ObjectiveTo analyze the association between the outcome of exophthalmos and the curative effect of hyperthyroidism in Graves disease after 131I therapy.Methods Five hundred and thirty-eight cases of Graves disease accompanied with exophthalmos and hyperthyroidism who received 131I therapy from January 2001 to January 2010 were reviewed retrospectively,and the association between the outcome of exophthalmos and the curative effect of hyperthyroidism was analyzed.ResultsThe effective rate of hyperthyroidism after 131I therapy was 94.8％ (510/538).The effective rate of exophthalmos after 131I therapy was 73.2％(394/538).And the effective rate of hyperthyroidism with exophthalmos was 71.6％ (385/538).The incidence of improvement,inefficiency,exacerbation was 75.5％ (385/510),21.0％ (107/510),3.5％( 18/510) in hyperthyroidism effective patients ( 510 cases ) and 32.1％ ( 9/28 ),50.0％ ( 14/28 ),17.9％ ( 5/28 )in hyperthyroidism ineffective and recrudescence patients(28 cases),there was significant difference between the two patients (P ＜ 0.05 ).The incidences of improvement,inefficiency,exacerbation were 78.1％(281/360),18.9％(68/360),3.1％(11/360) in hyperthyroidism cured patients(360 cases),78.2％(36/46),17.4％ (8/46),4.3％ (2/46) in hypothyroidism patients(46 cases),there was no significant difference between the two (P ＞ 0.05 ).The incidence of improvement,inefficiency,exacerbation was 86.4％ ( 229/265 ),9.8％(26/265 ),3.8％( 10/265 ) in mild exophthalmos after 131I therapy(265 cases),59.9％(106/177),35.6％(63/177),4.5％(8/177) in moderate and severe inactive exophthalmos after 131I therapy( 177 cases),there were significant differences in the inciclence of improvement and inefficiency between the two patients (P＜0.05).For patients with moderate and severe active exophthalmos,glucocorticoids therapy could obtain satisfactory effect.Conclusion131I therapy is an effective method for Graves disease with exophthalmos,and there is a significant association between the outcome of exophthalmos and the curative effect of hyperthyroidism.

Objective To investigate the effects of nerve growth factor (NGF) on retinal synaptic plasticity of diabetic mellitus rat and its underlying mechanisms.Methods A total of 24 clean SD male rats were randomly divided into three groups (n =8),and they were control group,diabetic group and treatment group.In the latter two groups,a model of diabetic rats was induced by streptozotocin,and then the rats of treatment group were injected intraperitoneally 800 U · kg-1 NGF once a day after the model was induced successfully.Both control group and diabetic group were given the same amount of normal saline.Twelve weeks later,MDA content and SOD activity were detected;meanwhile,the expression of retinal synaptophysin was detected by immunofluorescence,and the expressions of retina synaptophysin and Caspase-3 were detected by Western blot.Results The difference of MDA content in the three groups was statistically significant (F =85.46,P ＜ 0.01);and the content of MDA in the diabetic group was significantly higher than that in the control group (P ＜0.01),while its content in the treatment group was significantly lower than that in the diabetic group (P ＜0.01).The difference of SOD activity in the three groups was statistically significant (F =17.76,P ＜0.01);and the SOD activity in the diabetic group was significantly lower than that in the control group (P ＜0.01),while its activity in the treatment group was significantly higher than that in the diabetic group (P ＜0.01).The difference of immunofluorescence intensity of synaptophysin in the three groups was statistically significant (F =395.42,P ＜ 0.01);immunofluorescence intensity of synaptophysin in the diabetic group was attenuated compared with the control group (P ＜0.01),while the intensity in the treatment group was enhanced compared with the diabetic group(P ＜0.01).The difference of the relative expression of synaptophysin in the three groups was statistically significant (F =17.27,P ＜ 0.01);and the expression of synaptophysin in the diabetic group was significantly downregulated compared with the control group (P ＜ 0.01),while its expression in the treatment group was upregulated compared with the diabetic group (P ＜ 0.01).The difference of relative expression of Caspase 3 protein in the three groups was statistically significant (F=217.13,P ＜0.01);and the expression level of Caspase 3 in the diabetic group was significantly higher than that in the control group (P ＜0.01),while its level in the treatment group was significantly lower than that in the diabetic group (P ＜ 0.01).Conclusion NGF can help to inhibit the apoptosis of retinal cell,restore the number of retina synapse by reducing the oxidative stress in diabetic retina,which suggests that NGF may be involved in the changes of synaptic plasticity in diabetic retina via oxidative stress pathway.

Objective To investigate the effects of inhibiting NgR on retinal ganglion cells density and synaptophysin expression of diabetic rat.Methods Thirty-two SD male rats were randomly divided into normal control group,diabetic group,siNgR group and scNgR group,8 rats in each group.Normal control group was given no any treatment.Diabetes model was induced by intraperitoneal injection of 50 mg · kg-1 streptozotocin in diabetic group,siNgR group and scNgR group,and the blood giucose more than 16.7 mmol · L-1 at 72 hours was set as the successfully model.The rats of siNgR group were intravitreally administrated with anti-NgR nucleotide and the rats of scNgR group intravitreally administrated with negative nucleotide.Eight weeks later,HE staining was conducted to detect density of retinal ganglion cell (RGC),immunofluorescence was used to evaluate the expression and distribution of synaptophysin (a marker of synaptic number).Relative expression of NgR and synaptophysin in retina were analyzed by Western blot.Results RGC density in normal control group,diabetes group,siNgR group and scNgR group were (624.33 ± 3.51) mm-2,(420.00 ± 2.65) mm-2,(621.67 ± 1.53) mm-2,(416.67 ± 2.52) mm-2,respectively.There was significant difference among four groups (F =5985.37,P ＜ 0.01).Compared with normal control group,RGC density in diabetes group and scNgR group were obviously decreased (all P ＜0.01),but siNgR group had no obviously change (P ＞ 0.05).The synaptophysin mainly expressed in the inner and outer network layer.Compared with normal control group,the positive expression of synaptophysin in diabetes group and scNgR group were decreased,but siNgR group had no obviously change.The relative expression of NgR in normal control group,diabetes group,siNgR group and scNgR group were (11.26 ±0.02) ％,(19.38 ± 0.10) ％,(11.17 ± 0.02) ％,(19.47 ± 0.31) ％,respectively.There was significant difference among four groups (F =2466.09,P ＜ 0.01).Compared with normal control group,the relative expression of NgR in diabetes group and scNgR group were obviously decreased (all P ＜ 0.01),but siNgR group had no obviously change (P ＞0.05).The relative expression of synaptophysin in normal control group,diabetes group,siNgR group and scNgR group were (35.76 ± 0.15) ％,(25.47 ± 0.36) ％,(35.28 ± 0.12) ％,(25.03 ± 0.75) ％,respectively.There was significant difference among four groups (F =583.70,P ＜ 0.01).Compared with the normal control group,the expression of synaptophysin in diabetic group and scNgR group were decreased increased (all P ＜ 0.01),while there was no significant difference in siNgR group (P ＞ 0.05).Conclusion Inhibiting the expression of NgR in the retina of diabetic rats can help to restore the number of synapses and protect the damaged RGC.

Objective The aim of this study was to explore the effect of testosterone deficiency on serum lipid levels and hepatic lipid accumulation in miniature pigs fed a high-fat diet (HFD).Methods Eighteen sexually mature male Chinese Wuzhishan miniature pigs (6~7 months old) were used in this study.The pigs were divided in three groups ( n =6 animals/group ) as follows: intact male pigs , castrated male pigs and castrated male pigs with testosterone replacement .They were fed a HFD diet for 12 weeks and body weights were recorded weekly .Serum levels of testosterone , total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG) were measured.Hepatic TG and TC levels were also determined , and liver tissues were embedded in paraffin and stained with hematoxylin and eosin (H&E).Results (1) The body weights of pigs in each group were found to be linearly elevated over time .Though castrated pigs gained less weight than did pigs in the other groups , no significant differences were found between them .( 2 ) Castration caused a significant decrease in serum testosterone levels in pigs . This effect was recovered by testosterone treatment .(3) Serum levels of TC, LDL-C and TG were significantly increased in castrated pigs.However, castration had no significant effect on serum HDL-C levels.Testosterone treatment reduced the increased serum lipids in castrated pigs .(4) Hepatic TG and TC contents in castrated pigs were also significantly higher than those in other groups of pigs .Testosterone treatment reduced the increased hepatic lipids in castrated pigs .( 5 ) Compared with other groups of pigs , castrated pigs showed increased steatosis .However , testosterone treatment attenuated hepatic steatosis in castrated pigs .Conclusion Testosterone deficiency caused severe dyslipidemia , and increased hepatic lipid accumulation in miniature pigs fed a high-fat diet.

Objective:To evaluate the technical approach and application value of DynaCT biliary reconstruction with CT images fusion (DynaCT-CT fusion) for the treatment of complex hepatolithiasis.Methods:The data of 18 patients with complex hepatolithiasis admitted to the First Affiliated Hospital of Guangzhou Medical University from May 2022 to October 2022 were retrospectively analyzed, including 7 males and 11 females, aged (50.6±15.0) years. Preoperative DynaCT biliary reconstruction with CT images fusion was performed to guide the percutaneous transhepatic one-step biliary fistulation (PTOBF). The technical data, including the bile duct with stones identified by preoperative imaging, the actual bile duct with stones confirmed intraoperatively, the satisfied stone removal time for each targeted bile duct, the actual stone removal time for each targeted bile duct, the intraoperative identification of CT-negative stones, the postoperative complications and reoperation were analyzed.Results:In 18 patients, a total of 95 target bile ducts with stones were identified by preoperative DynaCT-CT fusion technology, involving the first, secondary and tertiary bile ducts. Preoperative CT identified 29 lesions of stones involving the first and secondary bile ducts. CT negative stones were confirmed in 5 patients by DynaCT-CT fusion. Bile duct stricture occurred in 12 patients. All procedures were completed without postoperative bile leakage or hemorrhage. A total of 82 lesions of stones were successfully removed with a removal time of (25.9±12.8) min. The satisfied stone removal time for each targeted bile duct was (10.1±7.6) min, and the actual stone removal time was (10.5±7.4) min. Immediate stone clearance was achieved in 13 patients. Biliary tract infection occurred in 2 patients, and 5 patients underwent reoperation for residual or recurrent stones.Conclusion:The DynaCT-CT fusion technology guided PTOBF is feasible and safe in patients with complex hepatolithiasis. It could effectively detect more stones, shorten the stone clearance time. DynaCT-CT fusion technology provides a new strategy for the treatment of hepatolithiasis.

Objective To explore the application of Plan-Do-Check-Act(PDCA)cycle management to continuously im-prove the service quality of outpatient pharmacy and enhance patient satisfaction.Methods To address the problem of long wait-ing time for patients in outpatient pharmacy,we applied PDCA cycle to investigate the factors affecting patients'waiting time in the process of medicine collection,analyze the current situation,determine the expected goals,formulate the service quality im-provement plan of outpatient pharmacy,implement the improvement plan,follow up and supervise,and summarize and analyse the problems regularly until it was solved.Results After implementing the PDCA cycle in the management,the service quality of outpatient pharmacy was improved,the waiting time was significantly shortened and the satisfaction of medical treatment was in-creased.Conclusion The application of PDCA cycle method is effective in improving the service quality of outpatient pharmacy.Therefore,it is recommended for broader implementation.

Type 1 diabetes mellitus is a chronic autoimmune disease caused by the destruction of pancreatic islet β cells. Pancreatic islet transplantation provides a treatment method for patients with type 1 diabetes mellitus to restore endogenous insulin secretion. However, some problems limit the widespread application of islet transplantation, such as the shortage of donors and post-transplantation rejection damage. Mesenchymal stem cell-derived exosome (MSC-Exo) has become a potential tool for islet transplantation therapy due to their immunomodulatory and tissue repair capabilities. MSC-Exo shows great promise for application, because of low immunogenicity, easily being stored and transported, and the potential as drug delivery vehicles. However, challenges such as preparation, purification, standardization and safety verification need to be overcome before converting MSC-Exo into clinical practice. Therefore, this article reviews the application and potential advantages of MSC-Exo in islet transplantation, aiming to providing more effective and safer treatment options for patients with type 1 diabetes mellitus.

AIM:Bone morphogenetic protein 7(BMP7)reduces the expression of Yes-related protein 1(YAP1)by down-regulating Ajuba level and decreasing extracellular matrix(ECM)deposition.This study aimed to inves-tigate the influence of these factors on modifying the degree of renal fibrosis in rats with diabetic nephropathy.METH-ODS:Eighteen Sprague-Dawley(SD)rats were randomly divided into three groups:the normal control(NC)group,the diabetes mellitus(DM)group,and the DM group treated with BMP7 overexpressing adeno-associated virus(DM+rAAV-BMP7).Each group consisted of six rats.Diabetic kidney disease(DKD)was established in the DM and DM+rAAV-BMP7 groups by injecting 55 mg/kg streptozotocin(STZ)via the tail vein.NRK-52E cells were divided into three groups:the normal glucose(NG)group,the high glucose(HG)group,and the high glucose group treated with recombinant hu-man BMP7(HG+rhBMP7)group.Pathological changes in renal tissues were observed using hematoxylin and eosin(HE)and Sirius red staining.Immunohistochemical staining was performed to examine the expression sites of Ajuba and YAP1 in the renal cortex.Western blot analysis was conducted to determine the expression levels of BMP7,Ajuba,YAP1,colla-gen type Ⅲ(Col-Ⅲ),and fibronectin(FN)in the rat renal cortex and NRK-52E cells.RT-qPCR was used to measure the mRNA levels of Ajuba and YAP1 in the rat renal cortex.RESULTS:Biochemical indices revealed significantly ele-vated levels of blood glucose,serum creatinine,triglycerides,total cholesterol,and 24-hour urinary protein in the DM group compared to the NC group(P<0.05).In the DM+rAAV-BMP7 group,the levels of serum creatinine,24-hour uri-nary protein,triglycerides,and total cholesterol were lower than those in the DM group(P<0.05).Pathological staining demonstrated that the renal interstitium of the DM group exhibited inflammatory cell infiltration,fibrous tissue,collagen fi-ber deposition,disordered renal tubule arrangement,atrophy,and vacuolar degeneration,which were ameliorated in the DM+rAAV-BMP7 group.Immunohistochemistry revealed that Ajuba and YAP1 were mainly expressed in the cytoplasm and nucleus,with high expression in the cytoplasm of the DM group,which was significantly decreased in the DM+rAAV-BMP7 group.Western blot results indicated that the protein levels of FN,Col-Ⅲ,Ajuba,and YAP1 were up-regulated in the DM and the HG groups(P<0.05),but significantly down-regulated in the DM+rAAV-BMP7 group(P<0.05).RT-qP-CR results demonstrated that the mRNA levels of Ajuba and YAP1 were higher in the DM group and significantly lower in the DM+rAAV-BMP7 group(P<0.05).CONCLUSION:The overexpression of BMP7 can ameliorate renal fibrosis in rats with DKD.This effect is likely mediated by the down-regulation of Ajuba,reduction of YAP1 expression,and subse-quent inhibition of ECM deposition.