2016年 · 第96卷第19期

translational medicine, or translational research, has been exactly 20 years since the concept of "translational medicine" was formally proposed by Lancet in 1996. Its main purpose is to promote the two-side way of basic medical research and clinical application: "from bench to bedside" refers to the validation of laboratory research results in humans, thus translating them into clinical practice; "from bedside to bench" It means that the scientific questions of clinical refinement are answered through basic research methods, thus deepening the understanding of the mechanisms behind clinical phenomena. It should be said that translational medicine builds a bridge between basic researchers and clinicians, refining scientific problems from clinical needs, finding solutions to problems through basic and clinical research, and ultimately improving the level of diagnosis, treatment and prevention^[1,2]。

The pituitary is the most complex and important endocrine organ of the human body. There are many pituitary diseases, including pituitary adenomas, craniopharyngiomas, pituitary cysts, etc. With the development of medical diagnostic technology and the improvement of people's health awareness, the detection rate of pituitary diseases has been increasing in recent years^[1]。 They can cause endocrine dysfunction, damage of adenopituitary-target gland axis, compression and invasion of surrounding important tissue structures, and seriously affect human health. The diagnosis and treatment of pituitary diseases in China began in the 1970s. With the development of modern neurosurgery, endocrinology, imaging and pathology, great progress has been made in the research of pituitary diseases. In 2015, the "Expert Consensus on Surgical Treatment of Pituitary Adenoma in China" was released, which played a positive role in promoting the standardized diagnosis and treatment of pituitary diseases in China^[2]。

Case 1, 12 years old, underwent radical resection for tetralogy of Fallot in an external hospital 6 years ago. Postoperative review revealed residual ventricular septal shunt. Six months ago, the patient developed active chest tightness and shortness of breath, without cyanosis and dyspnea. In August 2015, he went to the People's Hospital of Zhengzhou University and was admitted to the Children's Heart Center with the diagnosis of "6 years of residual leakage of ventricular defect after radical resection of tetralogy of Fallot". Physical examination: heart rate 78 beats/min, peripheral blood oxygen saturation 98%, blood pressure 100/60 mmHg (1 mmHg =0.133 kPa), body weight 40 kg, height 160 cm, coarse breathing sounds in both lungs, no dry and wet rales, no bulge in the precordial area, no obvious enlargement of the heart turbidity boundary, uniform heart rhythm, grade III/6 systolic murmur can be heard in the 3rd to 4th intercostal area on the left margin of sternum, and P2 is not hyperactive. Echocardiography of the admitted heart showed that a strong patch-like echo of the interventricular septum was visible at 11 o'clock in the short axis section of the great artery, and the position was fixed. The residual shunt beam width was about 6 mm above the patch, and the stump was about 4 mm away from the right coronary valve root of the aorta. The blood flow in the right ventricular outflow tract was unobstructed, the suprapulmonary valve flow velocity was 2.62 m/s, the pulmonary valve was moderate regurgitation, the tricuspid valve was mild regurgitation, the right heart was large, and the inner diameter of the rest of the cardiac chambers and large blood vessels was normal. Ultrasound impression: consistent with changes after radical resection of tetralogy of Fallot, residual shunt at ventricular level (left to right), pulmonary regurgitation (moderate), tricuspid regurgitation (mild), and right heart enlargement. Thoracic orthographic radiograph showed postoperative changes of tetralogy of Fallot, and the cardiothoracic ratio was 0.53. Admission electrocardiogram showed sinus rhythm, incomplete right bundle branch block, right deviation of QRS axis. Laboratory tests: No obvious abnormalities were found in blood routine, urine routine, coagulation analysis and biochemical analysis. Based on the above clinical data, it was clearly diagnosed as "residual ventricular septal leakage after radical resection of tetralogy of Fallot". The patient and his family refused reoperation and interventional occlusion under radiation, and finally decided to perform ultrasound-guided percutaneous residual ventricular septal occlusion.

Rejection is the basic function of the immune system to maintain homeostasis of the internal and external environment of the body. Immune response plays an important role in inhibiting the growth and invasion of bone metastases. In the skeletal microenvironment of bone metastases, tumor cells can stimulate osteoclastogenesis and enhance osteolytic activity of osteoclasts. Osteolysis releases growth factors stored in the bone, which in turn further promote tumor growth and secretion of related factors in the bone. A vicious circle of bone destruction forms between tumor cells and osteoclasts. According to the regulatory effects on bone metastasis, immune cells are divided into three categories: anti-bone metastasis immune cells, pro-bone metastasis immune cells and dual regulatory immune cells. Immune cells are involved in regulating the vicious cycle of bone metastases. Immune cell function may be altered under different conditions, or even completely opposite.

The Encyclopedia of DNA Elements (ENCODE) study indicates that nucleotides in the human autosomal genome are essentially transcribed, and confirms that 80% of the genome has specific biological functions^[1]。 Among them, less than 3% of the transcripts are from genes encoding proteins, and the remaining non-coding transcripts may affect gene expression through different mechanisms. According to their length, non-coding RNAs can be divided into long-chain non-coding RNAs (lncRNAs,>200 nt) and short-chain non-coding RNAs (≤200 nt)^[2]The latter include microRNAs (miRNAs), RNAs that interact with Piwi proteins (piRNAs), and small interfering RNAs (siRNAs). Exosomes are vesicles secreted by cells with double lipid membranes, which can achieve horizontal transfer of proteins, mRNA, miRNA and lncRNA by fusion with target cells. The study on the role of lncRNA in exosomes in diseases is just beginning, and the research on the role of lncRNA in exosomes in diseases is reviewedTable 1)。

Dopamine receptor agonist (DA), as a first-line treatment for prolactin (PRL) adenoma, can effectively reduce PRL levels and reduce tumor volume, thereby improving neurological dysfunction caused by space occupation, and restoring gonadal function^[1,2]。 Previous studies have reported that DA can restore prolactin levels to normal in 85% to 90% of patients with prolactin adenoma, and reduce the tumor bodies in 80% of prolactin macroadenomas^[3]。 Currently, DA includes cabergoline, bromocriptine, quigolide, dihydroergoline, ergoethylurea and methergoline, with cabergoline and bromocriptine being the most commonly used. Bromocriptine as the first DA introduced into clinical practice^[4]Has a relatively short elimination half-life, therefore, doses ranging from 2.5 to 15 mg 2 or 3 times a day, and 18% to 25% of patients show bromocriptine resistance^[5,6]。 Compared with other DA, cabergoline has better efficacy and fewer adverse effects^[1,7]。 Because cabergoline has a plasma half-life of approximately 65 h, it should only be taken once or twice a week, which greatly improves patient compliance^[8]。 However, cabergoline and bromocriptine have a common disadvantage, that is, they need to be taken for a long time or even lifetime, and blind withdrawal of the drug can easily lead to the rebound of hyperprolactinemia and tumor regeneration^[9,10,11]。 If prolactin levels remain normal for at least 2 years and the tumor size shrinks by more than 50%, the DA dose can be gradually reduced, as low-dose drug therapy maintains stable prolactin levels and tumor size at this stage^[12]。 Therefore, how to reasonably reduce or even stop the drug is a very important clinical topic. In this paper, the discontinuation strategy of prolactin adenoma after DA treatment was reviewed, hoping to be useful for clinical reference.