Physicians often encounter patients with both hyperthyroidism and pregnancy in clinical practice. Proper treatment will help a lot for both mother and fetus. However, whether propranolol could be applied routinely in the medical therapy other than antithyroid drugs is not regularly mentioned in text book, because there were few literatures reporting its side effects including miscarrage, intrauterine growth retardation, bradycardia, respiratory depression, hypoglycemia, and hyperbilirubinemia. Animal experiments revealed bradycardia after propranolol administration, and respiratory depression after birth due to blockage of β receptors in the lungs. Nevertheless, this drug has been considered safe in pregnant hyperthyroid women according to long-term experience, as no malformation has been demonstrated in the offsprings, and it helps a lot in hyperemesis gravidarum as well. Specialists also recommend short-term use like a few weeks before antithyroid drugs set in action and during thyroid storm, in order to avoid potential side effects. It is suggested that less than routine-dose of the drug be administered before labor, as the plasma drug concentration in the neonate would elevate after birth. As for lactating mother, it's safe to take regular dose of the drug because only extremely low dose will be taken by the neonate through milk.

Cellular functions like proliferation,differentiation,migration,morphogenesis and apoptosis are modulated by the extracellular matrix.Integrins are the prototypic heterodimeric transmembrane matrix receptors with competing affinities for individual extracellular matrix ligands.The intracellular integrin domain clusters cytoplasmic proteins into focal adhesion plaques for bidirectional(outside-in and inside-out) signaling.Integrin-linked kinase(ILK) is an intracellular serine/threonine protein kinase that interacts with the cytoplasmic domains of ?-integrins.ILK organizes the connections of the extracellular matrix via integrins to the cytoskeleton and is involved in adhesion plaque signaling,and it plays a crucial role in the pathogenesis of chronic renal fibrosis.High glucose induces the upregulation of the synthesis and activity of ILK in cultivated mouse podocytes and mesangial cells.The ILK protein level is significantly increased in diabetic glomeruli.ILK activity is likely to provide the basis for an effective therapeutic method for diabetic nephropathy.This review gives an introduction of ILK structure and function,followed by a summary of our current understanding of ILK in diabetic nephropathy with a special focus on glomerular cell-matrix interaction.

Objective To analyze the second time blood screening results of ALT deferred donors,and to evaluate the importance of alanine aminotransferase(ALT) testing on the improvement of blood safety.Methods The ALT testing results of 565 360 blood donors from Feb.2006 to Jan.2008 of Shanghai Blood Center were studied retrospectively.The screening results and donation intervals of such donors who delayed their donation just because of their former unqualified ALT level were also analyzed.Results A total of 32 042 donors(5.67%) failed in ALT testing among 565 360 donors.And 3 395 ALT deferred donors participated the second time blood donation,among which 2 205(64.95%) passed the blood screening tests,while the other 1 190(35.05%) failed.Among the 1 190 unqualified blood donors,1 151(33.90%)failed again in ALT testing,and 11(0.32%) in Syphilis,12(0.35%) in HBsAg,7(0.21%) in anti-HCV and 1 in anit-HIV(0.03%).Meanwhile,donors failed both in ALT testing combined with HBsAg,anti-HCV,and anit-HIV sero-converted were 1(0.03%),2(0.06%) and 1(0.03%),respectively.And 72.64% of ALT deferred donors participated the second time blood donation within 6 months.The average donation intervals of donors with qualified ALT level but sero-converted were 140 days(from 24 to 267 days),and those with both unqualified ALT level and sero-converted were 158 days(from 91 to 220 days).Conclusion Before the new methods such as NAT were applied to blood donation screening system,ALT test could prevent the window-period failure of ELISA screening so as to improve the blood safety.

Objective To explore the pathogenesis of ischemic preconditioning to warm ischemia reperfusion injury of hepatocytes in rats. Methods Ninety SD rats were randomly divided into three experimental groups:sham operation group (group A), warm hepatic ischemia/reperfusion group(group B and group C). Group C was given ischemic preconditioning treatment. Serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were detected 0 h, 2 h, 6 h, 12 h and 24 h after ischemia reperfusion injury. Levels of TNF-α and IL-1β were tested detected by ELISA. Levels of malondialdehyde (MDA) and superoxide dismutase (SOD) of hepatocytes were detected at the same time points. Mitochondrial membrane potential was examined to assess ischemia reperfusion injury of hepatocytes in rats using chart of intensity of JC-1 in mitochondria. Results The serum levels of ALT, TNF-α, IL-1β, and MDA were significantly higher in hepatic warm ischemia reperfusion group and ischemic preconditioning group than those in sham operation group (P<0.05). Values of prothrombin activity and cholinesterase were significantly lower in liver warm ischemia reperfusion group and ischemic preconditioning group than those of sham operation group (P<0.05). The SOD level of liver was significantly lower in warm ischemia reperfusion group and ischemic preconditioning group than that in sham operation group. The indexes were better in ischemic preconditioning group than those of warm ischemia reperfusion group (P<0.05). The mitochondrial membrane potential level of liver cells reached the lowest value 0 hours after ischemia and reperfusion, and then increased gradually within 24 hours (P<0.05). And the level of mitochondrial membrane potential of liver cells was significantly higher in ischemic preconditioning group than that in warm ischemia reperfusion group (P<0.05). Conclusion Ischemic preconditioning may play a protective role in warm ischemia-reperfusion injury in rats. Ischemic preconditioning may significantly decrease the levels of ALT, AST, TNF-α, IL-1βand MDA, and increase the SOD activity in hepatocytes. Thedamage of mitochondrial membrane potential is decreased after ischemic preconditioning, which might be the pathogenesis of ischemic preconditioning to warm ischemia reperfusion injury of hepatocytes in rats.

[Summary] The theory of fetal origins of adult disease (FOAD) is now widely accepted by researchers who hold the opinion that adult degenerative and metabolism diseases have close relationship with the environment of fetal development inside and outside the womb. Some studies have proved that maternal hypothyroidism can negatively affect the glucose metabolism of their offsprings. However, the whole mechanism is not clear yet. Insufficient thyroid hormone during pregnancy was proved to slow down the formation of fetal pancreatic cytoskeleton, to decrease the proinsulin gene transcription, and to modulate series of cytokines and enzymes which are related to glucose dependent insulin secretion. Thyroid hormone receptor is also considered to be partially responsible for the relation between low thyroid hormone and β cell insufficiency. However, more studies in vivo should be carried out to prove this hypothesis. Epidemiologic studies have suggested that type 2 diabetes and low birth weight can be different phenotypes of the same genotype. The definite mechanism of maternal hypothyroidism in influencing fetal β-cell function should be studied by further investigation.

Objective To investigate the response of cryopreserved ovarian tissue after autologous implantation in mouse stimulated with gonadotrophin.Methods Thirty six female mice were randomly divided into three groups,with 12 mice in each group.In group of fresh ovarian tissue,fresh ovarian tissue was implanted into kidney capsule of mice:in group of cryopreserved ovarian tissue,ovarian tissue was implanted into kidney capsule of mice after cryopreserved by vitrification for two weeks.We investigated the response of ovarian tissue two weeks later after autologous implantation stimulated with gonadotrophin.Immunohistochemistry staining method was used to observe the expression of follicle stimulating hormone receptor.Results Before and after stimularian with gonadotrophin,the mature follicle rate of group of fresh ovarian tissue was 2.3%and 4.2%.that of group of cryopreserved ovarian tissue was 2.3%and 4.0%,and that of group of control was 2.6%and 5.8%.Regarding the percentages of mature follicle.there were significant differences after stimulation with gonadotrophin(P＜0.05).After stimulating with gonadotrophin the percentages of mature follicle were the same in the fresh tissue group,cryopreserved tissue group and control group(P＞0.05).The integrated optical density of follicle stimulating hormone receptor of fresh ovarian tissue in antrofollicle and pre-antrofollicle were 9408±2777 and 4531±1903.that of cryopreserved ovarian tissue were 9175±3093 and 4808±1386.and that of the control ovarian tissue were 8838±2064and 5516±1136 respectively.There was no significant difference between any two groups(P＞0.05).Conclusion The follicle stimulating hormone receptor is preserved by cryopreservation and transplantation,small pieces of ovarian tissue response to gonadotropin stimulation is normal.

Objective To explore the relationship between long chain non-coding RNA metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) and prognosis of hepatocellular carcinoma, and to provide evidence for perioperative treatment. Methods One hundred and twenty five samples from patients with hepatocellular carcinoma treated in Tianjin Unite Medicine Center Hospital during June 2008 to June 2014 were collected in this study. The expression of MALAT1 was detected by using real-time quantitative PCR (RT-qPCR). The relationship between MALAT1 expression level and prognosis of patients with hepatectomy was analyzed. The risk factors affecting the prognosis of patients were determined. Results The expression level of MALAT1 was significantly higher in hepatocellular carcinoma samples (P<0.05). There was no relationship between the expression of MALAT1 with age, hepatitis B history, cirrhosis history, tumor size, tumor number, tumor TNM stage, vascular invasion, pathological differentiation and preoperative alpha-fetoprotein (AFP) level (P>0.05). The survival rate was calculated with Kaplan-Meier method. The overall 1-, 3-and 5-year survival rates in low level MALAT1 group were 85.9%, 55.2% and 33.8%. The overall 1-, 3- and 5-year survival rates in high level MALAT1 group were 66.0%, 34.6%and 3.9%, respectively. There was significant difference in survival rate between the two groups (P<0.01). The multivariate COX regression model analysis showed that the independent risk factors for postoperative survival rate in patients with hepatocellular carcinoma included tumor vascular invasion (RR=3.055, 95%CI:1.986-4.053, P<0.01) and over expression of MALAT1 (RR=2.918, 95%CI:1.736-3.672, P<0.01). Conclusion Long chain non-coding RNA MALAT1 is a novel tumor marker for prognosis of hepatectomy in patients with hepatocellular carcinoma, which can be used for preoperative and postoperative evaluation in patients with hepatocellular carcinoma.

Anterior approach refers to a method of hepatectomy which is first to resect the hepatic parenchyma and then to free the liver; hanging maneuver refers to placing a tape before the inferior vena cava for hanging the liver during hepatectomy.In October 2011,anatomical trisectionectomy was performed on a 54-year-old male patient with large hepatocellular carcinoma in the left medical lobe and right lobe with anterior approach and hanging maneuver.The diameter of the tumor was 16 cm,and was in the ⅢA/T3NOM0 stage.The indocyanine green retention at fifteen minutes was 5.4％,and the ratio of hepatic left lateral lobe volume over the standard total liver volume was 44％.The left bile duct was slightly dilated because of the compress of the tumor.The operation started with the isolation and dissection of the inflow vessels,including the right hepatic artery,the right portal vein,the middle hepatic artery,the portal vein branches of left internal lobe.The hepatic parenchyma transection was performed along the fight side of the falciform ligament.A tape was passed between the anterior surface of inferior vena cava and liver,and the liver was suspended during the transection.The left bile duct was cut at the right side of round ligament,and then the middle hepatic vein and the right hepatic vein were resected.The ligaments around the liver were dissected and the right hepatic lobe was removed.Finally,the end-toend anastomosis between the left hepatic duct and the common hepatic duct was performed.The operation lasted for 4 hours and the intra-operative blood loss was 350 mL.The patient was recovered well.At the end of 4 months after surgery,magnetic resonance cholangiopancreatography showed that the anastomosis of the bile duct was unobstructed,and there was no recurrence of tumor inside the liver.

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.

Objective To investigate the dosage and safety of insulin aspart in continuous subcutaneous insulin infusion plus oral antidiabetic drugs for the treatment of hyperglycemia in elderly hip fracture.Methods Patients with hip fracture and hyperglycemia who required insulin pump therapy were divided into 2 groups according to age:elderly group (patients aged over 65 years,n=42) and non-elderly group (patients aged under 65 years,n=43).All patients were treated with insulin aspart in continuous subcutaneous insulin infusion plus oral antidiabetic drugs combined with diet therapy.Dosages of aspart insulin and adverse effects were compared between the two groups.Results There were no significant differences in basic aspart dosage and additional premeal dosage between elderly and non-elderly groups [(0.29±0.09) IU/kg vs.(0.30±0.07) IU /kg,(0.27±0.09) IU/kg vs.(0.27±0.07) IU/kg,both P＞0.05].The incidences of hypoglycemia with and without symptoms in elderly versus non-elderly groups were 4.8％ vs.4.7％ and 14.3％ vs.18.6％,which had no significant differences between the two groups (P＞0.05).Hypoglycemia accompanied by consciousness disorders,allergy,nonhealing and slow healing wounds were not found in the two groups.The ratio of oral antidiabetic drugs including metformin,glimepiride,and glycosidase inhibitor had no differences between the two groups.Conclusions Aspart insulin in continuous subcutaneous insulin infusion is effective and safe in the treatment of acute severe hyperglycemia in elderly patients with hip fractures when combined with diet therapy and oral antidiabetic drugs.