急性放射病五例随访5.5年的内分泌功能改变

随访“６·２５”６０Ｃｏ源辐射事故造成的ＡＲＳ５例５．５年各内分泌腺体的功能改变。方法主要用放射免疫法测定激素水平。结果急性期血睾酮明显减少、血ＴＴ３减少、血皮质醇可能因受地塞米松抑制而减少、血垂体激素（如ＡＣＴＨ等）也因照射而减少，而血雌二醇、ＰＲＬ、ＬＨ、ＦＳＨ等一度明显升高。至后期不同程度地逐渐恢复，并逐渐趋于平稳或趋于降低。肾素－血管紧张素－醛固酮系统反应活跃，一般以偏高居多。结论照射后各内分泌腺体功能改变较大，但至５．５年，除睾酮偏低，ＲＡＡ系统反应活跃外。

Spleen:A new role ffoorr an old player?

The spleen could be considered a neglected organ.To date,it has been deemed an ancillary organ in portal hypertension or an organ localization in lymphoproliferative diseases,even though it has had significant attention in infectious diseases for some time.Now,it is thought to be central in regulating the immune system,a metabolic asset and involved in endocrine function with regard to nonalcoholic fatty liver disease.The main mechanisms involved in this complex network will be critically discussed in this article.

Acupuncture for Treatment of Climacteric Syndrome—A Report of 35 Cases

To evaluate the effects of acupuncture for treatment of climacteric syndrome.Methods:The 65 cases in this series were randomly assigned to the acupuncture group (N=35) and the control group (N=30), with the former treated by acupuncture and the latter by medication respectively.The therapeutic effects were evaluated by means of the clinical outcome,improvement in the symptom scores and the results of radioimmunoassays.Results:In the acupuncture group,12 cases were cured,16 cases markedly effective,and 6 cases improved,the total effective rate being as high as 97.14%.The decrease in the symptom scores,and especially the elevation of the decreased E_2 level and the decrease of the increased FSH and LH levels, demonstrated that acupuncture therapy was superior to medication.Conclusion:Acupuncture for regulating the mental activities and reinforcing the kidney is an effective therapy for climacteric syndrome.

Relationship between perioperative glycemic control and postoperative infections

Perioperative hyperglycemia in critically ill surgery patients increases the risk of postoperative infection (POI), which is a common, and often costly, surgical complication. Hyperglycemia is associated with abnormalities in leukocyte function, including granulocyte adherence, impaired phagocytosis, delayed chemotaxis, and depressed bactericidal capacity. These leukocyte deficiencies are the cause ofinfection and improve with tight glycemic control, which leads to fewer POIs in critically ill surgical patients. Tight glycemic control, such as intensive insulin therapy, has a risk of hypoglycemia. In addition, the optimal targeted blood glucose range to reduce POI remains unknown. Since 2006, we have investigated tight perioperative blood glucose control using a closed-loop artificial endocrine pancreas system, to reduce POI and to avoid hypoglycemia. In this Topic Highlight, we review the relationship between perioperative glycemic control and POI, including the use of the artificial pancreas.

Endocrine and paracrine role of bile acids

Bile acids are not only important for the absorption of dietary lipids and fat soluble vitamins but are signalling molecules with diverse endocrine and paracrine functions. Bile acids regulate bile acid, lipid and glucose metabolism and modulate temperature and energy homeostasis. Furthermore, bile acids can not only promote cell proliferation and liver regeneration but can also induce programmed cell death. Bile acid functions are mediated through different pathways which comprise the activation of nuclear hormone receptors, of intracefular kinases and of the plasma membranebound, G-protein coupled bile acid receptor TGRS/Gpbar-1.

Transsphenoidal microsurgical treatment of infradiaphragmatic craniopharyngioma

Objective Typically,the transcranial approach has been used for the treatment of craniopharyngiomas with suprasellar extension,whereas the transsphenoidal approach has been used mostly for infradiaphragmatic craniopharyngioma.Total resection of craniopharyngioma can reduce the recurrence rate,especially in young children,but it may lead to severe complications.Therefore,any benefit of the degree of resection must be weighed against the risk of complications by the surgeons.The purpose of this study was to explore the therapeutic outcome after transsphenoidal microsurgical treatment of infradiaphragmatic craniopharyngioma and share our experiences.Methods Between January 2003 and June 2013,30 patients with infradiaphragmatic craniopharyngioma underwent transsphenoidal microsurgical resection in our hospital.The neurological,visual,and endocrine functions,and extent of resection were analyzed retrospectively.Recurrence or growth of residual tumor tissue during follow-up was assessed using magnetic resonance imaging(MRI).Results Total resection was achieved in 25 patients(83.3%),subtotal resection was achieved in 4 patients(13.3%),and partial resection was achieved in 1 patient(3.4%).There were no perioperative deaths.Cerebrospinal fluid(CSF) leakage occurred in 6 patients,and among them,2 required surgical repair of the sella.New-onset postoperative diabetes insipidus(DI) developed in 8 patients.Vision and visual fields were improved at different levels in 13 out of 16 patients who had sight impediments before treatment.Tumor recurrence and regrowth was observed in 2 patients;1 patient underwent transsphenoidal reoperation,the condition of the other patient who had undergone several craniotomies grew worse over the 6-month follow-up period.Conclusion Transsphenoidal surgery is an ideal choice in treating infradiaphragmatic craniopharyngioma.The transsphenoidal approach,which preserves pituitary function and avoids damage to the hypothalamic structures and optic nerve,is associated with fewer complications than the transcranial approach and a low mortality rate.

Update on endoscopic pancreatic function testing

Hormone-stimulated pancreatic function tests (PFTs) are considered the gold standard for measuring pancreatic exocrine function. PFTs involve the administration of intravenous secretin or cholecystokinin, followed by collection and analysis of pancreatic secretions. Because exocrine function may decline in the earliest phase of pancreatic fibrosis, PFTs are considered accurate for diagnosing chronic pancreatitis. Unfortunately, these potentially valuable tests are infrequently performed except at specialized centers, because they are time consuming and complicated. To overcome these limitations, endoscopic PFT methods have been developed which include aspiration of pancreatic secretions through the suction channel of the endoscope. The secretin endoscopic pancreatic function test (ePFT) involves collection of duodenal aspirates at 15, 30, 45 and 60 min after secretin stimulation. A bicarbonate concentration greater than 80 mmol/L in any of the samples is considered a normal result. The secretin ePFT has demonstrated good sensitivity and specificity compared with various reference standards, including the "Dreiling tube" secretin PFT, endoscopic ultrasound, and surgical histology. Furthermore, a standard autoanalyzer can be used for bicarbonate analysis, which allows the secretin ePFT to be performed at any hospital. The secretin ePFT may complement imaging tests like endoscopic ultrasound (EUS) in the diagnosis of early chronic pancreatitis.This paper will review the literature validating the use of ePFT in the diagnosis of exocrine insufficiency and chronic pancreatitis. Newer developments will also be discussed, including the feasibility of combined EUS/ ePFT, the use of cholecystokinin alone or in combination with secretin, and the discovery of new protein and lipid pancreatic juice biomarkers which may complement traditional fluid analysis.

An Investigation into Disease Progression and the Correlation between Diabetes Mellitus and Hepatocellular Carcinoma

Diabetes mellitus has been associated with anincreased risk of hepatocellular carcinoma in recent studies ofpatients. At the same time, advanced hepatocellular carcinomaitself can cause glucose intolerance and can aggravate diabetes.Diabetes mellitus inducing hepatocellular carcinoma may resultin changes in the following aspects: dysfunction of organism,endocrine hormone balance and interactions, endothelins andso on. One way, diabetes mellitus may induce hepatocellularcarcinoma through the effects of chemotherapeutics and otheradjuvant drugs. This review outlines the relationship betweendiabetes mellitus and the risk of hepatocellular carcinoma as wellas treatments for hepatocellular carcinoma, which may be helpfulfor clinicians.

Dysfunction of neuroendocrine system in sepsis and implication of hormone therapy

Sepsis and related syndromes are the major cause of multiple organ failure and death in patients with critical illnesses. Neuroendocrine dysfunction has long been thought to be an important event in sepsis. In clinic, optimal management of the hormones could alleviate severe complications in sepsis. In this article, we review the dysfunction ofneuroendocrine system as well as autonomic nervous system in sepsis, and summarize the respective therapy strategies.

Leptin in normal physiology and leptin resistance

Since the discovery of leptin as an adipokine in 1994, much progress has been made in the research about leptin. Circulating leptin binds to leptin receptor, activates STAT3-dependent and STAT3-independent signaling pathways, and plays an effective role in energy home- ostasis, neuroendocrine function and metabolism mainly through acting on the central nervous system, especially the hypothalamus. Leptin resistance is considered as a key risk factor for obesity. Various mechanisms have been formu- lated in order to explain leptin resistance, including impairment in leptin transport, attenuation in leptin sig- naling, ER stress, inflammation and deficiency in autop- hagy. Here, we review our current knowledge about leptin action, leptin signaling and leptin resistance, hoping to provide new ideas for the battle against obesity.