The liver has diverse functions such as metabolism， detoxification， and immune defense， and the maintenance of hepatic microenvironment homeostasis is crucial for overall bodily health. The hepatic microenvironment consists of the components such as parenchymal cells， non-parenchymal cells， and non-cellular components. Chronic inflammatory responses induced by various etiological factors may promote the formation and progression of liver fibrosis. During the dynamic progression of liver fibrosis， from the early to advanced stages， various components within the hepatic microenvironment undergo a series of changes， which can promote the malignant progression of liver fibrosis. An in-depth exploration of the mechanisms underlying such changes in each component of the liver fibrosis microenvironment is of great significance for understanding the pathogenesis of liver fibrosis and discovering potential treatment strategies.

Aromatase deficiency (AD) is a rare autosomal recessive genetic disease caused by loss-of-function mutations in aromatase gene (CYP19A1), leading to congenital estrogen deficiency syndrome. Both mothers of AD patients during pregnancy and female AD fetus show virilization, while male patients are usually diagnosed in adulthood due to continued height increase and metabolic abnormalities. In 2019, a patient with AD was admitted in the Second Xiangya Hospital. The patient was a 37-year-old adult male who continued to grow linearly after adulthood. His estradiol was below the measurable line, the follicle-stimulating hormone (FSH) increased, bone age delayed, epiphysis unfused, and the bone mass reduced. CYP19A1 gene detection showed that c.1093C>T, p.R365W was homozygous mutation. This disease is rare in clinic. Clinicians need to raise awareness of the disease for early diagnosis and treatment to improve the long-term prognosis of patients.
46, XX Disorders of Sex Development/genetics* ; Adult ; Aromatase/metabolism* ; Female ; Gynecomastia/genetics* ; Humans ; Infertility, Male ; Male ; Metabolism, Inborn Errors ; Mutation ; Pregnancy

Fibroblast growth factor 23 (FGF23) is a new endocrine factor, mainly expressed in osteoblasts and osteoblasts. Many studies have found that FGF23 can act on kidney, parathyroid and other tissues after binding with Klotho protein, and participate in bone mineral metabolism. In addition, in recent years, the role of FGF23 in exoskeleton has been gradually discovered, such as FGF23 and thyroid diseases, diabetes and so on. Therefore, understanding the biological characteristics, regulatory mechanism of FGF23 and its relationship with related diseases is of great clinical significance for the diagnosis and treatment of diseases. This article reviews the relationship between FGF23 and metabolic diseases such as phosphorus metabolic disease, parathyroid disease, hyperthyroidism, osteoporosis, diabetes, iron metabolism and so on.

Vitamin D can regulate calcium and phosphorus metabolism and maintain bone health. In recent years, more and more studies have shown that vitamin D and its receptors have the potential to protect diabetic nephropathy. Animal studies and clinical trials have shown the correlation between vitamin D levels and the risk of diabetic nephropathy. Supplementation of vitamin D or its analogs can improve endothelial cell damage, reduce inflammation, proteinuria, and renal fibrosis and thus delay the process of diabetic nephropathy. Therefore, vitamin D and its receptor are expected to become a new choice for the prevention and treatment of diabetic nephropathy. This review summarizes the new research progress of vitamin D on the protective mechanism of diabetic nephropathy.

Clitoris lesion is most readily classified into hormone-dependent and hormone-independent cause. It can also be characterized as congenital or acquired nature. Clitoromegaly is the most common presentation of clitoral lesions clinically. Hormone-dependent clitoromegaly is mainly attibuted to the increase of androgen, while the most comomon cause of hormone-independent clitoromegaly is neurofibromatosis. Except that, there are so many other disorders which can cause clitoromegaly, leading to the difficulty for diagnosis. However, the literature concerning the management of clitoromegaly is scarce.The present study summarized the lesions of clitoromegaly from the etiology, diagnosis, and differential diagnosis to treatment. This may help clinicians to make a reasonbale management when facing this kind of disease.

Objective: To observe the changes in bone mineral density and microstructure parameters in sclerostin (SOST) gene knockout mice treated with glucocorticoid. Methods: 12 4-week-old SOST knockout mice were randomly divided into two groups (n=6): methylprednisolone intervention group [SOM group, methylprednisolone 3 mg/(kg·d), subcutaneous injection], placebo group (SOS group, isovolumetric saline subcutaneous injection). 12 wild-type mice were randomly divided into two groups (n=6): wild-type placebo group (WTS group, isovolumetric saline subcutaneous injection), wild methylprednisolone intervention group [WTM group, methylprednisolone 3 mg/(kg·d), subcutaneous injection]. 12 weeks later, mice were sacrificed and one lumbar vertebra of each mouse was selected for micro-CT analysis. Results: There was no difference in bone mineral density (BMD), trabecular volume fraction, trabecular number and trabecular thickness between SOM and SOS groups (P>0.05). BMD, trabecular volume fraction, trabecular number and trabecular thickness in SOM and SOS groups were significantly higher than those in WTS and WTM groups (P<0.05). BMD, trabecular volume fraction, trabecular number and trabecular thickness in WTM group were significantly lower than those in WTS group (P<0.05). Conclusions Sclerotin gene knockout mice can resist glucocorticoid-induced bone loss and bone microarchitectural deterioeration. The treatment of osteoporosis with SOST/sclerotin as a target will be an effective method in the future.

Objective To explore the association of nocturnal serum cortisol levels with diabetic microvascular complications in overweight or obese patients with type 2 diabetes mellitus. Methods Serum cortisol levels of 316 overweight or obese type 2 diabetic patients were tested at midnight by the method of chemiluminescence. Diabetic microvascular complications were compared among various groups according to nocturnal serum cortisol levels. All the patients with nocturnal serum cortisol level > 50 nmol/L were asked to undergo overnight low-dose dexamethasone suppression test to rule out the possibility of subclincal Cushing's syndrome. The incidences of diabetic nephropathy ( DN ) , diabetic retinopathy ( DR ) , and diabetic peripheral neuropathy ( DPN ) were examined in all the patients. Results (1)The incidence of DN was gradually increased from 13.3％to 27.7％and 44.2％in patients with low, medium, and high cortisol level groups, showing a statistical difference among 3 groups ( P<0.05) . The incidences of DR in medium and high cortisol level groups were higher than that in low cortisol level group (40.6％and 47.7％vs 22.7％, both P<0.01). The incidence of DPN in high cortisol level group was higher as compared with low cortisol level group (60.5％ vs 38.7％, P<0.01). (2) Nocturnal serum cortisol level in patients with diabetic microvascular complications was higher than that in patients without complications [ (136.87 ± 105.78 vs 97.55 ± 93.48) nmol/L, P<0.01]. Nocturnal serum cortisol level in patients with multiple diabetic microvascular complications was higher than that in patients with single diabetic microvascular complication [ (151.66±114.54vs117.69±90.26)nmol/L,P<0.05].(3)Singlefactorlogisticregressionanalysisshowedthat higher nocturnal serum cortisol level was a risk factor for diabetic microvascular complications in addition to female, age, longer diabetic duration, higher fasting plasma glucose ( FPG ) . Multivariate logistic regression analysis showed that higher nocturnal serum cortisol level was still a risk factor for diabetic microvascular complications after adjusted by diabetic duration, FPG, HbA1C, and the use of insulin (P=0.013). Conclusion Nocturnal serum cortisol level seems to be a risk factor for diabetic microvascular complications in overweight or obese patients with type 2 diabetes mellitus.

Objective To observe the analgesic effect of ultrasound-guided and nerve stimulator after artificial total knee athroplasty(TKA).Methods Forty elective cases receiving TKA under gen-eral anesthesia were randomly allocated into the ultrasound group (group C)and stimulator group (group S).The time for nerve block,onset time and complications were recorded in both groups. Results Compared to group S,the time for nerve block and onset time was significantly shortened in group C (P <0.05).There was no statistical difference in times of pressing analgesic pump and VAS score in postoperative 48 h.One patient suffered from nerve injury and two underwent vascular dam-age and hematoma in group S,while no complication was found in group C.Conclusion Compared to nerve stimulator,ultrasound-guided continuous femoral nerve block(CFNB)may reduce nerve block time and onset time and decrease complications,so that to increase safety of CFNB.

Bisphosphonate,as a first line medicine for treating osteoporosis,has been efficacious in reducing the incidences of fractures and some tumors.Although severe side effects such as osteonecrosis of the jaw (ONJ) and atypical fracture of femur would take place,its very low incidence does not affect the current status of bisphosphonates in the treatment of osteoporosis.

Bisphosphonates have been efficacious in preventing bone loss and reducing fractures in men and postmenopausal women with osteoporosis.Possible risks of osteonecrosis of the jaw and atypical femur fractures have been reported with bisphosphonates treatment,despite these incidences are very low.Oral bisphosphonates are associated with upper gastrointestinal side effects and iv bisphosphonates with acute phase reactions,the association of bisphosphonate use with esophageal cancer and atrial fibrillation is not well supported by current data.