Volume 94  ·   Issue 28  ·  2014

In 2014, the International Alliance Against Epilepsy (ILAE) Working Group released a practical definition of epilepsy based on practical clinical needs^[1]To distinguish it from the definition of epilepsy issued by the ILAE and the International Association of Epileptic Patients (IBE) in 2005^[2,3], referring to the latter as a conceptual definition. Therefore, in the new century, epilepsy has two definitions: a practical definition (hereinafter referred to as the new definition) and a conceptual definition (hereinafter referred to as the old definition). Why is there a new definition of epilepsy, what is the difference between the old and new definitions, how clinically operable is the new definition, and what is the importance of the new definition? Based on the literature and clinical practice, this article tries to make an analysis, to introduce the new definition, looking forward to everyone's heated discussion and in-depth discussion.

To evaluate the safety and efficacies of ultrasound-guided sclerotherapy of uterine fibroids with lauromacrogol.

A total of 102 consecutive premenopausal women with 113 uterine fibroids were enrolled. The treatment of lauromacrogol was performed under the guidance of ultrasound. Both conventional and color Doppler ultrasound were performed before treatment and at Month 1, 3, 6 and 12 after treatment. The changes of tumor volume reductions and vascular flow were analyzed and compared. And the alteration of symptoms was evaluated by the symptom severity score (SSS) questionnaire. And adverse events were also assessed during and after treatment.

At Month 1, 3, 6 and 12 after treatment, the mean volume of fibroids decreased by 40%, 47%, 58% and 70% respectively. And the differences had statistical significance before and after treatment (P<0.05). The clinical symptoms alleviated greatly or even disappeared. And the differences in SSS before and after treatment were also statistically significant (P=0.000). There was no onset of severe adverse events.

Both safe and efficacious, ultrasound-guided sclerotherapy of uterine fibroids with lauromacrogolis offers an alternative option for patients with fertility requirements.

To explore the early childhood caries (ECC) status of 5 year-old preschool children in Langfang, Hebei province.

For this cross-sectional study, a multiple stratified and cluster randomized sampling method was used to select 745 5-year-old preschoolers from 5 local districts. Oral health examination was performed to collect information for 726 children with a response rate of 97%.

The prevalence of ECC was 61.6% and dmft 2.97. The differences of caries level among sampled districts were statistically significant. The percentage of filled teeth among filled and decayed teeth was 2.5% and that for untreated caries 97.4%. Anterior teeth caries accounted for 41.5% and the percentage for posterior teeth was 58.5%. The percentage of pit and fissure caries was 21.8% and that for smooth surface caries 77.4%.

ECC is a public health issue for preschoolers in Langfang. And a large majority of caries remain untreated. Integrated ECC treatment and prevention programs are urgently needed.

To evaluate the efficacy and safety of catheter-directed thrombolysis (CDT) in treating with inferior vena cava (IVC) thrombosis after filter implantation.

A retrospective analysis of 13 patients with IVC thrombosis after filter implantation was conducted at our institution from June 2009 to June 2012. A total of 26 lower extremities were involved. IVC filters were implanted via right internal jugular vein. Then CDT was performed through small saphenous vein, popliteal vein or femoral vein. The dosage of urokinase was 0.6-1 million/day. The occlusive segment in IVC was managed with percutaneous transluminal angioplasty (PTA) and stenting.

The obstructed IVC was re-opened after CDT in 11 cases. The average CDT time was 8.3 (7-13) days. PTA (n=2) and stenting (n=1) were performed. A total of 4 retrievable filters were planted and retrieved later successfully. No severe complications occurred. During the follow-ups, no clinically detetable sighs of pulmonary embolism were observed.

CDT is effective, safe and feasible in the treatment of IVC thrombosis after filter implantation.

To detect the status of promoter region methylation of damage repair genes in gastric cancer and analyze its association with clinicopathologic characteristics.

A total of 70 human gastric cancer tissue samples representing all stages of disease were obtained from surgical resection specimens. DNA was extracted with the phenol-chloroform method. The technique of methylation specific polymerase chain reaction (MSP) was used to examine the methylation status of MLH1, CHFR, MGMT, FANCF, Rassf1A, BRCA1 and GSTpi in gastric cancer specimens. And MSP products were analyzed with 2% agarose gel electrophoresis.

The methylation rates of DNA damage related genes in human gastric cancer were as follows: MLH1 22.9% (16/70) , CHFR 47.1% (33/70), MGMT 34.3% (24/70), FANCF 11.4% (8/70), RASSF1A 7.1% (5/70), BRCA1 1.4% (1/70) and GSTpi 0% (0/70). And CHFR methylation was correlated with patient age (<60 year) (P=0.035), tumor size (diameter ≥5 cm) (P=0.031) and low differentiation (P=0.019). In addition, CHFR methylation was associated with MLH1 methylation and MGMT methylation respectively.

In human gastric cancer, the DNA damage repair genes of MLH1, CHFR and MGMT are frequently methylated while FANCF, RASSF1A, BRCA1 and GSTpi infrequently. Thus MLH1, CHFR and MGMT may play important roles during carcinogenesis of gastric cancer. And these methylated genes may serve as potential detection markers for gastric cancer.

To explore the analgesic effects and postoperative recovery of ropivacaine incision infiltration in elderly patients after total laparoscopic radical gastrectomy.

The clinical data were obtained prospectively from 61 elderly patients (≥65y) undergoing traditional total laparoscopic radical gastrectomy under standard general anesthesia at our department during January 2012 and September 2013. After surgery, they were randomly double-blindly divided into 3 groups: local infiltration of ropivacaine group (0.5% ropivacaine incision infiltration, 40 ml, n=22), local infiltration of sodium chloride group (0.9% sodium chloride injection incision infiltration, 40 ml, n=20) and control group (no analgesic, n=19). The intensity of postoperative pain was evaluated by numeric rating scale (NRS). And 10 mg of morphine was administered intramuscularly as rescue medication when NRS exceeded 4. NRS, cases on remedy analgesia and associated side effects were observed and recorded after 6 h postoperatively. A comparative study was made for postoperative first ambulation time, intestinal function recovery time, complication incidence, postoperative hospital stay and medical expenses among three groups.

Significant postoperative difference existed in NRS at 6, 12, 24, 48 h among ropivacaine, sodium and control groups respectively (6 h: 2.65±0.25 vs 5.47±0.12 vs 5.63±0.27, 12 h: 2.42±0.34 vs 5.82±0.63 vs 5.67±0.49, 24 h: 2.27±0.83 vs 3.95±0.51 vs 3.84±0.60, 48 h: 2.05±0.90 vs 3.75±0.72 vs 3.74±0.56, P<0.05). The patients with ropivacaine local infiltration had a lower rate of remedy analgesia than those with sodium chloride injection incision infiltration or without analgesic (bothP<0.05). There was no obvious adverse effect of ropivacaine infiltration at 48 h postoperatively. Both postoperative first ambulation and peristalsis recovery time were shorter (P<0.05) in ropivacaine group ((53±9) and (80±6) h)than sodium group ((91±11) and (105±9) h)and control group ((93±11) and (109±10) h). Meanwhile, ropivacaine group had significance decreased postoperative hospital stay and medical expenses than that in local infiltration of sodium group and control group((10.2±1.3) vs (12.6±1.3), (12.9±1.6) days, (57 000±5 000) vs (63 000±6 000), (65 000±6 000) yuan)(allP<0.05). Occurrence of complications significantly differed among three groups(local infiltration of ropivacaine group 9.10% (2/22), local infiltration of sodium chloride group 25.00% (5/20) and control group 21.05% (4/19),P<0.05).

Ropivacaine infiltration may reduce postoperative pain after total laparoscopic radical gastrectomy, enable faster recovery and provide an alternative analgesia in elderly patients.

To explore the effects of allitridi capsules on endothelial function and clinical prognosis in coronary artery disease (CAD) patients with obstructive sleep apnea hypopnea syndrome (OSAHS).

A total of 80 CAD patients with OSAHS were randomly assigned to receive conventional treatment (control, n=40) and additional allitridi treatment (120 mg/day, n=40) for 6 months. Another 40 CAD patients without OSAHS and 30 healthy individuals were chosen as controls. Endothelial function was assessed by endothelium dependent flow-mediated dilation (FMD) with high-definition color Doppler ultrasound. Serum nitric oxide (NO) and plasma endothelin-1(ET-1) levels were determined by enzyme-linked immunosorbent assay (ELISA) and radioimmunoassay. The duration of follow-up was 1 year.

The baseline clinical characteristics were not different between control and allitridi groups (P>0.05). Compared with CAD patients without OSAHS, FMD and serum NO level were significantly lower ((7.9±1.5)% vs (11.2±2.9)%,P=0.011 and (71.11±10.62) vs (86.28±11.03)μmol/L,P=0.007), plasma ET-1 level was markedly higher ((112.34±17.22) vs (89.87±11.56) ng/L, P=0.025) in CAD patients with OSAHS. At Month 6 post-treatment, FMD and serum NO level were significantly higher ((12.1±3.1)% vs (9.1±1.6)%, P=0.020 and (105.24±17.01) vs (82.39±11.12) μmol/L, P=0.001) and plasma ET-1 level in the allitridi group was lower ((77.12±9.65)vs (97.77±11.04) ng/L, P=0.001) than that in the control group. At Month 12 post-treatment, the incidence of MACE was lower in the allitridi group than that in the control group (8.3% vs 15.8%, P=0.016).

Allitridi capsules significantly improved endothelial function in CAD patients with OSAHS.

To analyze the recurrence characteristics of triple-negative breast cancer (TNBC) and explore their clinicopathological correlations in northern China.

Regression analyses were performed for 4 579 breast cancer patients from September 2002 to September 2007. Among them, there were 787 TNBC patients.

The median follow-up period was 72 (9-116) months. And 187 (23.8%) TNBC patients recurred and it was significantly different from the recurrence rate of non-TNBC group (17.4%, P=0.024). The median time to recurrence was 30.2 (4-110) months and 36.3% recurred 2 years while 27.8% did within 2-3 years. The rates of lung, liver and brain metastases to other sites were higher in TNBC patients than those in non-TNBC patients. TNBC patients had higher local recurrence rates than non-TNBC counterparts (2.92% vs 1.56%) (P=0.009). Age, regional lymph node infiltration, tumor size and pathological stage were all independent prognostic factors of TNBC.

TNBC has unique recurrence characteristics. It is prone to recur shortly with a high local recurrence rate. Metastatic rate is higher in visceral organ than bone.

To analyze serum proteins from pancreatic carcinoma patients, pancreatic benign tumor patients, chronic pancreatitis patients and normal controls to discover potential and specific biomarkers.

Serum samples were collected from 40 pancreatic carcinoma patients, 10 pancreatic benign tumor patients, 10 chronic pancreatitis patients and 40 cancer-free controls from May 2009 to April 2011. The samples were compared with two-dimensional differential gel electrophoresis (2D-DIGE) and differentially expressed proteins were further identified by matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF-MS). Then, two up-regulated proteins were further validated by real-time polymerase chain reaction (PCR), Western blot analysis and immunohistochemistry (IHC) from transcriptional and proteinic aspects.

We identified 12 differently expressed proteins in pancreatic carcinoma group compared with normal control group, including complement component C3, hemopexin, alpha-2-HS-glycoprotein, apolipoprotein H, serotransferrin, haptoglobin, apolipoprotein E, transthyretin, serum amyloid P-component, vitronectin, prothrombin and isoform 2 of Ig mu chain C region. High level of C3 and AHSG were detected in cancerous tissues by real-time PCR, Western blot and immunohistochemisty. Western blot revealed that gray ratios of C3 and AHSG were 0.11±0.01 and 0.26±0.02 respectively. The Immunohistochemical results showed that positive rate of C3 and AHSG were 72.5% and 82.5% in cancerous group versus 32.5% and 25% respectively in normal control.

C3 and AHSG may become pancreatic carcinoma-related biomarkers.

To evaluate the efficacy of platelet-rich plasma (PRP) in the treatment of acute wounds.

Randomized controlled trials (RCT) were identified from PubMed (1950.1-2014.2), Cochrane Central Register of Controlled Trials (CENTRAL, issue 4, 2014) of Cochrane Library, China National Knowledge Infrastructure (CNKI, 1979.1-2014.2), China Biology Medicine (CBM, 1978.1-2014.2) WANFANG database (1990.1-2014.2). References of retrieved articles were also identified. The quality of each RCT was evaluated by the Cochrane collaboration's tool for assessing the risk of bias. Data analysis was performed with Review Manager 5.1 to evaluate the efficacy of PRP in the treatment of acute wounds.

A total of 13 articles involving 982 patients were included. The results of systematic review and analysis showed that wound healing time of PRP treatment group was shorter than that of control group, so did length of hospital stay (mean difference (MD): -1.45, 95%CI: -2.07 to -0.83; P<0.01), the incidence of wound healing disturbance in PRP treatment group was less than that of control group (relative risk (RR): 0.11, 95%CI: 0.01 to 0.83; P<0.05), so did blood product transfusion. Moreover, post-traumatic pain level of PRP treatment group was lower than that of control group (MD: -1.26, 95%CI: -1.71 to -0.82; P<0.01).

Use of PRP can shorten acute wound healing time and length of hospital stay, reduce the incidence of disturbed wound healing and blood products transfusion and alleviate post-traumatic pain. Moreover, it has some effect on the control of wound infections.

To explore the global DNA methylation and the expression of regulatory genes for methylation in CD4⁺ T cells of the patients with immune related pancytopenia (IRP) and explore the role of methylation in the pathogenesis of IRP.

Thirty IRP patients (untreated, n=15; remission, n=15) and 15 healthy donors as controls were enrolled from December 2012 to December 2013. CD4⁺ T cells were sorted by immunomagnetic separation. The global DNA methylation was tested with enzyme-linked immunosorbent assay (ELISA). The mRNA levels of DNA methylation-related regulating genes, DNA methyltransferases (DNMTs) and methylated CpG binding proteins (MBDs), were measured by real-time quantitative-polymerase chain reaction (RT-PCR).

The level of global DNA methylation in peripheral blood CD4⁺ T cells of untreated IRP patients(3.525%±2.046%)and remission patients(4.790%±1.471%)were significantly lower than that of normal controls(10.101%±3.449%) respectively(both P<0.05). DNMT3b mRNA level of untreated IRP patients(1.332±0.785)was significantly lower than that of normal controls(2.077±1.059)in CD4⁺ T cells (P<0.05). The mRNA expression of MBD2 was significantly higher in CD4⁺ T cells from untreated and remission IRP patients(2.999±1.601, 2.055±1.576)than that in controls(0.581±0.247)(both P<0.05). The MBD4 mRNA level was significantly higher in CD4⁺ T cells from untreated IRP patients(2.736±2.719) compared to that in normal controls(1.167±1.006)(P<0.05). DNMT3b mRNA expression and CD4⁺ T cell DNA methylation to be positive correlated within IRP patients (r=0.569, P<0.01). The MBD2 mRNA expression was negatively correlated with CD4⁺ T cell DNA methylation and the ratio of Th1/Th2(r=-0.763, P<0.01;r=-0.652, P<0.05). The global methylation of CD4⁺ T cells negatively related to the ratio of CD5⁺ B cells(r=-0.439, P<0.05).

The globe DNA hypomethylation and abnormal expression of DNA methylation-related enzymes in peripheral blood CD4⁺ T cells may be related with the pathogenesis of IRP.

To investigate the effects of stellate ganglion block on AMP-ativated protein kinase and astrocyte in hippocampal neurons in postoperative aged rats.

A total of 96 male Sprague-Dawley rats aged 18-20 months, weighing 450-550 g, were randomly divided into 4 groups (n=24): Control group(GroupⅠ); Surgery group(GroupⅡ); Normal saline + surgery group(GroupⅢ); SGB+ surgery group(GroupⅣ). SGB with 0.25% bupivacaine 0.15 ml and operation was conducted after 15 min in groups Ⅱ, Ⅲ and Ⅳ. The eight rats were randomly sacrificed in each group postoperative 1, 3, and 5 d. The escape latency and swimming distance were recorded by morris water maze. The expression of AMPKmRNA, AMPK and phosphorylated AMPK(p-AMPK) was measured by RT-PCR and Western blot. The expression of GFAP was measured by immunohistochemisty.

Compared with Ⅰ group, the escape latency and swimming distance were significantly prolonged and the expression of AMPK mRNA, AMPK and p-AMPKwas up-regulated and the expression of GFAP in astrocyte was significatively increased in groups Ⅱ, Ⅲ and Ⅳ. Compared withⅡ and Ⅲgroup, the escape latency and swimming distance were significantly shorten and the expression of AMPK mRNA, AMPK and p-AMPKwas down-regulated and the expression of GFAP in astrocyte was significatively decreased in group Ⅳ.

SGB can improve the postoperative cognitive function, and the mechanism may be associated with down-regulating the expression of AMPK and restraining the activation of the astrocyte.

To explore the effect of extracts of Prunella vulgaris L. on proteome of human lung adenocarcinoma cell line A549 by two-dimensional electrophoresis and mass spectrometry and elucidate the mechanism of anti-lung adenocarcinom effect of Prunella vulgaris L. at the level of proteome.

The proliferative activity of human lung adenocarcinoma cell line A549 was evaluated by methyl thiazolyl tetrazolium (MTT) colorimetric assay. According to the difference of culture medium, all subjects were divided into the experimental group with culture medium of extracts of Prunella vulgaris L. (300 μg/ml) and the control group with culture medium of DMSO (0.3%). Proteins were isolated by two-dimensional electrophoresis and proteomic maps acquired by silver staining. And proteomic analysis was processed by Image Master 2D Quant Platinum 6.0. The proteins with > 2-fold differences were used to analyze by mass spectrometry and confirmed by Western blot.

The expressions of inositol 1, 4, 5-triphosphate receptor-interacting protein-like 2 precursor, heat shock cognate protein 70, serine-threonine kinase receptor-associated protein, tropomyosin 2(β) isoform 1, cyclin B3, MED12L protein and macrophin 1 isoform 2 were higher in experimental group than those in control group(ratio (medicial/normal) 2.051 93, 1 000 001, 2.203 08, 5.042 01, 15.178 00, 1 000 001, 1 000 001). And the expressions of enolase 1, M2-type pyruvate kinase, heat shock protein 27, Rho GDP-dissociation inhibitor 1, heat shock protein β1, TapasinERP57 heterodimer chain A, inorganic pyrophosphatase and mitochondrial Cysteinyl-tRNA synthetase 2 (putative) were lower in experimental group than those in control group(ratio (medicial/normal) 0.485 18, 0.491 53, 0.465 43, 0.454 71, 0.499 34, 0.450 36, 0.494 62, 0.437 33).

The extracts of Prunella vulgaris L. have multi-target and multi-pathway effects on anti-lung adenocarcinoma. And its possible mechanisms may be due to the regulation of steady state of calcium ion, cell cycle and its steady state and the inhibition of tumor cell proliferation and metastasis.

To explore the effects of early cigarette smoke exposure on the immune functions of T-lymphocyte subsets in asthmatic mice model.

Forty mice (20 days) were randomly allocated into four groups: air control group, cigarette smoke (CS) control group, air+ ovalbumin (OVA) group, and CS+ OVA group (n=10 each). The CS control and CS+ OVA groups were exposed to cigarette smoke for 3 weeks while the other two groups exposed to air. At an age of 8 weeks, air+ OVA and CS+ OVA groups had OVA sensitization for establishing an asthma model while the other two groups were selected as control. The percentage of regulatory T cells (Treg), effect of T cell (Te) subgroup including T helper type (Th)1, Th2 and Th17 in splenic mononuclear T cell were determined by flow cytometry. The levels of transforming growth factor-β (TGF-β), interleukin (IL)-4, IL-5, IL-10, IL-13, IL-17A and interferon-γ (IFN-γ) in bronchoalveolar lavage fluid (BALF) were measured by enzyme-linked immunosorbent assay (ELISA). And the percentage ratios of Treg to Te were compared among four groups.

The percentages of Th1, Th2, Th17 and Treg in splenic mononuclear of CS+ OVA group ((21.47±2.84)%, (16.33±3.02)%, (1.89±0.23)% and (2.92±0.40)%, respectively) were all significantly higher than those in air+ OVA group ((14.78±2.21)%, (9.72±1.46)%, (1.01±0.12)% and (1.84±0.22)% , respectively), the levels of IL-4, IL-5, IL-10, IL-13, IL-17A, IFN- γ and TGF-β in BALF of CS+ OVA group ((138.6±18.9), (195.3±32.6), (22.8±3.9), (716.9±123.6), (62.8±7.9), (173.2±25.5) and (66.5±8.2) ng/L, respectively) were all significantly higher than those in air+ OVA group ((90.1±13.7), (128.5±21.8), (14.4±2.9), (421.4±60.4), (40.4±6.2), (113.8±16.9) and (42.9±3.8) ng/L, respectively) (all P<0.05). No significant difference of Treg/Te percentage ratio existed in mice spleen mononuclear cells between air+ OVA group and CS+ OVA group (P>0.05).

Early cigarette smoke exposure could significantly exacerbate T cell immune dysfunction in asthmatic mice.

To explore the effects of anti-aging Klotho protein in the proliferation, migration and adhesiveness of human umbilical vein endothelial cell (HUVEC) and its influence of vascular endothelial growth factor (VEGF) expression in HUVEC.

HUVEC were treated for 24 h with various concentrations of Klotho protein (final concentrations of 0.1, 1, 10 nmol/L respectively). At the same time, HUVEC treated with PBS, 10 nmol/L VEGF and 10 nmol/L Klotho protein plus AKT inhibitors served as blank control, positive control and AKT signaling pathway inhibition group respectively. The effects of Klotho proteins on proliferation, migration and adhesiveness of HUVEC were determined by thiazolyl blue tetrazolium bromide (MTT), scratches, Transwell and cell adhesion assays respectively. After HUVEC exposed to Klotho protein, the induced function of VEGF expression was measured by Western blot analysis.

The MTT results showed that the A values of 0.1, 1, 10 nmol/L Klotho protein group increased respectively to 0.63±0.03, 0.71±0.04, 0.80±0.04, control to the blank group (0.59±0.03, F=9.32, all P<0.05). The scratches tests showed that compared with the blank control (9.40±2.07)%, the cell migration rates of 0.1, 1, 10 nmol/L Klotho protein group increased significantly to (12.28±0.62)%, (31.66±1.50)%, (36.69±0.79)%, (F=9.50, all P<0.05). Transwell assay found that cell migration count of 0.1, 1, 10 nmol/L Klotho protein group increased to 95.88±9.54, 143.13±7.83, 178±12.77, higher than the blank control group (80.13±12.19), the difference was statistically significant (F=11.51, all P<0.05). In cell adhesion assays, the number of cell adhesion increased to 59.60±5.13, 78.40±7.16, 114.60±5.55 at 0.1, 1, 10 nmol/L Klotho protein group versus the blank control (49.40±6.23) and the difference was also statistically significant (F=9.75, all P<0.05). Using Western blot, the expressions of VEGF were significantly induced to 0.46±0.02, 0.71±0.12, 0.81±0.16 at 0.1, 1, 10 nmol/L Klotho protein group versus blank control group (0.35±0.08,F=8.95, all P<0.05).

Klotho protein can promote the proliferation, migration and adhesiveness of HUVEC and induce a significant expression of VEGF, and its functions are related with the AKT signaling pathway.

At present, chronic obstructive pulmonary disease (COPD) is mainly treated with drugs, including bronchodilators, beta-adrenergic receptor agonists, anticholinergic drugs and inhaled corticosteroids, and oral hormone therapy in acute exacerbation. However, none of these methods can improve the mechanical mechanism of emphysema caused by hyperinflation. For some end-stage patients, the effect of drug therapy is not ideal. Trans-bronchoscopic LVRS developed on the basis of surgical lung volume reduction (LVRS) provides a new option for the treatment of patients with severe emphysema^[1]。 Since November 2012, we have completed 3 trans-bronchoscopic LVRS, but only 1 was successful, which is summarized below.

The patient was a female, 11 years and 5 months old. He was admitted to the Department of Endocrinology of Peking Union Medical College Hospital in March 2014 due to clitoral hypertrophy for 2 years. The patient was the third child and the first birth. The mother had no abnormalities in prenatal examination during pregnancy. Full-term dystocia was converted to caesarean section. There was no asphyxia after birth. She had a birth weight of 3.2 kg and a length of 55 cm. She had a normal baby girl's vulva, small clitoris, no dark skin color and esotropia in both eyes. Height since childhood is taller than children of the same age. 2 and a half years old, diagnosed "hyperopia and amblyopia" in an outside hospital. At 3 years old, he underwent binocular esotropia correction operation, and his visual acuity improved after operation. At 4 years old, the nails of both hands showed spoonlike nail-like changes, which later developed to both toenails. He went to primary school at the age of 7, with above-average grades and good sports scores. At the age of 8, bilateral eyebrows fell off, and then returned to growth and were thicker on their own. From the age of 9, the clitoris gradually became bigger, and occasionally the clitoris was erect. There was pain in both breasts, but the breasts were not enlarged. The height and weight increased significantly faster than those of children of the same age, and the height increased by 8~9 cm every year. After that, the voice gradually became thicker, the pubic hair grew, the appetite was better, the strength was greater than that of girls of the same age, and there were no menstrual cramps and periodic abdominal pain. In February 2014, I went to an outside hospital, and the color ultrasound of the uterus and adnexes showed "hypoechoic nodules behind the bladder, about 2.6 cm ×1.1 cm, shaped like the uterus; bilateral ovaries were not detected; and no obvious mass echoes were found in the pelvic cavity". Color ultrasound of perineal area and bilateral inguinal area "no obvious testicular echo detected; clitoral hypertrophy". The peripheral blood karyotype is "46, XY". In March 2014, I visited the outpatient department of endocrinology of Peking Union Medical College Hospital, and checked the sex hormones: total testosterone 8.1 nmol/L (normal value for women 0.2~3.0 nmol/L), luteinizing hormone (LH) 38.15 U/L, follicle stimulating hormone (FSH) 109.8 U/L, and estradiol 155.6 pmol/L. Prolactin 0.59 nmol/L (normal<0.87 nmol/L). The patient's parents denied that there were androgenic drugs at home, and denied that the patient had a history of taking drugs or health products. Past history, personal history, family history: Nothing special.

Chronic constipation refers to a decrease in the frequency of bowel movements, dry stool, and laborious bowel movements, with a course of at least 6 months. The prevalence rate of chronic constipation in people over 60 years old in China is 7.30% ~20.39%, and the prevalence rate increases significantly with age. The prevalence rate of women is significantly higher than that of men, and the prevalence ratio of men to women is 1:1.77~1:4.59. Functional disorders associated with chronic constipation include functional constipation (FC), functional defecation disorders, and constipation-type irritable bowel syndrome (IBS-C). The pathogenesis of chronic constipation is not clear, and dietary intervention, laxatives and prokinetics are usually used. In recent years, there has been gradual evidence that intestinal flora abnormalities are involved in the pathogenesis of chronic constipation, so the intervention of intestinal flora by microecological preparations to treat chronic constipation has gradually attracted people's attention.

Insomnia and obstructive sleep apnea (OSA) are two common diseases in sleep medicine^[1,2], associated with hypertension, stroke, cardiovascular death and mortality^[3,4]。 Studies show that 40% to 67.4% of OSA patients have insomnia symptoms^[5], but there are few studies on comorbid OSA in patients with insomnia. 1973, Guilleminault et al.^[6]A case of insomnia comorbid OSA is reported for the first time. However, over the past 40 years, insomnia-related OSA has received little attention compared to OSA-related daytime sleepiness. The comorbidity research of insomnia and OSA is summarized as follows.

Dyslipid metabolism is considered to be a major risk factor for ischemic cardiovascular disease, especially stroke^[1]。 Many epidemiological studies focused on the correlation between blood lipids and cardiovascular and cerebrovascular diseases^[2,3]。 In 2007, the "Guidelines for the Prevention and Treatment of Dyslipidemia in Chinese Adults" redefined the dyslipidemia of Chinese people with ischemic cardiovascular disease events (including coronary heart disease and stroke) as the joint endpoint^[4]。 The aorta, as the main pipeline connecting the heart with the organs and limbs of the whole body, is also bound to be affected by dyslipidemia and cause disease. As an important unit of aortic disease, the correlation between abdominal aortic aneurysm (AAA) and blood lipids has received more attention. This paper summarizes the research progress in this area.

A 55-year-old male underwent hepatocellular carcinoma in January 2009. In July 2012, he was treated with radiofrequency ablation once due to recurrence of liver surgery area. In November 2012, palpitation and fatigue gradually worsened. Physical examination at admission: heart rate 90 beats/min, regular rhythm, mild edema of both lower limbs, normal liver function, AFP 9.9 μ g/L, nuclear magnetic resonance (MRI) showed recurrence involving inferior vena cava and right atrial tumor thrombus (7.0 cm ×4.6 cm) after comprehensive treatment of liver cancer. Therefore, gamma-ray stereotactic radiotherapy for recurrent lesions and tumor thrombus in the left inner lobe of the liver was given 3.5 Gy/time ×10 times, and cardiac V30=21%. Six months after radiotherapy, the atrial tumor thrombus was partially remitted (1.8 cm ×2.0 cm), and the atrial tumor thrombus completely disappeared on 12 November 2013 (Figure 1)。 The patient had a higher quality of life with a KPS score of 90.