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Abstract:Owing to the effectiveness and minimal invasiveness，radiofrequency ablation（RFA） has been used in the clinic to treat tumors. Recently，the incidence of thyroid nodules has been increasing yearly. The application of RFA in the treatment of thyroid nodules has become a research hotspot. This paper aims to present the history of RFA briefly，and focus on the application and con－troversy of treating tyroid nodules.

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Abstract:Objective：To investigate the influence of postoperative thyroid stimulating hormone（TSH） suppression on serum anti-mul－lerian hormone（AMH） level in women of childbearing age with differentiated thyroid cancer（DTC），and to observe whether TSH sup－pression therapy has negative interference on ovarian reserve in women of childbearing age. Methods：The DTC subjects were selected from the patients enrolled in the postoperative follow-up pro－gram conducted by China-Japan Union Hospital of Jilin Uni－versity. The female patients，aged 20-48 years，who did not ex－perience menopause and regularly received levothyroxine（LT4） for postoperative TSH suppression for more than 3 years were enrolled，and their general clinical data and menstrual history were recorded. Venous blood samples were collected and serum was separated. Chemiluminescence immunoassay was used to measure the serum levels of TSH，free thyroxine（FT4），free triiodothyronine（FT3），and AMH. After being matched for age，healthy fe－male individuals who underwent physical examination in the Physical Examination Center in The First Affiliated Hospital of China Medical University were enrolled as healthy control group，and their serum samples were collected to measure the levels of TSH，FT4，FT3，and AMH. Results：There was no significant difference in age between postoperative TSH suppression group with 98 patients and healthy control group with 40 individuals. There was also no significant difference in serum AMH level [median（interquartile range）] between the two groups[1.19（0.58-2.21） ng/mL vs. 1.15（0.22-2.72） ng/mL），P=0.89]. The women of childbearing age with DTC were further divided into four subgroups according to the level of TSH suppression，i.e.，TSH<0.1 mIU/L group with 26 patients，0.1 mIU/L ≤TSH<0.4 mIU/L group with 23 patients，0.4 mIU/L≤TSH<2.0 mIU/L group with 36 patients，and TSH≥2.0 mIU/L group with 13 patients；the serum AMH levels in these subgroups were 1.20（0.71-1.62），1.01（0.57-2.22），1.25（0.67-2.83），and 0.92（0.10-2.81） ng/mL，respectively，and there was no significant difference in serum AMH level between these four subgroups and the healthy control group（P=0.58）. In the patients with DTC，serum AMH level was not correlated with TSH，FT4，and FT3 in TSH suppression patients（all P >0.05）. Conclusion：As a good indicator of ovarian reserve，serum AMH level shows no significant difference between women with DTC undergoing postoperative suppression therapy and healthy women of the same age，suggesting that TSH suppression therapy does not affect ovarian reserve，i.e.，reproductive potential，in DTC patients of childbearing age.

Abstract:Objective：In order to achieve high-quality manual annotation of large-sample thyroid ultrasound images，we developed a semi-automatic semantic annotation software tool for multi-feature thyroid ultrasound images. In the study，we aimed to explore the reproducibility of doctors’ application of the thyroid ultrasound image annotation tool. Methods：Fifty cases of thyroid nodules in our hospital were randomly selected. Two ultrasound doctors independently used the annotation software tool to perform thyroid ultrasound image recognition. Two ultrasound doctors independently performed ultrasound images recognition through visual images.One ultra－sound doctor randomly used annotation software tools and visual images for image recognition，and then observer consistency analysis was performed. Results：In this study，two ultrasound doctors used annotation software tools to observe the differences between ultra－sound features and ultrasound grading（?资 value）：boundary 0.94，morphology 0.94，echo 0.63，internal structure 0.87，calcification 0.89，2015 American Thyroid Association（ATA） risk stratification was 0.84（P<0.01）. The difference between the two ultrasound doctors through the visual ultrasound image was as follows（?资 value）：boundary 0.75，morphology 0.80，echo 0.53，internal structure 0.62，calcification 1.00，ATA risk stratification 0.42（P<0.01）. The difference between the observers using the image annotation system and the visual ultrasound image was（?资 value）：boundary 1.00，morphology 1.00，echo 1.00，internal structure 0.88，calcification 1.00，ATA risk stratification 0.96（P<0.01）. Conclusion：The multi-feature thyroid ultrasound image semi-automatic semantic annota－tion software tool provides a standardized method for the diag－nosis of thyroid nodule ultrasound diagnosis，and provides high-quality training and verification data sets for its fine-grained in－telligent recognition research.

Abstract:Objective：To investigate the clinical features of patients with polycystic ovary syndrome（PCOS） and autoimmune thyroiditis（AIT）. Methods：The clinical data of 51 patients with PCOS were collected，including age，body mass index，thyroid function，thyroid autoimmune antibodies，biochemical parameters，hormone levels，and ovarian morphology on ultrasound，and a statistical analysis was performed. Results：The PCOS patients with positive thyroid autoimmune antibodies had significantly higher serum estradiol level and estradiol-to-progesterone ratio than those with negative thyroid autoimmune antibodies [serum estradiol level：193（144-251） vs. 148 （94.8-193.25），P <0.05；estradiol-to-progesterone ratio：155.17（69.17-319.72） vs. 112.91（79.18-141.55），P <0.05]. Compared with those with polycystic ovaries，the PCOS patients without such manifestation had significant increases in serum estradiol level[201 （149-350） vs. 174 （105.3-196），P <0.05]，estradiol-to-progesterone ratio[209.38（105.19-341.11） vs. 116.86 （83.74-153.75），P <0.05]，and positive rate of thyroid autoimmune antibodies（P <0.05）. In the PCOS patients，the serum level of thyroid autoimmune an－tibodies was positively correlated with serum estradiol level and estradiol-to-progesterone ratio（P <0.05）. Conclusion：The PCOS pa－tients without polycystic ovaries tend to develop AIT. The pro－duction of thyroid autoimmune antibodies may be associated with the increases in serum estradiol level and estradiol-to-pro－gesterone ratio.

Abstract:The prevalence rate of Graves’ orbitopathy（GO） in children is lower than that in adults，which may be attributed to a low smoking rate. GO in children tends to have mild clinical manifestations，mainly mild soft tissue involvement，eyelid contracture，and exophthalmos. Since the control of GO and supportive treatment can significantly improve GO，the strategy of follow-up observation is mainly used for the treatment of GO in children. In case of poor response，glucocorticoids can be used for treatment，and ophthalmic surgery should be performed as soon as possible when GO threatens eyesight. Ophthalmologists should cooperate with endocrinologists to improve the quality of life and physical and mental development in children with GO.

Abstract:Objective：To investigate the efficacy of 131I therapy in patients with Graves’ disease（GD） and its influencing factors. Methods：A retrospective analysis was performed for 497 GD patients treated with single 131I therapy at the outpatient service of the Nuclear Medicine Department of Nanjing Drum Tower Hospital from 2013 to 2016. These patients were followed up at 3，6，12，and 36 months after therapy. The general data of patients，such as age，sex，the duration of disease，symptoms，and signs，as well as the findings on thyroid color Doppler ultrasound，thyroid iodine uptake rate，thyroid function，thyroid autoimmune antibodies，and the dose of 131I，were collected to assess the treatment outcome of 131I therapy. The independent-samples t test，chi-square test，and logistic regression were used to analyze the efficacy of 131I therapy in GD patients and its influencing factors. Results：The response rates based on the follow-up performed at 3，6，12，and 36 months after therapy were 75.6%，79.4%，93.9%，and 94.7%，respectively. Compared with the hyperthyroidism or normal group，the hyperthyroidism group had significantly longer duration of disease and duration of use of antithyroid drugs before radioactive iodine（RAI） therapy and significantly higher thyroid weight，2-h iodine uptake rate，thyroid stimulating hormone receptor antibody titer，and 131I dose per gram of thyroid（P<0.05）. The treatment response of GD patients with abnormal liver function was not inferior to that of those with normal liver function（P=0.001）. A higher response rate was seen in the patients taking propranolol before RAI therapy（P=0.000）. Compared with those with poorer response to treatment，the GD patients with better response to treatment had a significantly shorter duration of hyperthyroidism（OR=0.939，95%CI＝0.895 to 0.986，P=0.011） and a significantly lower thyroid weight（OR=0.961，95%CI＝0.937 to 0.986，P=0.002）. Conclusion：The effi－cacy of 131I in the treatment of GD tends to increase over the course of treatment. Thyroid weight and the duration of disease are main influencing factors for the efficacy of 131I therapy for GD；Higher thyroid weight and longer duration of hyperthyroidism are associated with poorer treatment response.

Abstract:Objective：To investigate the clinical characteristics of different vitamin D status in patients with Graves disease（GD） and the risk factors for vitamin D deficiency and insufficiency in GD patients. Methods：The medical data of 328 patients with GD were collected. These patients were divided into two groups according to their vitamin D levels：vitamin D deficiency and insufficiency group [25（OH）D3 <75mmol/L] and vitamin D sufficiency group[25（OH）D3≥75mmol/L]. Age，sex，the levels of thyroid stimulating hor－mone，free triiodothyronine，free thyroxine，thyrotropin receptor antibody（TRAb），thyroid peroxide antibody（TPOAb），and thyroglobu－lin antibody（TGAb） were compared to investigate the clinical characteristics of these two groups. Univariate and multivariate logistic regression analyses were used to identify the risk factors for vitamin D deficiency and insufficiency in patients with GD. Results：The prevalence of vitamin D deficiency and insufficiency in GD patients was 64.02%. The age of the vitamin D deficiency and insuffi－ciency group was significantly younger than that of the vitamin D sufficiency group （34.89±12.25 vs. 39.11±11.97，P<0.05）. There were significant differences in sex and seasonal compositions between the two groups（both P<0.05）. The multivariate logistic regression analysis showed that the risk factors for vitamin D deficiency and insufficiency in GD patients were sex and season；no association with thyroid antibody，thyroid function，or liver function was found（P >0.05）. The risk of vitamin D deficiency and insufficiency in fe－male GD patients was 3.052 times higher than that in male GD patients（odds ratio[OR]=3.052，95% confidence interval（CI）：1.641 to 5.676，P<0.05）. Moreover，the risk of vitamin D deficiency and insufficiency in winter was 2.173 times higher than that in summer（OR=2.173，95% CI=1.303 to 3.623，P<0.05）. Conclusion：The risk of vitamin D deficiency and insufficiency is higher in female GD patients than in male GD patients and in winter than in summer，which prevention measures should be taken for. In the mean－time，the above risk factors should be adjusted when studying the vitamin D level in GD patients.

Abstract:Objective：To investigate the role of the new Bethesda System for Reporting Thyroid Cytopathology（TBSRTC） in the diag－nosis of thyroid disease using fine needle aspiration（FNA）. Methods：A retrospective analysis was performed for the data on thyroid FNA cytopathology and postoperative pathology of 2 838 patients treated in our hospital from January 2015 to April 2017. Results：Among the 2838 thyroid FNA specimens，101 were considered unsatisfactory；1 268 were benign lesions；195 were evaluated as atypia of undetermined significance/follicular lesion of undetermined significance；5 were follicular tumor/suspected follicular tumor；401 were suspected malignancies，among which 2 were diagnosed with non-invasive follicular thyroid neoplasm with papillary-like nuclear features（NIFTP）；868 were malignant lesions. A total of 791 patients underwent surgical treatment，and the results showed that the risk of malignancy in the six categories was 0%，34.4%，71.4%，66.7%，69%，and 97%，respectively. One case of follicular tumor/suspected follicular tumor diagnosed by cytopathology was confirmed to be well-differentiated tumor of uncertain malignant potential by postop－erative pathology. Two cases of NIFTP were confirmed by surgery and 3 cases of malignancies diagnosed by cytopathology were proved to be hyalinizing trabecular tumor by postoperative pathology. Conclusion：Thyroid cytopathology reveals a low incidence rate of bor－derline thyroid tumors，and according to the new TBSRTC system，such tumors are mainly classified into follicular tumor/suspected follicular tumor，suspected malignancies，and malignancies. These tumors often have a follicular or solid structure，with or without papillary-like nuclear features，and overdiagnosis should be avoided in clinical practice.

Abstract:With the change in the diagnostic and therapeutic concept of thyroid diseases and increasing demands for minimally inva－sive methods and beauty，endoscopic technology has made great progress in the field of thyroid surgery. Various surgical approaches have been developed，such as endoscope-assisted thyroid surgery，transthoracic/breast approach，transoral approach，and robotic thy－roid surgery，and they all have their own advantages and disadvantages. This article reviews the surgical approaches，advantages/dis－advantages，and development trends of endoscopic thyroid surgeries commonly used in clinical practice.

Abstract:Objective：To investigate the iodine nutrition status and thyroid function and their changes in different stages of pregnancy among pregnant Uygur and Han women in Urumqi，China. Methods：The cross-sectional method was used to assess the pregnant women who underwent thyroid function screening in Department of Endocrinology in The People’s Hospital of Xinjiang Autonomous Region from January 2016 to September 2017，and urinary iodine and thyroid function were evaluated. A total of 1268 healthy pregnant women with a single fetus who had complete clinical data were enrolled，among whom 1261 Han，Uygur，Hui，and Kazakh pregnant women were included for further comparison between different ethnic groups. Results：The median urinary iodine of all women was 172.3 μg/L，and of all women，3.79% had severe iodine deficiency，36.99% had iodine deficiency，35.49% had sufficient iodine，18.69% had super sufficient iodine，and 5.05% had excessive iodine. The Han women had the highest level of urinary iodine（182.95 μg/L），and the Uygur women had the lowest level（156.30 μg/L），with a significant difference between the two groups（P=0.01），while there was no significant difference between the other ethnic groups. There was no significant change in urinary iodine during the dif－ferent stages of pregnancy in each ethnic group. There was a significant difference between the Han and Uygur groups in serum thy－roid stimulating hormone（TSH） level in the first，second，and third trimesters（first trimester：3.57±2.93 vs. 5.13±7.12，P <0.001；second trimester：2.92±1.68 vs. 3.82±4.52，P=0.008；third trimester：2.70±1.31 vs. 3.62±1.85，P <0.001）. There was no clear cor－relation between urinary iodine and TSH. Conclusion：There is good iodine nutrition status in pregnant women in Urumqi，but 40.77% of these women have iodine deficiency，and Uygur women have more serious iodine deficiency. Han women have a lower TSH level than Uygur women during each stage of pregnancy，which is dif－ferent from the results of the local natural population during the same period of time. There is no correlation between urinary iodine and TSH.

Abstract:Thyroid cancer is the most common endocrine malignancy，and its incidence has increased rapidly in recent decades and has become a major health problem. In recent years，our understanding of the molecular mechanisms of thyroid cancer has made sig－nificant progress，with significant advances in diagnosis，prognosis and treatment，but there are still cases where the risk of developing more aggressive and fatal thyroid cancer. The discovery of long non-coding RNA（lncRNA） has dramatically changed our understand－ing of cell biology，especially the pathophysiology of cancer. Several studies have demonstrated that they have key regulatory roles in gene expression，cell biological behavior and carcinogenesis. Deregulated expression levels of lncRNA have been observed in various types of cancer including thyroid cancer，however，their role and molecular mechanism in thyroid cancer remains unclear. In this re－view，we summarize recent literature to highlight the current status of such lncRNAs in thyroid cancer.

Abstract:Objective：To compare the clinical characteristics of patients with Hürthle cell adenoma（HCA） and multinodular goiter （MNG），and to summarize the clues for the diagnosis of HCA. Methods：A total of 92 patients，who underwent resection of thyroid nodules in Peking University First Hospital from January 2000 to December 2017 and were confirmed to have HCA according to postoperative histopathological analysis of paraffin-embedded sections，were enrolled. Meanwhile，276 age-，sex-，and year-of-opera－tion-matched patients with MNG were enrolled and paired with the above patients with HCA at a ratio of 3∶1. The two groups of patients were compared for the differences in course of disease，clinical manifestations，thyroid function，thyroid peroxydase antibody （TPOAb），thyroglobulin antibody（TgAb），thyroglobulin（Tg），and ultrasonographic characteristics. Results：There were no significant differences between the two groups in patients’ family history，course of disease，clinical manifestations，preoperative thyroid function，and positive rates of TPOAb，TgAb，and Tg. The maximum diameter of thyroid nodules in the HCA group was significantly larger than that in the MNG group（P<0.05），and the rate of nodules with a diameter of not less than 2 cm was significantly higher in the HCA group than in the MNG group（P<0.05）. The HCA group had a significantly higher proportion of patients with solitary and solid nodules and abundant intra-nodular blood flow on ultrasonography than the MNG group（P <0.05）. Conclusion：It is difficult to distinguish HCA from MNG just from the course of disease，symptoms，thyroid function，and presence or absence of antibodies. It may indicate the possibility of HCA if relatively large，solitary，and solid nodules with abundant intra-nodular blood flow are found on ultrasonography.

Abstract:Objective：To investigate the clinical effect and toxic and side effects of external beam radiotherapy in patients with recur－rent and metastatic thyroid carcinoma. Methods：A total of 29 patients with metastatic thyroid carcinoma and 35 patients with recurrent thyroid carcinoma，who were admitted to Department of Radiology in Peking Union Medical College Hospital from January 2008 to January 2018，were enrolled. Three-dimensional conformal radiotherapy，intensity-modulated radiotherapy，or stereotactic radiotherapy was applied as the external beam radiotherapy. Patients’ survival，clinical outcome，and adverse reactions were evaluated. The Verbal Rating Scale and Response Evaluation Criteria in Solid Tumors（RECIST1.1） were used for outcome evaluation. The Kaplan-Meier method was used to calculate survival rate，and the Cox proportional hazards model was used to analyze prognostic factors. Results：The median follow-up time was 38 months. The 2- and 3-year overall survival rates were 67.2%（95% confidence interval[CI]：0.556-0.787） and 51.6%（95%CI：0.394-0.638），respectively. Pathological type was a prognostic factor for overall survival rate（hazard ratio=0.32，95%CI：0.163-0.629，P=0.001）. As for the 40 patients with measurable lesions，disease control rates after one month and two years of external beam radiotherapy were 92.5% and 60.94%，respectively. No RTOG grade 3 or above toxic and side effects were observed. Conclusion：In patients with recurrent and metastatic thyroid carcinoma，external beam radiotherapy can significantly improve symp－toms and control local lesions.

Abstract:Objective：To investigate the association between congenital simple absence of axillary hair and Hashimoto’s thyroiditis （HT）. Methods：A total of 116 patients with thyroid diseases were divided into two groups according to the presence or absence of congenital simple absence of axillary hair：52 patients with congenital simple absence of axillary hair as group A and 64 patients without congenital simple absence of axillary hair as group B. In group A，there were 5 male patients and 47 female patients；the mean age was 35.3±11.5 years；there were 46 HT patients，2 Graves’ disease（GD） patients，and 4 thyroid carcinoma（TC） patients. In group B，there were 26 male patients and 38 female patients；the mean age was 41.4±12.6 years；there were 25 GD patients，2 HT patients，19 TC patients，13 nodular goiter patients，and 5 subacute thyroiditis patients. All patients underwent physical examination for sex hair and the thyroid，thyroid function test，measurement of thyroid autoimmune antibodies，and thyroid ultrasound. Results：The proportion of HT patients in group A was significantly higher than that in group B（98.06% vs. 3.13%，P=0.000）. Among all patients in group A，55.77% had a family history of congenital simple absence of axillary hair，44.23% had a family history of thyroid diseases，26.54% had hypothyroidism，and 94.21% were positive for thyroid peroxidase antibody thyroglobulin antibody，and these proportions were significantly higher than those in group B（P=0.000，0.029，0.000，0.000，and 0.000）. Conclusion：Congenital simple absence of axillary hair may be a genetic marker of HT，thus providing clinical evidence for early identification of HT patients and timely inter－vention.

Abstract:Objective：To investigate arterial stiffness in non-dialysis patients with diabetic kidney disease（DKD） and its influence on cardiovascular death and all-cause death. Methods：A total of 54 non-dialysis DKD patients who were admitted to People’s Hospital，Peking University，from April 2006 to November 2010 were enrolled，and carotid-femoral pulse wave velocity（CFPWV） was measured after admission. According to CFPWV，these patients were divided into increased CFPWV group（CFPWV≥12 m/s） and normal group（CFPWV<12 m/s） and were followed up to observe cardiovascular death and all-cause death. The Kaplan-Meier method and the Cox proportional hazards model were used for the multivariate analysis of influencing factors for prognosis. Results：The mean follow-up time was 79.7±41.3 months for all patients. Compared with the normal group，the increased CFPWV group had significantly higher rates of all-cause death（76.9% vs 33.3%，P<0.01） and cardiovascular death（58.7% vs 13.3%，P<0.01）. The death group had a sig－nificantly higher CFPWV value than the survival group（P<0.01）. The Kaplan-Meier curves of cardiovascular death and all-cause death in the increased CFPWV group were well separated from those in the normal group，and the increased CFPWV group had significantly higher rates of cardiovascular death and all-cause death than the normal group. The multivariate Cox regression analysis revealed that high CFPWV，increase in C-reactive protein，and reduction in corrected calcium were the independent risk factors for cardio－vascular death and all-cause death（P<0.05）. Conclusion：Non-dialysis DKD patients with increased CFPWV have higher rates of cardiovascular death and all -cause death than those with normal CFPWV，and increased CFPWV is an independent risk factor for cardiovascular death and all-cause death in non-dialysis DKD patients with stage 3-5 chronic kidney disease.

Abstract:Objective：To study the relationship between serum asprosin level and metabolic indices in patients with type 2 diabetes mellitus（T2DM）. Methods：A total of 98 patients with a preliminary diagnosis of T2DM and 93 subjects with normal glucose tolerance （NGT） were enrolled. According to the China Expert Consensus on Nutritional Therapy for Overweight or Obese Patients（2016），the two groups were further divided into non-obesity（NOB） and obesity（OB） subgroups，with body mass index（BMI）≥28 kg/m2 as the cut-off point. Body indices and metabolism-related blood biochemical indices were tested，and serum asprosin level was measured with ELISA. The correlation between asprosin level and other metabolic indices was analyzed by linear correlation and multiple linear regression. Results：The asprosin level in the T2DM group was significantly higher than that in the NGT group[（352.579±40.742） pg/mL vs. （189.411±32.635） pg/mL，P=0.002]. Univari－ate correlation analysis showed that the serum asprosin level of T2DM patients was negatively correlated with high-density lipoprotein-cholesterol（HDL-C）（r=-0.447，P=0.000），and positively correlated with fasting blood glucose（FBG），fasting insulin（FINS），homeostasis model of assessment for insulin resis－tance index（HOMA-IR），and glycosylated hemoglobin（HbA1c）（r=0.187，0.198，0.202，and 0.159，respectively，all P <0.05）. Stepwise multiple regression analysis showed that FBG （β=0.333，P =0.000） and HOMA-IR （β=-0.176，P=0.047） were independent risk factors for serum asprosin level. Conclusion：The serum asprosin level in T2DM patients is significantly higher than that in NGT patients；it is positively correlated with FBG，FINS，HOMA-IR，and HbA1c，and negatively correlated with HDL-C. FBG and HOMA-IR are independent risk factors for serum asprosin level.

Abstract:Nonalcoholic fatter liver disease（NAFLD） refers to liver lesions induced by the factors other than alcohol，drugs，and hereditary diseases，and its pathogenesis may be insulin resistance，dyslipidemia，and oxidative stress. Hypoglycemic agents including DPP4 inhibitor exert a protective effect against NAFLD，possibly by improving insulin resistance and inhibiting lipid synthesis and in－flammatory response. The incidence rate of NAFLD is increasing year by year，but there are still no effective intervention measures in clinical practice. Treatment measures should be actively explored based on pathogenesis.

Abstract:Objective：To investigate the characteristics of glucose metabolism and the effect of metformin treatment on the insulin re－sistance and islet function in elderly mice with the history of gestational diabetes mellitus（GDM）. Methods：The mice were randomly divided into the control group（n=6），GDM group（n=6） and treatment group（n=6）. The animal model was established by high fat diet and the treatment group was administered metformin in the 11.5-17.5d of pregnancy. The body weight was monitored every month after delivery. Nine months after delivery，oral glucose tolerance test（OGTT） and insulin tolerance test（ITT） were adopted to detect the glucose metabolism in elderly mice with GDM history. The pathological changes of islets were observed under HE staining，and the expression of Ki67 in pancreatic tissues was detected by immunohistochemical staining. Results：Two months after delivery，the body weights of GDM and treatment group increased significantly（F=3.875，P=0.044） compared with the control. In GDM group，Glucose decreased slowly after intraperitoneal injection of insulin（P=0.004），islet shrank and the number of islets decreased. The expression of Ki67 was strongly positive in the islets of the control group（P=0.032）. Conclusion：For mice with GDM，blood glucose can return to be normal after delivery，but insulin resistance persists. For the elderly mice with GDM history，the islets present atrophy，function de－generates gradually，and the proliferation ability decreases. Metformin treatment during pregnancy can reverse the elderly insulin re－sistance and improve the pathological changes of islets，but can not change the proliferation ability.

Abstract:Metformin，as a classic oral hypoglycemic agent for the treatment of type 2 diabetes，has been shown to have a positive ef－fect on bone mineral metabolism in recent years，but its mechanism of action is very complicated，including inducing osteoblast differ－entiation，reducing the number of osteoclasts，and reversing the apoptosis of osteocytes and osteoblasts directly or indirectly induced by hyperglycemia. This article reviews the research advances in this field.

Abstract:The prevalence of obesity and type 2 diabetes（T2DM） which arise from the social lifestyle changes and the improvement of people’s living standard，continues to rise worldwide causing serious health problems. Weight management is beneficial in the treatment of T2DM，since weight loss can improve glycose control，improve insulin resistance and reduce the need for anti-glucose-agent. Therefore，weight management plays an important role in the prevention and treatment of T2DM. 2018 American Diabetes As－sociation（ADA） Standards of Medical Care in Diabetes and 2017 China Guideline for Type 2 Diabetes re-emphases the importance of weight management in the treatment of T2DM，and provides a new strategy for weight management in T2DM patients concerning lifestyle intervention，medical and metabolic surgery.

Abstract:Objective：To investigate the bone mineral density of Tibetan patients with type 2 diabetes and related risk factors，and to provide a theoretical basis for the prevention and treatment of osteoporosis in type 2 diabetes among the Tibetan population in Tibet. Methods：The patients with type 2 diabetes who were hospitalized in Department of Endocrinology，The People’s Hospital of Tibet Autonomous Region，from January 2016 to March 2018 were enrolled，and their general information and biochemical parameters were collected. According to the T value of dual-energy X-ray absorptiometry，they were divided into normal group（T value ≥-1.0），low bone mass group（T value ranging from -2.5 to -1.0），and osteoporosis group（T value ≤-2.5）. The three groups were compared in terms of general information and biochemical parameters，and a multiple linear regression analysis was performed for the data and pa－rameters with differences to identify risk factors. Results：A total of 456 patients（286 male and 170 female patients） were enrolled in this study，with a mean age of 55.7±11.3 years. There were significant differences between the three groups（177 patients in the nor－mal group，202 in the low bone mass group，and 77 in the osteoporosis group） in age，course of disease，body mass index（BMI），uric acid，and high-density lipoprotein cholesterol（all P<0.05），while there were no significant differences in fasting blood glucose，HbA1c，blood calcium，blood magnesium，serum phosphorus，triglyceride，cholesterol，low-density lipoprotein cho-lesterol，alkaline phosphatase，25-hydroxyvitamin D，and para-thyroid hormone（all P >0.05）. Uric acid was a risk factor for reduced bone mass in the lumbar ver－tebra（β=0.215，P <0.05），and age，BMI，and uric acid were risk factors for reduced bone mass in the femoral neck（β=-0.329，0.177，and 0.173，all P <0.05）. Conclusion：Old age，low BMI，and low uric acid are risk factors for reduced bone mass in Ti－betan patients with type 2 diabetes and should be taken seri－ously in clinical practice.

Abstract:Severe gestational hypertriglyceridemia may lead to serious complications such as acute pancreatitis，premature delivery，miscarriage，and even maternal-fetal death. This review summarizes the treatments of severe gestational hypertriglyceridemia in recent years，and suggests that strict low-fat diet control，appropriate medication，and timely plasma exchange are crucial to prevent acute pancreatitis during pregnancy and improve maternal and infant outcomes.

Abstract:Objective：To investigate the influence of melanocortin-4 receptor（MC4R） gene rs17782313 polymorphism on the weight-reducing effect of laparoscopic Roux-en-Y gastric bypass（LRYGB）. Methods：A retrospective analysis was performed for the clinical data of 81 patients with morbid obesity who were admitted to Shengjing Hospital of China Medical University from January 2011 to December 2013 and underwent LRYGB. Peripheral blood DNA was extracted，the target gene was amplified by PCR，and then direct sequencing was used to determine the genotype of rs17782313. According to the genotype，the patients were divided into risk gene group and non-risk gene group，and the two groups were compared in terms of the changes in metabolic indices，body mass index （BMI），and excess weight loss（EWL） after surgery. Results：The frequencies of TT，TC，and CC genotypes of rs17782313 were 50.62%（41 patients），35.80%（29 patients），and 13.58%（11 patients），respectively. There were no significant differences between the patients with different genotypes in body weight，BMI，blood lipids，fasting blood glucose，and glycosylated hemoglobin. The non-risk gene group had slightly greater reductions in BMI and EWL than the risk gene group at 6 and 12 months after surgery（BMI in female patients：P6 months=0.296，P12 months=0.179；EWL in female patients：P6 months=0.139，P12 months=0.094；BMI in male patients：P6 months=0.295，P12 months=0.072；EWL in male patients：P6 months=0.106，P12 months=0.077）. Conclusion：The patients who carry C allele（risk gene） in MC4R rs17792313 have a similar weight loss as those who do not carry this allele.

Abstract:Objective：To investigate the value of 11C-choline positron emission tomography/computed tomography（PET/CT） in the pre－operative localization diagnosis of difficult cases of primary hy－perparathyroidism（PHPT）. Methods：A total of 92 patients with PHPT（including 21 male patients aged 54.2±14.1 years） who planned to undergo surgical treatment and had difficulties in localization after ultrasound and 99mTc-MIBI were enrolled. PET/CT was performed at 20 minutes after the intravenous in－jection of 111-333MBq（3-9mCi）11C-choline. Visual and quantitative methods were used for image analysis，and with pathological results as the gold standard，PET/CT findings were compared with the results of serological examination. IBM SPSS 23 was used for statistical analysis. Results：A total of 103 lesions were detected by 11C-choline PET/CT in 92 patients，among which there were 83 lesions of parathyroid adenoma or hyperplasia，5 lesions of parathyroid carcinoma or its metastatic lesions，4 lesions of pulmonary neuroendocrine tumor，7 lesions of nodular goiter，and 4 lesions of metastatic lesions of medullary thyroid carcinoma；86 lesions were strongly positive and 17 were weakly positive. One lesion of cystic degeneration of parathyroidoma and one of parathyroid tissue were not detected. 11C-choline PET/CT had an overall sensitivity of 98.9%，a specificity of 6.3%，an accuracy of 84.8%，a positive predictive value of 85.4%，and a negative predictive value of 50%. The 78 strongly positive lesions of PHPT had significantly higher maximum standard uptake value（SUVmax） and standardized uptake value（SUV） ratio than the 10 weakly positive lesions（SUVmax：3.95（2.77，7.73） vs. 2.60（1.95，4.42），P=0.036；SUV ratio：1.72（1.43，2.42） vs. 1.19（1.11，1.51），P=0.002）. There were no significant differences between the PHPT group and the non-PHPT group in blood PTH，serum calcium，and serum phosphate（P=0.115，0.217，and 0.901）. Conclusion：11C-choline PET/CT can be used for preoperative local－ization diagnosis of PHPT，with a high sensitivity and a poor specificity. The differentiation of PHPT from nodular goiter and malignant tumor should be taken seriously in clinical practice.

Abstract:Objective：To investigate the clinical value of 99mTc-HYNIC-TOC whole-body scintigraphy and single photon emission com－puted tomography/computed tomography（SPECT/CT） in the diagnosis of adrenal pheochromocytoma. Methods：A total of 83 patients suspected of adrenal pheochromocytoma were enrolled and underwent both 99mTc-HYNIC-TOC whole-body scintigraphy and SPECT/CT. The findings of 99mTc-HYNIC-TOC whole-body scintigraphy and SPECT/CT were compared with pathological results. Results：Of all 83 patients，19 obtained positive results of 99mTc-HYNIC-TOC whole-body scintigraphy，among whom 17 had pathologically confirmed pheochromocytoma；among the 64 patients with negative results on whole-body scintigraphy，24 had pathologically con－firmed pheochromocytoma. Among the 56 patients with positive results of SPECT/CT，38 had pathologically confirmed pheochromocy－toma；among the 27 patients with negative results of SPECT/CT，3 had pathologically confirmed pheochromocytoma. In the diagnosis of adrenal pheochromocytoma，99mTc-HYNIC-TOC whole-body scintigraphy had a sensitivity of 41.5%，a specificity of 95.2%，an accu－racy of 68.7%，a positive predictive value of 89.5%，and a negative predictive value of 62.5%，while SPECT/CT had a sensitivity of 92.7%，a specificity of 57.1%，an accuracy of 74.7%，a positive predictive value of 67.9%，and a negative predictive value of 88.9%. The receiver operating characteristic（ROC） curve of the long di－ameter of adrenal pheochromocytoma measured by 99mTc-HYN－IC-TOC whole-body scintigraphy showed that the long diameter of adrenal pheochromocytoma had an area under the ROC curve of 0.735（95% confidence interval：0.578-0.892，P=0.011） at the cut-off value of 4.0 cm，with a sensitivity of 76.5% and a specificity of 75.0% in diagnosis. Conclusion：Compared with 99mTc-HYNIC-TOC whole-body scintigraphy，SPECT/CT had higher accuracy，sensitivity，and negative predictive value in the diagnosis of adrenal pheochromocytoma，as well as a higher detection rate of tumor with a relatively short long diameter or solid-cystic lesions.