Volume 94  ·   Issue 33  ·  2014

With the rapid development of biomedicine, especially molecular pathology, epigenetics, tumor stem cells^[1]With the emergence of theory, the individualized, humanized and rational treatment concept of tumor is gradually being accepted^[2]It is recognized that most tumors are a systemic disease. The concept of radical tumor resection, which originated more than 120 years ago and was mainly based on surgical methods, was questioned. This is the progress of medical science, and the development of science is not shifted by human will.

To discuss the method, safety and effect of embedding ¹²⁵I to Brachytherapy vertebral column metastasis tumor by CT guided.

31 cases of vertebral column metastasis tumor were treated with percutaneous embedding ¹²⁵I by CT guided. They were observed the preoperative size and contour of lesions and were planed the activity and dosage of ¹²⁵I, the PD (prescribed dose) was 110-140 Gy, and the particle activity was 26.0-29.6 Mbq. CT scanning and therapeutic effect analysis were immediately carried out after operations. We also made CT scanning regularly to analyze the effect.

31 cases of vertebral column metastasis tumor were respectively re-examed of CT in 2, 4, 6 and 12 months after operation. We surveyed the local rate, evaluate the easement of pain and observed the tumor. The local response rate of 19 cases with paravertebral mass was 19/19, 19/19, 18/19, 17/19 cases in turn. The probability of odynolysis 31cases after 2, 4, 6 months therapy was 96.8%(30/31), 96.8%(30/31), 90.3%(28/31), 71.0%(22/31)in turn. 9.68% of 31 cases that was happened significant ossification in the devastated vertebral body. 12 cases appeared skin pigmentation without myelodiastasis or cutaneous ulcer.

The method to treat the vertebral column metastasis tumor of embedding ¹²⁵I by CT guided was simple, reliable and safety.

To compare the effectiveness of percutaneous microwave ablation with those of repeat hepatectomy in the treatment of late recurrent small hepatocellular carcinoma measuring ≤ 5 cm (interval of recurrence from initial hepatectomy was >12 months).

66 patients who underwent initial hepatectomy for primary liver cancer in April 1998 to December 2010, and subsequent initial recurrent hepatocellular carcinoma treated with percutaneous microwave ablation or repeat hepatectomy, were enrolled in the study. Among these patients 39 were treated with percutaneous microwave ablation and 27 were treated with repeat hepatectomy. Technique effectiveness was evaluated by means of contrast enhanced techniques one month after ablation. The overall survival and disease-free survival were evaluated by using the Kaplan-Meier method.

The technique effectiveness rate determined one month after ablation was 94.9%. The 1, 3, and 5 year overall survival rates were 86.2%, 73.3%, and 62.2%, respectively, for the microwave ablation group and 96.2%, 76.9%, and 61.2%, respectively, for the repeat hepatectomy group (P=0.471). The corresponding recurrence-free survival rates were 65.8%, 28.0%, and 14.0%, respectively, for the microwave ablation group and 66.7%, 50.7%, and 43.4%, respectively, for the repeat hepatectomy group (P=0.323).

In patients with late recurrent small hepatocellular carcinoma, Percutaneous microwave ablation was efficient, and showed similar long-term survival and recurrence-free survival compared with repeat hepatectomy.

To investigate the efficacy of transcatheter arterial chemoembolization (TACE) plus sorafenib in the treatment of hepatocellular carcinoma with portal vein tumor thrombosis.

A total of forty four patients of hepatocellular carcinoma with portal vein tumor thrombosis were retrospectively analyzed. There were twenty one patients in the treatment group, and the patients took oral 0.4 g sorafenib twice a day 7 days before or 14 days after TACE. Twenty three patients of control group were treated by TACE without sorafenib. Disease control rate (DCR), overall survival (OS), time to tumor progression (TTP) and side effects were followed up.

The times of TACE in the treatment group was more than that in the control group (2.5±1.1 vs 1.8±1.1, P= 0.019). DCR of the treatment group and the control group were 81.0% vs 26.1%, 47.6% vs 0, 19.0 vs 0, and 4.8% vs 0, 3, 6, 9, and 12 months after TACE respectively, and the DCR of the treatment group were significantly higher than that of control group (P<0.05). The median OS of the treatment group and the control group were (252±32)d and (123±18) d (P=0.001) respectively. The median TTP of the treatment group and the control group were (187±16)d and(71±8)d (P=0.000) respectively. Hand foot skin reaction and diarrhea of the treatment group and the control group were 90.5% vs 0 (P=0.000) and 66.7% vs 8.7% (P=0.000) respectively.

Sorafenib is efficacious, and may prolong OS and TTP in hepatocellular carcinoma with PVTT treated by TACE.

To investigate related clinical factors of hepatocellular carcinoma (HCC) patients received transcatheter arterial chemoembolization (TACE) complicated with hepatogenous diabetes (HD).

Forty eight cases of HCC line after TACE combined HD patients as the case group, and another forty eight cases of HCC line after TACE without HD patients as control group. A case-control study was retrospectively analyzed among two groups. A logistic regression modelwas established.

Multivariates analysis showed that family history of diabetes (OR= 3.464, 95%CI 1.100-10.909, P= 0.034), HBV DNA >1×10 ⁵ IU/ml (OR= 5.420, 95%CI 1.235-23.792, P=0.025), liver function Child-Pugh C (OR= 7.653, 95%CI 1.385-42.301, P=0.020), major larger tumors >10 cm ( OR=5.347, 95%CI 1.499-19.067, P=0.010), the initial embolism area > 70% ( OR=9.031, 95%CI 1.782-48.537, P=0.008), TACE > 3 times ( OR=3.726, 95%CI 1.151-12.065, P=0.028) were independent risk factors of HD in patients with HCC after TACE.

Family history of diabetes, HBV DNA > 1×10 ⁵ IU/ml, Child-Pugh C, major tumors size > 10 cm, the initial embolism area > 70%, TACE > 3 times were independent risk factors of HD in HCC patients after TACE.As for factors to these patients, the blood glucose was monitored promptly in order to early diagnosis and treatment.

To analyze the clinical and laboratory characteristics of postoperative patients of valproate encephalopathy (VHE), summarize the diagnostic and treatment experiences, discuss the reason of misdiagnosis and improve the level of early diagnosis.

A total of 12 VHE patients diagnosed after an application of valproate were recruited from January 2010 to April 2013. The characteristics of clinical manifestations and laboratory examinations were retrospectively analyzed.

Among them, the misdiagnoses included intracranial hemorrhage (n=1), secondary brain edema (n=1), postoperative cerebral infarction (n=1), postoperative epileptic deterioration (n=4), electrolyte disorder (n=2), intracranial infection (n=1), vasospasm (n=1) and non-specific (n=1). All patients had disturbance of consciousness associated with elevated blood ammonia. The symptoms of VHE were not correlated with the dosage and concentration of valproate. VHE was more likely to occur in patients treated with valproic acid sodium injection or other antiepileptic drugs. The symptoms dramatically improved after a withdrawal of valproate.

VHE should be considered in postoperative neurosurgical valproate-treated patients with unknown disturbance of consciousness. Timely diagnosis is needed and valproate should be withdrawn to avoid serious consequences.

To measure the ultrasonic parameters of transverse diameter, anteroposterior diameter and volume of fetal thymus through two and three-dimensional (2D and 3D) probes, establish normal reference range of fetal thymus development and assess the correlation between fetal intrauterine growth restriction and fetal thymus development.

A total of 53 patients with suspected fetal intrauterine growth restriction (IUGR) at our hospital from December 2012 to May 2014 were selected into the observation group while another 53 cases as the control group corresponding to the former group's gestational week (GA). The transverse and anteroposterior diameters were measured in the three vessel view by 2D-ultrasound and the volume of fetal thymus was measured through 3D ultrasound. The control parameters were analyzed by linear regression analysis. And two groups of parameters were tested by rank sum test.P<0.05 was deemed significant.

The regression equation of fetal thymus transverse diameter and GA was: Y=0.14X-1.174, R²=0.766, P<0.05; the regression equation of fetal thymus anteroposterior diameter and GA was:Y=0.49X-0.166, R²=0.792, P<0.05; the regression equation of fetal thymus volume and GA was:Y=0.652X-10.611, R²=0.791, P<0.05. Two groups underwent rank sum test of fetal thymus transverse diameter, anteroposterior diameter and volume (P<0.05).

Fetal thymus transverse diameter, anteroposterior diameter and volume increase with gestational weeks. In IUGR, fetal thymus transverse diameter, anteroposterior diameter and volume are less than those of the same GA fetal thymus.

To explore the early diagnosis of painful diabetic neuropathy by observing the alterations in corneal innervation with corneal confocal microscopy.

Fifty aged-matched control subjects, 45 diabetic neuropathy including 20 subjects with type 2 diabetes and painful neuropathy (PDN) and 25 subjects with type 2 diabetes and painless neuropathy (PLN) underwent detailed evaluations of their neuropathic symptoms. The examinations of visual analogue scale (VAS), contact heat evoked potential (CHEP) and corneal confocal microscopy (CCM) were employed to quantify small nerve fiber pathology and their degree of pain. We evaluated the use of a novel in vivo technique CCM in assessing painful neuropathy compared to CHEP.

The results of CHEP and CCM were significantly different in the diabetic groups compared to controls. T test indicated patients with PDN had significant reductions in corneal nerve fiber length (NFL), nerve branch density (NBD), nerve fiber density (NFD) and increased corneal nerve fiber tortuosity (NFT) (13±4 vs 11±3, 62±24 vs 47±19, 32±13 vs 22±8, 2.8±0.9 vs 3.2±0. 8; t=40.43, 27.27, 42.21, 194.39, P=0.039, 0.011, 0.017, 0.006), (t=40.43, 27.27, 42.21, 194.39, P=0.039, 0.011, 0.017, 0.006). Pearson's correlation analysis showed pain severity correlated significantly with cornea nerves damage. VAS correlated significantly with NFL, NBD, NFD and NFT (r=0.782, -0.376, -0.504, all P<0.001).

CCM provides a sensitive and noninvasive modality of detecting small nerve fiber damage in patients with PFN. And these abnormalities may be a sensitive predictor for the presence of pain in diabetic neuropathy patients.

To explore the mortality risks of elders with and without type 2 diabetes mellitus (T2DM) during a fellow-up period of 17 years.

The subjects were elderly patients (>60 years old) undergoing annual health examinations at our hospital. And the incidence and risk factors were analyzed by Kaplan-Meier method and COX's proportional hazard.

A total of 2 142 subjects were divided into T2DM group (DM, n=746) and non-T2DM group (N-DM, n=1 396). During a 17-year follow-up, the mortality rate of all causes was 50.9% in DM group versus 32.45% in N-DM group (P<0.01). The major mortality causes were malignant tumor, respiratory disease and cardiovascular disease. Kaplan-Meier analysis revealed that the accumulative mortality of all causes and cardiovascular with DM was significantly above that of N-DM. The independent mortality risk factors of elders was T2DM(P<0.01,HR=1.36, 95%CI: 1.192-1.558)and cardiovascular disease(P<0.01,HR=3.26, 95%CI: 2.887-3.690)based upon the COX's proportional hazard analysis.

Type 2 diabetes mellitus is an independent risk factor for elders with increased mortality risk.

To explore the association between body mass index (BMI) and male primary osteoporosis (OP) in a Chinese Han population.

The association of BMI with OP was assessed in 276 Chinese healthy aged males for physical examination. They were classified into OP, osteopenia and normal groups according to the World Health Organization (WHO) criteria, i. e. OP was defined arbitrarily when any T-score was -2.5 standard deviations or less at femoral neck, total hip or lumbar spine (L1-4) site. We also classified the subjects as different BMI groups of low weight, normal weight, overweight and obesity. The prevalence of OP was compared among different BMI groups. We determined the sensitivity, specificity and area under the curve of receiver operating characteristic (ROC) for validating the valuation of BMI to predict male primary OP.

Among them, 6/12 had OP in the low weight group, 17.36% (21/121) in the normal group and 12.59% (18/143) in the overweight and obesity group. And the difference was significant. The analysis of ROC curve showed that BMI was of limited value in predicting OP (P>0.05).

BMI has a positive correlation with male OP. The value of BMI is limited for predicting OP in males. And the relevant factors associated with male OP should to be further studied.

To observe the healing status of surgical incisions in human immunodeficiency virus (HIV)-positive patients with fractures and explore the factors related with poor wound healing, treatment and preventive measures.

Retrospective analyses were performed for the clinical data of 61 HIV-positive patients with fractures. And the influencing factors, treatment and outcomes of poor wound healing were analyzed.

Among them, the healing status was good (n=50) and poor (n=11). And the outcomes included redness (n=10), oozing (n=8), split (n=3), infection (n=2), hematoma (n=1), fat liquefaction (n=2) and delayed healing (n=2). All healed well after treatment. There was no infection or death during the follow-up period. Compared with HIV-negative patients, it was not statistically significant in wound infection. However, poor healing rates were significantly different (P<0.05). The risk factors included advanced age, low body mass index, low albumin, low hemoglobin, low total lymphocyte count, low CD4⁺ T lymphocyte count, high HIV infection clinical stage, long operative duration, emergency surgery and incision contamination.

In HIV-positive patients with fractures, the healing of surgical incision is generally good. However few have poor wound healing due to multiple factors. If poor healing is identified early and handled timely and correctly, good healing ensues.

To explore the characteristics of cognitive impairment and correlation analysis in patients with chronic renal failure (CRF).

The Addenbrooke's cognitive examination revised (ACE-R) scale was used to evaluate the cognitive function for 101 cases of chronic renal failure patients (group CRF) receiving outpatient and inpatient treatments and selected 30 individuals with normal renal function as normal controls (group NC) for cross-sectional analysis. T test, receiver operating characteristic (ROC) curve and other statistical methods were adopted for comparing differences.

(1) Compared with group NC (83.4±6.5), group CRF(71.9±17.6) showed significantly statistical difference on Addenbrooke's cognitive examination revised (ACE-R) scale scores (P<0.01); (2)compared with normal controls, the patients with CRF had significantly statistical difference on the scores of visual spatial ability (11.5±3.2, 14.0±3.0 respectively), language fluency (7.0±2.6, 8.7±1.9)(P<0.01) and memory (18.1±7.0, 21.5±3.6 respectively) (P<0.05); (3) the cognitive function of patients with CRF were significantly positive correlated with glomerular filtration rate (GFR) (r=0.614, P<0.01) and negatively correlated with the duration of illness (r=-0.492, P<0.01); (4) From ROC curve and the area under curve (AUC), ACE-R scale (AUC=0.680) showed a higher sensitivity than mini-mental state examination scale (AUC=0.576) in assessing cognitive function in patients with CRF (P<0.01).

(1) Under similar basic conditions of age, level of education and background, CRF patients showed significant damage overall cognitive function, cognitive impairment in visual spatial ability, executive function, long-term memory and logical judgment ability was particularly impaired. Immediate and delayed memory, attention, orientation and language ability also manifested different degrees of decline; (2) the severity of cognitive impairment in patients with CFR was closely related with the level of GFR; (3) the ACE-R scale showed a higher sensitivity than mini-mental state examination scale in assessing cognitive function in patients with CRF.

To evaluate the impact of sequential targeted therapy including vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKI) and everolimus on progression-free survival (PFS) in metastatic renal carcinoma.

A total of 17 patients of metastatic renal cell carcinoma from Department of Kidney Cancer and Melanoma, Peking University Cancer Hospital since January 2008 until April 2014 were enrolled into this retrospective study. They took at least 2 lines of VEGFR-TKIs and everolimus. The data of total PFS and PFS of each therapy were extracted and analyzed.

The sequential targeted therapies affected total PFS (18.0 vs 46.0 months, Kaplan-Meier survival analysis, P=0.015) with a statistical dislike of VEGFR-TKI/VEGFR-TKI/mTOR inhibitor (TTM) over VEGFR-TKI/mTOR inhibitor/VEGFR-TKI (TMT), HR=5.44 (Cox regression analysis, 95% CI 1.18-25.06).

TMT may prolong the total PFS of metastatic renal cell carcinoma.

To compare the metabolic activity by ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) uptake across the various histologic subtypes of non-Hodgkin lymphoma (NHL) and to investigate the relationship between metabolic activity and immunophenotype.

Positron emission tomography/computed tomography (PET/CT) studies of patients with newly diagnosed NHL from Jul 2010 to Mar 2012 were retrospectively reviewed, 82 patients were enrolled in our study according to the inclusion and exclusion criteria. The maximum standardized uptake value (SUVmax) of each patient reflecting the metabolic activity was recorded. Mean SUVmax of aggressive B-cell NHL, indolent B-cell NHL and T-cell NHL were compared. Pearson and Spearman test were used to analyze the relationship between SUVmax and immunophenotype.

The SUVmax of various subtypes of lymphoma revealed a wide range from 0.9 to 40.3, but lesions of 79 patients in this study showed obviously FDG uptake. SUVmax of indolent B-cell NHL (4.5±2.4) was significantly lower than that of aggressive B-cell NHL (13.1±7.6) (P=0.000), T-cell NHL (8.0±3.8) (P=0.03). SUVmax of aggressive B-cell NHL was significantly higher than that of indolent B-cell NHL, T-cell NHL (P=0.000, P=0.005). SUVmax of B-cell NHL had positive correlation with Ki-67 expression (r=0.493, P=0.001) and negative correlation with CD138 (r=-0.654, P=0.008). While SUVmax of T-cell NHL had no correlation with Ki-67 expression (P=0.213), but had negative correlation with CD56 (r=-0.545, P=0.044).

Different subtype of NHL manifests markedly different intensity of FDG uptake, but most lesions of lymphoma are FDG avid. Metabolic activity is lower in indolent B-cell NHL than in aggressive B-cell NHL and T-cell lymphoma, which is concordant with its aggressiveness. SUVmax of B-cell NHL correlates with expression of Ki-67 and CD138. SUVmax of T-cell NHL is associated with the expression of CD56, no correlation is detected between SUVmax of T-cell NHL and Ki-67 proliferation.

Warfarin is currently a commonly used drug for preventing embolism in patients with atrial fibrillation, but warfarin has limitations such as regular monitoring, narrow treatment window, and drug-drug interaction. Large-scale phase III clinical trials have confirmed that new oral anticoagulants (NOACs, dabigatran, rivaroxaban, apixaban, and edoxaban) are not inferior or even superior to warfarin in efficacy, respectively, while their bleeding incidence is similar or lower. However, there are no clinical trials that directly compare the efficacy and safety of these drugs with each other. Flemming Skjoth, Institute of Thrombosis, Aalborg University, Denmark, et al. used indirect comparative analysis to compare the differences in efficacy and safety between edoxaban and three other anticoagulants. "Efficacy and safety of edoxaban in comparison with dabigatran, rivaroxaban and apixaban for stroke prevention in atrial fibrillation-an indirect comparison analysis" Published in February 2014Journal of Thrombosis and HaemostasisOn.

To explore the protection mechanisms of telmisartan on inflammation and fibrosis after myocardial infarction in rats.

The model of acute myocardial infarction (AMI) was established by ligating left anterior descending coronary artery. The surviving rats were divided into AMI (AMI) and telmisartan treatment (telmisartan) groups. And another sham operation group (sham) was designated (n=8). At the end of study, total heart weight (THW), left ventricular weight (LVW) and weight index were measured; myocardial infarction and inflammatory reactions detected by hematoxylin and eosin and Masson staining; the serum levels of C-reactive protein (CRP), tumor necrosis factor-alpha (TNFα), monocyte chemotactic protein-1 (MCP-1), interleukin-6 (IL-6) and interleukin-1 beta (IL-1β) by enzyme-linked immunosorbent assay (ELISA); the levels of transforming growth factor 1 (TGFβ1), collagen Ⅰ, collagen Ⅲ and MMP9 mRNA in myocardial tissue by reverse transcription-polymerase chain reaction (RT-PCR); the expressions of TGFβ1, collagen Ⅰ, collagen Ⅲ, matrix metallopeptidase 9 (MMP9) and nuclear factor-kappa B (NF-κB) by Western blot.

Compared with sham group, significant pathological changes of myocardium occurred in AMI group. The serum levels of CRP [(472±132) vs (104±28) ng/ml], TNFα [(229±41) vs (18±5) pg/ml], MCP-1[(558±116) vs (158±20) pg/ml], IL-6 [(404±63) vs (21±4) pg/ml] and IL-1β [(625±145) vs (189±34) pg/ml] increased (P<0.05). RT-PCR analysis showed that the expression levels of TGFβ1, collagen Ⅰ, collagen Ⅲ and MMP9 increased significantly. The results of Western blot were consistent and NF-κB was activated significantly (P<0.05). Compared with AMI group, the above-mentioned indicators decreased obviously in telmisartan group (P<0.05).

Telmisartan may regulate inflammation and myocardial fibrosis after acute myocardial infarction by signaling pathways of NF-κB and TGFβ in rats.

To explore the in vitro antitumor effect of interleukin-24 (IL-24) gene regulated by ovarian-specific promoter-1 (OSP-1) on human ovarian cancer cell line SKOV3.

An expression vector (pcDNA3.0-OSP-1-IL-24) containing IL-24 gene under ovarian-specific promoter-1 was constructed by molecular biological methods and then transfected into human ovarian cancer cell SKOV3, human hepatoma cell HepG2 and human fibroblast BJ by cationic liposome. Reverse transcription-polymerase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay (ELISA) were used to detect the IL-24 gene in cells and supernatants. The antitumor effects of IL-24 gene were investigated by direct cell count, flow cytometry and methyl thiazolyl tetrazolium (MTT) assay.

After transfections with pcDNA3.0-OSP-1-IL-24, the expression of IL-24 gene was detected only in SKOV3 cells. And only the growth of SKOV3 cells was inhibited significantly while those of HepG2 and BJ cells were not affected. The culture supernatant of SKOV3 cells transfected with pcDNA3.0-OSP-1-IL-24 could significantly inhibit the growth of SKOV3 cells. But the antitumor efficiency in SKOV3 cells of OSP-1 system was significantly lower than that of CMV promoter system.

With a high specificity, IL-24 gene therapy under the control of ovarian-specific promoter-1 is a novel target for the treatment of ovarian cancer.

To explore the proliferation inhibition of miR-16 to U87MG in vivo.

The miR-16 over-expression U87MG cells were obtained by infecting U87MG with lentivirus-hsa-GFP-miR-16. The models of subcutaneous transplantation and orthotopic brain glioma were obtained by injecting cells into flank and brains of nude mouse separately. Untransfected U87MG, negative control U87MG and miR-16 over-expression U87MG were separatively cultured and injected into brains of balb/c-nu mice for establishing an orthotopic model of brain glioma. Tumor growth curve was calculated for subcutaneous tumor. The brains were sectioned and stained with hematoxylin & eosin (H&E) and immunohistochemistry for CD31 and cyclinD1.

The miR-16 over-expression U87MG cells formed no apparent tumors while the negative control U87MG grew into large tumors. HE stain of brains showed that gliomas of miR-16 over-expression U87MG (0.11±0.04 mm³) were smaller than those of negative control U87MG (6.50±1.41 mm³) and untransfected (6.41±0.91 mm³) in murine brains. Immunohistochemistry showed that cyclinD1 staining was less in gliomas of miR-16 over-expression U87MG than the other two groups. CD31 immunohistochemistry also yielded the similar results. The mean microvascular density (MVD) of gliomas of miR-16 over-expression U87MG (4.50±1.58/×200) was smaller than negative control (30.40±6.57/×200) and untransfected (29.40±4.93/×200) (P<0.05).

miR-16 can significantly inhibit the in vivo growth of U87MG glioma. This is probably the results of cell proliferation inhibition and angiogenesis suppression.

To explore the antagonistic effect of estrogen on iron-induced bone resorption and the role of oxidative stress.

In vivo, 8-week-old female imprinting control region mice were randomly divided into 3 groups of ferritin (F), ovariectomy (OVX) and F+ OVX. Intervention was made by ferric ammonium citrate (FAC) and OVX. Serum levels of ferritin, malondialdehyde (MDA) and superoxide dismutase (SOD) were measured. The expression changes of TRAP, CTR, matrix metallopeptidase 9 (MMP9) and CTK derived from murine bilateral tibia were detected by reverse transcription-polymerase chain reaction (RT-PCR). A high-resolution micro-computed tomography was utilized for scanning distal femur. In vitro, RAW264.7 cells were used and intervened by FAC and estradiol. Tartrate resistant acid phosphatase (TRAP) staining was performed and wine-red TRAP positive cells were counted. ROS level was detected by 2', 7'-dichloro-dihydrofluorescein diacetate (DCFH-DA) with a multi-detection reader.

The serum ferritin were heightened in F and F+ OVX groups [(335.30±44.10) vs (41.38±5.56) μg/L, (324.80±38.60) vs (41.38±5.56) μg/L respectively, P<0.01]. The trend of MDA level was F+ OVX>OVX>F while SOD level was quite opposite. Body mass density of F+ OVX group was lower than that of OVX group (0.114±0.013 vs 0.187±0.029 mg/mm^3,P<0.05) or F group (0.114±0.013 vs 0.902±0.064 mg/mm^3,P<0.05). RT-PCR: TRAP and CTK gene expression of OVX group was lower than that of F+ OVX group. However, TRAP, CTR and CTK gene expression of F+ OVX group was higher than that of F group. TRAP staining: FAC increased the number of TRAP positive cells (41.7±5.5 vs 20.0±4.0,P<0.05) while estradiol decreased it (14.8±5.1 vs 41.7±5.5,P<0.05). DCFH-DA test show that reactive oxygen species was elevated by FAC (160%±8% vs 100%±9%,P<0.05) and reduced by estradiol (53%±13% vs 160%±8%,P<0.05).

The antagonistic effect of estrogen on iron-induced bone resorption is probably regulated by oxidative stress.

female pseudohermaphroditism is a common type of hermaphroditism. Patients have a normal female karyotype (46, XX), and there is only one gonad-ovary in the body, while the external genitalia and secondary sexual characteristics have male manifestations, such as clitoris enlargement, left and right fusion of labia majora, Adam's apple and beard, etc. The cause of female pseudohermaphroditism is that patients are exposed to excessive androgens since childhood, among which congenital adrenocortical hyperplasia, especially 21-hydroxylase (21-OHD) deficiency (which can lead to increased androgen synthesis in the body), is one of the main causes. This disease is not uncommon clinically, but familial rare. In January 2014, Peking Union Medical College Hospital admitted two cases of hermaphroditism in a family, which were biological sisters. The diagnosis and treatment results are reported as follows.

microRNA is a kind of 21-25 nucleotide long small non-coding ribonucleic acid encoded by endogenous genes widely existing in eukaryotic cells. After specific binding to target genes, it may induce the degradation of target mRNA by deadenylation, inhibit the initiation of protein translation or the extension of polypeptide chain, and degrade nascent proteins to regulate the role of target genes^[1,2]。 This complex regulatory network can not only regulate the expression of multiple genes through one miRNA, but also fine regulate the expression of a certain gene through the combination of several miRNAs. The expression patterns of miRNA have different phases and sequences, that is, the miRNA expression profiles are different in different tissues, organs and physiological phases^[3]。 Studies have shown that miRNA is involved in a series of important physiological and pathological processes in organisms, and is closely related to the occurrence and development of many kinds of diseases such as tumors, hematopoietic diseases, cardiovascular diseases and neurological diseases^[4,5,6]。

A 55-year-old male was admitted with headache for 2 months, aggravated with walking instability for 1 week. He has been in good health, has been exposed to radioactive elements, and has smoked for more than 30 years. Physical examination: Shen Qing Li, left isotropic hemianopia, bilateral limb muscle strength grade V, and no obvious abnormalities were found in the physical examination of the remaining nervous system. Laboratory tests: Hematuria routine, liver and kidney function were not abnormal, hepatitis B markers, human immunodeficiency virus antibody (Ⅰ + Ⅱ), Mycobacterium tuberculosis antibody and Treponema pallidum antibody were all negative, and pulmonary tumor markers were not abnormal. CT examination of the head showed that there was an irregular circular linear high-density shadow in the right occipital lobe, with low-density shadow in the ring, obvious edema around the lesion, and left deviation of the midline. MRI of the head showed that the right occipital lobe was about 6.5 cm ×5.5 cm ×5.0 cm in size, with cystic-solid lesions with long T1 and long T2 changes, uneven signals, clear boundaries, close relationship with the dura mater, and obvious edema around the tumor. After intravenous contrast, the lesions showed irregular annular enhancement, with a liquid dark area in the middle, seeFigure 1。 Plain CT scan of the lung showed irregular nodules in the upper lobe of the left lung, 1.4 cm ×0.9 cm in size, considering peripheral lung cancer. Admission diagnosis: (1) Right occipital lobe occupation: metastatic tumor? High-grade glioma? (2) Left lung nodule: peripheral lung cancer? The patient refused to undergo biopsy of pulmonary lesions and underwent resection of right occipital lobe mass under general anesthesia. During the operation, the mass was closely adhered to the dura mater, easily peeled off, gray-yellow, gelatinous, brittle, clear boundary, no envelope, general blood supply, and no pathological blood vessels. Pathological diagnosis: Cryptococcal spores were seen in the mucous tissue of the right occipital lobe, and foam cells with glial proliferation were seen around it, which was considered to be cryptococcal encephalitis, seeFigure 2。 The fever appeared on the 3rd day after operation. The results of cerebrospinal fluid bacterial culture were: Cryptococcus neoformans. The single drug fluconazole 400 mg/d intravenous drip was ineffective, and the symptoms could not be controlled after increasing to 800 mg/d. After combining with hydroprednisone 100 mg/d for 3 weeks, the patient's fever symptoms resolved, and the cerebrospinal fluid bacteriology was negative after re-examination. The medication was adjusted to oral fluconazole 400 mg/d and discharged. Five months after operation, there were no signs of recurrence in head MRI enhancement, no obvious changes in lung CT, negative cerebrospinal fluid bacteriology, and normal range of lung tumor markers. The patient was instructed to take medication outside the hospital for at least 18 months. The patient has been followed up for 6 months and is in good condition.

A 27-year-old male came to our outpatient clinic in February 2014 due to infertility for 1 year after marriage. Specialist examination: the penis and scrotum develop normally, and the pubic hair is evenly distributed in an inverted triangle; The left testis, epididymis and spermatic cord are normal, and two masses can be accessed in the right scrotum. The texture is similar to that of the left testis, and there is no tactile tenderness. The scrotal ultrasound showed that the left testis was about 5.2 cm ×2.9 cm ×2.4 cm in size and 18.9 ml in volume, with normal shape, smooth capsule and uniform parenchymal echo. Two testicular echo masses can be detected in the sheath cavity of the right testis (Figure 1) with a size of about 3.5 cm ×3.2 cm ×2.0 cm and 2.9 cm ×2.4 cm ×1.8 cm, respectively, and a volume of about 11.8 and 6.6 ml, respectively; The morphology is still regular, the parenchymal echo is still uniform, and there is no obvious abnormal blood flow signal in it. The left epididymis was normal in size and shape, the capsule was smooth, and the parenchyma echoed uniformly. The epididymal head could be detected without echo, the size was about 0.9 cm ×0.78 cm, the boundary was not clear, and the echo of the posterior wall was enhanced. The right epididymis is slightly longer, the shape is still regular, and the parenchymal echo is still uniform. No obvious abnormalities were observed at the bilateral spermatic cords. Ultrasound impression: polyorchidism is likely, left epididymal head cyst. Semen routine results: Semen volume 3.5 ml, pH 7.4, sperm motility 52.95%, sperm motility grade A 7.24%, grade B 33.71%, sperm concentration 106.71×10⁹/L. Five results of sex hormones: follicle-stimulating maturation hormone 5.47 U/L, luteinizing hormone 1.18 U/L, serum prolactin 95.19 mU/L, estradiol 238.55 pmol/L, testosterone 21.83 nmol/L.