[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.

Platelet -derived growth factor (PDGF)is an important factor of promoting cell growth which has a physiological role ranging from DNA synthesis,cell mitosis inducement,promotion on a variety of extracellular matrix accumulation as well as impact on the cell phenotype and growth.Studies showed that PDGF played an important role in growth and proliferation of vascular and nerve.It has a significant effect on accelerating tissue repair and promoting healing of chronic diabetic foot ulcers.

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.

Lithium carbonate is a fundamental drug used in the management of acute mania and prophylaxis of bipolar disorders.It has been found that some patients on lithium carbonate therapy developed hypothyroidism.Therefore,this medication becomes a second-line choice for the treatment of patients with hyperthyoidism,though no standardized protocol has been approved.It remains worthwhile to investigate the efficacy and safety profiles of lithium carbonate in the management of hyperthyroidism.

Objective To observe the clinical effect of lithium carbonate on hyperthyroidism.Methods Forty-seven cases of hyperthyroidism with abnormal hepatic function and/or leucopenia were recruited from January 2010 to January 2012.Thyroid function,adverse reactions,and clinical outcome of patients treated with lithium carbonate were observed and recorded before and after treatment.Results Thyroid function,liver function,and leucopenia in all patients were improved markedly after treatment.Among the treated patients,9 cases resulted in complete remission and had the drug discontinued,11 cases received radioactive iodine therapy afterwards,6 cases underwent surgical treatment,16 cases continued to use the same drug,and 5 cases were lost during follow-up.No obvious adverse reaction appeared during the treatment.Conclusions Lithium carbonate can be effectively used in patients with hyperthyroidism complicated by leukopenia or liver damage.It is also indicated during preparation for radioactive iodine or surgical treatment in patients with thyrotoxicosis.

[Summary] The aim of this study was to investigate the changes of sex hormone in male patients with type 2 diabetes and complicated with non-alcoholi fattty liver disease (NAFLD),and to detect the characteristics of the metablic indexs.A total of 112 patients were enrolled and divided into NAFLD group (n =54) and non-NAFLD group (n =58).All patients were measured for waist circumference,body mass index,metablic index,sex hormone,and serum transaminase.Compared with non-NAFLD group,the levels of fasting blood glucose,2 hour postprandial blood glucose,HbA1C in NAFLD group were significantly elevated [(8.75 ± 2.58 vs 7.79 ± 1.89) mmol/L,(18.12 ± 3.95 vs 15.63 ± 3.89) mmol/L,(11.96 ±4.85 vs 10.05 ±4.15)％,all P＜0.05].In addition,total cholesterol,triglyceride,body mass index,fasting insulin,and postprandial insulin in NAFLD group were significantly elevated [(4.97± 1.02 vs4.15±0.92) mmol/L,(2.74±2.25 vs 2.01± 1.45)mmol/L,(27.34±3.93 vs 22.38±3.39) kg/m2,(9.62 ± 5.80 vs 6.18 ± 4.21) μIU/ml,(72.71 ± 109.70 vs 31.72 ± 42.27) μIU/ml,all P＜0.05];while the total testosterone and free testosterone were lowered dramatically[(14.18 ±6.39 vs 18.21 ±6.14) nmol/L,(0.32 ± ± 0.03 vs 0.39 ± 0.08) ng/dl,both P＜0.05].Male patients with type 2 diabetes mellitus complicated with NAFLD are more prone to have disturbance in the lipid metabolism and had larger percentages of obesity and with lower level of testesterone.

Objective To investigate the risk factors of hypogonadism in male type 2 diabetic patients.Methods A total of 213 male patients with type 2 diabetes were enrolled and divided into low testosterone group (n=75) and normal testosterone group (n=138). Blood pressure, blood glucose, blood lipids, serum insulin and sex hormones including total testosterone (TT), sex hormone binding globulin (SHBG), progesterone, prolactin, estradiol, luteinizing hormone (LH), follicle-stimulating hormone (FSH), dehydroepiandrosterone (DHEA) were measured in all patients.The correlations between the metabolic index and sex hormone levels were analyzed.Results Compared with normal testosterone group, body mass index (BMI), fasting insulin (FINS), and homeostasis model assessment insulin resistance (HOMA-IR) levels were significantly increased in low testosterone group(all P<0.05)while LH, FSH, and SHBG levels were significantly decreased(all P<0.05).Pearson correlation analysis showed that TT was negatively correlated with FINS and HOMA-IR(r=-0.142,-0.154, both P<0.05)while positively correlated with LH and FSH (r=0.157, 0.138, both P<0.05).TT level in patients with metabolic syndrome(MS) was significantly decreased (P<0.05).A multiple logistic regression analysis revealed that BMI, MS, HOMA-IR, and LH were significant independent risk factors for hypogonadism.Conclusions Hypogonadism often occurs in male patients with type 2 diabetes,especially in patients with MS.BMI, HOMA-IR, LH, and MS are risk factors for hypogonadism in male type 2 diabetic patients.

Diabetic nephropathy (DN) is a common microvascular complication of diabetes mellitus. Cardiovascular disease often occurs in patients with DN. Patients with DN often experience changes in cardiac structure and function as proteinuria increases, glomerular filtration rate decreases, and blood creatinine levels increase, leading to the occurrence of cardiovascular disease. Additionally, inflammatory factors play a crucial role in cardiac structure and function. Understanding the pathological and physiological effects of inflammation on diabetic nephropathy-related cardiovascular disease and clarifying the relationship between cardiac structure and function in patients with DN are crucial for effective prevention and treatment of DN.

Objective To investigate the changes of sex hormone levels in male patients with metabolic syndrome and its clinical significance.Methods From January 2012 to January 2016,a total of 186 male patients in the Integrated Chinese and Western Medicine Hospital Affliated to Nanjing University of Traditional Chinese Medicine were enrolled,and they were divided into MS group(n =112) and non-MS group(n =74) according to the definition of adult metabolic syndrome.All of patients were measured blood pressure,blood glucose,blood lipid,pancreas islet function and sex hormone,such as testosterone (TT),sex hormone binding globuli (SHBG),progestin (P),prolactin (PRL),luteinizing hormone (LH),follicle-stimulating hormone (FSH),estradiol (E2),dehydroepiandrosterone (DHEA).The sex hormone level and the correlation of components of metabolic syndrome between the two groups were compared.Results Compared with those in the non-MS group,the BMI,blood pressure,lipid levels in the MS group were significantly increased,the fasting blood glucose,HbA1c,FINS HOMA-IR in the MS group were significantly increased[(8.74 ± 1.93) mmol/L vs.(7.49 ± 2.39) mmol/L,(10.86 ±2.45)％ vs.(9.09 ±2.61)％,(13.62 ± 6.37) mIU/L vs.(6.88 ±5.05)mIU/L,(5.53 ±2.28) vs.(3.24 ±1.35),t=5.76,4.49,2.47,2.81,all P ＜ 0.05],and TT,SHBG in the MS group significantly decreased [(18.95 ± 9.51) nmol/L vs.(10.10 ±2.97)nmol/L,(35.86±27.93)nmol/Lvs.(25.56±19.90)nmol/L,t=3.18,5.46,allP＜0.05].Conclusion MS was associated with hypogonadism,and the more components of metabolic syndrome,the more hypogonadism.

Objective: To compare the clinical therapeutic effects of arterial first approach pancreaticoduodenectomy(AFA-PD) with standard approach pancreaticoduodenectomy(SPD) in the treatment of borderline resectable pancreatic cancer (BRPC). Methods: A retrospective analysis of the clinical data of 113 cases of pancreatic cancer patients from January 2014 to August 2015 at Department of Hepato-Biliary-Pancreatic Surgery, Changhai Hospital, the Second Military Medical University, including 43 cases in AFA-PD group and 70 cases in SPD group.Every patient had gone high-resolusion computed tomography before the surgery, when BRPC was definitely diagnosed by both experienced radiologist and pancreatic surgeon.There were 24 males and 19 females in the AFA-PD group, with average age of (61.6±10.2)years.And in the SPD group, there were 47 males and 23 females, with average age of (62.7±9.4)years. Results: The operation time was (210.7±31.5)minutes in AFA-PD group, (187.9±27.4)minutes in SPD group, and peroperative bleeding volume was (1 007.1±566.3)ml in AFA-PD group, (700.0±390.0)ml in the other group.Those two indicators of AFA-PD group, compared with SPD group, were relatively higher, the difference was statistically significant(all P<0.01). And with regard to postoperative diarrhea(9.3% vs.5.7%), postoperative 1, 3 days of white blood cells(postoperative 1 day: (13.3±1.1)×10⁹/L vs.(12.4±2.4)×10⁹/L; postoperative 3 days: (12.7±1.6)×10⁹/L vs.(11.7±2.5)×10⁹/L), postoperative 1, 3, 5 days of peritoneal drainage fluid volume(postoperative 1 day: (184±42)ml vs.(156±54)ml; postoperative 3 days: (155±48)ml vs.(133±35)ml; postoperative 5 days: (66±20)ml vs.(47±31)ml), the differences between the two groups were statistically significant (all P<0.05). One patient in the SPD group was treated with unplanned secondary surgery for postoperative intraperitoneal hemorrhage, and the patient was cured and discharged.There was no death in the two groups within 30 days after surgical operation and no patient with positive gastric margin, duodenal margin, or anterior margin.The resection rate of superiormesenteric artery(SMA) margin R0 in AFA-PD group was higher than that in SPD group (P=0.019). The two groups were followed up for 14 to 30 months.As for AFA-PD group, the average survival time, progression free survival time and median survival time was respectively (20.4±1.2)months, (21.5±1.4)months and 20 months.There were 3 cases(7.0%) with local recurrence and 8 cases(18.6%) with liver metastasis or distant metastasis.In the SPD group, the average survival time, progression free survival time and median survival time was (17.1±1.1)months, (16.4±1.3)months and 16 months, respectively.There were 13 cases(18.6%) with local recurrence and 25 cases(35.7%) with liver metastasis or distant metastasis.As a result, the AFA-PD group had longer survival time(P=0.001)and progression free survival time(P=0.002). However, the lower local recurrence and distant metastasis rate in AFA-PD group did not reach statistical standard (P>0.05). Conclusion The arterial first approach pancreaticoduodenectomy is safe and effective in the treatment of borderline resectable pancreatic cancer, which can improve the resection rate of SMA margin R0, and prolong patient survival time.