Autoimmune disease is the result of interplay between genetic and environmental factors, Immunoregulatory genes and thyroid specific genes play important roles in the pathogenesis of autoimmune thyroid diseases.

79 patients with an initial onset of ketosis or ketoacidosis were classified into four groups,based on the presence of islet autoantibodies(A+or A-) and-βcell functional reserve(β+or β-).According to their clinical characteristics,biochemical parameters and therapeutic consequences,the four groups can be considered as type 1 DM,idiopathic type 1 DM,latent autoimmune diabetes in adults(LADA) and type 2 DM respectively.

Objective To explore the clinical characteristics of multiple primary carcinoma (MPC) in elderly patients and the effects of postoperative adjuvant chemotherapy on the prognosis and advanced cancer genesis. Methods The study population consisted of 220 elderly patients with malignant tumor. Thirty-seven elderly patients with MPC were selected in the study. The characteristics including onset age, carcinoma sites, effects of postoperative adjuvant chemotherapy, interval and survival time between first and advanced cancer were analyzed. Results of the 220 subjects,37(16.8%) patients were MPC, among whom 2 patients were synchronous multiple primary carcinomas (SMPC) and 35 patients were metachronous multiple primary carcinomas(MMPC). The median ages at onset were 70,77 and 77.5 years old for the first,second and third tumor respectively. Among a total of 82 tumor focus, the most predilection site of MPC was gastrointestinal tract, with a 34.2%(28 cases) in colorectum and a 13.4%(11 cases) in stomach. The postoperative patients were divided into two groups: 23 accepted adjuvant chemotherapy (chemotherapy group) and 14 accepted no adjuvant chemotherapy (no chemotherapy group). The survival time of chemotherapy group was significantly longer than no chemotherapy group (x2= 4.63, P = 0.0427 ). The median intervals between the first and the second cancer were 6 years and 4 years in chemotherapy group and no chemotherapy group, respectively(x2=1.63, P = 0.207), while the median intervals between the second and the third cancer were 7 years and 2 years, respectively(x2 = 4.255,P=0.043). The mediansurvival time of the third cancer postoperative patients were 3.5 years and 7 months in chemotherapy group and no chemotherapy group, respectively (x2 = 4.62, P = 0.0316 ) . ConclusionsPostoperative adjuvant chemotherapy may prolong the survival time and delay the advanced cancer genesis in elderly patients with MPC.

Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar status (HSS) are severe acute diabetic complications. This article mainly discusses the definition, mortality rate, pathophysiology, precipitating factors, main clinical manifestations, laboratory findings and principles of treatment in DKA and HHS.

Clinical data of 28 cases of childhood bronchiolitis obliterans treated from September 2008 to November 2010 were retrospectively analysis.Pulmonary high-resolution CT (HRCT) showed that bronchial wall thicken was seen in all 28 patients,the mosaic pattern in 26 cases,patchy shadows in 18 cases,bronchiectasis with typical signet ring sign in 2 cases,atelectasis in 2 cases without pleural effusion.Pulmonary function tests and flexible bronchofiberscopy were performed in 6 cases,which showed the inflammation in bronchial tunica intima and obstruction of small airway.Blood routine,blood sedimentation,c-reaction protein,TORCH,hepatic function,renal function and immune function were normal.Patients received comprehensive treatment with methylprednisolone,clarithromycin and montelukast.The clinical conditions of 28 cases were improved with varying degrees after treatment and no significant side effects were observed.

Objective To explore the relationship between benign prostatic hyperplasia (BPH)and obesity. Methods The 109 elder men were divided into two groups: BPH group (n=59) and non-BPH group (n= 50). The blood samples were collected for the detections of prostate specific antigen (PSA), triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), fasting blood glucose (FBG), insulin,androgen, estrogen, sex hormone binding globulin (SHBG) and dehydroepiandrosterone(DHEA).The anthropometric indexes including height, body weigh, waist circumference (WC), hip circumference (HC), systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR) were measured and calculated. The total prostate volume (TPV) were measured by transabdominal ultrasonography three times at least. Results The morbidity rate of BPH was significantly higher in obesity group and over weight group than in health control group (73.33% and 64.28% vs. 26. 67%, x2 = 13. 991 and 6. 836, both P＜0. 002). So was in central obesity group versus in health control group (71.19% vs.36.00%, x2 =12. 156, P＜0. 001). The waist-height index, waist circumference, body weight, BMI and hip circumference were significantly higher in BPH group than in non-BPH group [(0. 56±0. 05)vs. (0.52±0.06), (93. 6±8.8) cm vs. (87.0± 10. 1) cm; (72.6±9.7) kg vs. (64.5±9.3) kg;(25.7±3.4) kg/m2 vs. (23.1±2.9) kg/m2; (100.2±6.6) cm vs. (95.6±8. 1) cm; t=-3.3, -3. 65, -4.38, -4. 17 and -3.18, respectively, all P＜0.01]. The TPV was higher in obesity groupthan in normal group [ (40.8± 23.5 ) ml vs. (20. 1 ± 6.1 ) ml, t = - 2.82, P＜ 0. 002] and obviously higher in central obesity group than in non-central obesity group [(42.8±25.6)ml vs. (26. 9±11.2)ml, t= -3. 93, P＜0. 001]. The ratio of E2/TT and HOMA-IR were higher in central obesity group [(9. 06±4.36) and (2.81 ±2. 80)] than in non-central obesity group [(7. 38±3. 11) and (1. 55±0.76), t= -2.02 and -4.24, both P＜0. 05]. Inversely, the TT and SHBG were lower in central obesity group than in non-central obesity group [(4.54 ± 1.54) nmol/L vs. (5.20 ± 1.54) nmol/L,(45.8± 17.24) nmol/L vs. (59.6 ± 26.09) nmol/L, t = 2.16 and 2.79, both P＜ 0. 05]. Logistic regression analysis showed that waist circumference was a major factor affecting TPV (x2= 19.52, P=0. 000). The annual growth rate of TPV was significantly higher in obesity group and central obesity group than in health control group [(7. 14±8. 09)ml vs. (1. 49±5.14)ml, (7. 96±13.81)mlvs. (1. 35±5.36)ml, t=-2.19 and -3.28, both P＜0. 05]; The PSAD was significantly lower in central obesity group than in health control group [(0. 048±0. 036) vs. (0. 090±0. 093), t=2.02, P＜0. 05], and lower in obesity group than in health control group [(0. 052 ±0. 039) vs. (0. 091 ±0. 080), t= 3. 13, P＜0. 01]. Conclusions The occurrence of BPH is closely related to obesity,especially central obesity. Its mechanism may be related to sex hormone imbalance and the GH/IGF-1 axis disorders in obese patients.

Objective To assess the diagnostic value of CT and MRI findings of toxoplasma encephalitis among AIDS patients.Methods CT and MRI findings of toxoplasma encephalitis were retrospectively studied in 17 AIDS cases.Results The lesions were bilateral and multiple,involving basal nuclei in 12 cases,thalamus in 3 cases,bilateral cerebral hemispheres near corticomedullary junction in 1 case,and cerebellum and brain stem in 1 case.The lesions showed weak hypodensity on CT,and long T 1 and long T2 signal intensity on MRI,with marked peripheral edema effect.After contrast administration,the small ring or twist and target enhancement was seen in 12 cases,large ring enhancement-in 1 case.multiple focus in 15 cases and single focus in 2 cases;MRI was more sensitive in detecting a largest number of cerebral lesions than CT.Conclusion More small ring and twist,nodular,target enhancement are highly suggestive of toxoplasma encephalitis in the basal nuclei.Both CT and MRI are effective in diagnosing toxoplasma encephalitis,but MRI imaging without and with gadolinium is more sensitive than CT in the detection of toxoplasma encephalitis;MRI imaging may reveal a greater number of lesion when it is positive and so the detection rate of MRI is higher than that of CT.

Objective To evaluate the utility of clinical characters and variant examinations in discriminating benign from malignant thyroid lesions before operation.Methods We had retrospectively analyzed 1367 cases of thyroid nodule that were operated in Ruijin Hospital from 1999 to 2004.Results Clinical symptoms and signs,ultrasonography and fine needle aspiration(FNA)were all useful in indicating malignant thyroid lesions,especially FNA,whose sensitivity,specificity and diagnostic accuracy were 65.12%,95.08% and 82.69%,respectively.By logistic regression analysis,the thyroid nodule of young patients or solid or hard nodules,or nodules hard,or accompanied with calcification or nonached lymphadenectasis might be maligment nodules.At this time,FNA shoud be performed.Conclusion The above findings emphasize the importance of reviewing carefully and utilizing effectively the clinical information of each patient.

Objective In order to explore the effective dosage of insulin and its correlated elements in sulphonylureas failure in type 2 diabetes mellitus.Methods 61 cases of type 2 diabetics were separated into two groups,one group (group 1) is the first time using insulin and the other group (group 2) is in the use of insulin in the past.Results The effective insulin dosage of group 2 is significantly higher than that of group 1 (36.2?10.6 IU/d vs 30.1?10.5IU/d, P

A total of 115 patients with Hoshimoto thyroiditis were classified under 2 groups: one group being treated with selenium and L-throxine (L-T4) and other group with L-T4 alone.All patients were followed up for 3 months.In the selenium treated group thyroid peroxidase antibody level was decreased in 33 patients (56%) and thyroglobulin antibody level was decreased in cases.