Objective To study clinical characteristics,causes of misdignosis and diagnostic and therapeutic methods for primary hyperparathyroidism (PHPT).Methods Retrospective analysis was done for 51 patients of PHPT,47 confirmed by biopsy after surgical operation and 4 without operation diagnosed based on their serum levels of calcium,alkaline phosphatase ( ALP),intact parathyroid hormone ( iPTH ),and computed tomography (CT) or 99mtechnetium sestamibi (99mTcMIB1) imaging at the First Affiliated Hospital of Sun Yat-sen University,Guangzhou during June 1997 to November 2010.Results Bone-related complications were the most common clinical manifestation,accounting for 51％ (26/51 ) of the cases,and adenoma,a benign,enlarged and hyperactive parathyroid gland,in 34 of 47 cases ( 72％ ).In orthotopic lesions,the right inferior was affected in 19 of 46 cases (41％),followed by the left inferior in 13 cases (28％),while 5 of 51 cases (10％) with ectopic parathyroid gland.PHPT was easily misdiagnosed as urolithiasis,rheumatic disease,primary osteoporosis,etc,accounting for 92％ of the cases in our study.Preoperative serum levels of calcium,ALP and iPTH in the patients varied with their clinical type and pathological classification,the highest in patients with urolithiasis-bone-related complications [ (3.22 ±0.35) mmol/L,(1455 ± 1091 ) U/L and (1669 ± 515 ) ng/L,respectively ] and in patients with parathyroid carcinoma [ (3.46 ± 0.40) mmol/L,( 1410 ± 426) U/L and ( 1861 ± 768) ng/L,respectively ].Sensibility of preoperative localization diagnosis using ultrasonography,CT and 99mTcMIBI was 88％ (35/40),97％ (30/31) and 97％ (31/32),respectively.Conclusions PHPT is frequently misdiagnosed as other diseases.Measurement of serum calcium should be included in routine physical examinations,supplemented with measurement of serum ALP and iPTH,as well as medical imaging,which can help avoid misdiagnosis.CT combined with 99mTcMIBI imaging can improve accuracy of preoperative localization diagnosis.

Objective:To investigate the effects of continuous substaneous insulin infusion (CSII) on islet β cell function in newly diagnosed diabetic patients.Methods:Forty-six newly diagnosed diabetic patients who received treatment in Taishan People's Hospital from July 2011 to June 2014 were included in this study. They were treated with CSII for 14 days and followed up for 5 years. Before and after treatment, fasting blood glucose (FPG), 2-h postprandial blood glucose (2hPG), triglyceride (TG), fasting insulin (FINS), 2-h postprandial insulin (2hINS), glycosylated hemoglobin (HbA1c), superoxide dismutase (SOD), malondialdehyde (MDA) and the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) index, Homeostasis Model Assessment for beta-cell function (HOMA-β) index were compared between before treatment and 5 years after treatment.Results:Five years after treatment, the levels of FPG, 2hPG, TG, HbA1c, MDA and HOMA-IR were lower than those before treatment [FPG: (11.3 ± 1.2) mmol/L vs. (5.9 ± 0.4) mmol/L, t = 15.35, P < 0.01; 2hPG: (18.1 ± 4.2) mmol/L vs. (8.1 ± 1.6) mmol/L, t = 16.83, P < 0.01; TG: (2.9 ± 1.1) mmol/L vs. (1.5 ± 0.6) mmol/L, t = 9.81, P < 0.01; HbA1c: (11.2 ± 2.5)% vs. (5.6 ± 1.0)%, t = 11.48, P < 0.01; MDA: (4.6 ± 1.2) μmol/L vs. (2.7 ± 0.9) μmmol/L, t = 16.37, P < 0.01; HOMA-IR: (2.81 ± 0.35) vs. (1.87 ± 0.32), t = 9.37, P < 0.01]. Five years after treatment, the levels of FINS, 2hINS, SOD and HOMA-β were significantly higher than those before treatment [FINS: (5.6 ± 1.3) mU/L vs. (7.4 ± 1.5) mU/L, t = - 6.15, P < 0.01; 2hINS: (15.8 ± 7.5) mU/L vs. (25.8 ± 9.1) mU/L, t = - 5.65, P < 0.01; SOD: (28.9 ± 7.6) U/L vs. (39.6 ± 7.8) U/L, t = - 7.93, P < 0.01; HOMA-β: (14.36 ± 3.82) vs. (65.67 ± 6.67), t = - 18.72, P < 0.01]. Linear regression analysis showed that HOMA-β was positively correlated with SOD level ( R2 = 0.319, P < 0.01). Five years after treatment, the final outcome was insulin therapy in 3 cases (6.5%), oral medication in 25 cases (54.4%), and lifestyle intervention in 18 cases (39.1%). Conclusion:CS II for the treatment of newly diagnosed diabetes mellitus can effectively inhibit oxidative stress, improve the function of islet β cells, and exhibit long-term effects.

Objective To observe the influence of epalrestat combined with insulin therapy on islet beta cell function in newly diagnosed type 2 diabetic patients.Methods 45 newly diagnosed type 2 diabetic patients were randomly treated with 4 times of subcutaneous insulin therapy(RI group) or epalrestat plus 4 times of subcutaneous insulin therapy(RI + EP group).Patients were followed up for 3 months.The fasting blood-glucose (FPG),the 2 hour postprandial blood glucose (2 h PG),fasting insulin (FINS),the 2 hour postprandial blood insulin (2 h INS),glycated hemoglobin (HbA1 C),superoxide dismutase (SOD),malondialdehyde (MDA),insulin resistance index (HOMA-IR) and insulin release index(HOMA-β) were observed at 3th month after the initiation of therapy.Results Follow-up evaluation of 22 cases in RI group,23 cases in group RI + EP were completed 3 months of treatment.After treatment,FPG,2 h PG,HbA1 C,MDA and HOMA-IR in the two groups were decreased than those before treatment,the serum FINS,2 h INS,SOD and HOMA-β were higher than those before treatment,the differences were statistically significant (all P ＜0.05).After treatment,FINS,2 h INS,SOD and HOMA-β of RI + EP group were higher than those in RI group,MDA was lower than that of RI group,the differences were statistically significant (t =3.228,2.536,3.021,2.343,2.122,all P ＜ 0.05).FPG,2 h PG,HbA1 C,HOMA-IR between the two groups had no significant differences (all P ＞ 0.05).Linear regression analysis showed that HOMA-β was positively correlated with SOD level (r =0.888,r2 =0.783,all P ＜ 0.01).Conclusion The results suggest that epalrestat combined with insulin therapy can inhibit oxidative stress,and improve islet beta cell function in newly diagnosed type 2 diabetic patients,and its clinical effect is better than monotherapy with insulin.

Objective To assess the efficacy and safety of methimazole combined with selenium therapy in the treatment of hyperthyroidism .Methods 130 cases with hyperthyroidism were selected , and according to the digital table they were randomly divided into methimazole plus selenium treatment group ( ATD +Se group ) and methimazole treatment group(ATD group),65 cases in each group.The patients were followed up for 3 months.The thyroid function index and thyroid antibody index were observed before and after treatment .The adverse reactions were observed,too.Results After treatment,the serum levels of FT3,FT4,TSH in the ATD +Se group were (3.32 ± 0.53)pg/mL,(1.02 ±0.17)ng/dL,(2.72 ±0.32)mIU/L,respectively,which in the ATD group were (4.82 ± 0.75)pg/mL,(2.41 ±0.32)ng/dL,(2.72 ±0.32)mIU/L,respectively.The change ranges of the ATD +Se group were better than those of the ATD group ,the differences were statistically significant (t=4.591,3.814,3.567,all P<0.05).The TPOAb,TGAb,TRAb in the ATD+Se group were (120.3 ±23.1) IU/mL,(123.3 ±26.5) IU/mL, (1.72 ±0.89)IU/mL,respectively,which in the ATD group were (132.8 ±21.1)IU/mL,(134.8 ±21.3)IU/mL, (3.68 ±1.06)IU/mL,respectively.The changes of the ATD+Se group were more significant than those of the ATD group,the differences were statistically significant (t=4.291,3.514,3.767,all P<0.05 ).The total effective rate of the ATD+Se group was higher than that of the ATD group (90.77％vs.76.92％χ2 =13.147,P<0.05 ).The incidence rate of adverse reactions in the ATD +Se group was lower than that in the ATD group (12.31％vs.27.69％χ2 =18.685,P<0.05 ).Conclusion The results suggest that methimazole combined with selenium treatment is effective and safe for hyperthyroidism .