A patient with severe hypoglycemia due to insulin-like growth factor ( IGF)-IIsecreted by a giant solitary fibrous tumor of the pleura ( SFTP) was investigated through comprehensively reviewing his medical history and clinical records. The patient had severe hypoglycemia accompanied with significantly decreased serum insulin level. A solitary fibrous tumor of the pleura was found, and right pneumonectomy removed this giant tumor. Two years after the operation, the patient was fit and well with no further hypoglycemia episodes. Non-islet-cell tumor hypoglycemia should be considered in patients who have hypoglycemia episodes accompanied with significantly decreased serum insulin level.

OBJECTIVE:To explore the establishment of DUE criteria for the evaluation of glucocorticoids(GCs)use in oncol-ogy department of our hospital,and to evaluate the rationality of glucocorticoid use. METHODS:DUE criteria for GCs in our hos-pital was established preliminary,and used to evaluate medication indication,medication course,medication results,etc. Medical records of 300 patients receiving GCs were collected from oncology department of our hospital during Apr. to Dec. in 2013(before intervention)and Jun. 2014 to Mar. 2015(after intervention)via hospital information system. The application of GCs was evaluat-ed. RESULTS:Pexamethasone sodium phosphate injection was used most frequently in our hospital(82.34%),followed by Dexa-methasone acetate tablet(15.33%)and prednisone asetate tablets(2.33%). The mest common purpose of GCs use in oncology de-partment of our hospital is radiotherapy and chemotherapy induced vomiting prevention and treatment(55.55% of total case),fol-lowed by anti-inflammatory therapy(14.19%)and chemotheraphy drug pretreatment(12.76%). After intervention,rational use of GCs for tumor had been improved greatly,and the rate of unqualified drug dosage and medication course decreased from 6.87% to 3.95%,and that of decreased from 3.58% to 2.74%. CONCLUSIONS:The establishment of DUE criteria and continuous criteria improvement during clinical rational drug use guidance can promote rational use of GCs in oncology department.

Objective To raise the awareness of adrenal Castleman′s disease by analyzing the clinical features and management of a patient with adrenal Castleman′s disease. Methods A case of adrenal Castleman′s disease of our hospital was retrospectively analyzed, including clinical feature, laboratory findings, pathology, treatment, and follow-up. All the data and pertinent literatures were reviewed and analyzed. Results An incidentaloma measuring 4. 8 cm × 6. 3 cm in the right adrenal gland was observed in a 30-year-old men in a ultrasonography examination performed due to a medical check-up. Laboratory analysis showed that the lesion was not hyperfunctioning. The patient subsequently underwent an exploratory laparotomy. Pathological examination revealed retroperitoneally localized Castleman′s disease of the hyaline vascular type. Conclusion Adrenal Castleman′s disease is a rare cause of lymph node hypertrophy, and it is necessary to keep in mind the possibility of its occurrence and take it into consideration in the differential diagnosis of any solitary, heterogeneous, and hypervascular retroperitoneal mass. The proper cooperation between the clinician and pathologist allows early diagnosis and suitable therapy.

Objective To explore the relationship between serum leptin level and the hypothalamuspituitary-gonad ( HPG) axis in female adolescents with anorexia nervosa ( AN). Methods Sixteen newly diagnosed female adolescents with AN in Shanghai and Zhejiang province were investigated, and their serum leptin, FSH, LH and body composition were measured before and after 18 weeks treatment, and their menorrhea cycles were observed. The rhythm of 24 h serum leptin secretion was studied in 4 patients with AN. Twenty-six, healthy females with normal weight and without contraceptive medication were studied as controls. Results (1) All of 16 patients had amenorrhea, 3 primary amenorrhea and 13 secondary amenorrhea. At admission LH in 14 patients and FSH in 12 patients were below the low limit of the normal reference range (1.5 U/L and 4. 6 U/L respectively), and among them 5 patiend had both 15% weight gain and significantly increased serum leptin level (P

Purpose　The aim is to compare the sterols in Hericium crinaceus ethanol extract and water extract from solid fermented hyphae and to study the pharmaceutical chemical basis of the different medicinal effects. Methods　The nonsaponifiable lipids were isolated by saponification.The sterols were then detected by TLC and RP-HPLC.Results　The content of sterols in ethanol extract was found to be higher than that in water extract.And one type of sterols from Hericium erinaceus hyphae was identified as ergosterol.Conclusion　Due to ergosterol′s multifunction in biological activities,it may well be one of the active components of hyphae.And higher content of lipids, especially sterols may be one of the reasons for the better medicinal effect of ethanol extract than water extract.

Objective To study the genotype of the thyroid hormone receptor ? (THRB) gene in a patient with thyroid hormone resistance syndrome. Methods The peripheral blood samples of the patient and his parents were collected, then DNA was isolated. PCR and direct sequencing techniques were performed to determine if there were mutations in their THRB gene. Results No mutation was found in exon 1-9. There was a point mutation in exon 10 of THRB which is a T to C transition in nucleotide 1658 resulting in the replacement of the normal Val (GTG) with an Ala (GCG) (V458A). The mutation was located in exon 10 of THRB gene and was a heterozygote. No mutation was found in THRB gene of his parents.Conclusion The gene diagnosis confirms that the patient has a mutation V458A located in the ligand binding area of THRB.

Objective· To investigate the association between neck circumference (NC) and cardiovascular risk factors among middle-aged and elderly people without diabetes in Jiading District in Shanghai.Methods· A cross-sectional study was conducted among 4 657 nondiabetic inhabitants aged 40 and above in Jiading District,Shanghai from August 2014 to July 2015.Clinical information collection,anthropometric measurements,and biochemical analyses were performed.The objects were divided into 4 groups according to the quartiles of NC in order to analyze association between NC and cardiovascular risk factors.Results· With increase of NC,the prevalences of abdominal obesity,insulin resistance,hypertension,and dyslipidemia all increased as well as waist circumference,body mass index (BMI),blood pressure,lipid profile,fast blood glucose,and HOMA-IR level (all Ptrend ＜0.01).Multiple Logistic regression analysis showed that individuals in Q2,Q3 and Q4 group had significantly higher risk of abdominal obesity,insulin resistance,hypertension,and dyslipidemia compared with those in Q1 group after age,sex,smoking,drinking,physical activity,BMI,waist circumference,systolic blood pressure,C-reactive protein,fast blood glucose,and lipid profile were corrected (all Ptrend ＜0.01).Conclusion· NC is positively and independently correlated with cardiovascular risk factors in middle-aged and elderly nondiabetic people in Jiading District in Shanghai.

[Summary] All patients with cholesterol side-chain cleavage enzyme ( P450scc) deficiency that have been reported presented with early adrenal failure. Here we described a 35-year-old male presented with infertility as the only initial presenting complaint. He had received two separate surgeries to remove bilateral testicular masses. We reevaluated the resected tumors and found testicular adrenal rest tumor ( TART) pathology in the resected tumor. We profiled steroid hormones and found significantly elevated ACTH. CT scan revealed bilateral adrenal hyperplasia. Mutation screening identified compound heterozygous mutations (R353W and P432L) in the P450scc encoding gene (CYP11A1). The patient was finally diagnosed as congenital adrenal hyperplasia.

Objective To analyze the association of elevated carotid intima-media thickness(CIMT)with low-grade albuminuria in a community-based population. Methods A total of 10 375 participants aged 40 years or older were recruited using cluster sampling from Jiading district, Shanghai. Standardized questionnaires were adopted to collect information on health status and lifestyles. Anthropometric measurements including weight, height, and blood pressure, and biochemical tests for blood and urine were performed. CIMT was detected by B-mode ultrasound examinations. 9 523 subjects were included for final analysis. All these subjects were divided into 4 groups according to sex-specific urinary albumin to creatinine ratio ( UACR ) quartiles. CIMT≥upper decile of the population was defined as elevated CIMT and low-grade albuminuria was defined as UACR≥sex-specific upper quartile. The relationship between UACR and CIMT was investigated by multiple logistic regression analysis. Results The prevalence of elevated CIMT in this population aged 40 years or older with albuminuria in normal range was 21. 44%. Comparing to participants without elevated CIMT, those with elevated CIMT showed higher level of UACR (4. 79 vs 4. 51 mg/g, P<0. 01). The metabolic status was deteriorated with the increment of UACR level. The prevalences of elevated CIMT were 18. 99%, 19. 24%, 20. 20%, and 27. 33% from the lowest to highest UACR quartile, respectively(Ptrend<0. 01). After adjusting for some conventional cardiovascular risk factors, multiple logistic regression revealed that compared with the participants in the lowest quartile of UACR, those in the highest quartile had a 1. 25-fold risk of elevated CIMT. Conclusions This study shows that low-grade albuminuria is positively associated with elevated CIMT, independent of conventional cardiovascular risk factors in middle-aged and elderly adults.

The relationship between abnormal circulating GH-insulin-like growth factor (IGF) axis and hypoglycaemia was explored in 2 cases of non-islet cell tumor associated hypoglycaemia (NICTH). Serum level of IGF-Ⅱ was increased, the levels of GH, IGF-Ⅰ, IGFBP-3 were decreased to some extent, and IGF-Ⅱ/IGF-Ⅰ (molar ratio) was significantly increased in these two cases. In one case, circulating GH-IGF axis returned to normal after complete removal of the tumor. In the diagnosis of NICTH, the abnormal circulating GH-IGF axis is quite valuable and IGF-Ⅱ/IGF-Ⅰ appears to be a more sensitive parameter.