Acromegaly is a commonly functional pituitary tumor. Standardized managements are crucial for the patients. Chinese Expert Consensus on the Diagnosis and Treatment of Acromegaly(2020) has been updated in 2020 based upon latest advance. This essential introduction about genetic causes would further guide and standardize the management of acromegaly.

Objective To assess the feasibility and safety of modified laparoscopic totally extraperitoneal(TEP)hernia repair.Methods From January to August 2007,a total of 31 patients with hernia were treated with modified TEP hernia repair under general anesthesia in our hospital.During the operation,the anterior peritoneal space was separated,and then a domestic single balloon catheter was inserted into the extraperitoneal space to expand the latter.The mesh was not fixed during the operation.Results All the operations were successfully completed with a mean operation time of(69.8?21.8)minutes,mean blood loss of(7.6?4.2)ml,and mean postoperative hospital stay of(2.6?1.3)d.Five cases developed laceration of the peritoneum during the operation,and 2 had scrotal hydrocele after the operation.The patients were followed up for 1-7 months [mean,(4.2?2.4)months],no recurrence or chronic pain at operative area were found during this period.Conclusions Modified TEP is feasible for hernia repair.The method is a safe and tension-free technique with a low rate of postoperative chronic pain at the operation region.

Objective To evaluate the clinical efficacy of nerve-related acupoints electrical stimulation in preventing urinary retention after hemorrhoid surgery. Method Ninety-seven patients were randomized into two groups: the treatment group received nerve-related acupoints electrical stimulation 1 h after Milligan-Morgan hemorrhoidectomy for mixed hemorrhoids, while the control group was taken as a blank control. The incidence of postoperative urinary retention, residual urine volume after the first urination, general urinary condition score, and satisfaction evaluation were compared between the two groups. Result The incidence of postoperative urinary retention and residual urine volume after the first urinary were lower, and the general urination condition and satisfaction evaluation were higher in the treatment group compared to those in the control group. Conclusion Nerve-related acupoints electrical stimulation can prevent and reduce the adverse reactions such as urinary retention after hemorrhoidectomy, and it can effectively protect the bladder function and improve the prognosis.

Objective To comprehensively analyze the effect of low-dose radiation on the lens of the eye of radiation workers.Methods The papers dealing with the relationship between occupational radiation exposure and the lens of the eye were collected by retrieving documents of the domestic and foreign medical information databases with references to other papers.There were 28 papers finalized with 17 608 workers included in the Meta-analysis.Stata12.0 was used for Meta-analysis,Q-test and I2 statistic for heterogeneity test,and funnel regression method,Begg's rank method and Egger's regression method for publication bias.Results The pooling odds ratio (OR) opacity in radiation workers were 2.51 (2.01,3.13),4.03 (2.77,5.85),respectively.Conclusions Low-dose radiation may lead to negative impact on ocular lens under the current occupational protection conditions.The proportion of posterior subcapsular opacity in radiation-related cataract is higher than that in age-related cataract.It is important to strengthen radiation protection of ocular lens.

Objective To explore the correlation between the joint detection of cholinesterase(CHE),alpha-L-fucosidase(AFU) and alpha-fetoprotein(AFP)and primary hepatic cancer(PHC).Methods 56 cases of patients with PHC(PHC group),52 cases of patients with liver cirrhosis(LC group)and 60 cases of healthy individuals(control group)were enrolled in this study,and serum levels of CHE,AFU and AFP were detected and statistically analysed.Results Serum levels of CHE in patients with PHC were negatively correlated with levels of AFU and AFP(correlation coefficient was -0.889 and -0.797 respectively,P <0.05),the ser-um levels of CHE in patients with LC were also negatively correlated with levels of AFU and AFP (correlation coefficient was-0.598 and -0.653 respectively,P <0.05).The positive rates of joint detection of CHE,AFU and AFP in PHC group and LC group were higher than that in the control group,had statistically significant differences(P <0.05 ).Conclusion CHE,AFU and AFP are sensitive indicators of liver lesions,and the joint detection could provide reference value for diagnosis and monitoring pro-gression of PHC.

Objective To quantitatively investigate the effect of low-dose ionizing radiation on the frequencies of chromosome aberrations and micronucleus-containing cells of radiation workers.Methods Nine electronic databases were systematically searched on the basis of the published studies evaluating the effects of low-dose ionizing radiation on the frequencies of chromosome aberrations and micronucleuscontaining cells.Of the 195 studies searched,21 studies were identified with a total of 1 970 626 cells under studying.Cochrane' s Q and I2 statistics were used to evaluate heterogeneity among studies and pooling odds ratio (OR) with 95％ confidence intervals (CI) were calculated using random-effect models or fixed-effect models,and publication bias were also calculated.Meta-analysis was performed using Stata 12.0.Results The pooling OR of chromosome-type aberrations [OR =3.03 (2.59,3.56)],dicentric plus centric rings [OR =4.12 (2.99,5.67)],translocations [OR =2.73 (1.67,4.46)],micronucleuscontaining cells [OR =1.70 (1.40-2.06)] were higher for radiation workers when compared with control group.Conclusions The frequencies of chromosome aberrations and micronucleus cell of peripheral lymphocytes are significantly high in radiation workers who were occupationally exposed to low-dose ionizing radiation.It should be noted that the radiation protection of radiological workers be enhanced.

ObjectiveTo investigate the effect of acup point injection and rehabilitation techniques on recovery of upper limb function and activities of daily life (ADL) in patients with shoulder-hand syndrome (SHS) after cerebral infarction.Methods Ninety-six patients with SHS after cerebral infarction admitted to Jiuquan City Traditional Chinese Medicine Hospital and Jiuquan City People's Hospital from January 2014 to February 2016 were enrolled, and they were randomly assigned to observation group (56 cases) and control group (40 cases). The patients in the two groups were given the same routine comprehensive cerebral infarction treatments and rehabilitation technological training. In the control group, additionally intermediate frequency physiotherapy was used, while in the observation group, acupuncture and acupoint injection of salvia miltiorrhiza and ligustrazine were added. The patients in two groups were treated consecutively for one month, afterwards, the upper limb motor function, ADL, shoulder joint pain, degree of swelling and range of motion were assessed, and the clinical effects were observed.Results After treatment, the modified Fugl-Meyer motor function score (FMA), modified barthel index (MBI) and the ranges of voluntary activities of shoulder abduction, adduction, flexion, extension, internal rotation and external rotation in patients of two groups were significantly increased than those before treatment; the pain visual analog scale (VAS) and the edema volume difference in observation group were lower than those in the control group, and after treatment, the changes of above indexes were more significant in the observation group than those in the control group [FMA: 70.10±6.38 vs. 41.76±18.69, VAS: 2.00±1.37 vs. 5.00±1.25, MBI: 75.17±3.51 vs. 51.56±2.12, edema volume difference (cm3): 2.13±2.05 vs. 5.75±1.17, flexion: (153.1±6.7)° vs. (56.0±10.9)°, extension: (39.6±5.8)° vs. (17.2±6.7)°, abduction:(168.1±9.6)° vs. (52.1±8.9)°, adduction: (52.1±3.6)° vs. (21.8±4.3)°, external rotation: (49.8±7.6)° vs. (23.2±5.2)°, internal rotation: (107.0±8.5)° vs. (51.2±6.1)°], the total effect in observation group was significantly higher than that in the control group [91.1% (52/56) vs. 70.0% (28/40),P < 0.05].Conclusions Acupuncture and acupoint injection combined with three-level therapeutic regimen of rehabilitation technological training for treatment of shoulder-hand syndrome after cerebral infarction can reduce the patient's pain and edema, and improve upper limb motor function and activities of daily living.

Objective To quantitatively analyze the effects of high background radiation area (HBRA) on the frequencies of translocation and unstable chromosome aberrations in human peripheral blood lymphocytes.Methods Based on the data from 9 published articles retrieved from 7 electronic databases,the Meta-analysis was performed to evaluate the effects of high natural background radiation (HNBR) on the frequencies of chromosome aberrations in the peripheral blood lymphocytes in 17 777 persons from HBRA and 10 386 from the control area (CA).Cochrane's Q and I2 statistics were used to evaluate heterogeneity among studies and pooling odds ratio (OR) with 95％ confidence intervals (95％ CI) were calculated using random-effect models.Publication bias was also calculated by funnel plot,Egger linear regression test and Begg rank correlation test.Results The pooling OR of translocation [OR(95％ CI) =1.57(1.10-2.24)] and unstable chromosome aberration [OR(95％ CI) =2.04(1.32-3.14)] of long-term exposed inhabitants living in HBRA were higher than control.The subgroup analysis showed that,fortranslocation,the OR (95％ CI) were 1.24 (1.09-1.42,I2 =0.00) for male,1.37 (1.17-1.60,I2 =0.00) for female,1.17 (1.05-1.30,I2 =69.50％) for adults,and 1.38 (1.25-1.51,I2 =0.00) for Chinese.For unstable chromosome aberration,the OR (95％ CI) were 3.78 (2.40-5.97,I2 =0.00) for female,2.60 (2.25-3.00,I2 =69.60％) for adults,1.03(0.85-1.24,I2 =0.00) for children,3.19 (2.46-4.13,I2 =21.60％) for Iranian,and 1.64 (1.33-2.02,I2 =0.00) for Chinese.HBRA,age and sex differences were the reasons of above heterogeneity.Conclusions To the inhabitants living in HBRA,the frequencies of translocation and unstable chromosome aberration of peripheral blood lymphocytes are higher than those in control area.More comprehensive analysis should be performed to assess the health risk in HBRA inhabitants,which may arise new stragety in radiation protection.

_ Objective_ To evaluate the efficacy of unilateral subtotal adrenalectomy in the treatment of bilateral adrenal solitary neoplasma causing Cushing's syndrome and to elaborate the therapeutic principle. Methods From 2007 to 2013, a total of ten patients were diagnosed with Cushing's syndrome caused by bilateral solitary adrenal neoplasma. We compared patients'clinical symptoms, hormone profiles, biochemical and metabolic parameters, and imaging data before and after the surgery. Five of them chose the optimal neoplasma based on the lateralization ratio of adrenal venous sampling result and the other 5 patients chose the optimal neoplasma based on the diameter of the mass reflected by the computed tomography result and were then operated. Results After the unilateral subtotal adrenalectomy,the24-hour urinary free cortisol decreased significantly(P<0.05)and the midnight serum cortisol level also significantly reduced(P<0. 01). Plasma adrenocorticotropic hormone level increased significantly(P<0. 01). Nine patients of them did not need contralateral adrenalectomy and one patient received contralateral adrelectomy because of the remnant of Cushingnoid symptoms. Conclusion Unilateral subtotal adrenalectomy is an effective and safe way to treat Cushing's syndrome caused by bilateral solitary neoplasma.

Objective To explore the effects of arsenic exposure on learning and memory and its potential mechanism in rats.Methods Water-based arsenic-exposed rat models were established on 4-l0 postnatal days.The experimental animals were divided into 4 groups (10-12 cases in each group):the control group,the 15 μg/L As2O3 water group,the 30 μg/L As2O3 water group,and the 45 μg/L As2O3 water group.Cognitive functions were examined with the Morris water maze,exploratory behavior was detected by the exploratory behavior test.The hippocampus of pups from each experimental group was sectioned at various time points after arsenic exposure.The morphologies and neurogenesis of the neurons in the hippocampus CA1-CA3 region and dentate gyrus (DG) were observed by hematoxylin-eosin staining,Nissl staining,and doublecortin (DCX) immunostaining at different time points after arsenic exposure.Results Compared with the normal control group,the escape latency of the rats in the arsenic-exposed group was prolonged.The average escape latency of the rats in the normal control group,15 μg/L As2O3 group,30 μg/L As2O3 group and45 μg/L As2O3 group were (17.00±9.53) s,(35.89 ±19.81) s,(26.60 ±18.84) s,and (33.79 ±18.08) s,respectively,and the difference among 4 groups was statistically significant (F =3.591,P ＜ 0.05),and the residence time in the original target quadrant was shortened,respectively,(38.93 ± 8.33) s,(36.03 ± 16.25) s,(29.85 ± 9.27) s,and (29.84 ± 10.16) s,respectively,and there was no significant difference among 4 groups (F =1.681,P =0.187).HE staining and Nissl staining showed that pathological changes such as edema,degeneration and necrosis were observed in the hippocampal CA1 area and CA2 area as well as dentate gyrus cells in rats exposed to arsenic in the acute phase.The higher the concentration of arsenic exposure,the more obvious the cell structure disorder was.However,5 weeks after exposure,the pathological changes in hippocampal neurons in the arsenic-exposed group gradually returned to normal.Immunohistochemistry showed that the expressions of DCX in the CA1,CA2 and dentate gyrus of rats exposed to arsenic decreased significantly 24 h after arsenic exposure,especially in the 45 μg/L group.Five weeks after arsenic exposure,there was no expression in the hippocampal CA1-CA3 area,and there was still a small amount of expression in the dentate gyrus.Conclusions Postnatal low-concentration arsenic exposure may impair learning and abnormal germination of neurons in the hippocampal dentate gyrus may be the underlying mechanism.