4-treated patients with normal TSH levels and persistent non-specific symptoms and discomforts.Therefore,combination therapy with L-T4and liothyronine (L-T3) has been considered as an alternative option for hypothyroidism.However,more prospective studies are needed to provide evidence-based effects for this kind of regimen.

It has been 50 years since the discovery of thyrotropin receptor autoantibody (TRAb). Advances in the knowledge of thyrotropin receptor ( TSHR) structure and function, combined with the elucidation of TSHR signaling and TSHR-autoantibody interaction have greatly facilitated our understanding of TRAb and their clinical applications. Measurement of TRAb activity plays an important role in the diagnosis of Graves' disease ( GD) and Graves' opthalmopathy. It has also been well recognized that TRAb is an effective predictor of GD relapse or remission after antithyroid drug and radioactive iodine treatment. TRAb test is of particular help in pregnant women and lactating mothers with recent iodine load, where radioactive iodine or technetium tests are contraindicated. In addition, it is useful in the diagnosis and differential diagnosis of fetal and neonatal hyperthyroidism as well as some rare forms of thyrotoxicosis in clinical practice. Accumulating evidence also indicates the possible correlation between thyroid cancer occurring in GD patients with positive TRAb and adverse outcomes. However, further innovation and standardization of TRAb tests are required to help pave the way for clinical applications.

[Summary] Lifestyle intervention is one of the important strategies for the prevention of type 2 diabetes. Recently, caloric restriction regimen has become a hot topic as one of the cornerstone of lifestyle intervention. The alternate day fasting regimen is simple, and increases the patient compliance. Both daily calorie restriction and alternate day fasting regimen can reduce body-weight significantly in pre-diabetes subjects, and reduce the visceral fat mass and the fasting insulin levels, and improve the insulin sensitivity, as well as maintain the lean mass, though the effect on fasting blood glucose was not significant. Nevertheless, the most recent studies have demonstrated that daily calorie restriction,in particular, alternate day fasting regimens can be effective in individuals with pre-diebates in order to prevent type 2 diabetes.

Objective To investigate the effect of metformin on the growth of human anaplastic thyroid cancer cell HTh74Rdox which is doxorubicin resistant. Methods The HTh74Rdox was treated with different concentrations of metformin for 48 h. Cell morphology was observed by microscope, cell viability was tested by methylthiazoletetrazolium (MTT), cell apoptosis by annexin Ⅴ and propidium iodide double staining, the anti-oncogenic miRNA was assayed by realtime fluorescence quantitative PCR (RT-PCR), and the adenosine monophosphate-activated protein kinase (AMPK)/mammalian target of rapamycin (mTOR) signaling pathway tested by western blot. Furthermore, the anti-oncogenic miRNAs were knockdown by miRNA inhibitors (miR-34a, miR-101, miR-125b, and miR-138 inhibitors) and the cells were treated by metformin for 48 h, after that, cell apoptosis was detected by annexin Ⅴ and propidium iodide double staining, the expression of protein related to AMPK/mTOR signaling pathway was detected by western blot. Results Metformin inhibited the growth of human anaplastic thyroid cancer cell HTh74Rdox in a concentration-dependent manner, the cell apoptosis was induced by metformin, and there was a significantly lower expression of miR-34a, miR-101, miR-125b, and miR-138 in the HTh74Rdox. However, the four above miRNAs were upregulated by metformin, and AMPK/mTOR pathway was also activated by metformin. When these miRNAs were suppressed by miR-inhibitors (miR-34a, miR-101, miR-125b, miR-138 inhibitors), the stimulating effect of apoptosis and AMPK/mTOR pathway by metformin were reversed. Conclusion Metformin significantly suppresses cell viability of human anaplastic thyroid cancer cell HTh74Rdox, and stimulates AMPK/mTOR pathway and apoptosis by upregulating the expressions of miR-34a, miR-101, miR-125b, miR-138 in HTh74Rdox cell.

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.

Objective To study the safety,efficacy and advantages of enhanced recovery after surgery (ERAS) combined with clinical pathway management in laparoscopic common bile duct exploration and lithotomy (Laparoscopic common bile duct exploration,LCBDE).Methods 78 patients who underwent LCBDE in the Department of Hepatobiliary and Pancreatic Surgery in the First Hospital of Fuyang District in Hangzhou were selected as the non-ERAS group (the control group).76 patients who underwent LCBDE treated with fast track surgery and ERAS clinical pathway management were selected as the ERAS group.The data between the two groups which included the postoperative insulin resistance index,changes in C-reactive protein,duration of postoperative analgesic use and analgesia,timing of first passage of postoperative flatus,postoperative abdominal tube removal,postoperative bile leakage,recurrence of biliary stones,intestinal ileus and other complications.Results All the two groups were discharged home successfully.On preoperative 7 day,the differences on the postoperative insulin resistance index and the levels of C reactive protein were significantly different (P＜0.05).The time to first get out of bed after operation,the postoperative analgesic use,the time to first passage of flatus,the time to postoperative abdominal drainage tube removal,and the time to clamping of the T tube after operation were significantly different (all P＜0.05).The postoperative complications of pulmonary infection,abdominal infection and the incidence of prolonged intestinal ileus were significantly different (all P＜0.05).Conclusions ERAS combined with clinical pathway management reduced postoperative stress reaction and complication rate.The treatment accelerated recovery and shortened hospital stay for patients who underwent LCBDE,which led to good social and economic benefits.