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ObjectiveTo characterize delayed visits of elderly patients with tuberculosis aged ≥60 years in Anji County， Zhejiang Province from 2010 to 2021， and to provide evidence for the prevention and control of tuberculosis in elderly population.MethodsData of elderly patients with tuberculosis in Anji County from 2010 to 2021 were collected through the Tuberculosis Management Information System of National Information System for Disease Control and Prevention. Multivariate logistic regression model was used to determine the influencing factors of delayed visits.ResultsA total of 1 191 cases of elderly tuberculosis were reported in Anji County from 2010 to 2021， with an average annual incidence of 112.43/105， showing a decreasing trend （χ2trend=11.297， P=0.001）. The male-to-female ratio was 2.29∶1， the active detection rate was 0.34%， and the pathogen-positive rate was 50.63%. There were 718 cases of delayed hospital visits， with a median delay time of 19 days and a delayed visit rate of 60.29%， showing an increasing trend （χ2trend=6.651， P=0.01）. Multivariate logistic regression analysis showed that local household registration status was a risk factor affecting the delayed visits for elderly tuberculosis patients （OR=1.944， 95%CI：1.388‒2.729）.ConclusionThe elderly patients with tuberculosis are a key population for tuberculosis prevention and control. It is necessary to strengthen early diagnosis and treatment， improve the active detection rate， reduce delayed hospital visits， so as to lower the risk of community transmission.

Objective To investigate the pathogenic gene mutations and clinical characteristics in a patient with compound heterozygote gene mutations in luteinizing hormone/choriogonadotropin receptor (LHCGR) gene. Methods Clinical features, laboratory data and radiologic manifestations were collected. The whole exon was sequenced. Pathogenicity of the mutations was evaluated by using the Mutation Taster, PANTHER software. The relationship of the splice site mutation and the phenotype of the LHCGR gene was investigated by literature review. Results 1)The patient presented with a micropenis.2)The level of gonadotropins was high but level of testosterone was low. 3)Compound heterozygotic mutations including a splicing mutation (c.233+1G＞A) and a missense mutation (c.547G＞A) were identified in LHCGR gene. Both variations were derived from his parents with normal epitope so it was the first case reported in this familiy. 4)The patient had a good response to testosterone therapy. Conclusions LHCGR mutation may cause micropenis. Our report expands the spectrum of clinical manifestations and mutation of LHCGR gene.

It is found that patients with hyperprolactinemia may have impulse control disorder(ICD) when treated with dopamine receptor agonist(DA), such as pathological gambling, high sexual desire, high appetite and forced shopping. This phenomenon also occurs in patients with Parkinson's disease (PD) or other neurological diseases treated with dopamine agonists. The pathogenesis may be that DA overstimulates D3 receptor. Drug withdrawal is a well accepted treatment method, which may reach a better catabatic outcome.

Objective To investigate the pathogenic gene mutations and clinical characteristics of type 2 Kabuki syndrome by analyzing a patient with novel splicing KDM6A gene mutation. Methods Clinical features, laboratory data and radiologic manifestations were collected. The whole exon was sequenced. Results 1)Patient presented with typical facial, skeletal and dermatoglyphic abnormalities, and mild intellectual impairment. 2)The main clinical manifestations were central precocious puberty and short stature. 3)Whole exon sequencing peripheral lymphocytes of the patient and of her parents identified a denovo splicing mutation in KDM6A gene. Conclusions KDM6A mutation may cause Kabuki syndrome, central precocious puberty and dwarfism. This case expands the understanding of clinical manifestations and gene mutation in Kabuki syndrome.

Objective To explore and practice“rain classroom” in basic medical teaching. Methods Take the undergraduates majoring in Imaging Technology and Biotechnology in the class of 2018 of Dalian Medical University as the research objects Through questionnaire, the teachers and students' feedback on the wisdom teaching of “rain classroom” was investigated, so as to reflect and summarize the auxiliary teaching of “rain classroom”. Results Students believe that “rain classroom” is helpful to their physiology learning and hope to extend this method to use other courses. The teachers impressed on the “rain classroom” exercise answering system,data collection and analysis function which are helpful to understand the learning outcomes of students quantitatively, evaluate the teaching process and adjust the teaching strategy. Conclusions Under the guideline of “Internet +”, “rain classroom” can improve the quality and efficiency of education , encourage students' autonomous learning, promote students' personalized talents training, and thus support the reform of medical education and teaching methodology.

The effects of transgenic Cry1Ab/Cry1Ac rice (Huahui 1) and its original parent (Minghui 63) the on the growth and development of indian meal moth during storage were studied. The results showed that,transgenic rice with Cry1Ab/Cry1Ac gene has a strong lethal effect on the youth larvae (1st to 3rd instars).Temperature has a significant effect on the development duration and speed of each stage of indian meal moth, and the development period was significantly prolonged after being fed with 2% transgenic brown rice meal. The nonlinear model of temperature-dependent developmental rate showed that the developmental threshold temperature of indian meal moth was 7.40 ℃ to 15.94 ℃, while those fed with 2% transgenic brown rice meal was 4.90 ℃ to 17.36 ℃. Our research can deepen the understanding of ecological safety of Bt transgenic rice in theory, and provide theoretical support for scientific development and utilization of Bt transgenic rice in practice.

Transgenic cry1Ab/cry1Ac rice (Huahui 1) is able to control the stored pest Plodia interpunctella.Our previous study confirmed that the enzymatic activities of three major antioxidases, including POD, CAT,and SOD, could be significantly changed after short-term stressed with these Bt containing rice. This study focused on the characteristics of rice during storage, the results showed that the Bt protein content in rice husk and brown rice was 5.534 μg/g and 1.003 μg/g respectively, and after 270 days at 25 ℃, the degradation rate was 67.3% and 27.7%, respectively. Moreover, the enzymatic activities of three antioxidases in P.interpunctella long-term fed with transgenic cry1Ab/cry1Ac rice powder would be addressed by enzymatic detection assays. Our data showed that the SOD activities could be significantly inhibited by the Bt containing rice after fed with Bt-rice powder for 12 days or 5 months, However, the enzymatic activities of POD and CAT significantly increase with the concentrations of Bt toxins. In addition, the change trend of protective enzyme activity in the Indian Meal Moth fed with transgenic rice flour for 5 months was consistent with that after 12 days of feeding. Our researches find that there are differences in the trend of increase and decrease of the three major protective enzymes after fed with Bt containing rice powder for a long time,which indicates that the expression mechanisms of the three protective enzymes might be different. Our results provide a theoretical basis for the study of toxicology and related resistance mechanism of transgenic Bt crops.

The Cry1Ab/Cry1Ac transgenic crops can effectively control pests. In the present study, the world-wide distribute pest, Indian meal moth Plodia interpunctella (Hübener), was taken as the research object. The genes closely related to Bt toxin protein were sequenced using a high-throughput sequencing to reveal the insecticidal mechanism of Bt transgenic rice. The results showed that the de novo assembly generated a total of 37,246 unigenes among of which 23,310 unigenes could be annotated after the transcriptome sequencing was performed on the non stressed population and Bt transgenic rice meal stressed population of Indian rice borer, respectively. Then, 34,466 significantly differentially expressed genes including 15,741 up-regulated genes and 18,725 down-regulated genes were determined by the Reads Per kb per Million reads (RPKM) method. Our database provides powerful tools for transcriptome analysis of P.interpunctella and further understanding of the molecular basis of Bt related mechanisms in P. interpunctella.

Objective To analyze the coupling and coordination relationship between the supply of medical resources and the utilization of medical services in Chengdu-Chongqing economic circle from 2016 to 2021, so as to provide reference for optimizing the allocation of medical resources. Methods Based on the comprehensive evaluation index system of medical resources supply and service utilization, a comprehensive evaluation model and a coupling coordination degree model were constructed to analyze the coupling and coordination relationship between medical resources supply and service utilization in Chengdu-Chongqing economic circle from 2016 to 2021. With the use of exploratory spatial data analysis, the spatial-temporal evolution characteristics of medical resources coupling coordination were analyzed. Results From 2016 to 2021, the development levels of medical resources supply and service utilization in Chengdu-Chongqing economic circle were 0.11-0.13 and 0.14-0.15, respectively, and the relative degree of development changed from shortage of medical resources (0.78) to mutual complement and promotion of development (0.92). However, the proportion of cities subject to lagging supply of medical resources was still large (68.8% in 2021). The level of coupling coordination changed from 0.47 to barely coordinated development. By 2021, only Chongqing and Chengdu had a good coordinated development. The LISA diagram showed that the "high-high" areas increased year by year, and the "cold point" effect disappeared, but there was still a "highland" phenomenon centered on Nanchong. Conclusion The development level of medical resource supply and service utilization in Chengdu-Chongqing economic circle is stable and rising, but the overall level is low and the regional gap is obvious. The coupling coordination level needs to be further improved, which is mainly limited by the lagging supply of medical resources. The spatial positive correlation of coupling coordination degree is gradually enhanced, but the spatial heterogeneity is still prominent. [ABSTRACT FROM AUTHOR]

The ultrafine-palygorskite/copper composites(ultrafine-P/Cu) were prepared by mechanical ball milling. The extreme pressure properties and the effect of load and speed on tribological properties of ultrafine-P/Cu powders, as 150N base oil additive, were evaluated on a four ball friction wear tester. The morphologies, element distributions and micromechanical properties of the worn surface were investigated by means of scanning electron microscopy, energy dispersive spectrometry and X-ray photoelectron spectroscopy. The results indicate that ultrafine-P/Cu used as a lubricant additive can effectively improve the tribological properties of base oil. The non-seizure value PB of ultrafine-P/Cu lubricant is increased by 31.6% than the base oil and by 9.1% than the single particles. Load and speed can affect the tribological properties of ultrafine-P/Cu. Ultrafine-P/Cu exhibits the optimum friction-reducing property and anti-wear property at the load of 245N and speed of 1200r/min, respectively. The excellent tribological properties of ultrafine-P/Cu can be attributed to the porous auto-restoration film of palygorskite and extended film of Cu formed on the worn surface to compensate wear and repair friction.

In view of problem of differences in tendency of coal spontaneous combustion at different regions in goaf, data of measured points were classified by using division method of spontaneous combustion 'three zones' in goaf based on fuzzy clustering analysis and differences of each classification under different λ-intercept matrix were analyzed. Analysis results showed that the data can be divided into different categories by different values of λ; in a certain range, original categories will be divided into smaller subclasses with increasing of value of λ; when value of λ increases, data of measured points in areas close to working face can be divided into smaller subclasses more easily and data of measured points in areas far from working face are stable, so environmental properties in goaf far from working face are relatively stable and forepart changes greatly; the categories to optimal λ calculated by F-statistics uniform with division of 'three zones' in goaf.

随着中国的加速崛起以及奥巴马政府“重返亚太”战略的实施，中美与东南亚地区的关系在近年发生了很多变化，在东南亚地区的影响力也随之变化。中美两国在政治、经济、军事、文化等方面都加强了与东南亚地区的关系，对东南亚地区的影响力都有不同程度的增长。比较而言，中国对东南亚的经济影响力更大，而美国对其军事以及安全方面的影响力更大。中国大力推行以“亲、诚、惠、容”为理念的周边外交政策，美国积极推进“亚太再平衡”战略，而东南亚各国则继续选择“在经济上依赖中国、在安全上依靠美国”的大国平衡战略，这导致了中美在东南亚地区影响力的持续博弈。 With China’s rapid rise and the implementation of the Obama Administration’s ”Return to the Asia Pacific” strategy, both China and the United States have significantly changed their relations with Southeast Asia in recent years. Also, the influence of China and the United States in this region has changed too. Both China and the United States have strengthened relations with the Southeast Asia region in terms of political, economic, military, cultural and other aspects, and their influence has also risen in varying degrees. In comparison, China has a greater impact on the economy of Southeast Asia, while the US has more influence on its military and security. China vigorously implements the neighborhood diplomacy featuring amity, sincerity, mutual benefit and inclusiveness. The United States actively promotes the Asia-Pacific rebalancing strategy. The Southeast Asian countries continue to choose the balance of power strategy, relying on China regarding the economy, relying on the United States regarding the security. This has resulted in the continuous game between China and the United States in the Southeast Asian region.

In order to simplify the mechanics and mathematical model of the vibrating screen rigid body plane motion, in this paper it is equivalent to vibrating screen motion by using the crank connecting rod, crank vector synthesis is equal to the centroid displacement of vibrating screen, angle between the connecting rod and its sliding axis is equal to the vibrating screen rotation angle around the mass center, the method is simple and intuitive, pointed out the crank length determine mass centroid amplitude, length of connecting rod determine the swing degree of the vibrating screen, and therefore got the size of eccentric mass and its installation location which was the design parameters. According to the vibrating screen rotation angular was zero, gave the sufficient and necessary conditions of vibrating screen that the vibrating screen was only to do translational motion. According to the velocity and acceleration of the vibrating screen instantaneous center, and the velocity and acceleration of the mass center, gave the calculating method of the velocity and acceleration of the arbitrary point on the vibrating screen, a simple method was proposed that was the basis of the vibrating screen design and material movement analysis. [ABSTRACT FROM AUTHOR]

Objective: To explore the potential interactions among obesity-related proteins in the pathogenic process of breast cancer (BC) in women., Methods: We conducted a case-control study, enrolling 279 primary breast cancer cases and 260 age-frequency-matched healthy women between April 2014 and May 2015. Based on the evidence of previous published literature on obesity-related proteins and BC risks, we selected proteins that received more attention and measured the plasma levels of these proteins by enzyme-linked immunosorbent assay (ELISA). After stratification of the subjects according to their menopausal status, an analytic strategy combining multivariate logistic regression and generalized multifactor dimensionality reduction (GMDR) was used to explore the effect of the possible interactions of these proteins on BC risk., Results: There were marginal high-order interactions among insulin-like growth factor 1 (IGF-1), insulin-like growth factor binding protein 3 (IGFBP-3), C-reactive protein (CRP), resistin (RETN), soluble leptin receptor (sOB-R), and adiponectin (ADP) in premenopausal women (with the balanced accuracy for the testing set being 59.01%, cross-validation consistency being 10/10, and permutation test P =0.05). There were high-order interactions among leptin (LEP), sOB-R, ADP, CRP, IGFBP3 and visfatin (VF) in postmenopausal women (with the balanced accuracy for the testing set being 67.31%, cross-validation consistency being 10/10, and permutation test P =0.01). Along with an increase in the number of obesity-related proteins to which the subjects were exposed, the risk of developing breast cancer gradually increased in both pre- and postmenopausal women ( OR pre =2.18, 95% CI : 1.69-2.82; OR post =2.41, 95% CI : 1.75-3.32)., Conclusions: This preliminary study suggested high-order interactions among obesity-related proteins on BC risk in both pre- and postmenopausal women. In future studies, close attention should be given to these potential interactions when these proteins are used jointly as predictors, as well as in developing a comprehensive risk scoring system for BC., (Copyright© by Editorial Board of Journal of Sichuan University (Medical Sciences).)

Objective: To explore the role of small-dose recombinant human coagulation factor VIIa (rFVIIa) for coagulopathy in patients with isolated traumatic brain injury., Methods: A total of 86 isolated traumatic brain patients with coagulopathy were treated at our neurosurgery intensive care unit (NICU) from January 2010 to December 2012. Their trauma registry data included mortality, pre-and post-rFVIIa coagulation parameters. Two-tailed paired t-test was used to determine significant changes in coagulation parameters and other major clinical parameters., Results: Twenty-seven patients made up the low-dose rFVIIa (20 µg/kg) group. And the control group had 59 well-matched subjects. At admission, age, blood pressure, Glasgow coma scale score, hemoglobin, platelets and international normalize ratio were similar in both groups. After treatment, the INR of patients on rFVIIa was lower than that of the conventional treatment group (1.1 ± 0.2 vs 1.2 ± 0.2, P < 0.01) and it declined more in the rFVIIa group (0.3 ± 0.2 vs 0.1 ± 0.4, P = 0.05). No significant difference existed in mortality or length of stay between two groups.There was no occurrence of subsequent thromboembolic events., Conclusion: The application of small-dose rFVIIa can effectively reduce the value of INR and improve the coagulation status of patients. During the course of treatment, no major adverse events occur.

Objective: To explore whether neonatal endotoxin challenge alters reproductive hormone secretion in adult female rats., Methods: Rats were intraperitoneally injected with lipopolysaccharide (LPS) or normal saline at postnatal days 3 and 5. At Week 12, the animals underwent bilateral oophorectomy and were exposed to LPS or saline. The secretion levels of luteinizing hormone (LH) and estradiol were measured., Results: The LPS injection in adult neonatal saline rats caused the suppressed secretion of LH and estradiol. However, the decreased secretion of both LH and estradiol were much more apparent in adult neonatal LPS-treated rats., Conclusion: The neonatal LPS challenge alters the secretions of LH and estradiol during adulthood. And the mechanism may be mediated by epigenetic programming of hypothalamic-pituitary-gonadal axis.

Objective: To explore the clinical profiles of patients with lower extremity deep venous thrombosis (DVT) complicated with inferior vena cava (IVC) thrombus and summarize their clinical diagnostic and therapeutic experiences., Methods: The clinical characteristics, diagnosis and treatment of 20 hospitalized patients with DVT complicated with inferior vena cava thrombus were analyzed retrospectively., Results: All of them were of proximal DVT. There were phlegmasia cerulea dolens (n = 3), pulmonary embolism (n = 3) and completely occlusion of IVC (n = 5). Clinical manifestations were severe. Retrievable inferior vena cava filter (IVCF) was implanted for 17 cases. Catheter-directed thrombolysis (CDT) through ipsilateral popliteal vein was applied for 7 cases and systemic thrombolysis therapy for 8 cases. The effective rate of thrombolysis for fresh IVC thrombus was 100%. Among 5 cases with Cockett Syndrome, 3 cases underwent balloon dilatation angioplasty and endovascular stenting of iliac vein. And 17 IVCFs were retrieved successfully within 3 weeks. IVC thrombus disappeared completely in 15 cases., Conclusion: Systemic or local thrombolysis with protective IVCF is a safe and effective therapy for nonocclusive IVC thrombus in DVT. And CDT is recommended for symptomatic occlusive IVC thrombus.

Objective: To explore the effects of tetramethylpyrazine on the nitric oxide synthase activity and calcium ion concentration in skeletal muscle fiber and decipher the possible mechanisms of anti-muscle atrophy function of tetramethylpyrazine in hindlimb unloading rats., Methods: Hindlimb unloading (HLU) rats were used as a muscle atrophy model to study the activity of nitric oxide synthase by colorimetry. The concentration of intracellular calcium ion was measured by laser scanning confocal microscope. A total of 18 female rats were randomly divided into 3 groups: control (CON), hindlimb unloading with water (HLU + W) and hindlimb unloading with tetramethylpyrazine (HLU + Tmp) (n = 6 each)., Results: (1) Compared with CON, the activity of nitric oxide synthase decreased by 28% in HLU + W (P < 0.05) and decreased by 46% in HLU + Tmp (P < 0.01). The activity of nitric oxide synthase less decreased in HLU + Tmp than that in HLU + W, but it was not statistically significant (P > 0.05). (2) Compared with CON, the concentrations of intracellular calcium ion in HLU + W and HLU + Tmp increased by 330% and 86% respectively (P < 0.01). Compared with HLU + W, the concentration of intracellular calcium ion decreased by 130% in HLU + Tmp (P < 0.01)., Conclusion: The activity of nitric oxide synthase decreases and the concentration of calcium ion increases in hindlimb unloading rats. And tetramethylpyrazine may suppress the calcium ion overloading but not the activity of NOS associated with disuse muscular atrophy.

Objective: To investigate the effects of obesity on the lipid and glucose metabolism in female rats., Methods: The litter size was adjusted to 4 pups per litter for the small litter (SL, treatment group) and 12 neonates per dam in the normal litter (NL, controls) at postnatal day 0. Body weights were measured weekly. At the age of 6 weeks, bilateral ovariectomy was performed. The blood levels of free fat acid, triglyceride, total cholesterol, free blood glucose and free insulin were evaluated. The muscular expression of AMP-activated protein kinase was detected by immune staining., Results: As compared to normal litters, the levels of fat acid, triglyceride, total cholesterol, free blood glucose and free insulin significantly increased. The muscular activity of AMP-activated protein kinase decreased. All difference were statistically significant (P < 0.05)., Conclusion: Obesity in early life has obvious effects on the lipid and glucose metabolism in female rats.

Objective: To apply ultrasonic technology in positioning and monitoring for pediatric caudal blocks and compare it with traditional landmark approach and Swoosh test., Methods: After obtaining the approval of hospital ethics committee and written parental informed consent, a total of 102 American Society of Anesthesiologists (ASA) I-II pediatric patients aged from 1 month to 8 years and scheduled for urologic or perineal surgery were recruited. Patients were randomly divided into 2 groups: ultrasound group (n = 52) and control group (n = 50). The sites of sacral cornu and sacral hiatus were determined by ultrasonic imaging or classic method of anatomical surface landmarks. Patients of two groups were punctured according to the scheduled site. Local anesthetic was injected slowly into caudal space after a successful caudal puncture and the positive reaction in caudal space was monitored simultaneously by ultrasound and classic swoosh test. The observational results and relevant date were recorded., Results: In ultrasound and control groups, the number of puncture attempts was 1.10 ± 0.30 vs 1.56 ± 0.63, the duration of puncture (1.40 ± 0.39) vs (3.23 ± 1.23) min, the success rate at the first puncture attempt 90.4% vs 66% and the total puncture success rate 100% vs 92% respectively. After the injection of local anesthetic, the positive reaction rate of ultrasonography and swoosh test was 97.96% vs 62.24% respectively. All of above results in ultrasound group were superior to those in control group or with classic test. And the difference had statistical significance (P < 0.01)., Conclusion: Ultrasonic positioning and monitoring for pediatric caudal block is both scientific and reasonable. The positioning detected by ultrasonic imaging is accurate and the monitoring results of ultrasound are reliable. It is obviously superior to traditional method and has clinical application values for caudal block in children.

Objective: To explore the diagnosis and surgical treatment of infectious abdominal aortic aneurysm (IAAA)., Methods: All 3 IAAA patients at our department in 2010 underwent the combined procedures of axillary-bilateral femoral arterial bypass and IAAA resection. Their clinical data were collected and analyzed., Results: There was no intraoperative death or complication. On average, the operative duration was 5 hours and the estimated blood loss 1500 ml. All patients received a 2-week post-operative regimen of antibiotics. And they recovered with healed incision in the first intention. No fever, abdominal symptom or intermittent claudication occurred during a 4-month follow-up period., Conclusion: Axillary-bilateral femoral arterial bypass plus IAAA resection is an effective surgical procedure for resecting IAAA, assuring arterial blood supply to lower limbs and preventing post-operative graft infections. The short-term therapeutic efficacy is satisfactory, but its long-term efficacy requires further follow-ups.

Objective: To investigate the clinical values of luteinizing hormone-releasing hormone (LHRH) α (triptorelin) stimulating test in the differential diagnoses of hypothalamus-pituitary-gonad axis (HPGA) disorders., Methods: A total of 229 male patients with various HPGA disorders were recruited for triptorelin stimulating test. And all patients were followed up for 12 - 48 months until a definite diagnosis was made. The values of triptorelin stimulating test in the differential diagnoses of HPGA disorders were assessed by examining the close relationship between LHmax and the final clinical diagnosis., Results: (1) LH levels rose steady after an intramuscular injection of triptorelin 100 µg and the time of LHmax appeared at 45 - 60 min. (2) LHmax < 4 U/L indicated the function of HPGA was not activated. LHmax in the range of 4 - 12 U/L indicated the patients might have constitutional delayed puberty development. LHmax > 12 U/L indicated the fulfilled puberty development., Conclusion: Triptorelin stimulating test can precisely evaluate the functions of HPGA in various HPGA disorders and provide valuable information for the differential diagnoses in constitutional delayed puberty development, hypogonadotropic hypogonadism, central and peripheral precocious puberty disorders.

Objective: To study the clinical features of 9 patients with X-linked adrenal hypoplasia congenita (AHC) by gene sequencing so as to provide diagnostic rationales., Methods: The patients were 9 cases of X-linked AHC treated at our hospital from July 2007 to June 2009. The clinical manifestations were analyzed. The blood biochemistry tests and the hormone examinations including luteinizing hormone-releasing hormone (LHRH) stimulation tests and human chorionic gonadotropin (HCG) stimulation tests were conducted to evaluate the functions of gonads. And CT scans of adrenal glands and gene tests of DAX1/NR0B1 were performed., Results: Nine AHC patients from 8 families were studied. All patients had DAX1/NR0B1 gene mutations. The main clinical features were: (1) some patients (3 families) had a family history of X-linked recessive inheritance; (2) the ages of onset were all below 10 years old (from 2 month after birth to 9 years old) and ages of being treated at our hospital were from 15 to 34 years old; (3) all patients had adrenocortical hypofunctions, but clinical situations were different, most of them had pigmentation (n = 9), nausea and vomiting (n = 8), hypotension (n = 6), Addisonian crisis (n = 4). Others were debility, hypoglycemia and cold susceptibility. Laboratory tests indicated that all patients had hyponatremia at the onset and higher blood adrenocorticotropic hormone level, lower blood 17-hydroxyprogesterone level compared to normal controls; (4) none of the patients had puberty and there was no responses to LHRH stimulation tests, 3 of them had normal responses to HCG stimulation tests; (5) small bilateral adrenal glands were displayed on CT scans., Conclusions: The main clinical features of X-linked AHC are adrenocortical hypofunction and hypogonadotropic hypogonadism. But the phenotypes vary greatly in different patients. So male children with adrenal cortical hypofunction should be suspected of X-linked AHC and DAX1/NR0B1 gene tests should be performed. The sexual development of the patients also should be followed up.

Objective: Endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAA) has become a viable alternative to open surgical repair in the last decade. We report here our experience on the mid-term results of EVAR and analysis of the outcomes associated with endograft AAA repair., Methods: Between Nov 2002 and Mar 2007, 26 patients with AAA were enrolled in a single institution. Indications for EVAR included unfavorable condition of body (eg. Heart, lung, or renal dysfunction, etc) for open surgery and maximum diameter of AAA > 5.0 cm. Customized stent-grafts were Talent TM, Zenith and some of products made in China. All of the patients were followed up with ultrasonography or computed tomography angiography every 3 months first year after EVAR and every year after., Results: The mean (SD) follow-up was 38.8 ± 12.7 months (median, 35.0 months; range, 24 to 64 months), and no patients were lost to follow-up. All cause mortality was 15.4% (4/26), with all deaths occurring within the first 2 postoperative year; 30-day mortality was 4.1%. No patient died during the operation. Completion angiography demonstrated successful sealing in 25 of 26 patients. There was no stent occlusion of renal artery. The mid term complication were observed including 2 type I endoleak after 3 months of the operation, 2 sustained type II endoleak caused by lumber artery, 1 aneurysm of left femoral artery after 16 months of operation, 1 proximal neck dilation after 12 month of operation. The aneurysm sac size didn't increase significantly during follow time, except one of the type I endoleak., Conclusions: The mid-term results of EVAR support the continued use in patients with contraindications for traditional open surgery of AAA. Close surveillance is mandatory for endoleak, especially for type I endoleak. Some proximal neck dilation can be caused by the stent-graft expansion, injury, and aortic pathological changes. Endoleak of type II can not lead to enlargement of aneurysm sac probably.

Objectives: To determine the impact of BMI on clinical outcome in patients with heart failure underwent coronary revascularization., Methods: The DESIRE-plus (Drug-Eluting Stent Impact on Revascularization-plus) was a single-center registry of coronary revascularization in our institution between July 1, 2004 and September 30, 2005. We analyzed heart failure patients with the complete data of body mass index (BMI) data from the DESIRE-plus trial and grouped them by BMI (normal BMI group, BMI < 24; overweight group, BMI 24-27.9; obesity group, BMI > or = 28). Total mortality, cardiac mortality and MACCE including death, neo-myocardial infarction, stroke, re-revascularization were recorded. We evaluated risk estimates for three bodyweight groups., Results: 1010 patients were included in the study (295 in normal BMI group; 495 in overweight group and 220 obesity group). Median follow-up was 542 days. Overweight and obese patients were younger (59.3 +/- 10.14 years, 58.6 +/- 10.30 years vs 62.6 +/- 9.93 years, P < 0.01) and had a significantly higher incidence of hypertension (61.2, 66.8% vs 52.5%, P = 0.017), stable angina pectoris (21.2%, 23.7% vs 17.0%, P = 0.05) and higher triglyceride [(1.90 +/- 1.05) mmol/L, (2.10 +/- 1.12) mmol/L vs (1.48 +/- 0.92) mmol/L, P < 0.01)], fasting blood glucose level [(6.07 +/- 2.09) mmol/L, (5.96 +/- 1.53) mmol/L vs (5.67 +/- 1.92) mmol/L, P = 0.021), blood creatinine (84.9 +/- 21.7) micromol/L, (90.2 +/- 30.9) micromol/L vs (82.2 +/- 25.8) micromol/L, P = 0.002] compared with normal BMI patients. Multivariate Cox regression model showed obese patients had an decreased hazard risk (HR) for total mortality (0.285, 95%CI 0.104 - 0.777) and MACCE (0.596, 95%CI 0.401 - 0.885) compared with those for patients with normal BMI, overweight patients had no increased risk for total mortality (HR 0.769, 95%CI 0.442 - 1.338) and MACCE (0.998, 95%CI 0.754 - 1.322), there was hardly any significantly difference in cardiac mortality between three groups (P = 0.223)., Conclusion: There were more risk factors in heart failure patients with coronary heart disease complicated with obesity or overweight, but the prognosis after revascularization of them is at least no worse than the normal weight coronary heart disease patients.

Objective: To assess whether chronic renal insufficiency and anemia are significant independent and combined predictors of poor long-term outcomes after percutaneous coronary intervention (PCI)., Methods: We examined the clinical and outcome data of 3770 PCI patients based on the pre-PCI values of glomerular filtration rate (GFR) and hemoglobin (Hb). Depending on their baseline GFR and Hb, the patients were classified into six groups: normal renal function with anemia or not; mild renal impairment with combined anemia or not; severe renal insufficiency with anemia or not. The clinical features and prognosis of patients were compared., Results: Significant differences were found between the groups regarding female gender, age, body mass index, prior history of hypertension, diabetes mellitus, prior stroke, acute coronary syndrome, systolic blood pressure, left ventricular ejection fraction, total serum cholesterol, LDL-C and angiographic features (P < 0. 01). When evaluated as continuous variables, GFR and Hb were independent predictors of long-term mortality after adjusting for effects of each other (GFR: HR 0.979, 95% CI 0.960-0.999, P = 0.035; Hemoglobin: HR 0.952, 95% CI 0.921-0.984, P = 0.004). Mild renal insufficiency with anemia (HR 4.123, 95% CI 1.637-10.386, P = 0.003), severe renal insufficiency without anemia (HR 5.287, 95% CI 1.627-17.183, P = 0. 006) and severe renal insufficiency with anemia (HR 7.134, 95% CI 2.180-23.342, P = 0.001) having a statistically significant decrease in survival in patients undergoing PCI ., Conclusion: Renal insufficiency and anemia are significant independent and combined predictors of long-term mortality in patients undergoing PCI.

Objective: To summarize the clinical features of osteonecrosis of the jaw (ONJ) in multiple myeloma (MM) patients treated with bisphosphonate., Methods: The clinical data of 4 patients with bisphosphonate-related (ONJ) in MM were reported and literatures were reviewed., Results: In these patients, 3 males and 1 female, aged 59-73, pamidronate combined with chemotherapy, high dose glucocorticosteroid, and anti-angiogenic drug had been used for 12-44 months before the occurrence of ONJ. In treatment of ONJ conservative debridement of necrotic bone, systematic use of antibiotics, use of chlorhexidine acetate gargle, and withdrawal of bisphosphonates were preferable to aggressive surgical measures., Conclusion: Long-term use of bisphosphonates combined with chemotherapy in MM may cause ONJ that involves both mandible and maxilla. No satisfactory therapy is currently available.

Objective: To evaluate the effect of testosterone replacement therapy in patients with hypogonadotrophic hypogonadism (HH) on insulin sensitivity and high sensitivity C reactive protein (hsCRP)., Methods: 21 males with HH, aged 15 - 30, and 18 age, and BMI-matched healthy males underwent detection of homeostasis model assessment insulin resistance index (HOMA-IR). Second, the values of weight, abdominal circumstance, grips strength, body composition, total testosterone (TT), fast blood glucose and insulin, serum lipid profile, and hsCRP were compared before and after 9-month testosterone replacement therapy in the HH patient group., Results: (1) Before treatment the TT level of the HH patients WAS (0.9 +/- 0.6) nmol/L, significantly lower than that of the healthy control group (18.8 +/- 3.2) nmol/L. The fast insulin level of the HH patients was (16.0 +/- 9.8) mIU/L, significantly higher than that of the control group [(8.4 +/- 3.3) mIU/L, P = 0.018]. The HOMA-IR of the HH patient was 3.7 +/- 2.4, not significantly different from that of the control group (1.8 +/- 0.7, P = 0.021). (2) After testosterone therapy, the fast insulin level of the HH patients decreased from (16.0 +/- 9.8) mIU/L to (12.1 +/- 7.4) mIU/L (P = 0.03); the HOMA-IR decreased from (3.7 +/- 2.4) to (2.7 +/- 1.7) (P = 0.045); and the total cholesterol, LDL-c, HDL-c, and Triglyceride all decreased, but not significantly (all P > 0.05). The hsCRP decreased from (1.49 +/- 1.18) mg/L to (0.70 +/- 0.56) mg/L (P = 0.025)., Conclusion: Short period of testosterone replacement therapy in young HH male patients significantly improves the insulin sensitivity and decreases the risk of cardiovascular disease.

Objective: To evaluate the prevalence of unrecognized diabetes in patients with coronary heart disease, the control of the risk factors of CHD, and the long-term prognosis of these patients., Methods: The clinical data of CHD patients with complete data, including clinical characters, target organ damage, percentage of controlled risk factors, and clinical results during follow up in the DESIRE (Drug-Eluting Stent Impact on REvascularization) database were analyzed., Results: 3763 patients after revascularization for coronary heart disease were registered in the DESIRE database, 3683 of which had complete data recorded. 721 of the 3683 patients (19.8%) had established diabetes at admission, 303 (10.2%) without history of diabetes had fast glucose higher than the diagnostic criteria of diabetes. Another 722 patients had impaired fast glucose (IFG). 47.4% of the 3683 CHD patients had impaired glucose metabolism. The prevalence rates of systolic blood pressure>or=140 mm Hg, low density lipoprotein cholesterol>or=2.6 mmol/L, and current smoker at admission were 46.2%, 59.4%, and 48.8% respectively, all significantly higher than those of the established diabetes patients and those without (P=0.05, 0.0001, and 0.0001 respectively). The prevalence of three vessel disease was 41.6%, similar to that of the established diabetic patients (45.7%), and significantly higher than that of those without diabetic (P=0.0001). The percentage of creatinine>132 mmo/L signifying impaired renal function was 8.7% in the patients with unrecognized diabetes, significantly higher than those of the other 3 groups (all P=0.0001). 80.6% patients were followed up for a mean time of 30.0+/-12.1 months. The mortality rate of the patients with unrecognized diabetes was 5.7%, significantly higher than those of the patients with established diabetes (4.3%), those with IFG (3.6%), and those without diabetes (2.3%, all P=0.01). The rate of major adverse cardiac and cerebral events of the patients with unrecognized diabetes was 13.9%, similar to that of patients with established diabetes (14.3%), and significantly higher than that of the patients without diabetes (10.0%, P=0.01)., Conclusion: The prevalence rate of diabetes is high in the CHD patients, the diagnosis of one third of which is missed. The target organ damages are more common and the risk factors control is poor among these patients. The prognosis of unrecognized patients after revascularization is poor in comparison with other groups.

Objective: To analyze the prevalence and characteristics of metabolic syndrome (MS) in the patients with coronary artery disease (CAD) of different genders who underwent revascularization., Methods: The clinical data of 2596 patients in the DESIRE (Drug-eluting Stent Impact on Revascularization) study who underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) were analyzed and the patients were followed up till death. MS was diagnosed based on the Chinese standard (modified ATP III)., Results: The mean follow-up time was 828.8 +/- 373.2 days. 1139 of the 2596 patients were diagnosed as with MS. The prevalence of MS in the female patients was 50.9%, significantly higher than that in the male patients (41.8%, P < 0.0001). Complication of MS was the only predictive factor of poor prognosis in female CAD patients (OR = 2.019, 95% CI = 1.751 - 2.506, P = 0.023). Fasting blood glucose >or= 110 mg/dl was responsible for most of the increased risk associated with MS (adjusted OR 2.511, 95% CI 1.396 approximately 4.511, P = 0.002)., Conclusion: In comparison with the male patients the female patients undergoing revascularization have a higher he prevalence of MS and worse prognosis. In the 4 elements of MS hyperglycemia is directly associated with prognosis.

Objective: To investigate whether a large-scale visual network and visual consciousness are still retained in the patients with minimally conscious state (MCT) and the possibility of promoting the rehabilitation of brain function by visual stimulation., Methods: Fifteen standardized pictures provided by the International Affective Picture System (IAPS2005) were passively presented to 10 normal adult controls and 9 patients in MCT recovering from severe craniocerebral injury or cerebral hemorrhage. Functional magnetic imaging was conducted. The AFNI software was used to process the images thus collected., Results: The primary visual cortex, occipital lobe, and the secondary visual cortexes, including temporal lobe, parietal lobe, fusiform gyrus, orbital gyrus, and prefrontal lobe were all activated in the 10 normal persons. Similar visual activation was found in 2 of the patients in MCS, however, with a smaller activation volume. Activation of partial visual network was found in 3 patients and the other 4 failed to be activated., Conclusion: It is feasible to promote the rehabilitation of brain function by visual stimulation in the patients in MCS.

Objective: To evaluate the impact of drug-eluting stent (DES) on transferring treatment with coronary surgical revascularization among the patients initially admitted to department of internal medicine., Methods: 2598 patients initially admitted in department of internal medicine underwent revascularization by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) before the introduction of DES from 1 July 2001 to 30 June 2002 [bare metal stent (BMS) era group, n = 923) or after the introduction of DES from 1 July 2003 to 30 June 2004 (DES era group). The clinical manifestations and coronary angiography characteristics were analyzed retrospectively., Results: In the DES era group 1333 patients (80.1%) were revascularized with PCI, and 331 patients (19.9%) were transferred to treatment with CABG; and in the BMS era group, 721 patients (77.2%) underwent PCI, and 213 patients (22.8%) were transferred to treatment with CABG. The rate of transference to CABG of the DES era group was lower by 12.7% compared with the BMS era group. The rates of left main coronary disease, proximal left anterior descending coronary stenosis and diffuse long lesions among the patients revascularized with PCI in the DES era group were 3.2%, 44.2%, and 19.7% respectively, all significantly higher than those in the BMS era group (1.4%, 39.8%, and 11.2%, P = 0.025, P = 0.047, and = 0.021 respectively). But no matter if DES was implanted or not, left main coronary disease, proximal left anterior descending coronary stenosis, diffuse long lesions and ostial lesions were the most common coronary lesions in the patients revascularized with CABG. Logistic regression showed that number of diseased vessels, left main coronary disease, chronic total occlusion lesions, and proximal left anterior descending coronary stenosis were independent predictor for transferring treatment with CABG (all P < 0.0001)., Conclusion: DES has a certain impact on the coronary revascularization strategies, because the rate of in-stent restenosis and repeat revascularization are lower significantly after implantation of DES than after implantation of BMS. Many coronary lesions that should undergo CABG in non-DES era may be revascularized with PCI and implantation of DES.

Objective: To investigate the puberty timing in healthy adolescent boys in Daqing city in northern China., Methods: A cross-sectional and longitudinal combined survey was performed. On 150 male students aged 6-15. Follow up was conducted for 4 years. The serum levels of luteinizing hormone (LH), Follicular Stimulating Hormone (FSH) and total testosterone (TT) were measured. The puberty timing and anthropometry including the body height, weight, and genital development according to Tanner's stages were all recorded., Results: The mean age of puberty onset in healthy adolescent boys is (12.0+/-1.6) years. The growth velocity in the first year after puberty onset is (6.9+/-0.4) cm/year. The level of plasma TT at the time of puberty onset is (1.0+/-0.3) nmol/L., Conclusion: The puberty timing of boys in the Daqing city, northern China is in the range from 8 to 14 years.

Objective: To elucidate the profile of risk factors modification after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with coronary artery disease in order to scale the gap between real world practice and evidence-based guidelines., Methods: 3767 patients with at least 30 days' followed-up after discharge in the single-center DESIRE (Drug-Eluting Stent Impact on REvascularization) registry were enrolled to compare in-hospital and follow-up data including smoking, body weight, blood pressure, fasting blood sugar and lipid levels., Results: Of the 3763 patients, 3017 (80.2%) were successfully followed up for at least one month with a median of 670 (35 - 1930) days. During follow-up, 18.5% (170/917) of the in-hospital current smokers continued smoking, whereas 6.1% (71/1168) of the non-current smokers during hospitalization became cigarette addict despite a marked reduction in the general rate of current smoking (43.5% vs 9.5%, P < 0.0001). At follow-up, 24.3% (264/1087) of the overweight or obese patients experienced weight gain after revascularization. In patients with diabetes mellitus, 48.3% (143/296) had higher follow-up levels of average fasting blood sugar. In patients complicated with hypertension, 33.1% (469/1419) and 31.9% (453/1419) had higher average systolic or diastolic pressures than in-hospital measurements. During follow-up, 36.4% (111/184) had lower levels of serum high-density lipoprotein cholesterol (HDL-C), whereas 54.1% (98/181) and 56.8% (121/213) patients had higher levels of serum low-density lipoprotein cholesterol (LDL-C) and triglycerlin (TG)., Conclusion: Risk factors modification after coronary revascularization is far beyond optimal, with a high rate of continued smoking and poor control of body weight, blood sugar, blood pressure and serum lipids. Prompt and effective measures should be taken to enhance the secondary prevention and patient education to minimize the gap between clinical practice and evidence-based guidelines.

Objective: To investigate the influence of initial admission department for coronary arteriography on the choice of mode of coronary revascularization., Methods: From October 2003 to June 2004 2156 patients with coronary heart disease were admitted into the department of internal medicine (1667 cases) or department of surgery (489 cases) to undergo coronary arteriography (CAG) and coronary revascularization. The influence of the initial admission departments on the choice of mode of coronary revascularization for the patients with different clinical manifestations and angiographic characteristics, including one-vessel disease, two-vessel disease, three-vessel disease, and multi-vessel disease of different types was analyzed., Results: 1336 (80.1), 326 (19.6%), and 5 (0.3%) of the 1667 patients initially admitted to the department of internal medicine, received percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), and CABG + PCI respectively with a complete revascularization rate of 63.3%. 52 (10.6%) and 437 (89.4%) of the 489 patients initially admitted to the department of surgery received PCI and CABG respectively with a complete revascularization rate of 75.5%. The CABG rates for the patients different types of lesion were all significantly higher in the patients initially admitted to the department of surgery than in the patients initially admitted in the department of internal medicine (all P < 0.05). The in-hospital death rate, new-onset myocardial infarction rate, and main adverse cardio-cerebral event rate of the patients admitted into the department of surgery were 3.9%, 1.8%, and 5.7% respectively, all significantly higher than those of the patients initially admitted in the department of internal medicine (1.2%, 0.5%, and 1.5% respectively, all P < 0.01). Logistic regression showed that initial admission into department of surgery, number of diseased vessels, left main trunk disease, proximal descending anterior branch disease, and chronic total occlusion rate were independent predictor for choice of CABG (all P < 0.01)., Conclusion: Cardiologists are more likely to choose PCI and cardiac surgeons are more likely to choose CABG. It is imperative to collect more evidence-based data so as to develop guidelines for the choice of reasonable mode of revascularization.

Objective: To investigate the effects of BBSKE (1,2-[bis (1,2-benzisoselenazolone-3 (2H)-ketone)]ethane), a novel organoselenium compound, on the proliferation and apoptosis of the prostate cancer cell line PC-3, and to study its effect on the growth of prostate cancer in vivo., Methods: Prostate cancer cells of the cell line PC-3 was cultivated in media with different concentrations of BBSKE and cisplatin. The inhibition of proliferation was measured by colorimetric MTT assay. The morphologic changes were observed by fluorescence microscopy, DNA fragmentation was visualized by agarose gel electrophoresis, and the DNA degradation was determined by flow cytometry. Western blot analysis was used to identify the expression of bcl-2 and bax. The activity of caspase-3 was determined by a micro-ELISA reader. Mouse prostate cancer cells of the TRAMP-C2 line were cultured and then injected subcutaneously into 2 male C57BL/6 mice to establish the animal model. Then the 2 mice were killed to collect the cancer cells. Twenty-four mice were injected intraperitoneally with single cell suspension of TRAMP-C2 cell and then divided into 3 groups of 8 mice undergoing intraperitoneal injection for 7 days: BBSKE group (BBSKE was administered at the dosage of 25mg/kg/day), cisplatin group (cisplatin 2mg/kg/d was injected), and control group (pure solvent was injected). Three weeks after the mice were killed and the tumors were taken out to calculate the inhibition rate., Results: BBSKE inhibited the growth of the PC-3 cells dosage-dependently with a value of IC(50) of 17.90 micro mol/L after a 48 h exposure, higher than that in the case of cisplatin (15.00 micro mol/L). After exposure of PC-3 cells to BBSKE at the dosage of 20 micro mol/L for 48 hours the apoptosis rate was 26.32%, significantly higher than that of the control group (1.75%, P < 0.01). The expression of bcl-2 was decreased and the expression of bax remained almost unchanged along with the increase of BBSKE concentration. The activity of caspase 3 in the subgroup of BBSKE of the concentration of 5 micro mol/L remained almost unchanged, and was increased to 3.65 +/- 0.57 and 4.39 +/- 1.01 respectively in the BBSKE 10 micro mol/L and 20 micro mol/L subgroups, both significantly higher than that of the control group (both P < 0.05). In the in vivo experiment, the growth of tumor was significantly inhibited by BBSKE with an inhibition rate of 40% and the inhibition rate of the cisplatin group was 48%., Conclusion: The novel organoselenium BBSKE inhibits the proliferation of PC-3 cell and promote its apoptosis, probably through downregulating the expression of bcl-2 and the activity of caspase-3. BBSKE also inhibits the growth of prostate cancer in vivo.