Objective To evaluate the efficacy and safety of sunitinib versus sorafenib in the first-line treatment of advanced renal cell carcinoma.Methods Forty-two patients with advanced renal cell carcinoma were divided into two groups according to the therapeutic method.Twenty patients were treated with sunitinib (50 mg, oral administration, once a day, for 4 weeks, drug withdrawal of 2 weeks, 6 weeks was a cycle) and 22 patients were treated with sorafenib (400 mg, oral administration, twice a day, until the disease progression, 6 weeks was a cycle).The efficacy and toxicity were evaluated every 2-cycle treatment.Results All 42 patients could be evaluated.The disease remission rate (RR), disease control rate (DCR) of sunitinib group and sorafenib group were 30.0％ (6/20), 22.7％ (5/22), 90.0％ (18/20), 77.3％ (17/22) respectively,the median progression free survival (PFS) were 10.8, 6.2 months, the median overall survival (OS) were 25.6, 18.6 months respectively.There were no statistical differences in the RR (x2 =0.287, P =0.592) and DCR (x2 =1.222, P =0.269) between the two groups.There were statistical difference in the PFS (x2 =6.041, P =0.014) and OS (x2 =11.245, P =0.001) between the two groups.The most common toxicities of the sunitinib group were diarrhea, fatigue, oral mucositis, nausea, vomiting, all these toxicities were mainly Ⅰ-Ⅱ degree, and could be well tolerated.The hand-foot syndrome rate of the sorafenib group obviously exceeded the sunitinib group (59.1％ vs.25.0％ , x2 =4.972, P =0.026).Conclusion Sunitinib has good efficacy in the first-line treatment of advanced renal cell carcinoma with less toxicity than sorafenib, so it is worthy of popularization.

Malignant pleural effusion is a common complication of advanced cancer.The present study employed chest circulating hot infusion chemotherapy for 55 cases of malignant pleural effusion.The outcomes were complete remission (n =23,41.8％),partial remission (n =25,45.5％),stable disease (n=4,7.3 ％) and progressive disease (n =3,5.5％).And the effective rate was 87.3％.After treatment,the levels of interleukin-10 (IL-10) and interleukin-6 (IL-6) were significantly lower than those before treatment (P ＜ 0.05).And the levels of interleukin-2 (IL-2) and interferon-gamma (IFN-γ) were significantly higher than those before treatment (P ＜ 0.05).Pleural circulation perfusion chemotherapy is both safe and effective in the treatment of malignant pleural effusion.And it helps to enhance immune functions and improve the quality-of-life of patients.

[Summary] Riedel thyroiditis is an extremely rare form of thyroiditis, the etiologic mechanism remains obscure. It often onsets insidiously and has non-specific clinical manifestations, most of the patients visit doctor because of goiter and clinical manifestation caused by involvement of the surrounding tissue and organs, histopathological examination is the gold standard for diagnosis. Riedel thyroiditis can be easily confused with the other common thyroiditis and thyroid malignant tumor due to lack of understanding of Riedel thyroiditis. Thyroid isthmus wedge resection is recommended if symptoms of oppression are obvious, glucocorticoid or tamoxifen treatment can be used after the operation if Riedel thyroiditis still progresses. Here we present a case of Riedel thyroiditis with diagnosis and treatment in order to call attention to the diagnosis and treatment of this disease.

Objective:To explore the factors affecting bone mineral density (BMD) in adult males with low-to-moderate fluoride exposure in Henan Province.Methods:Adult male villagers from low-to-moderate fluoride exposure areas in Tongxu County, Kaifeng City, Henan Province were recruited from April to May 2017 based on cluster random sampling. Questionnaire survey, physical measurements and urinary samples collection were conducted respectively. Urinary fluoride (UF) was determined by fluoride ion-selective electrode. Ultrasound bone densitometer was used to measure BMD (T-score). Partial correlation analysis and multiple linear regression were used to analyze the influence factors of BMD.Results:A total of 439 adult males were included in this study. Age, body mass index (BMI), UF content, and T-score of the participants were (47.99 ± 8.49) years, (25.77 ± 3.23) kg/m 2, (1.34 ± 0.74) mg/L, and-1.79 ± 0.79, respectively. Partial correlation analysis showed a significantly positive correlation between BMI and T-score after age adjustment ( r = 0.194, P < 0.05). Multiple linear regression showed that T-score decreased by 0.015 (95% CI:-0.024 -- 0.005, P < 0.05) for each 1-year increase in age and T-score increased by 0.034 (95% CI: 0.009-0.059, P < 0.05) for each 1.0 kg/m 2 increase in BMI. Interaction analysis showed that T-score was closely related to the interaction between overweight (≥24.0 kg/m 2), non-smoking, tea drinking and UF [ β (95% CI): 0.134 (0.001-0.269), 0.163 (- 0.015-0.337), 0.215 (- 0.006-0.436), P < 0.10]. Conclusions:Our findings reveal a negative correlation between age and BMD, and a positive correlation between BMI and BMD in adult males with low-to-moderate fluoride exposure in Henan Province. In addition, low-to-moderate fluoride exposure is more likely to damage the BMD of smokers.

Objective To study gender-related differences of clinical characteristics and vascular complications in patients with aldosterone-producing adenoma(APA).Method Consecutive 315 patients with APA confirmed by pathological diagnosis were included and the clinical features and vascular complications were compared based on gender.Results (1) Of the 315 patients with APA,female accounted for 52.7％ (166/315).Male patients with APA presented a higher BMI,compared with females [(25.4± 2.9) vs (24.1 ± 3.2) kg/m2,P＜0.01],and the history of smoking and drinking was more common in male patients.No significant difference was found in regard to the age,duration,hypokalemia,tumor size,and family history of hypertension between two groups (P＞0.05).(2) No significant difference was found in the prevalence of hypertension,duration of hypertension,blood pressure,and antihypertensive medieation between two groups.However,the patients with grade 3 hypertension tended to be more prevalent in males(P =0.08).(3) Serum aldosterone concentrations were similar in two groups,but 24 h urinary aldosterone showed an increased trend in male group (P =0.07).(4) The overall prevalences of cardiovascular (51.0％ vs 36.1％) and cerebrovascular (9.4％ vs 3.0％) complications were significantly higher in male group (P ＜ 0.05).Further analysis of cardiac events revealed significantly higher rates of left ventricular hypertrophy (23.5％ vs 13.9％) and arrhythmia (21.5％ vs 10.8％) in males (P＜0.05).However,no significant difference in the prevalence between two groups was found in regard to cerebral hemorrhage,infarction,and chronic renal insufficiency.(5) The fall of blood pressure and recovery from hypokalemia were comparable between males and females in two weeks after sugery.However,in the patients with persistent hypertension,the number of antihypertensive drugs used in males was greater than that in females and more male patients needed ≥ 2 types of antihypertensive drugs.Conclusion There were significant gender-related differences with regard to clinical features and vascular complications in patients with APA.

Objective To explore the relationship between intracellular calcium levels ([Ca2+]1) and reactive oxygen species (ROS) in sodium fluoride (NaF)-induced injury in human neuroblastoma SH-SY5Y cells. Methods The levels of [Ca2+]1 and ROS were measured in different exposed times(0,3,6,12,18,24 h) respectively after SH-SY5Y cells were exposed to 40 mg/L NaF in vitro, and the optimal expose time was selected. Furthermore, the changes of [Ca2+]1, ROS and LDH levels in 40 mg/L NaF-treated groups incubated with 38.23 mg/L BAPTA-AM or 380.40 mg/L ethylene glycol-bis-(beta-aminoethyl ether)-N, N, N', N'-tetraacetic acid (EGTA) or 16.32 mg/L N-acetyl-L-cysteine(NAC) also observed at the optimal expose time(12 h), respectively. Results At 3,6,12,18 and 24 h, [Ca2+]1 level(5620.0±226.3,4775.5±85.6,3312.3±87.5, 3047.0±75.0,2717.0±66.5) was significantly increased, and so was the ROS level(4449.53±324.61,7463.07±117.43,20 227.33±178.04,8817.56±200.13, 7975.61±92.90) except at 3 h, compared with 0 h(2115.0±24.0,4098.01±21.22, all P<0.05). The levels of [Ca2+]1 and ROS reached the peak at 3 h and 12 h, respectively. [Ca2+]1 and LDH levels in NaF-treated group [3279.5±94.0, (1057.50±64.35)U/L], NaF+NAC treated group[ 3583.0±350.7, (561.02±85.50)U/L], NaF+EGTA treated groups[3701.5±157.7, (1074.50±86.97)U/L], and BAPTA-AM treated group[2766.5±38.9, (521.43±40.80)U/L] had increased, compared with the control[2022.5±118.1, (186.97±8.73)U/L], the difference being statistically significant (P<0.05). ROS levels in NaF-treated group (19 003.04±332.34), and NaF+EGTA treated group(19 170.12±95.46) was higher than that in the controls(4060.98±145.66), the difference being statistically significant (P<0.05). NaF and NAC had antagonistic effect on ROS and LDH levels (F=976.11,43.54,P<0.05). And NaF and BAPTA-AM had antagonistic effect on [Ca2+]1, ROS and LDH levels (F=15.65,1515.53,115.00, P<0.05). Conclusions NaF-related calcium is released from the site of intracellular calcium storage, which induces ROS production, both of them caused cytotoxicity and the increase of LDH level in human neuroblastoma SH-SY5Y cells.

AIM: To investigate the relationship between high temperature essential factor A-1(HTRA1) polymorphism and genetic susceptibility of wet age-related macular degeneration (AMD) in Han population. METHODS: Totally 201 patients of wet AMD in Han population were selected from May 2014 to January 2017 in our hospital as disease group,and 201 healthy persons of Han were selected as health group. Blood samples of peripheral vein were collected and genomic DNA was extracted. HTRA1 polymorphism loci were detected,and the rs11200638 and rs2248799 loci of HTRA1 gene were detected by Sequenom mass spectrometry platform. Then the relationship between HTRA1 polymorphism and genetic susceptibility of wet AMD were analyzed. RESULTS: The grade distributions of the genotype of the rs11200638 and rs2248799 loci in the two groups subjects had significant differences (P<0.01), and the frequencies of AA and TT in the disease group were respectively 51.2% and 57.7%,of which the health group were respectively 20. 9% and 28. 4%, and the former were significantly higher than the latter, with significant differences (P<0.01). The frequencies of risk allele A of rs11200638 loci and risk allele T of rs2248799 loci in the disease group were respectively 69.7% and 73.6%, of which the health group respectively were 45. 8% and 52 5%, and the former were significantly higher than the latter, with significant differences (P<0. 01). The OR values of rs11200638 genotype AA and AG were respectively 5.36 and 3.45,which were the risk factors of wet AMD (P < 0. 01). The OR values of rs2248799 genotype TT and TC were respectively 2.36 and 1.98, which were the risk factors of wet AMD (P<0.01). CONCLUSION: The rs11200638 and rs2248799 polymorphisms of HTRA1 gene are associated with the incidence of wet AMD,and the genotype AA and TT are closely related to the risk of wet AMD in Han population, of which the higher frequencies can increase the risk of wet AMD.

Objective To better understand the clinical management of tumor-induced osteomalacia (TIO) by analyzing the clinical features, diagnosis, treatment, postoperative biochemical changes, and clinical status in 12 cases of TIO. Methods Twelve cases of TIO hospitalized from 2004 to April 2010 were reviewed retrospectively. All cases were diagnosed based on their clinical manifestation, hypophosphatemia, and image study including technetium-99m octreotide scintigraphy (99mTc-Oct). Resuits There were 7 males and 5 females with mean age of (41.8±9.6) years (20 to 56 years). The course of disease was from 2 to 14 years ( median course 4.0 years). They all presented with bone pain, gait disturbance, muscle pain, and muscle weakness. Serum phosphate( Pi)levels were low in 12 cases with a range from 0.30 to 0.56 mmol/L. 99mTc-Oct was performed in 9 cases and it showed that the lesions were located in head of femur, fibula, retrocalcaneal area, foot, humerus,metacarpal, posterior chest wall or near nasal bone (apex partis petrosae ossis temporalis). Subcutaneous soft tissue mass was found in another 3 cases at loin, thigh, and foot by physical examination. The tumors were confirmed by CT, MRI or ultrasonography. Twelve patients underwent operation to remove the tumors and histopathology showed hemangioendothelioma or fibrous angioma (6 cases), giant cell tumor or fibroma of tendon sheath(4 cases), liposarcoma(1case), and phosphaturic mesenchymal tumor(1case). Serum Pi levels returned to normal in 10 patients after resection of tumor. During 2 to 64 months follow up, symptoms of bone pain and muscle weakness were improved obviously. Conclusions Patients with hypophosphatemic osteomalacia should be thoroughly investigated for TIO. 99mTc-Oct and other imaging examinations can effectively locate the tumors. Once the hidden tumor is found and excised, the patient will recover and enjoy normal life with normalized Pi concentrations and marked improvement of symptoms.

BACKGROUNDAcute lung injury/acute respiratory distress syndrome presents with not only local inflammation, but also pulmonary coagulopathy which is characterized by an alveolar procoagulant response, anticoagulant inhibition, fibrinolytic supression and fibrin deposition. We thus had hypothesized that if aerosolized unfractionated heparin was inhaled into alveolar spaces, it could block the procoagulant tendency, lessen depletion of coagulation factors, and even influence the inflammatory response. We also assessed the effects of different administration regimens of heparin.

METHODSMale Wistar rats were given inhaled heparin starting 30 minutes before (prophylactic heparin) or 2 hours after (therapeutic heparin) intravenous lipopolysaccharide (LPS) was administered at 6-hour intervals; control groups received inhaled normal saline with or without being exposed to LPS. Thrombin-antithrombin complexes, activated protein C, tissue type and urokinase type plasminogen activators (t-PA/u-PA), plasminogen activator inhibitor-1 (PAI-1), tumor necrosis factor-α, interleukin-6 in bronchoalveolar lavage, and lung tissue myeloperoxidase activity, and histology score were measured at three time-points. PAI-1/(t-PA + u-PA) was calculated based on the before-mentioned parameters. Statistical analysis was made using one-way analysis of variance (ANOVA) with post hoc test or Student's t test in the case of heterogeneity of variance.

RESULTSAn alveolar procoagulant reaction, depressed fibrinolysis, and inflammatory response occurred in endotoxemia-induced lung injury. Local prophylactic application of heparin attenuated coagulation and early inflammation, promoted fibrinolysis, and reduced the histology score. Therapeutic application of heparin had similar, but weaker effects.

CONCLUSIONSIntrapulmonary application of unfractionated heparin by inhalation might inhibit alveolar procoagulant reaction and the early inflammatory response, promote fibrinolysis, and alleviate pulmonary pathology in endotoxemia-induced lung injury rats. Administration of heparin before LPS challenge was more efficacious.

Acute Lung Injury ; blood ; drug therapy ; Administration, Inhalation ; Animals ; Blood Coagulation ; drug effects ; Endotoxemia ; complications ; Fibrinolysis ; drug effects ; Heparin ; administration & dosage ; Inflammation ; drug therapy ; Lung ; pathology ; Male ; Rats ; Rats, Wistar

Objective To study whether preoperative serum thyrotropin ( TSH) concentration can be used for risk prediction of papillary thyroid microcarcinoma ( PTMC ) . Methods The cohort of this retrospective study consisted of 1 707 patients who underwent surgery on thyroid nodules at Chinese PLA General Hospital from October 1999toFebruary2011. 37.32%(n=637)ofthesepatientssufferedfromdifferentiatedthyroidcancer(DTC),and 14. 18%(n=242) of patients with DTC suffered from PTMC. Results (1) The mean TSH level in patients with DTC was significantly higher than that in patients with benign thyroid nodules [(1. 99(1. 25-3. 19) vs 1. 48 (0. 85-2. 32) mU/L, P<0. 01]. DTC with diameter greater than 10 mm had higher serum TSH level compared with that in benign thyroid nodules[2. 04(1. 26-3. 36) vs 1. 45(0. 83-2. 30), P<0. 01]. Serum TSH level was not significantly raised in cases where-as the diameter of tumor was 10 mm or less. (2) With the increasing level of TSH, the prevalence of DTC and tumours with diameter greater than 10 mm rose significantly, but the increasing trend was not significant in PTMC. (3) Raised TSH level was an independent risk factor of DTC based on Binary logistic regression. Conclusions Serum TSH is an independent risk predictor of DTC, it is an independent risk predictor of the diameter of DTC greater than 10 mm, but it is not a good risk predictor in PTMC.