Objective To explore the clinicopathologic features,diagnosis,treatment and prognosis of ACTH-independent subclinical Cushing syndrome caused by cortisol-secreting and hypo-androgen black adrenal cortical adenomas with lipomatous metaplasis.Methods The clinical and pathologic features of 1 patient presented with hypo-androgen and atypical signs and symptoms of Cushing syndrome were reported.The patient's 24 h UFC (235.62 μg) was higher than normal range,his plasma ACTH concentrations (＜1.1 pmol/L,was lower than normal range and his serum cortisol concentrations lacked diurnal rhythm.There was absence of serum cortisol suppression in overnight dexamethasone suppression tests.Serum levels of androgens (1.2 nmol/L) were lower than normal range.24 h urine catecholamine was normal,NE was 160.5 nmol/24 h (5-591 nmol/24 h),E was 23.1 nmol/24 h (0-82 nmol/24 h),DA was 1496nmol/24 h (424-2612 nmol/24 h).Aldosterone lying and standing test:ALD1 138-415 pmol/L,AT-Ⅱ1 64.54 ng/L,PRA1 0.80 μg · L-1 · h-1 Abdomen CT showed right adrenal mass (3.1 cm).131Ⅰ-MIBG scanning was normal.Adrenocortical carcinoma was considered as a possible diagnosis based on cortisol hypersecretion,hypo-androgen and the imaging characteristics.This patient accepted laparoscopic adrenal adenoma resection.Results The adrenal tumor size was 3.5 cm.Immunohistochemical (IHC) staining showed Melan-A,CgA,α-inhibin and Syn positive and Ki-67 ＜ 1％.Histopathologic results showed black adrenal cortical adenomas with myelolipomatous change.After surgery,patient's serum androgen was normal,and the signs and symptoms of Cushing syndrome and oligo-androgen disappeared.There was recurrence after 1.5 years follow-up.Conclusions Although most patients with corticotropin-independent Cushing syndrome associated with abnormal androgen proved to have adrenocortical carcinoma,the clinician should be aware of the possibility of benign,black adrenal adenoma.

Objective To investigate the safety and clinical significance in presurgical application of tyrosine kinase inhibitor (TKI) targeted therapy in high-risk renal-cell-carcinoma patients.Methods TKI targeted therapy was applied to 33 high-risk renal-cell-carcinoma patients from Jun.2010 to Dec.2013,7 cases with paraneoplastic symdromes and 1 with bilateral lesions received surgical treatments.There were 6 males and 2 females in this group with average age of 50 (42-56) years.They were high-risk patients because of renal tumor and vena caval tumor thrombus in 3 cases,renal tumor and vena caval tumor thrombus and hypercalcinemia in 1 case,renal tumors with metastasis to lung and lymph nodes in 2 cases,renal tumor with metastasis to lung and bones in 1 cases,and bilateral kidney cancer in 1 case.The clinical stages included 3 cases of T3aN1M1 and T3bN0M0 respectively,and 1 case of T3bN0M1 and T3aN0M0,respectively.The primary metastasis sites were lymph nodes and lung (3 cases respectively),and another 1 in bone.4 cases suffered from vena cava tumor thrombi with 3 staged Mayo Ⅲ and 1 Mayo Ⅳ.7 cases with paraneoplastic syndromes were contra-indicated for surgery due to poor ECOG performance score (with score 3 in 3 cases and 2 in 4 cases).4 cases received Sorafinib 400mg po bid and the other 4 Sunitinib 50 mg po qd,4 weeks on and 2 weeks off,with duration of 8-12 weeks.Medical therapy ceased 6 to 16 days (median 12 days) before operation.Results Patients with neoadjuvant therapy experienced good toleration.The 7 cases with poor ECOGs improved during medical therapy.The tumor sizes in the bilateral lesions shrunk remarkably.All 7 patients received surgery:3 radical nephrectomies,4 nephrectomies and resections of Vena Caval tumor thrombus,and 1 bilateral lesions underwent nephron sparing surgery.Operations were successful though with mild to moderate adhesion,and the blood loss ranged from 120 to 500 ml,with averaged of 280 ml.Pathologic results were clear-cell renal carcinomas.All incisions were well-healed.4 patients with metastasis continued TKI therapy.All patients were alive without recurrence during the follow-up of 4 to 42 mon.Conclusions Presurgical application of targeted therapy is safe and may increase the opportunity of surgery for some patients with poor general situation,also patients with bilateral lesions may benefit from it for its possibility of nephron sparing.

Objective:To explore the effect of hemodialysis and conventional treatment on the heart function of elderly patients with chronic renal heart syndrome(CRCS).Methods:Sixty elderly patients with CRCS who were admitted to Qinhuangdao Port Hospital from July 2017 to July 2018 were selected and divided into the observation group (received hemodialysis and conventional treatment) and the control group (received conventional treatment) according to the random number table method, each group with 30 patients. The levels of left ventricular end-systolic dimension (LVESD) and left ventricular end-diastolic dimension (LVEDD), left ventricular ejection fraction (LVEF) and left atrium anterior and posterior diameter (LAD) before and after treatment of two weeks were compared between two groups, the levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), blood urea nitrogen (BUN), cystatin C (CysC), creatinine (Cr) and tumor necrosis factor (TNF)-α, high sensitivity C-reactive protein (hs-CPR), interleukin 6 (IL-6) before and after treatment for two week were compared between two groups, and the safety of the two treatment methods was evaluated.Results:After treatment, the levels of LVESD, LVEDD, LAD in the observation group were lower than those in the control group: (26.13 ± 1.28) mm vs. (29.09 ± 1.26) mm, (47.58 ± 1.22) mm vs. (51.34 ± 1.49) mm, (30.02 ± 0.83) mm vs. (33.15 ± 1.02) mm, the level of LVEF in the observation group was higher than that in the control group: (39.63 ± 5.21)% vs. (35.77 ± 4.93)%, the differences were statistically significant ( P<0.05). After treatment, the levels of NT-proBNP, BUN, CysC and Cr in the observation group were lower than those in the control group: (1 089.31 ± 243.29) ng/L vs. (2 990.56 ± 531.22) ng/L, (16.08 ± 3.35) mmol/L vs.(21.93 ± 4.21) mmol/L, (0.35 ± 0.11) mg/L vs. (0.57 ± 0.18 mg/L, (251.62 ± 29.28) μmol/L vs. (290.66 ± 38.12) μmol/L, the differences were statistically significant ( P<0.05). After treatment, the levels of TNF-α, hs-CPR and IL-6 in the observation group were lower than those in the control group: (149.26 ± 19.53) μg/L vs. (182.33 ± 20.25) μg/L, (4.02 ± 1.33) mg/L vs. (5.38 ± 1.57) mg/L, (18.91 ± 3.11) μg/L vs. (22.45 ± 3.82) μg/L, the differences were statistically significant ( P<0.05). The incidence of adverse reactions during the treatment in the two groups had no significant difference ( P>0.05). Conclusions:The use of hemodialysis on the basis of conventional treatment can improve the heart and kidney function of elderly patients with CRCS, and this method is beneficial to alleviate left heart dilation and inflammation. It is a safe and effective treatment method.

Objective:To explore the medical costs and influencing factors of patients diagnosed with Brucellosis in Datong of Shanxi province.Methods:Information on demographics, medical visits, and costs of patients diagnosed with Brucellosis between January 1, 2017, and December 31, 2019, were collected. Health care utilization and medical costs were analyzed from different genders, age groups, underlying diseases, clinical stages, and comorbidities.Results:A total of 2 289 patients (1 715 outpatient and 574 inpatient cases) were included in the analysis. 72.0% (1 649/2 289) were male, with an average age of (49.6±15.5) years; age between 45-59 years was the dominant group (36.2%,829/2 289). The mean age of inpatients (51.4±16.0) was higher than that of outpatients (49.0±15.2)( Z=-4.01, P<0.001). The average number of outpatient visits per outpatient was (1.6±1.5) times. The duration of hospitalization was (14.6±9.9) and (20.8±11.4) days for patients with central nervous system complications and (16.6±9.5) days for vascular system complications. Of the inpatients, 51.0% (293/574) had underlying diseases, and 30.3% (174/574) had endocrine and metabolic diseases. 54.0% (310/574) of inpatients were diagnosed with acute Brucellosis, and 46.0% (264/574) were diagnosed with chronic Brucellosis. A total of 64.3% (369/574) of inpatients had complications, 30.3% (174/574) of digestive system complications, followed by skeletal system complications (29.1%, 167/574). Among outpatients, age significantly affected medical costs ( P<0.001). For inpatients, age and complications and treatment effect were influential factors ( P<0.05). Patients with the combined skeletal system and central nervous system complications had significantly higher medical costs ( P<0.001). Conclusions:The medical costs for outpatient cases of Brucellosis were moderate. However, the economic burden was higher for inpatients, especially those with skeletal and neurological complications. Early detection, diagnosis, and treatment of cases were essential to avoid chronic Brucellosis and its complications and reduce medical costs.

Immunoscenescence plays a key role in the initiation and development of tumors. Furthermore, immunoscenescence also impacts drug delivery and cancer therapeutic efficacy. To reduce the impact of immunosenescence on anti-tumor therapy, this experimental plan aimed to use neutrophils with tumor tropism properties to deliver sialic acid (SA)-modified liposomes into the tumor, kill tumor cells via SA-mediated photochemotherapy, enhance infiltration of neutrophils into the tumor, induce immunogenic death of tumor cells with chemotherapy, enhance infiltration of CD8⁺ T cells into the tumor-draining lymph nodes and tumors of immunosenescent mice, and achieve SA-mediated photochemotherapy. We found that CD8⁺ T cell and neutrophil levels in 16-month-old mice were significantly lower than those in 2- and 8-month-old mice; 16-month-old mice exhibited immunosenescence. The anti-tumor efficacy of SA-mediated non-photochemotherapy declined in 16-month-old mice, and tumors recurred after scabbing. SA-mediated photochemotherapy enhanced tumor infiltration by CD8⁺ T cells and neutrophils, induced crusting and regression of tumors in 8-month-old mice, inhibited metastasis and recurrence of tumors and eliminated the immunosenescence-induced decline in antitumor therapeutic efficacy in 16-month-old mice via the light-heat-chemical-immunity conversion.