2014年 · 第94卷第33期

With the rapid development of biomedicine, especially molecular pathology, epigenetics, tumor stem cells^[1]With the emergence of theory, the individualized, humanized and rational treatment concept of tumor is gradually being accepted^[2]It is recognized that most tumors are a systemic disease. The concept of radical tumor resection, which originated more than 120 years ago and was mainly based on surgical methods, was questioned. This is the progress of medical science, and the development of science is not shifted by human will.

Warfarin is currently a commonly used drug for preventing embolism in patients with atrial fibrillation, but warfarin has limitations such as regular monitoring, narrow treatment window, and drug-drug interaction. Large-scale phase III clinical trials have confirmed that new oral anticoagulants (NOACs, dabigatran, rivaroxaban, apixaban, and edoxaban) are not inferior or even superior to warfarin in efficacy, respectively, while their bleeding incidence is similar or lower. However, there are no clinical trials that directly compare the efficacy and safety of these drugs with each other. Flemming Skjoth, Institute of Thrombosis, Aalborg University, Denmark, et al. used indirect comparative analysis to compare the differences in efficacy and safety between edoxaban and three other anticoagulants. "Efficacy and safety of edoxaban in comparison with dabigatran, rivaroxaban and apixaban for stroke prevention in atrial fibrillation-an indirect comparison analysis" Published in February 2014Journal of Thrombosis and HaemostasisOn.

female pseudohermaphroditism is a common type of hermaphroditism. Patients have a normal female karyotype (46, XX), and there is only one gonad-ovary in the body, while the external genitalia and secondary sexual characteristics have male manifestations, such as clitoris enlargement, left and right fusion of labia majora, Adam's apple and beard, etc. The cause of female pseudohermaphroditism is that patients are exposed to excessive androgens since childhood, among which congenital adrenocortical hyperplasia, especially 21-hydroxylase (21-OHD) deficiency (which can lead to increased androgen synthesis in the body), is one of the main causes. This disease is not uncommon clinically, but familial rare. In January 2014, Peking Union Medical College Hospital admitted two cases of hermaphroditism in a family, which were biological sisters. The diagnosis and treatment results are reported as follows.

microRNA is a kind of 21-25 nucleotide long small non-coding ribonucleic acid encoded by endogenous genes widely existing in eukaryotic cells. After specific binding to target genes, it may induce the degradation of target mRNA by deadenylation, inhibit the initiation of protein translation or the extension of polypeptide chain, and degrade nascent proteins to regulate the role of target genes^[1,2]。 This complex regulatory network can not only regulate the expression of multiple genes through one miRNA, but also fine regulate the expression of a certain gene through the combination of several miRNAs. The expression patterns of miRNA have different phases and sequences, that is, the miRNA expression profiles are different in different tissues, organs and physiological phases^[3]。 Studies have shown that miRNA is involved in a series of important physiological and pathological processes in organisms, and is closely related to the occurrence and development of many kinds of diseases such as tumors, hematopoietic diseases, cardiovascular diseases and neurological diseases^[4,5,6]。

A 55-year-old male was admitted with headache for 2 months, aggravated with walking instability for 1 week. He has been in good health, has been exposed to radioactive elements, and has smoked for more than 30 years. Physical examination: Shen Qing Li, left isotropic hemianopia, bilateral limb muscle strength grade V, and no obvious abnormalities were found in the physical examination of the remaining nervous system. Laboratory tests: Hematuria routine, liver and kidney function were not abnormal, hepatitis B markers, human immunodeficiency virus antibody (Ⅰ + Ⅱ), Mycobacterium tuberculosis antibody and Treponema pallidum antibody were all negative, and pulmonary tumor markers were not abnormal. CT examination of the head showed that there was an irregular circular linear high-density shadow in the right occipital lobe, with low-density shadow in the ring, obvious edema around the lesion, and left deviation of the midline. MRI of the head showed that the right occipital lobe was about 6.5 cm ×5.5 cm ×5.0 cm in size, with cystic-solid lesions with long T1 and long T2 changes, uneven signals, clear boundaries, close relationship with the dura mater, and obvious edema around the tumor. After intravenous contrast, the lesions showed irregular annular enhancement, with a liquid dark area in the middle, seeFigure 1。 Plain CT scan of the lung showed irregular nodules in the upper lobe of the left lung, 1.4 cm ×0.9 cm in size, considering peripheral lung cancer. Admission diagnosis: (1) Right occipital lobe occupation: metastatic tumor? High-grade glioma? (2) Left lung nodule: peripheral lung cancer? The patient refused to undergo biopsy of pulmonary lesions and underwent resection of right occipital lobe mass under general anesthesia. During the operation, the mass was closely adhered to the dura mater, easily peeled off, gray-yellow, gelatinous, brittle, clear boundary, no envelope, general blood supply, and no pathological blood vessels. Pathological diagnosis: Cryptococcal spores were seen in the mucous tissue of the right occipital lobe, and foam cells with glial proliferation were seen around it, which was considered to be cryptococcal encephalitis, seeFigure 2。 The fever appeared on the 3rd day after operation. The results of cerebrospinal fluid bacterial culture were: Cryptococcus neoformans. The single drug fluconazole 400 mg/d intravenous drip was ineffective, and the symptoms could not be controlled after increasing to 800 mg/d. After combining with hydroprednisone 100 mg/d for 3 weeks, the patient's fever symptoms resolved, and the cerebrospinal fluid bacteriology was negative after re-examination. The medication was adjusted to oral fluconazole 400 mg/d and discharged. Five months after operation, there were no signs of recurrence in head MRI enhancement, no obvious changes in lung CT, negative cerebrospinal fluid bacteriology, and normal range of lung tumor markers. The patient was instructed to take medication outside the hospital for at least 18 months. The patient has been followed up for 6 months and is in good condition.

A 27-year-old male came to our outpatient clinic in February 2014 due to infertility for 1 year after marriage. Specialist examination: the penis and scrotum develop normally, and the pubic hair is evenly distributed in an inverted triangle; The left testis, epididymis and spermatic cord are normal, and two masses can be accessed in the right scrotum. The texture is similar to that of the left testis, and there is no tactile tenderness. The scrotal ultrasound showed that the left testis was about 5.2 cm ×2.9 cm ×2.4 cm in size and 18.9 ml in volume, with normal shape, smooth capsule and uniform parenchymal echo. Two testicular echo masses can be detected in the sheath cavity of the right testis (Figure 1) with a size of about 3.5 cm ×3.2 cm ×2.0 cm and 2.9 cm ×2.4 cm ×1.8 cm, respectively, and a volume of about 11.8 and 6.6 ml, respectively; The morphology is still regular, the parenchymal echo is still uniform, and there is no obvious abnormal blood flow signal in it. The left epididymis was normal in size and shape, the capsule was smooth, and the parenchyma echoed uniformly. The epididymal head could be detected without echo, the size was about 0.9 cm ×0.78 cm, the boundary was not clear, and the echo of the posterior wall was enhanced. The right epididymis is slightly longer, the shape is still regular, and the parenchymal echo is still uniform. No obvious abnormalities were observed at the bilateral spermatic cords. Ultrasound impression: polyorchidism is likely, left epididymal head cyst. Semen routine results: Semen volume 3.5 ml, pH 7.4, sperm motility 52.95%, sperm motility grade A 7.24%, grade B 33.71%, sperm concentration 106.71×10⁹/L. Five results of sex hormones: follicle-stimulating maturation hormone 5.47 U/L, luteinizing hormone 1.18 U/L, serum prolactin 95.19 mU/L, estradiol 238.55 pmol/L, testosterone 21.83 nmol/L.