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Objective To compare the size discrepancy between ultrasonic and pathological measurement of solitary cN0M0 papillary thyroid microcarcinoma (PTMC), and to explore their correlation with lymph node metastasis. Methods From April 2021 to January 2022, 234 patients with solitary cN0M0 PTMC who received thyroid lobectomy or total thyroidectomy in the Department of Thyroid and Breast Surgery of Nanjing University of Chinese Medicine, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine were analyzed retrospectively. The size discrepancy between ultrasonic and pathological measurement were compared, and the risk factors of central lymph node metastasis were analyzed. Results The mean of maximum diameter of PTMC measured by ultrasound was 6.8 (range 5.6 to 8.4) mm, which was significantly bigger than that measured by pathology 5.0 (range 4.0 to 7.0) mm (P=0.000). Of them, 37.2% of the tumor size measured by ultrasound is consistent with pathology, 61.1% of the tumor size measured by ultrasound is bigger than that measured by pathology, and only 1.7% of the tumor size measured by ultrasound is smaller than that measured by pathology. There was a linear correlation between the diameter measured by ultrasound and pathology. And the regression equation can be expressed as: pathological diameter =0.799 × ultrasonic diameter -0.221. In addition, 28.6% patients had central lymph node metastasis. Multivariate Logistic regression analysis showed that the diameter measured by pathology is a risk factor for central lymph node metastasis in patients (OR=17.845, 95%CI: 2.507-127.025, P=0.004), and the cutoff value is 5.5 mm which corresponded to the diameter measured by ultrasound as 7.2 mm. Conclusions The sizes of solitary cN0M0 PTMC measured by ultrasound and pathology are different but also correlated. PMTC with pathological diameter >5.5 mm with its corresponding ultrasonic diameter as 7.2 mm indicated an increased risk of central lymph node metastasis.

Indoor safety concerns the safety of people′s life and property. Through indoor intrusion detection, it is possible to achieve early warning and avoid loss. Different from the common intrusion detection methods, the CSI(Channel status information) of the wireless communication signal WiFi is used to correlate with human behavior, which can achieve intrusion detection. The relationship between channel impulse response, channel frequency response and CSI is studied. The association between CSI and human behavior is verified using CSI dataset EHUCOUNT and machine learning method. The results show that the accuracy of intrusion detection based on SVM(Support Vector Machine) and CNN(Convolutional Neural Network) in six typical scenarios is 93.35%～99.23% and 89.17%～99.14%, respectively. Actual tests are carried out through collecting the WiFi signal using self-made spectrum sensor nodes. Experiment results show that intrusion detection accuracy is about 98%, which indicates that the intrusion detection based on WiFi signal is applicable to real scenario.

A novel approach using two-dimensional mixed baseline based on Multi-Input Multi-Output Synthetic Aperture Radar (MIMO-SAR) has been proposed for range delay and azimuth Doppler frequency modulation used in deceptive jamming. Based on MIMO-SAR phase coding method, which makes the multichannel signal orthogonal, we propose the detection of deceptive jamming phenomenon by employing multidimensional phase information, and suppress the jamming targets via phase compensation to improve the ability of countering deceptive jamming. Moreover, we utilize radar anti-jamming improvement factor as a quantitative evaluating index. In the limited platform space, the radar anti-jamming improvement factor of the proposed method is three times greater than that of conventional single-input multi-output systems. Experimental results demonstrate the validity of our method.

In the cardiovascular system, endothelial cells play an important role in maintaining the steady state of the vascular environment and are the key to repairing damaged blood vessels. Magnetic ferroferric oxide nanoparticles (Fe3O4-NP) have good magnetic targeting and attract much attention in the field of biomaterials. However, poor cell compatibility severely limits its application in the field of cardiovascular and endothelial cell therapy. In this study, through surface modification of Fe3O4-NP, CAG peptides with good affinity for endothelial cells were introduced to the surface of nanoparticles to obtain functionalized Fe3O4-CAG nanoparticles so as to improve the cell compatibility of nanoparticles. The results showed that the dispersion of Fe3O4-CAG particles was improved and the magnetic properties were reduced. The activity of endothelial cells could be enhanced and the proliferation rate could be increased by 187.4%. Under the action of an external magnetic field, the endothelial cells could be induced to migrate directionally and the migration distance increased by 33.5%. The results of this study indicate that by modifying CAG polypeptide on the surface of Fe3O4-NP, it provided a new method for its research and application in the cardiovascular system and vascular repair. [ABSTRACT FROM AUTHOR]

Multi-body separation is a kind of common mechanical problem which exists widely in the field of Aeronautics and Astronautics. Because of its complexity, studying this kind of problems is very difficult either using flight or wind tunnel test. Therefore, the establishment of an unified, efficient and accurate numerical method for simulating multi-body separation has great application value. In multi-body trajectory simulation, computational grids need to accurately depict the large magnitude of relative motion among all solid boundaries. The ideal approach is using a single set of mesh, without adding or deleting the grid nodes or changing the original grid topology, just through mesh deformation to depict the relative movement. On the basis of radial basis function (RBF) mesh deformation technology, the intelligent Laplacian smoothing algorithm is introduced, which greatly improve the ability of pure RBF mesh deformation technology to avoid quality decreasing and topology damaging, and successfully simulate the process of multi-body separation. The flow solver includes four types of grid cell, which respectively are tetrahedron, triangular prism, hexahedron and pyramid. A new unified mesh quality assessment standard is presented as the execute criterion of intelligent Laplacian smoothing. This mesh deformation and smoothing technology is fully integrated into Navier-Stokes equations and 6-DOF moving equations to validate its feasibility by a typical store separation problem. The computational results are compared with experimental data, which demonstrate the accuracy and ability of presented method in dealing with the large magnitude of relative motion among multiple moving boundaries. [ABSTRACT FROM AUTHOR]

Acute leukaemia is a group of aggressive malignancies with a high mortality rate. The reduction in functional immune cells due to the disease itself and radiotherapy/chemotherapy makes the patients susceptible to co-infections, of which pulmonary infection is a major cause of death. Early accurate diagnosis and appropriate treatment may prevent the spread of infection in patients with acute leukaemia complicated with pulmonary infection, thus reduce serious complications such as sepsis, respiratory failure and multi-organ failure. However, there are still clinical difficulties in the diagnosis and treatment of pulmonary infections in acute leukemia patients. Therefore, the current research advances in the diagnosis and treatment of bacterial, fungal and viral infections in the lungs of patients with acute leukemia were briefly summarized in this review.

Objective: To explore the effect of cytokine levels on early death and coagulation function of patients with newly diagnosed acute promyelocytic leukemia (APL)., Methods: Routine examination was performed on 69 newly diagnosed APL patients at admission. Meanwhile, 4 ml fasting venous blood was extracted from the patients. And then the supernatant was taken after centrifugation. The concentrations of cytokines, lactate dehydrogenase (LDH) and ferritin were detected by using the corresponding kits., Results: It was confirmed that cerebral hemorrhage was a major cause of early death in APL patients. Elevated LDH, decreased platelets (PLT) count and prolonged prothrombin time (PT) were high risk factors for early death ( P <0.05). The increases of IL-5, IL-6, IL-10, IL-12p70 and IL-17A were closely related to the early death of newly diagnosed APL patients, and the increases of IL-5 and IL-17A also induced coagulation disorder in APL patients by prolonging PT ( P <0.05). In newly diagnosed APL patients, ferritin and LDH showed a positive effect on the expression of IL-5, IL-10 and IL-17A, especially ferritin had a highly positive correlation with IL-5 ( r =0.867) and IL-17A ( r =0.841). Moreover, there was a certain correlation between these five high-risk cytokines, among which IL-5 and IL-17A ( r =0.827), IL-6 and IL-10 ( r =0.823) were highly positively correlated., Conclusion: Elevated cytokine levels in newly diagnosed APL patients increase the risk of early bleeding and death. In addition to the interaction between cytokines themselves, ferritin and LDH positively affect the expression of cytokines, thus affecting the prognosis of APL patients.

Objective: To investigate the expression and prognostic value of cytokines in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL)., Methods: Clinical data of 62 patients diagnosed with DLBCL in the First People's Hospital of Yunnan Province from June 2017 to November 2018 were collected. The differences in expression levels of 14 serum cytokines [interleukin (IL)-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12p70, IL-17A, IL-17F, IL-22, interferon (IFN)-γ, tumor necrosis factor (TNF)-α, TNF-β] in patients with different survival outcomes, and the impact of the cytokines on 3-year progression-free survival (PFS) and 3-year overall survival (OS) of patients with DLBCL were analyzed retrospectively., Results: Among the 14 cytokines, only the expression of IL-10 was significantly different in patients with different survival outcomes ( P =0.007). According to the receiver operating characteristic (ROC) curve, the optimal cut-off value for IL-10 was 11.74 pg/ml. Serum IL-10 was positively correlated with infection markers procalcitonin (PCT) ( r =0.321, P =0.029), C-reactive protein (CRP) ( r =0.320, P =0.013) and tumor burden index lactate dehydrogenase (LDH) ( r =0.439, P <0.001) in newly diagnosed DLBCL patients. The level of IL-10 in patients with pulmonary infection was significantly higher than that in patients without pulmonary infection ( P =0.012). However, there was no statistically significant difference on the 3-year survival outcomes between patients with or without pulmonary infection. There was no significant difference in IL-10 level in patients with different Ann Arbor stages ( P >0.05). Patients with high IL-10 level (IL-10>11.74 pg/ml) had significantly higher LDH level than those with low IL-10 level (IL-10≤11.74 pg/ml) ( P <0.001). The 3-year PFS rate and 3-year OS rate of DLBCL patients with high IL-10 level were significantly lower than those of low IL-10 level group [(44.4±11.7)% vs (81.8±5.8)%, P <0.001; (61.6±11.5)% vs (93.2±3.8)%, P =0.001]., Conclusion: Serum IL-10 level in newly diagnosed DLBCL patients can reflect the inflammatory state of the body, which may be related to tumor load. Newly diagnosed DLBCL patients with serum IL-10>11.74 pg/ml have higher early mortality and worse prognosis.

At present, acute myeloid leukemia (AML) is mainly treated with combination medication, high-dose, and early intensification. The treatment has achieved good results, but the long-term treatment effect is still not satisfactory. Studies have shown that the different levels of cytokine expression in AML patients can help AML risk stratification, search for treatment directions and predict the prognosis. It has been confirmed that the expression of IL-1β, IL-6, TNF-α, and TGF-β1 are increased in AML patients, and they all indicate a poor prognosis. However, IL-8, IFN-γ, and CCL5 have great research value in chemotherapy resistance and improvement of treatment effect. This article reviews the research progress of cytokine biomarkers in the prognosis of AML patients.

Abstract　　Philadelphia chromosome-like acute lymphoblastic leukemia (Ph-like ALL or BCR-ABL1-like ALL) is a kind of acute leukemia which has the similar gene expression profiles and manifests the biological behavior same to Ph-positive ALL, but lacks the BCR-ABL1 fusion gene. Ph-like ALL was involved in multiple abnormal changes of genomes, activating kinase and cytokine receptor signaling. This review focuses on the progress of classical genetic abnormalities of PH-like ALL in the JAK-STAT signaling, ABL kinase activation, TKI resistance in Ph-like ALL, SH2B3 gene inactivating mutation and IKZF1 gene abnormality. Besides, also summarizes the frontier progress of novel gene mutation (ATF7IP exon 9 fused with PDGFRB exon 11, PDGFRB C843G mutation caused by fusion of exon 11-23 of PDGFRB with exon 1-6 of AGGF1 gene) in recent years.

Objective: To evaluate the efficacy and safety of entecavir maleate (ETV) versus ETV in Chinese patients with hepatitis B e antigen(HBeAg)-positive chronic hepatitis B(CHB)., Methods: The patient population of this previously published randomized, double-blind, double-dummy, controlled, multicenter study was expanded by patients in the 0.5 mg/day ETV maleate group (total n = 110) and patients in the 0.5 mg/day ETV group (total n = 108). At treatment weeks 12, 24 and 48, hepatitis B virus (HBV) DNA levels were measured by the Roche Cobas Ampliprep/Cobas Taqman PCR assay. Adverse events (AE) were recorded., Results: As in the original analysis, the two treatment groups showed similar characteristics at baseline. In addition, the results for the all therapeutic effects showed identical trends to the results obtained in the original analysis, including the statistically similar effects of ETV and ETV maleate treatment-induced decreases in mean HBV DNA level at weeks 12, 24, and 48 (ETV: by 4.28, 5.00, and 5.53 log10 IU/ml vs. ETV maleate: by 4.46, 4.99, and 5.51 log10 IU/ml, respectively; all vs. baseline P more than 0.05), achievement of undetectable levels of serum HBV DNA ( less than 20 IU/ml) at week 48 (ETV: 38.18% vs. ETV maleate: 35.19%; P more than 0.05), HBeAg loss rates at week 48 (ETV: 10.91% vs. ETV maleate: 12.96%; P more than 0.05), HBeAg seroconversion rates at week 48 (ETV: 7.77% vs. ETV maleate: 10.38%; P more than 0.05), normalization of alanine aminotransferase at week 48 (ETV: 75.47% vs. ETV maleate: 82.86%; P more than 0.05), and overall incidence of AE (ETV: 18.02% vs. ETV maleate: 17.43%; P more than 0.05)., Conclusion: Performing analysis of the therapeutic efficacies of entecavir maleate versus entecavir with a larger study population confirmed our original findings of similar efficacy and safety profiles for these two drugs in patients with HBeAg-positive CHB.

Objective: To research the effects of Qingyang Toujie Mixture (QTM) in combination with prednisone tablet on the balance of Th1 and Th2 (Th1/Th2) of systemic lupus erythematosus (SLE) patients of yin deficiency syndrome (YDS)., Methods: Totally 42 patients with SLE were recruited from clinics of internal medicine and hospitalization department of First Hospital Affiliated to Guangzhou University of Traditional Chinese Medicine from August 2009 to March 2011. They were randomly assigned to the treatment group (22 cases) and the control group (20 cases) according to the random digit table. Another 12 healthy subjects were recruited as the healthy control group from employees of First Hospital Affiliated to Guangzhou University of Traditional Chinese Medicine and healthy students in physical examinations. All patients took prednisone tablet. The dosage was adjusted according to the severity of SLE activity index and the condition: 40 -60 mg per day for severe active stage; 20-40 mg per day for moderate active stage; 15 -20 mg per day for light active stage; and less than 15 mg per day for those in the stable stage, respectively. When patients' condition had been stabilized for 1 to 2 weeks, the dosage was gradually reduced according to the method of hormone reduction. In case of the recurrence of symptoms or when complicated with lupus nephritis or lupus encephalitis uncontrollable, standard shock therapy with Cyclophosphamide Injection (0.5-1 g/m2 body surface area, intravenous dripping, once every 4 weeks) was performed. Patients in the treatment group took QTM additionally, one dose daily, taken in two portions, once in the morning and once in the evening. Those in the control group took placebos additionally, one dose daily, taken in two portions, once in the morning and once in the evening. The therapeutic course was 6 months for all. No measure was taken for those in the healthy control group. Venous blood was withdrawal before and after treatment. Th1 cytokines (IFN-gamma, IL-12) and Th2 cytokines (IL-10, IL-4) were detected by ELISA., Results: Compared with the healthy control group, the serum Th1 cytokines such as IL-12 and IFN-gamma, Th2 cytokines such as IL-10 and IL-4 increased, the Th1/Th2 ratios such as IFN-gamma/IL-4 and IL-12/IL-10 decreased in the treatment group and the control group before treatment (P < 0.01). Compared with before treatment in the same group, the serum Th1 cytokines such as IL-12 and IFN-gamma decreased, the serum Th2 cytokines such as IL-10 and IL-4 decreased, the ratios of Th1/Th2 cytokines such as IFN-gamma/IL-4 and IL-12/IL-10 increased in the treatment group (all P < 0.05). Compared with the control group after treatment, IL-4 decreased, and the ratio of IFN-gamma/IL-4 increased in the treatment group (P < 0.05). Fewer patients suffered from adverse reactions in the treatment group than in the control group (P < 0.01)., Conclusion: QTM in combination with prednisone tablet was effective to improve the balance of Th1/Th2 cytokines, and alleviate the toxic and adverse reactions of hormone or immune inhibitors.

Objective: To evaluate the efficacy and safety of entecavir (ETV) maleate versus ETV in Chinese patients with hepatitis B e antigen (HBeAg)-negative chronic hepatitis B (CHB)., Methods: This was a randomized, double-blind, double-dummy, controlled, multicenter study. Patients were randomly assigned to receive 48 weeks of treatment with 0.5 mg/day ETV (group A; n = 26) or 0.5 mg/day ETV maleate (n = 31). Hepatitis B virus (HBV) DNA levels were measured at weeks 12, 24, and 48 by the Roche Cobas Ampliprep/Taqman PCR assay. Adverse events (AE) were recorded., Results: Baseline characteristics were similar between the two groups. At weeks 12, 24, and 48, the mean HBV DNA level had similarly decreased from baseline in both groups (A: by 4.24, 4.61 and 4.88 log10 IU/mL vs. B: 4.01, 4.50 and 4.99 log10 IU/mL, respectively; all P more than 0.05). Patients who achieved undetectable levels of serum HBV DNA (less than 20 IU/mL) at week 48 were similar in the two groups (A: 69.23% vs. B: 80.65%; P more than 0.05). Both groups achieved similar normalization of ALT at week 48 (A: 96.00% vs. B: 83.87%; P more than 0.05). The overall AE incidence was similar for the two groups (A: 22.22% vs. B: 9.38%; P more than 0.05)., Conclusion: Entecavir maleate and entecavir showed similar efficacy and safety in patients with HBeAg-negative CHB.

Objective: To explore the efficacy and safety of the combined therapy of valproic acid (VPA) and lamotrigine (LTG) for various types of epilepsy., Methods: The patients were recruited from the epilepsy center at Affiliated Tongji Hospital, Tongji Medical College, Huazhong Science & Technology University from January 2009 to September 2011. They were randomly selected through a number chart and divided into two groups: child group and adult group. The prospective follow-up study lasted for one year to examine the long-term efficacy and safety of combined therapy. Seizure frequency was recorded at Months 3, 6 and 12. The changes of seizure frequency were analyzed to calculate the 50% response rate, 75% response rate and seizure-free rate. All side effects during therapy were recorded. The correlation of efficacy with seizure type was also examined. Statistical analysis was performed through t test, variance analysis and χ(2) test., Results: Among a total of 134 patients, 10 of them withdrew. At Months 3, 6 and 12, as compared with baseline, the average reduction rate of seizure frequency per month was 56%, 62%, 70% in child group versus 74%, 82%, 85% in adult group (P < 0.05). Adult group was better than child group. At Month 3, 50% response rate, 75% response rate and seizure-free rate was 70.97% - 35.48% in child group versus 83.87% - 43.01% in adult group. When compared at Months 3, 6 and 12, 50% response rate, 75% response rate and seizure-free rate showed no statistical difference (P > 0.05). The worse outcomes occurred more frequently in the patients with complex partial seizure (CPS) and than those with simple partial seizure (SPS) and generalized seizure GS (P < 0.05). Rash was the major side effect for withdrawal., Conclusion: The co-medication of VPA and LTG is both effective and safe for all epileptic types, especially for SPS and GS. And the efficacy may last for up to one year. Combined therapy shows excellent safety.

Objective: To study on the difference of plasma renin activity (PRA), angiotensin II (Ang II), and aldosterone levels in patients with essential hypertension (EH) or primary aldosteronism (PA) or pheochromocytoma (PHEO), and to analyze the sensitivity and specificity on the diagnosis of PA among patients with hypertension with aldosterone/PRA ratio (ARR)., Methods: The plasma aldosterone, Ang II and PRA concentrations in supine and upright positions were measured by radioimmunoassay from 413 patients including idiopathic hyperaldosteronism (IHA, n = 111), aldosterone-producing adenoma (APA, n = 118), PHEO (n = 98) and EH (n = 86). ARR was calculated., Results: Plasma aldosterone concentrations in both of supine and upright positions in PHEO group [374 (294, 465) pmol/L and 629 (449, 997) pmol/L] and PA group [471 (346, 632) pmol/L and 673 (499, 825) pmol/L] were higher than those in EH group [277 (224, 332) pmol/L and 427 (341, 501) pmol/L] (P < 0.01). They were also higher in APA group [576 (416, 731) pmol/L and 726 (554, 906) pmol/L] than those in IHA group [399 (313, 504) pmol/L and 609 (485, 776) pmol/L] (P < 0.01). Ang II levels in both positions were lower in PA group [43.2 (26.4, 74.4) ng/L and 60.1 (38.5, 103.6) ng/L] than in EH group [56.7 (43.3, 78.9) ng/L and 84.3 (61.3, 108.4) ng/L] or PHEO group [54.3 (29.9, 101.5) ng/L and 102.8 (49.9, 167.0) ng/L] (all P values < 0.01), and there was no difference between IHA and APA group (P > 0.05). The PRA level in both positions of each group were PHEO group [0.3 (0.2, 1.0) µg · L(-1) · h(-1) and 1.4 (0.6, 3.4) µg · L(-1) · h(-1)] > EH group [0.2 (0.1, 0.4) µg · L(-1) · h(-1) and 0.6 (0.4, 1.0) µg · L(-1) · h(-1)] (P < 0.01) > PA group [0.1 (0.1, 0.1) µg · L(-1) · h(-1) and 0.2 (0.1, 0.3) µg · L(-1) · h(-1)] (P < 0.01), and APA group [0.1 (0.1, 0.1) µg · L(-1) · h(-1) and 0.1 (0.1, 0.3) µg · L(-1) · h(-1)] < IHA group [0.1 (0.1, 0.2) µg · L(-1) · h(-1) and 0.2 (0.1, 0.3) µg · L(-1) · h(-1)] (supine P < 0.01; upright P < 0.05). APA was divided into 2 types with renin-Ang II-responsive APA (n = 26) and unresponsive APA (n = 92). The plasma aldosterone concentration was lower in supine position but higher in upright position in renin-Ang II-responsive APA than in unresponsive APA patients. ARR in upright was higher in PA group (P < 0.01) but lower in PHEO group (P < 0.05) compared with EH. ARR was higher in APA than in IHA (P < 0.01). The sensitivity and specificity of ARR as 40 (aldosterone unit: ng/dl; PRA unit: µg · L(-1) · h(-1); its value should multiply 27.7 when transferred to pmol/L, simili) were 93% and 76%, respectively., Conclusion: The levels of PRA, Ang II and aldosterone from patients with EH, PA and PHEO are significant different. ARR as 40 in upright position could be used for PA screening cutoff point.

Objective: To investigate the variants and quasispecies of reverse transcriptase region in polymerase gene of hepatitis B virus (HBV) during lamivudine treatment and their relationship with genotypes and viral loads., Methods: HBV DNA of 117 chronic hepatitis B patients treated with lamivudine were amplified by using PCR. The PCR products including the YMDD motif were sequenced by DNA sequencer, of which, HBV DNA viral loads of 99 patients were determined by real-time PCR and 64 samples were sequenced by Pyrosequencing., Results: In HBV YMDD variant group and no variant group, the HBV genotypes were 79.6% and 86.7% of type C, 18.5% and 12.7% of type B, 1.9% of A/B recombinant type and 2.6% of type D, respectively. The viral loads (log 10) were 6.5699 and 6.6165, respectively. There was no significant difference in HBV genotypes and viral loads between these two groups. The rtL180M variant was found in association with the rtM204I/V variant, HBV variants and wild-type in YMDD motif all existed together in these two groups., Conclusions: HBV variants (quasispecies) in YMDD motif could be quantified by pyrosequencing, which would be a feasible measure during nucleoside or nucleotide analogue therapy against chronic HBV infection.

Objective: To analyse hyperinsulinemia in Bartter syndrome., Methods: Twenty-three cases of Bartter syndrome [age (27 ± 9) years; fasting serum potassium (2.8 ± 0.5) mmol/L], 20 patients of aldosterone-producing adenoma [APA, age (45 ± 11)years, fasting serum potassium (3.0 ± 0.4) mmol/L], 20 patients of idiopathic hyperaldosteronism [IHA, age (51 ± 11) years, fasting serum potassium (3.4 ± 0.2) mmol/L] were diagnosed in Peking Union Medical College Hospital from September 2003 to May 2008. All patients underwent 3-hours oral glucose tolerance test (3hOGTT), postural stimulation test and calculated HOMA-insulin resistance (HOMA-IR) and HOMA-insulin sensitivity (HOMA-IS) by Homeostasis model., Results: The insulin area under curve[(229.0 ± 162.4) mIU×L(-1)×h] was significantly higher than APA group [(121.2 ± 81.1) mIU×L(-1)×h, P < 0.05] and were similar to the aged-matched patients with IHA [(227.7 ± 158.6) mIU×L(-1)×h]. But HOMA-IR in Bartter group were similar to APA group (1.96 ± 1.14 vs 1.41 ± 0.91), and HOMA-IR in APA group was lower than IHA group (1.96 ± 1.14 vs 2.40 ± 1.60, P < 0.05). There was no deference in HOMA-IS among three groups, but APA group had lower level. In all three groups, the peak of insulin secretion was delayed., Conclusion: Bartter syndrome patients commonly present with hyperinsulinemia.

Objective: To compare the mRNA, protein expression of long leptin receptor (Ob-Rb) in human adrenal tissues and tumors and observe the plasma level of leptin in primary aldosteronism (PA), cortisol-secreting tumors (CS) and pheochromocytomas (PHEO)., Methods: Total RNA and protein were extracted from 6 normal human adrenal glands, 10 CS, 20 PHEO; and 14 aldosterone-producing adenomas (APA) (RNA), 10 APA (protein); plasma samples were drawn from 20 controls, 15 PHEO, 29 PA and 11 CS., Results: The mRNA and protein of Ob-Rb were widely expressed in human adrenal glands and tumors. The mRNA (0.32±0.12) and protein (1.31±0.26) expressions of Ob-Rb were higher in normal human adrenal cortex (C) than all other tissues (P<0.05) while the mRNA expression of Ob-Rb in APA (0.15±0.10) was higher than CS (0.05±0.02) (P<0.05). The mRNA expression of Ob-Rb in APA was positively correlated with plasma supine aldosterone level (r=0.670, P=0.024). The mRNA expression of Ob-Rb in CS was positively correlated with 24-hour urinary free cortisol level (r=0.870, P=0.005). The plasma level of leptin was higher in CS than in non-CS groups (P=0.001)., Conclusions: Ob-Rb is widely expressed in adrenal tissues and tumors. There is a differential expression in various tissues. Further studies are warranted to understand the relationship between leptin and adrenal gland.

Objective: To compare the diagnostic value of fluorescence in-situ hybridization (FISH) and traditional cytology in detection of bladder cancer, and to evaluate if FISH test is superior to cytologic examination in this respect., Methods: The electronic database of PubMed was searched. Criteria for inclusion and exclusion into the meta-analysis were established. The studies fulfilling the inclusion criteria were selected. Data of these studies were extracted for calculation of pooled odds ratio, likelihood ratio, sensitivity and specificity. Summary receiver operating curve and area under curve (AUC) were produced with Meta-DiSc software., Results: Fourteen studies were included, and data related to cytologic examination were available in nine of them. The pooled sensitivity and specificity of FISH test were 0.69 (95%CI 0.66 to 0.73) and 0.84 (95%CI 0.81 to 0.86), respectively. The pooled sensitivity and specificity of cytology were 0.46 (95%CI 0.42 to 0.51) and 0.88 (95%CI 0.84 to 0.90), respectively. The AUC for FISH and cytology were 0.87 and 0.81, respectively. The difference in AUC between the two tests was not statistically significant (P > 0.05)., Conclusions: Comparing with traditional cytological examination, FISH test is more sensitive. However, FISH test is still not proven to have better diagnostic value in detection of bladder cancer in both new and follow-up cases. More studies in this area are required for further evaluation.

Objective: To evaluate the safety and efficacy of retroperitoneal laparoscopic resection for pheochromocytoma., Methods: The clinical data of 107 cases of pheochromocytoma in PUMCH from 2003 to 2008 were analyzed retrospectively. There were 58 males and 49 females with an age range from 8 to 77 years (mean 44 years) in this cohort. One hundred and two cases were intra-adrenal and 5 extra-adrenal. Of the 102 intra-adrenal tumors, 43 tumors were located in left adrenal, 51 in right adrenal and 8 in both sides. All of the 5 extra-adrenal tumors were at para-abdominal aorta. Retroperitoneal laparoscopic resection was performed for the 107 cases. This period was separated to 3 stages based on the degrees of the practical ability for retroperitoneal laparoscopic resection, such as tentative and exploratory stage, accumulative stage, and mature stage., Results: At tentative and exploratory stage from June 2003 to December 2003, 10 cases underwent retroperitoneal laparoscopic surgery, of which 3 cases were converted to open surgery. The mean diameter was 4.2 cm (range in diameter from 2.5 cm to 6.0 cm). The mean operation time was 105 min (range from 60 min to 230 min). The mean volume of blood loss during operation was 620 ml (range from 150 ml to 1800 ml). At accumulative stage from January 2004 to December 2006, 66 cases underwent retroperitoneal laparoscopic surgery with none converted to open surgery. The mean diameter was 5.7 cm (range in diameter from 2.1 cm to 8.7 cm), and the diameter was above 6.0 cm in 19 cases. The mean operation time was 95 min (range from 40 min to 210 min). The mean volume of blood loss during operation was 350 ml (range from 50 ml to 1800 ml). At mature stage from January 2007 to June 2008, 31 cases, including 5 extra-adrenal pheochromocytomas, underwent retroperitoneal laparoscopic surgery. The mean diameter was 6.5 (range in diameter from 1.5 cm to 12.3 cm). The mean operation time was 75 min (range from 40 min to 160 min). The mean volume of blood loss during operation was 180 ml (range from 50 ml to 800 ml). No peri-operative death occurred. Follow up period was ranging from 1 to 62 months (the mean was 34 months), and 7 failed to be followed up, 3 cases recurred. And there was no distant metastases and death case., Conclusions: Retroperitoneal laparoscopic surgery for pheochromocytoma is feasible and safe. This procedure will be more and more performed as the advancement of the skill and accumulation of experience. The dimension, recurrence and location of tumor are not the absolute contraindication of retroperitoneal laparoscopic surgery for pheochromocytoma.

Objective: To report the analysis of a rare beta-thalassemia ternary heterozygote [+40 to +43(-AAAC)*CD41/42(-TTCT)*IVS-2-654] causing beta-thalassemia major in a Chinese., Methods: Using PCR-ASO probe hybridization analysis to scan 17 known types of beta-thalassemia mutations, and gene cloning and DNA sequencing to identify the underlying causative mutation., Results: Reverse dot blot (RDB) analysis showed that the patient's beta-globin gene had three mutations: +40 to +43(-AAAC), CD41/42(-TCTT) and IVS-2-654(C to T). Beta-globin gene cloning and sequencing proved that, the two deletions of +40 to +43(-AAAC) and CD41/42(-TCTT) co-existed on the same chromosome, and the other homologous chromosome had an IVS-2-654 (C to T) mutation. So the patient is a compound heterozygote of [+40 to +43(-AAAC)*CD41/42 (-TCTT)]/IVS-2-654 (C to T) leading to beta-thalassemia major., Conclusion: The triple mutation of [+40 to +43(-AAAC)*CD41/42(-TCTT)/N] is a new genotype of beta-thalassemia in Chinese.

Objective: To investigate the associations between polymorphisms of apolipoprotein B mRNA editing enzyme catalytic polypeptide-like 3G (APOBEC3G) and different outcomes of HBV infection in the Chinese Han population., Methods: Six hundred thirty-five chronic hepatitis B patients were divided into 3 groups: 202, 217 and 216 patients were HBV cleared, chronic hepatitis B, and with liver cirrhosis, respectively. Five tagSNPs (rs8177832, rs17000736, rs17496046, rs9622924 and rs2899313) were genotyped by pyrosequencing. HBV viral loads were determined by real-time PCR method. Chi square was used for statistics., Results: The majority of rs8177832 allele was A/A and the frequencies of rs8177832 allele among these groups were not significantly different (P more than 0.05). HBV viral loads were higher in chronic hepatitis B patients with G allele than in chronic hepatitis B patients with A allele (P less than 0.05). The rs17000736 and rs9622924 alleles were found only in G/G and C/C genotypes. There were also no significant differences in the other four SNPs alleles (rs17000736, rs17496046, rs9622924 and rs2899313) in these groups (P more than 0.05)., Conclusions: rs8177832, rs17000736, rs17496046, rs17000736 and rs2899313 of the APOBEC3G gene might not be associated with HBV persistent infection in patients in this study. However, the rs8177832 polymorphism may be involved in inhibiting HBV replication.

To construct a systemic structural model for interferon (IFN) signaling pathways with gene's single nucleotide polymorphisms (SNPs) information, it is visual to investigate the effects of gene-gene interaction on IFN signaling path-ways. The genes function information was retrieved from Pubmed and Embase database. The IFN signaling pathways were constructed by applying Teranode Design Suite (TDS) biological software. The SNPs information of genes in pathways was retrieved by using SNP Trawler biological software. The biological systemic structural model for IFN signaling pathways, involving in genetic information, particularly their SNPs information, was constructed successfully. It contained JAK-STAT, MAPK-p38 and PI3K pathways, through which IFNs play variable biological roles. Type-I-IFN makes an important role in against viral infection, cell proliferation and immunoregulation by these three pathways. However, the biological activities of type-II-IFN are through JAK-STAT and MAPK-p38 pathways, and type-III-IFN is only through PI3K pathway. These pathways contained 98 genes and 19 693 SNPs information, which consist of a complicate gene-gene interactional network. In conclusion, this software model not only helps us intensively research the effects of SNPs on IFN biological roles and predict IFN therapeutic effect, but also set up a good foundation for translational medicine, discovering new target of drugs and developing new drugs.

Objective: To analyze the characteristics of perioperative hemodynamics in pheochromocytoma secreting different types of catecholamine, and to discuss how to improve the hemodynamics., Methods: The clinical data of 202 patients with pheochromocytoma who had received operation were analyzed. Three classification systems were used to divided the patients: they were, firstly, divided into high and low epinephrine secreting groups (E(high) and E(low)) according to the 24 hours urine catecholamine quantitation; secondly, into high and low norepinephrine secreting groups (NE(high) and NE(low)) according to 24-h urine norepinephrine quantitation; and thirdly, into high and low dopamine secreting groups (DA(high) and DA(low)) according to the 24 hours urine dopamine quantitation. Relationship between the characteristics of perioperative hemodynamics and catecholamine secreting types were analyzed., Results: The highest preoperative systolic blood pressure values of E(high) and NE(high) groups were (201 +/- 40) mm Hg and (205 +/- 38) mm Hg, both significantly higher than those of the E(low) and NE(low) groups [(183 +/- 43) mm Hg, P = 0.003 and (181 +/- 43) mm Hg, P = 0.000]. The range of systolic blood pressure fluctuation during the operation of the E(high) group was 108 +/- 39 mm Hg, significantly larger than that of the E(low) group (91 +/- 33 mm Hg, P = 0.001). The incidence rates of persisting postoperative hypotension of the NE(high) and DA(high) groups were 23.3% (20/86) and 32.7% (17/52) respectively, both higher than those of the NE(low) and DA(low) groups [2.6% (3/116) and 4.0% (6/150) respectively, P = 0.000 and P = 0.000]., Conclusion: Different characteristics of perioperative hemodynamics are present in pheochromocytoma secreting different types of catecholamines. Patients with highly epinephrine secreting pheochromocytoma are apt to have larger blood fluctuation during the operation. Patients with highly norepinephrine and dopamine secreting pheochromocytoma are apt to suffer from persisting postoperative hypotension.

Objective: To analyze the histopathological and clinical features of viral chronic hepatitis patients with negative serological viral markers., Methods: 62 hepatitis patients with negative serological markers were assayed with serological viral hepatitis markers, liver function test and liver biopsies were enrolled in the study. Serum HBV DNA of HBV cases was analyzed by PCR. Liver specimens were examined by immunohistochemistry for HBsAg and HBcAg., Results: The fit rate of histopathological diagnosis with clinical diagnosis is 53.2%, the fit rate is 69.1% in moderate chronic hepatitis group. The immunohistochemistry showed that HBsAg and/or HBeAg positive rate was 45.2%, 53.6% had moderate chronic hepatitis and 25% had mild hepatitis. 13 (46.4%) had G1 hepatitis, 10 (35.7%) had G2 hepatitis, 3 (10.8%) had G3 hepatitis and 2 (7.1%) had G4 hepatitis, and serum HBV DNA positive rate was 35.7%. There were no differences in HBV DNA levels between different hepatitis group and fibrosis stage group (P > 0.05). There were no differences in all indexes between HBV DNA negative group and HBV DNA positive group (P > 0.05). There were no differences in all indexes between HBV patients and other patients (P > 0.05)., Conclusion: Occult HBV infection may account for a high proportion of the cases with chronic hepatitis of unknown etiology. Most patients are chronic mild hepatitis, but they still have HBV replication and can progress to liver cirrhosis. Serum PCR test, liver biopsy and immunohistochemistry are helpful for the diagnosis.

Objective: To investigate the early changes in function of hypothalamic-pituitary-target gland (HPTG) axis in patients with severe sepsis and septic shock, in order to clarify its relationship with severity and prognosis of the patients., Methods: The serum contents of cortisol (F), triiodothyronine (T(3)), thyroxine (T(4)), thyrotropic-stimulating hormone (TSH), growth hormone (GH), follicle-stimulating hormone (FSH), luteotropic hormone (LH), prolactin (PRL) and plasma concentration of adrenocorticotrophic hormone (ACTH) in 10 severe sepsis and 12 septic shock patients on day 1, 3, 5 after diagnosis was made, and 12 patients with no infection or septic shock served as controls. The hypothalamic-pituitary adrenal gland axis (HPAA) function of the patients with severe sepsis and septic shock were evaluated with 1 microgram ACTH stimulation test given 1 day after the concentrations of the above hormones were determined., Results: Compared with the control patients, ACTH, T(3), T(4), GH, FSH, LH and PRL levels were significantly changed in patients with severe sepsis and septic shock (P<0.05 or P<0.01). The numbers of patients with reaction to 1 microgram ACTH stimulation test were similar between patients with severe sepsis (6 cases non-reaction and 3 cases reaction) and patients with septic shock (9 cases non reaction and 2 cases reaction, P>0.05). According to the acute physiology and chronic health evaluation II (APACHE II) and sepsis-related organ failure assessment (SOFA) score, changes in ACTH, T(3), T(4), GH and PRL levels were closely related to the severity of illness (P<0.05 or P<0.01). Significant differences were found in ACTH, T(3), T(4) levels between survivors and non-survivors (P<0.05 or P<0.01). ACTH, T(4) levels and SOFA score were independent predictors of the 28-day hospital mortality (P<0.05 or P<0.01)., Conclusion: The early changes in HPTG axis are closely related with the severity and hospital mortality in patients with severe sepsis and septic shock.

Objective: To identify the genotype of RET gene in one multiple endocrine neoplasia type 2A (MEN2A) kindred., Methods: Genome DNA was extracted from peripheral blood leucocytes. The DNA sequence of gel-purified polymerase chain reaction (PCR) products was determined with the previously reported 6 pairs of primers of PCR amplification of 10, 11, 13, 14, 15, and 16 exons of RETgene., Results: No abnormalities were found in exon 10, 13, 14, 15, and 16. C to G replacement in nucleotide 14 996 of exon 11 was identified in DNA samples obtained from both peripheral blood of 2 affected brothers. This missense point mutation arisen in heterozygosity and caused a substitution of Cys to Trp residue at codon 634 ( Cys 634 Trp) in RET protein., Conclusion: The genotype of the family is identified as Cys 634 Trp substitution of RET gene.

Objective: To investigate the effect of potassium deficiency on glucose and insulin metabolism in primary hyperaldosteronism, including aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (IHA)., Methods: Totally 178 patients who were diagnosed as primary hyperaldosteronism (103 patients with APA and 75 with IHA) were divided into hypokalemia group and normal potassium group according to their serum potassium levels. All patients received 3 hours of oral glucose tolerance test and aldosterone test to observe the relationship among glucose, insulin and serum potassium., Results: Area under curve of serum potassium, area under curve of plasma insulin, and fasting serum insulin were significantly lower in the hypokalemia group than in the normal potassium group (P <0. 05, P <0. 01); area under curve of glucose and aldosterone level were significantly higher in the hypokalemia group than in the normal potassium group ( P < 0. 05 ) . The prevalence of metabolic syndrome was significantly higher in IHA than in APA (57. 3% vs 38. 8% ; P < 0. 05)., Conclusion: Hypokalemia may play an important role in inhibiting insulin secretion in primary hyperaldosteronism.

Objective: To compare the mRNA expression of renin-angiotensin-aldosterone system in human subcutaneous and visceral adipose tissues., Methods: Total RNA was extracted from 12 human subcutaneous adipose tissues, 12 perirenal adipose tissue and 9 periadrenal adipose tissues. The expressions of angiotensinogen ( AGT) , renin, angiotensin converting enzyme ( ACE) , angiotensin converting enzyme 2 (ACE2), angiotensin I1 receptor type 1 (AT1), angiotensin II receptor type 2 (AT2 ), CYP11 B2, and their internal reference glyceraldehyde phosphate (GAPDH) were studied by reverse transcription-polymerase chain reaction. The ratios of each target genes were used to evaluate the expression levels of AGT, renin, ACE, ACE2, AT1, AT2, and CYP11B2 in different adipose tissues., Results: The mRNA expressions of AGT, ACE, ACE2, AT1, and AT2 were detected in human subcutaneous, perirenal, and periadrenal adipose tissues. However, CYPI B2 mRNA expression was not found in these three adipose tissues. The mRNA expressions of renin was only detected in perirenal and periadrenal adipose tissues, which was significantly higher in perirenal adipose tissues than in periadrenal adipose tissues ( P < 0. 05 ). The mRNA expressions of ACE and ACE2 in perirenal adipose tissues were significantly higher than that in subcutaneous adipose tissues ( P < 0. 05). The mRNA expressions of ACE were significantly higher than that of ACE2 in subcutaneous, perirenal, and periadrenal adipose tissues (P <0. 05). The mRNA expressions of AT1 were significantly lower than that of AT2 in periadrenal adipose tissues (P < 0. 05)., Conclusion: Local renin-angiotensin system exists in the adipose tissues; however, aldosterone is not synthesized in the adipose tissues.

Objective: To evaluate the efficacy of octreotide in the diagnosis and treatment of pituitary thyrotropin (TSH)-secreting adenoma., Methods: A 34-year man presented with central hyperthyroidism and pituitary TSH-secreting macroadenoma was reported. (99 m)Tc-octreotide scan and magnetic resonance imaging were completed to make the location diagnosis of the adenoma. Octreotide in 0.1 mg dose was subcutaneously injected every 8 hours for 10 days. Serum TSH level and tumor size were observed and trans-sphenoidal adenoma resection was completed., Results: Pituitary TSH-secreting adenoma displayed positive sign in (99 m)Tc-octreotide scan. Antithyroid drug was of no help in depressing thyroid function to normal. However, octreotide treatment could revert thyroid function to normal rapidly. A significant shrinkage of tumor mass from 3.0 cm x 2.0 cm x 2.5 cm to 2.0 cm x 2.0 cm x 1.5 cm was observed and a shrinkage of thyroid gland from III to II also observed., Conclusions: (99 m)Tc-octreotide scan is one of the useful tools for location diagnosis of TSH-secreting adenoma. Octreotide can effectively control central hyperthyroid and make tumor shrink, and it can be a satisfactory method of preoperative preparation for TSH-secreting adenoma.

Objective: Bilateral pheochromocytomas are rare diseases. The purpose of this retrospective study was to elucidate the clinical characteristics of patients with bilateral pheochromocytomas., Methods: We analyze the clinical data of 25 patients with bilateral pheochromocytomas who were treated at Peking Union Medical College Hospital between 1952 and 2004., Results: The average age at diagnosis was (32 +/- 14) years. 19 cases (76%) were familiar type, and among the 19 cases, 13 cases were multiple endocrine neoplasia (MEN), 5 cases von Hippel-Lindau (vHL) disease and 1 case of isolated familial pheochromocytomas. In the 25 patients, bilateral pheochromocytomas were discovered at the same time in 88%, and multiple tumors existed in at least one side of the adrenal gland in 56%. 50% of cases recurred after resection of pheochromocytomas., Conclusions: Hereditary syndromes should be screened when pheochromocytoma is bilateral, and the patients' family members also should be screened for hereditary syndromes. During operation for bilateral adrenal pheochromocytoma, multiple tumors in one side should be considered. Long-term follow-up is necessary because recurrence may develop many years after operation.

Objective: To investigate the expression of human adrenomedullin (ADM) and its receptor-receptor activity modifying protein 2/calcitonin receptor-like receptor (RAMP2/CRLR) mRNA in the tissues of normal adrenal medulla and pheochromocytoma., Methods: Total RNA was extracted from normal adrenal medulla and pheochromocytomas. The expression of ADM and RAMP2/CRLR mRNA were studied by reverse transcription-polymerase chain reaction. The ratios of ADM/GAPDH, RAMP2/ GAPDH, CRLR/GAPDH were used to evaluate the expression levels of ADM, RAMP2 and CRLR mRNA., Results: Expressions of ADM and its receptor- RAMP2/CRLR mRNA were detected in normal adrenal medulla and pheochromocytoma tissues. ADM/GAPDH were 0.48+/-0.09 and 0.75+/-0.24, RAMP2/ GAPDH 0.79+/-0.12 and 1.29+/-0.30, CRLR/GAPDH 0.40+/-0.08 and 0.87+/-0.22 in normal adrenal medulla and pheochromocytomas, respectively (P < 0.05)., Conclusion: ADM exerts a possible autocrine or paracrine effect in the adrenal. ADM may be involved in the pathogenesis of pheochromocytoma.

Cardiovascular bioactive peptides constitute life activity of human beings. They play important roles in regulating the development of cardiovascular system, and controlling disease progression. Recently, interests have arised on the adjusting effects of cardiovascular bioactive peptides on endocrine metabolism, its changes during disease course, influence on disease pathogenesis, as well as its effects on the diagnosis, treatment, and early interventions. New advances have been increasingly achieved in basic and clinical researches. It has become one of the most active areas in life sciences.

Objective: To investigate the expression of urotensin II (U II) and G-protein coupled receptor 14 (GPR14) mRNA in human pheochromocytoma tissues., Methods: Total RNA from normal adrenal and pheochromocytoma tissues was extracted. The reverse transcription-polymerase chain reaction method was used to evaluate the levels of U II and GPR14 mRNA expression in human pheochromocytoma tissues., Results: There was no significant difference of U II and GPR14 mRNA expression between normal adrenal cortex and medulla. The expression of U II and GPR14 mRNA in pheochromocytoma was significantly lower than that in normal adrenal cortex and medulla (P < 0.05). The expression of GPR14 mRNA in adrenal pheochromocytomas was significantly lower than that of extra-adrenal pheochromocytomas (P < 0.05)., Conclusion: U II and GPR14 may play a role in the pathogenesis and hypertension regulating of pheochromocytoma.

Urotensin II (U II ) is currently the most potent vasoconstrictor. G-protein coupled receptor 14 ( GPR-14) is its specific receptor. This review mainly discribes the structure and distribution of U II and GPR14, the activities that U II and GPR14 stimulates proliferation of vascular smooth muscle cells and vasoconstriction, as well as its mechanism.

Objective: To compare the effects of doxazosin mosylate and phenoxybenzamine in preoperative volume expansion of pheochromocytoma., Methods: Phenoxybenzamine 30-240 mg/d was given orally to 38 patients of pheochromcytoma for 3 weeks. After the blood pressure was restored to the primary level before taking phenoxybenzamine, doxazosin mosylate 2-8 mg/d was given orally for three weeks. If the maximum dose of doxazosin mosylate (16 mg/d) still failed to achieve efficient blood volume expansion then phenoxybenzamine was added till completely efficient blood volume expansion was achieved. The effect in volume expansion and side effects were observed with the criteria including decrease of blood pressure to less than 120/80 mm Hg and restoration of the microcirculation imaging to normal., Results: All the patients got complete volume expansion after taking phenoxybenzamine with tachycardia occurring in 23 of them and postural hypotension in 13 patients. In the 25 cases mainly with increase of norepinephrine before medical treatment doxazosin mosylate was completely effective in 18 cases with their blood pressure < 180/140 mm Hg; and was partially effective in the other 7 cases with their blood pressure > 180/140 mm Hg of which 2 suffered from postural hypotension. Doxazosin mosylate was partially effective in the other 13 cases mainly with increase of both norepinephrine and epinephrine. The total efficiency rate of these two medicines was not significantly different (chi(2) = 18.05, P > 0.05). The side-effect rate of doxazosin mosylate was significantly lower than that of phenoxybenzamine (chi(2) = 324, P < 0.01)., Conclusions: Doxazosin mosylate has a lower complete volume expansion rate and side-effect rate as well for patients of pheochromocytoma. Pheochromocytomas with mild or moderate level of blood pressure are indicative of the use of doxazosin mosylate.

Objective: To discuss the standards for clinical functional gradation and preoperative preparation of pheochromocytoma., Methods: According to the preoperative clinical manifestations and 24 hr urine catecholamine, 172 cases of pheochromocytomas were divided into 4 grades. Functionary grade 0 including 22 patients was given no volume expansion. Functionary Grade 1 consisted of 17 cases, 10 of which were given phenoxybenzamine orally 5 - 10 mg/d for 1 week (therapeutic group), the rest were control group; the results were analyzed by the chi(2) test. Functionary Grade 2 including 120 patients had phenoxybenzamine orally 30 - 240 mg/d for 4 weeks, hemodynamics and microcirculation image were standards for evaluating volume expansion. Functionary Grade 3 consisted of 13 patients including 1 with acute heart failure, 2 and 10 patients with past history of cerebral hemorrhage and hypertensive crisis respectively, they were treated with enough phenoxybenzamine and other emergent measures., Results: The perioperative blood pressure of Functionary Grade 0 had no fluctuation. The blood pressure of therapeutic group of Functionary Grade 1 had small range fluctuation (< 20 mm Hg), that of the control group was large (> 40 mm Hg). Chi(2) = 13.12, P < 0.01. The hemodynamics of Functionary Grade 2 and Grade 3 recovered within 24 hours postoperatively and no complications occurred., Conclusion: According to the function of pheochromocytoma, it is safe and efficient to use different preoperative preparations. Hemodynamics and microcirculation image are golden standards for evaluating preoperative preparations.

Objective: To compare the expressions of transforming growth factor alpha (TGFalpha), tumor necrosis factor alpha (TNFalpha), and vascular endothelial growth factor (VEGF) between pheochromocytoma (PHEO) tissues and normal adrenal medulla tissues., Methods: The mRNA expressions of TGFalpha, TNFalpha, and VEGF detected by RT-PCR, were compared between 22 PHEO tissues and 18 normal adrenal medulla tissues (according with the principle of medical ethnics). Immunohistochemistry staining was performed on 27 PHEO tissues and 14 normal adrenal medulla tissues. The comparisons of the protein expression of TGFalpha, TNFalpha, and VEGF were analyzed in both of PHEO tissues and normal adrenal medulla tissues., Results: Compared with normal adrenal medulla tissues, the expressions of TGFalpha and TNFalpha mRNA and protein were higher in PHEO tissues, and VEGF145 mRNA expression was also higher in PHEO tissues, while there was no significant difference of the mRNA expression of VEGF121 and VEGF165 between these two tissues. Positive staining rates for VEGF of endothelial cells and tumor cells were higher in PHEO tissues than in normal adrenal medulla tissues. Expressions of the TGFalpha, TNFalpha, and VEGF protein were higher in extra-adrenal PHEO than in adrenal PHEO. The TNFalpha immunohistochemistry staining rate was higher in the malignant or multiple PHEO than in the benign or single PHEO., Conclusions: The mRNA and protein expressions of TGFalpha, TNFalpha, and VEGF are higher in PHEO tissues than those in normal adrenal medulla tissues. Expressions of these cytokines vary in PHEO with different characteristic.

Objective: To study the clinical characteristics and factors of symptomatic propylthiouracil (PTU)-induced hepatic injury in patients with hyperthyroidism., Methods: A retrospective study of the patients diagnosed with symptomatic PTU-induced hepatic injury, admitted to Peking Union Medical College (PUMC) Hospital from January 1993 to December 2002, were carried out with regard to clinical characteristics, laboratory findings and management. In addition, a comparative study was carried out in hyperthyroidism with symptomatic, asymptomatic and without PTU-induced hepatic injury at the same time. Symptomatic PTU induced hepatic injury was defined as the development of hepatitis symptoms or jaundice with at least 3-times elevation of liver function test without other causes., Results: Nine hundred fourteen patients were admitted to PUMC Hospital from January 1993 to December 2002. Clinically overt symptomatic hepatic injury developed in twelve patients [1.3%, age (30 +/- 9) yr, male:female ratio, 1:11] between 7 and 77days after PTU administration. Abdominal distention and fatigue developed in all patients. Serum level of ALT and total bilirubin (TBil) increased to (531.7 +/- 352.0) 113 - 1425 U/L and 67.6 (17.1 - 567.7) micro mol/L, respectively. Prothrombin time prolonged in three cases and plasma ammonia elevated in one case. The types of hepatic injury were hepatocellular in eight, cholestatic in one and mixed in two. None resulted from viral hepatitis and autoimmune hepatitis. There was significant difference in history of side effects of antithyroid agents, PTU dose and abnormal ratio of serum ALT among patients with symptomatic, asymptomatic and without hepatic injury (P < 0.05). However, there were no statistic differences in age, sex, serum levels of T(4), T(3), and increased thyroglobulin antibody, thyroid peroxidase antibody and thyrotrophin receptor antibody at initial diagnosis. The liver function test normalized in all patients from 14 to 140 days after the PTU withdrawal., Conclusions: Symptomatic hepatic injury usually develops with PTU administration in the first few months, though it is unusual. It may be difficult to predict its development and the patient should be monitored for the liver function in the early stage of PTU administration.

Objective: To investigate the prevalence and correlative factors of subclinical hepatic encephalopathy (SHE) in patients with cirrhosis in China by using psychometric tests with big sample size., Methods: 409 patients with cirrhosis and 416 patients with chronic hepatitis were investigated for the prevalence of SHE. In prevalence study questionnaire, psychometric tests (NCT and DST), laboratory data were used to estimate their liver function., Results: According to age, the patients were divided into 5 groups (including<35, 35 to 44, 45 to 54, 55 to 64 and >65 groups). There was highly statistical significance on the results of NCT and DST, between the cirrhosis patients and the controls (t> or =4.108, P<0.01). The prevalence of SHE in cirrhosis patients was 51.3%. Highly statistical significance was found (chi 2=23.910, P<0.01) among the Child-Pugh A, B, C groups (39.9%, 55.2% and 71.8%). According to age, gender, smoking, etiology and education, no statistical significance was found. Logistic regression showed that there was a close relationship between the SHE prevalence and the Child-Pugh score only, and no relationship had been found between the SHE prevalence and other factors including age, gender, smoking, etiology and education., Conclusion: The SHE prevalence in hepatic cirrhosis patients is 51.3%, and the Child-Pugh score may be an important risk factor

Objective: To investigate the expression of human urotensin II (UII) mRNA in normal adrenal medulla and pheochromocytoma tissues., Methods: The total RNA of normal adrenal medulla from 9 males who died of accidents and the total RNA of pheochromocytoma tissues resected from 19 patients were extracted. The expression of UII mRNA was studied by reverse transcription-polymerase chain reaction (RT-PCR). UII and its internal control GAPDH were co-amplified in the same tube. Semi-quantitative analysis of the mRNA expression level of UII was carried out based on the ratios of the grey scale of the amplified target band to that of the control band (UII/GAPDH)., Results: The amplified product of UII is a 385 bp fragment and 99.7% of the bases were the same as the sequence registered in the GenBank. The UII/GAPDH in the normal adrenal medullae and pheochromocytomas were 0.69 +/- 0.29 (n = 9) and 0.22 +/- 0.18 (n = 19) respectively (P < 0.05)., Conclusion: Both the normal adrenal medulla and pheochromocytoma express UII mRNA. The expression of UII mRNA is lower in pheochromocytoma than in normal adrenal medulla.

Objective: To observe the natural history of subclinical hepatic encephalopathy (SHE) and to compare the efficacy of long-term and short-term treatment of lactulose., Methods: Sixty SHE patients with abnormal psychometric tests performance and/or evoked potentials were randomly divided into 3 groups of 20 cases: control group (given vitamin B complex only for 24 weeks), short-term lactulose group (administered orally with lactulose 15 - 90 ml/d for 8 weeks in addition to vitamin B complex as described above), and long-term lactulose group (administered orally with lactulose 15 - 90 ml/d for 24 weeks in addition to vitamin B complex as described above). Blood ammonia, liver function, number connection test (NCT), digital symbol test (DST), quality of life, and somatosensory evoked potential (SEP) were investigated 0, 8, 16, and 24 weeks after the onset of experiment. The incidence of HE was recorded., Results: No statistically significant difference was found in terms of liver function score of ENVER, and SEP any time after the onset of the experiment (all P > 0.05). Eight weeks after the onset of experiment the performance of NCT and DST was significantly improved in the 2 lactulose groups than in the control group (both P < 0.05), without significant difference between the two treatment groups (P > 0.05). However, significant difference failed to appear in blood ammonia 8 weeks after, and began to be found since the 16th week between the control group and long-term lactulose group (P < 0.05). Since the 16th week the condition of the long-term lactulose group was much better than those of the other 2 groups in terms of blood ammonia, NCT performance, scores of PHYS, PSYCH, and SCOIL (all P < 0.05), and not in DST performance (P > 0.05). 24 weeks after, the condition of the long-term lactulose group was still better than those of the other 2 groups (all P < 0.05), however, no significant difference was found in terms of the above-mentioned indicators between the control and short-term lactulose groups (all P > 0.05). The HE prevalence of the control, short-term lactulose, and long-term lactulose groups were 40%, 30%, and 5% respectively 24 weeks after, with a significant difference between the long-term lactulose group and between any of the other groups (both P < 0.05) and without a statistically significant difference between the control and short-term lactulose groups (P > 0.05)., Conclusion: Long-term lactulose treatment lowers blood ammonia and improves the psychometric performance and quality of life, thus lowering the prevalence of clinical HE. However, short-term lactulose treatment fails to improve of the natural course of HE.