Objectives To investigate the relationship of sex difference with serum bisphenol-A (BP-A),adiponectin and metabolic syndrome (MetS)in elderly patients with isolated systolic hypertension(EISH).Methods A retrospective study of the clinical data was conducted in 540 subjects from the Cardiology and Geriatric Department in the Affiliated Hospital of Shanxi Medical University,Changzhi Municipal People,s Hospital and the Department of Cardiology of Shanxi Medical University,First Clinic Hospital from January 2010 to December 2013.Elderly patients with EISH were divided into male group(n=270)and female group(n=270).Meanwhile 560 older health persons were severed as controls,including 300 females and 260 males.The changes of BP-A and adiponectin (Ad) concentration were measured.The blood lipid,insulin resistance index (HOMA-IR),blood pressure,body mass index,heart rate variability and ultrasonic change of heart and blood vessel were tested regularly.Results The level of serum BP-A[(0.89±0.10)ng/L vs.(0.57±0.04)ng/L]and [(0.64±0.10)ng/L vs.(0.55 ± 0.08)ng/L] were higher in male EISH vs in male control,and in female EISH than in female control (F =23.76,23.86,all P ＜ 0.01),respectively.The levels of adiponectin were lower in male EISH vs control[(4.9±1.4)ng/L vs.(10.5±2.7)ng/L and in female EISH vs control(6.0±1.3) ng/L vs.(11.5±3.3)ng/L),F=13.10,16.20,all P＜0.01.Root mean sequare of the successive normal sinus RR interval difference(rMSSD)were lower in male/ female EISH than control groups(F=13.10、13.70,P ＜0.01).Serum BP-A level was positively correlated with the bocly mass index and systolic pressure (r =0.38,0.54,P ＜ 0.01),and was negatively correlated with serum Ad and rMSSD(r=-0.46,-0.42,P＜0.01).Conclusions Obvious gender difference in changes of serum BP-A exists in older patients with EISH.Network cytokines may take part in the pathophysiological process of the obesity related hypertension.

Ovotestis is a rare disorder of sexual differentiation in which the gonads have both ovarian and testicular elements. The patients always present with ambiguous external genitalia, and there are usually with serious disorder between chromosomal sex, gonadal sex, social sex, and psychological sex. The definite diagnosis and gender confirmation, appropriate surgery in internal genitalia and orthomorphia in external genitalia, as well as psychological support are essential for a multidisciplinary medical group in managing this disease. The medical data of two children with ovotestis who were reared as boy or girl respectively were analyzed.

Objective To describe a case of female sexual abnormality with 46, XX caused by an androgen-producing adrenocortical tumor and to explore the mechanism of abnormal androgen secretion from the tumor. Methods The tumor tissues as the experimental group were compared with the normal adrenal tissue. The LH/human chorionic gonadotropin ( hCG) receptor was determined by immunohistochemisty, the activity of 3β-hydroxysteroid dehydrogenase ( 3β-HSD ) , 17α-hydroxylase ( CYP17 ) , and 17β-hydroxysteroid oxidoreductase ( 17β-HSD ) by enzyme linked immunosorbent assay(ELISA) and the expression of mRNA of 3β-HSD2, 17β-HSDB3, CYP17, and LH/hCG receptor by real-quantitative polymerase chain reaction ( RQ-PCR ) . Results The immunohistochemisty results showed that the LH/hCG receptor was negative in the experiment group, but positive in control. The activity of 3β-HSD and CYP17 of the experiment group was higher than that in the control (P<0. 01), while the activity of 17β-HSD was lower(2 638. 798±70. 551 vs 9 148. 174±382. 836, P<0. 01) according to ELISA results. The relative contentof3β-HSD2mRNAoftheexperimentgroupwashigherthanthatinthecontrol(P<0.05),andtherelative content CYP17 mRNA of the experiment group was much higher than that in the control (P<0. 01). However, the relative content of 17β-HSDB3 mRNA and LH/hCG receptor mRNA were much lower than those in the control ( P<0. 01) by RQ-PCR. Conclusion Sexual abnormality and virilization could be caused by the excessive androgen secreted by androgen-producing adrenocortical tumor, which is an extremely rare disease. The mechanism of the secretion of androgen from the tumor remains unknown so far. It may be related to the increased activity of 3β-HSD and CYP17, but has no relationship with the expression of LH/hCG receptor.

Objective To investigate the clinical features, diagnosis, differential diagnosis, treatment, and prognosis of adrenal lymphangioma. Methods Three cases of adrenal lymphangioma were reported, and the clinical features, treatment and prognosis were analyzed. Results Three cases were incidentally discovered, laboratory tests and endocrine hormone examinations were normal, CT or MRI showed lesions with low density, no reinforced or mild enhancement. All 3 cases underwent laparoscopic adrenalectomy, postoperative pathology supported the diagnosis of adrenal lymphangioma. They were followed up for 8-months, 1-year, and 4-years respectively, with no recurrence. Conclusions Adrenal lymphangioma is a rare benign adrenal leison, with no typical clinical manifestations. Preoperative diagnosis depends on imaging examinations. Histopathological examination is essential in making final diagnosis. Surgery is the preferred treatment option. The prognosis is relatively good.

[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 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.

Objective:To analyze the clinical characteristics of fulminant type 1 diabetes (FT1DM) in China.Methods:Clinical data of 279 cases related to FT1DM in Chinese Database from January 2005 to December 2018 were collected, and other 20 patients from our hospital were included in the present study.Results:(1) There has been a progressive increasing in the number of reported cases every year in China, and the number in the southern region were significantly more than that in the northern region. (2) The median age of the onset of FT1DM patients in China was 32.5 years old, without significant gender difference. Moreover, 36.5% (54/148) of the female patients caught the disease during their prenatal period, most of them were onset in the second or third trimesters of pregnancy and 2 weeks after delivery (37/40), and the prognosis of the fetus was extremely poor. (3) Compared with new-onset type 1 diabetes, FT1DM patients were younger, and with higher blood glucose [(39.7±15.3) vs (21.2 ± 9.9) mmol/L], higher serum creatinine [(188.4±115.9) vs (51.8 ±23.1) μmol/L], and higher amylase levels [245.5 (26.0-5 137.0) vs 54.7 (14.0-404.9) U/L]. FT1DM patients were with more severe acidosis, and lower HbA 1C level [(6.6 ±0.8)% vs (12.9 ± 2.5)%, P<0.01]. (4) FT1DM patients may combine with multiple organ dysfunction or severe metabolic disorders, electrolyte disorders, as well as liver and kidney dysfunctions, and elevation of amylase and muscle enzymes. Conclusion:FT1DM are with some clinical characteristics different from classic new-onset type 1 diabetes, including adult-onset, frequent in the southern China. Pregnancy may be a predisposing factor for female patients. Significant metabolic disorders and multiple organ involvements are common in the patients with FT1DM.

To improve the differential diagnosis of sellar region mass,4 cases with sellar mass and misdiagnosed as lymphocytic hypophysitis (LYH) were reviewed retrospectively.The 4 patients (2 male and 2 female) aged 20-60 years old were all presented with symptoms of headache,polydipsia and polyuria.Biochemical studies confirmed the diagnoses of central diabetes insipidus and hypopituitarism.Head MRI scans showed LYH like image for all the cases,and,thus,high dose methylprednisolone pulse therapy (HDMPT) was applied to the patients.Their symptoms deteriorated and the sellar mass enlarged after a short period of partial improvement.Operations were performed in all the patients.Histology study showed craniopharyngioma with abscess,primary abscess,secondary hypophysitis caused by Wegener's granulomatosis,and germinoma with secondary hypophysitis,respectively.In conclusion,surgery or biopsy is necessary for those who presented with sellar region mass and was suspected to be with LYH,but with poor response or even worse after HDMPT.

Objective To explore risk factors of recurrence in papillary thyroid microcarcinomas ( PTMC ) and papillary thyroid carcinomas with 1-2 cm diameter. Methods From January, 2008 to December, 2010 in PLA General Hospital, 323 eligible patients received first surgery and diagnosed pathologically with papillary thyroid cancer≤2 cm were analyzed retrospectively. According to rumor size, patients were divided into PTMC and PTC of 1-2 cm, which were investigated recurrence factors. Results Finally we indentified 320 PTC≤2 cm, including 218 (68.1%)PTMCand102(31.9%)PTCof1-2cmwithamedianfollow-uptimeof72.5(55-90)months.32cases (10%)of patients relapse, includig 22 cases(10%)in PTMC and 10 cases(9. 8%)in PTC of 1-2 cm. In the clinical characteristics analyses of PTC≤2 cm, the PTC of 1-2 cm was different from PTMC in age, lymph node metastasis and TNM stage. The univariate analysis showed that tumor location and lymph node metastasis influenced recurrence of PTMC and PTC of 1-2 cm,while tumor foci and extrathytoidal extension were risk factors of recurrence in PTMC but not in PTC of 1-2 cm. Lymph node metastasis was independent factor which influenced the recurrence of PTMC and PT C of 1-2 cm according to COX multivariate analysis. Conclusion Disease recurrence did not differ significantly between the PTMC and PTC of 1-2 cm and lymph node metastasis was an independent recurrence factor.

Objective To investigate long-term clinical efficacy and side effects of intravenous glucocorticoid therapy with or without orbital radiotherapy in moderate to severe Graves’ ophthalmopathy. Methods A total of 38 patients with moderate to severe Graves’ ophthalmopathy were investigated. 19 of them were treated with intravenous glucocorticoid only; in the other 19 patients glucocorticoid treatment was followed by orbital radiotherapy. Eye tearing, eye pain, soft tissue congestion, edema, exophthalmos, and diplopia were compared before and after treatment. These symptoms, general curative effect, and patients satisfaction were compared between the 2 groups, and side effects were recorded. Results Photophobia, tearing, eye pain, soft tissue congestion, edema, exophthalmos, and diplopia were all improved after treatment. Hormone combined with radiotherapy and hormone therapy alone did not yield a difference in these symptoms. Patients in the 2 groups showed the same satisfaction rate. However, in regard to the general curative effect, the group with orbital radiotherapy showed a better response rate. Of all these patients, 7 patients developed severe osteoporosis and complained bone pain, 7 patients put on body weight more than 2. 5 kg each, and 1 patient developed diabetes. There was no severe liver damage or cardiovascular event. Conclusion The project of intravenous glucocorticoid given on 3 consecutive days every 4 weeks in one to 3 circles is an effective treatment for patients with moderate to severe Graves’ ophthalmopathy. Intravenous glucocorticoid combined with orbital radiotherapy is more effective than intravenous glucocorticoid alone for moderate to severe Graves’ ophthalmopathy patients. Strict assessment before treatment may avoid severe side effects, and in a long-time follow-up, osteoporosis is the main side effect which should be alerted.