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.

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.

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.

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.

Objective To compare the clearing effect between combination use of mosapride and polyethylene glycol (PEG) and polyethylene glycol only for colonoscopy preparation of patients with constipation caused by functional diseases.Methods A total of 212 adult patients who underwent colonoscopy examination were recruited to this randomized single blinded controlled study.Patients in control group received 3 liters of PEG only,whereas patients of experimental group received 10mg mosapride 30min before 3liter PEG.The patients were surveyed for the tendency of constipation.Experimental variables including time of first defecation and completion of bowel cleansing,defecation frequency,and degree of discomfort during colonoscopy preparation were recorded.Results The times of first defecation and completion of bowel cleansing of experimental group were shorter than those of control group ( P ＜ 0.05 ),but there were no significant differences in defecation frequency,the degree of discomfort and the bowel cleansing quality between 2 groups ( P ＞ 0.05 ).The percentages of patients with constipation in control and experimental groups were 26.61％ and 26.67％,respectively.The defecation frequency and the degree of discomfort of constipative patients were similar in both groups ( P ＞ 0.05 ).The time of first defecation and time of completion of bowel cleansing of constipative patients in experimental group were shorter than those in control group ( P ＜ 0.05 ).The bowel cleansing quality of constipative patients in experimental group was better than that of control group ( P ＜ 0.05 ).There was no difference in defecation frequency and adverse reaction between 2 groups (P ＜ 0.05).Conclusion Combination of mosapride and PEG for colonoscopy preparations of patients with functional constipation tends to shorten times of first defecation and completion of bowel cleansing,and to increase the bowel cleansing quality.

Fine-needle aspiration biopsy is the mainstay of preoperative diagnosis of thyroid cancer which is the most common type of endocrine malignancy.However,some aspirates yield indeterminate cytology and there is no clear recommendation for the management on these situations.The use of emerging molecular markers such as BRAF、RET、PAX8/PPARγ will likely improve the diagnosis of malignancy in thyroid nodules and facilitate more individualized therapeutic options and postoperative management.Some markers have been extensively characterized and introduced into clinical practice.

[Summary ] Accumulating evidence showed the associations between subclinical hyperthyroidism or subclinical hypothyroidism and adverse health outcomes. The related guidelines could be very helpful in making treatment decisions. However, even within the reference range, thyroid function is associated with adverse health outcomes, such as atrial fibrillation, coronary artery disease, osteoporosis, and dyslipidemia. Also, there is limitation to use TSH value as intervention threshold by the influence of age and other diseases. In this regard, a grading system is proposed to diagnose thyroid dysfunction, and risk stratification according to individual TSH values and comorbidities would be constructed to evaluate the utility of treatment.

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.

Objective To study the chemical constituents from the fungal fruiting bodies of Ganoderma sinense.Methods Individual constituents,isolated and repeatedly purified on silica gel and Sephadex LH-20 column chromatography,were identified by physicochemical constants and structurally elucidated by spectral methods.Results Four compounds were isolated and identified as: sinensoic acid(1),cerebroside D(2),poke-weed cerebroside(3),hemisceramide(4).Conclusion Compound 1 is a new compound,others are isolated from the fungus of Ganoderma for the first time.